Prolonged Exposure Therapy for PTSD

Prolonged exposure therapy, also known as PE therapy, is the term for a form of psychotherapy that purposefully exposes the individual to situations that trigger debilitating or dysfunctional stress reactions. This exposure is intended to help a person overcome damaging reactions and develop a new ability to cope with the effects of stress. Current evidence indicates that PE therapy is a highly effective way to address the symptoms of post-traumatic stress disorder (PTSD). People affected by PTSD commonly benefit from the therapy, even when they have other serious, coexisting mental health problems.

Prolonged Exposure Therapy Basics

Prolonged exposure therapy was  developed at the University of Pennsylvania School of Medicine’s Center for the Treatment and Study of Anxiety. It is one specific form of a larger group of psychotherapeutic techniques that psychologists and psychiatrists refer to as cognitive behavioral therapy.  Like all forms of this therapy, it centers on the identification of harmful stress reactions and the development of new reactions that improve a person’s well-being and ability to function in daily life.

Specific steps in a course of PE therapy include a period of education regarding the therapy and the individual’s mental health issue(s), instruction in techniques designed to help improve breathing control, monitored periods of exposure to the situations that trigger a person’s stress-related mental health symptoms, and an extensive review of past traumatic experiences undertaken in concert with the mental health professional conducting the therapy. As a rule, therapists start by addressing relatively minor triggers for their patients’ dysfunctional stress responses, then gradually address more and more prominent sources of these responses. Depending on the individual, a prolonged exposure therapy program can continue over two to four months of weekly sessions. Each individual session usually lasts for about an hour and a half.

PTSD Basics

PTSD is the classic mental disorder associated with exposure to events that pose a direct or perceived threat to human life. Significant minorities of any population group will develop the condition in the aftermath of physical or sexual attacks, combat experiences, the deaths of close friends or family members, major accidents, major injuries or health scares, acts of terror or uncontrollable disasters such as storms, floods or earthquakes. Certain intervening factors increase the risks that a person will develop PTSD in connection with these events, while other factors decrease these risks. However, no one can tell for sure if he or she will experience the condition in the months following trauma exposure.

Effectiveness in PTSD Treatment

Roughly 80 percent of all people with longstanding PTSD symptoms experience a meaningful reduction in those symptoms after going through a course of PE therapy. The treatment is effective, at least in part, because a therapist can alter its form to meet the specific symptoms and needs of each individual patient. In a study published in 2012 in the European Journal of Psychotraumatology, a multinational research team reviewed the usefulness of prolonged exposure therapy in PTSD patients affected by at least one of the disorders or additional symptoms that commonly occur alongside post-traumatic stress. Examples of these disorders and symptoms include major depression, borderline personality disorder, substance use disorders, psychosis, suicidal actions and nonsuicidal self-injury (also known as self-harm). The authors of the review concluded that PE therapy can frequently simultaneously improve the symptoms of PTSD and these coexisting conditions and symptoms, although doctors sometimes need to use separate treatments for severe forms of co-occurring mental illness.


Not all people with PTSD can tolerate the direct confrontation with stress-inducing situations that forms the core of prolonged exposure therapy. For this reason, significant numbers of PTSD patients who start the treatment don’t finish it, and therefore don’t gain the therapy’s typical benefits. PTSD-affected individuals who develop certain forms of a mental state called moral injury have particularly strong chances of not responding well to PE therapy. Moral injury occurs when a person witnesses, participates in, or is unable to stop events that deeply damage his or her moral code and sense of right and wrong. On its own, this moral damage does not constitute a mental disorder. However, it can potentially contribute to the onset of post-traumatic stress disorder, worsen the existing symptoms of the disorder, trigger a PTSD relapse in recuperating individuals or make PTSD more resistant to treatment.