National Center for PTSD

ptsd.va.gov | Mar 9th 2011

After a traumatic event, many individuals experience distress and symptoms of posttraumatic stress disorder (PTSD). This distress may be highest when dealing with memories, thoughts, feelings, and situations that are related to the trauma. Exposure therapy is a type of therapy that helps you decrease distress about your trauma. This therapy works by helping you approach trauma-related thoughts, feelings, and situations that you have been avoiding due to the distress they cause. Repeated exposure to these thoughts, feelings, and situations helps reduce the power they have to cause distress.

Prolonged Exposure (PE) is one exposure therapy that works for many people who have experienced trauma. It has four main parts:

Education: PE starts with education about the treatment. You will learn as well about common trauma reactions and PTSD. Education allows you to learn more about your symptoms. It also helps you understand the goals of the treatment. This education provides the basis for the next sessions.
Breathing: Breathing retraining is a skill that helps you relax. When people become anxious or scared, their breathing often changes. Learning how to control your breathing can help in the short-term to manage immediate distress.
Real world practice: Exposure practice with real-world situations is called in vivo exposure. You practice approaching situations that are safe but which you may have been avoiding because they are related to the trauma. An example would be a Veteran who avoids driving since he experienced a roadside bomb while deployed. In the same way, a sexual trauma survivor may avoid getting close to others. This type of exposure practice helps your trauma-related distress to lessen over time. When distress goes down, you can gain more control over your life.
Talking through the trauma: Talking about your trauma memory over and over with your therapist is called imaginal exposure. Talking through the trauma will help you get more control of your thoughts and feelings about the trauma. You will learn that you do not have to be afraid of your memories. This may be hard at first and it might seem strange to think about stressful things on purpose. Many people feel better over time, though, as they do this. Talking through the trauma helps you make sense of what happened and have fewer negative thoughts about the trauma.

With the help of your therapist, you can change how you react to stressful memories. In PE, you work with your therapist to approach trauma-related situations and memories at a comfortable pace. Usually, you start with things that are less distressing and move towards things that are more distressing. A round of PE therapy most often involves meeting alone with a therapist for about 8 to 15 sessions. Most therapy sessions last 90 minutes.

With time and practice, you will be able to see that you can master stressful situations. The goal is that YOU, not your memories, can control what you do in your life and how you feel. Therapy helps you to get your life back after you have been through a trauma.

PE therapy for Veterans

PE has been shown to be one of the most effective treatments for PTSD. For this reason, the VA's Office of Mental Health Services has rolled out a national PE training program. VA providers throughout the country will be trained in how to use PE treatment. The providers will at first be supervised as they use these treatments in actual cases. Then they will be asked to use PE in their routine clinical care. Others will be selected and trained as consultants.

See this video describing how In-Context Exposure Therapy Helps Bring Closure to Veterans.