Approaches / Trauma-focused
Prolonged exposure (PE)
A structured therapy for post-traumatic stress that involves approaching trauma memories and avoided situations that are safe.
Overview
Prolonged exposure is a cognitive behavioural therapy developed for post-traumatic stress. It involves revisiting memories of the trauma and gradually approaching situations that are safe but have been avoided because they are trauma-related.
Core ideas
PE draws on the idea that avoidance can maintain post-traumatic reactions. It includes education about common reactions, breathing practice, gradual approach to safe avoided situations and repeated recounting of the memory, with discussion afterwards.
What a session can involve
The US Department of Veterans Affairs describes PE as usually taking 8 to 15 weekly sessions of 60 to 90 minutes. A programme may include recounting a trauma memory aloud, listening to a recording between sessions and planning gradual approaches to safe avoided situations. Recording security can be discussed with the practitioner.
Formats and settings
PE is usually one to one. It is used in clinics, veterans' services and research programmes, and adaptations exist for adolescents.
How it relates to other approaches
PE belongs to the exposure tradition, alongside exposure and response prevention. EMDR is another trauma-focused therapy, with a different procedure. See the comparison page for exposure and response prevention and prolonged exposure.
Limits and open questions
Exposure can be distressing, and some people leave treatment early or prefer another approach. Questions include its place after multiple or complex trauma and how to adapt it across cultures.
Guidance differs between the UK and US. The 2018 NICE PTSD guideline for England and Wales lists prolonged exposure among individual trauma-focused CBT interventions for adults in defined circumstances. The American Psychological Association has a separate adult PTSD guideline.
History
Edna Foa developed PE from the 1980s, building on her work on emotional processing of fear with Michael Kozak in 1986.
Key people
Edna Foa developed PE.
Sources and inspection notes
Supports: The theoretical account of emotional processing of fear on which exposure therapies, including PE, draw.
NICE, Post-traumatic stress disorder (NG116)
Supports: The 2018 guideline lists prolonged exposure as an individual trauma-focused CBT intervention for adults with PTSD or clinically important symptoms, in defined circumstances (England and Wales).
US Department of Veterans Affairs, National Center for PTSD. Prolonged Exposure (PE) for PTSD.
Supports: Description of PE, approaching safe avoided situations, typical US session duration, recordings and their privacy, and potential distress.
Supports: The existence and scope of a separate US guideline for treatment of PTSD in adults; no specific recommendation is attributed to the guideline here.
Supports: Publisher record identifies the authors, title and 2007 first edition. The catalogue description is not an independent effectiveness review.