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Prolonged Exposure Therapy

What does prolonged exposure therapy look like?

Prolonged exposure therapy (PE) is simply a treatment for anxiety and related disorders that involves exposing patients to safe, but anxiety-provoking situations, to help them become desensitized to the fear. It comes from a theory about PTSD called emotional processing theory, which basically proposes that when a reaction to fear or trauma is not worked out, the fear will remain.

PE usually begins with education about trauma reactions. This may include learning about the body’s physiological response to trauma, emotional responses, etc. The patient will be informed about how avoidance serves to maintain PTSD symptoms and trauma-related distress. Avoidance in this context refers to actions that cause an individual to dodge places, things, people etc. that cause them feelings of anxiety. For example, someone who has experienced a traumatic car accident may avert a specific intersection where the accident took place.

Breathing training

Breathing training is important to help lower the amount of anxiety generally felt by the patient. Breathing training helps the body remember how to breathe in a way that relaxes it and releases tension. In other words, breathing training sends signals throughout the brain that the individual is currently safe. While some people report experiencing little benefit, others find this technique to be extremely useful and utilize it daily!

Repeated exposure to situations or objects

Exposure will often begin during the second session. Here, individuals will be exposed to safe situations that they may have been avoiding, such as a crowded store, or an elevator. It is important to note that the amount of exposure is decided by the therapist and the client together so that there is not too much distress at the same time. This therapy is a process that often proceeds very slowly at times and only with the consent of the patient.

Repeated prolonged imaginal exposure to trauma memories, including recounting the trauma event, will often begin during the third session. The narrative surrounding these exposures will be audiotaped with the intention that the client will listen to that recording throughout the week as homework. The exposure elements of the therapy are the core and most essential portions. These exposures are what truly help an individual to process the fear that still bothers them.

There are 4 essential elements to exposure therapy

A patient may think, “But I’ve been exposed to my triggers many times.” This may be true, but there are still elements that have to be in place to make exposure therapy effective. First of all, the exposure needs to be prolonged and remain until anxiety begins to decrease. If the exposure is too short, the brain doesn’t have adequate time to process the emotion. Secondly, there has to be an element of repetition. The brain often needs daily practice to be able to adapt and emotionally process the stimuli. Thirdly, the anxiety emotion has to be focused on. This means using techniques to decrease anxiety during exposure actually makes the therapy less effective. In a biological sense, we are attempting to convince the fear center of the brain (the amygdala) that the stimuli are not actually dangerous. When the feelings are avoided, the amygdala is simply not convinced that the trigger isn’t dangerous. Lastly, there can be no safety behaviors during the exposure. If steps are taken to eliminate some of the anxious feelings then the emotion cannot be fully worked out. However, it is important to note that true exposure therapy includes a therapist or other helper to lean on in case an exposure becomes too intense.


Anxiety, PTSD, and related disorders are very common and treatable. Exposure therapy is often very helpful for patients to overcome these negative feelings so they can live life more fully. The process may seem daunting, but the truth is most people have significantly improved symptoms by the time PE is completed.

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