Prolonged exposure therapy

Prolonged exposure therapy was developed by Edna B Foa, Director of the Center for the Treatment and Study of Anxiety at the University of Pennsylvania. Prolonged exposure therapy (PE) is a theoretically based, and is posited to be, a highly effective treatment for chronic post-traumatic stress disorder (PTSD) and related depression, anxiety, and anger. PE falls under the category of "exposure-based therapy" and is supported by scientific studies which reflect its positive impact on patient symptoms. Exposure-based therapies focus on confronting the harmless cues/triggers of trauma/stress in order to unpair them from the feelings of anxiety and stress. with the only reliable predictor of treatment outcomes being pre-treatment chronic PTSD symptom severity. With PTSD, it is thought that traumatic events cause inaccurate associations to develop, between stimuli and responses from the event. These inaccurate associations lead to avoidance of trauma-related stimuli, which acts as a barrier to emotional processing. ==Components==

PTSD is characterized by the re-experiencing of the traumatic event through intrusive and upsetting memories, nightmares, flashbacks, and strong emotional and physiological reactions triggered by reminders of the trauma. Most individuals with PTSD try to ward off the intrusive symptoms and avoid the trauma-reminders, even when those reminders are not inherently dangerous. To address the traumatic memories and triggers that are reminders of the trauma, the core components of exposure programs for the disorder are: • Imaginal exposure, revisiting the traumatic memory, repeated recounting it aloud, and processing the revisiting experience • In vivo exposure, the repeated confrontation with situations and objects that cause distress but are not inherently dangerous The goal of this treatment is to promote processing of the trauma memory and to reduce distress and avoidance evoked by the trauma reminders. Additionally, individuals with emotional numbing and depression are encouraged to engage in enjoyable activities, even if these activities do not cause fear or anxiety but have dropped out the person's life due to loss of interest. The imaginal exposure typically occurs during the therapy session and consists of retelling the trauma to the therapist. For the in vivo exposure, the clinician works with the client to establish a fear and avoidance hierarchy and typically assigns exposures to these list items as homework progressively. The therapist may also record the session and ask the patient to continue to complete in vivo exercises on their own time with the help of the recording. Randomized control trials reflect that only 10–38% of PTSD patients who take part in PE therapy terminate treatment before their program is complete (generally after at least eight sessions). ==Studies==

Practitioners throughout the United States and many other countries currently use prolonged exposure to successfully treat survivors of varied traumas including rape, assault, child abuse, combat, motor vehicle accidents, and disasters. Prolonged exposure has been beneficial for those with co-occurring PTSD and substance abuse when combined with substance abuse treatment. Studies have also reflected that prolonged exposure therapy aids patients who have both PTSD and borderline personality disorder when the treatment is coupled with dialectical behavior therapy. Conducted studies have reflected positively on the effectiveness of PE. For example, in the Netherlands, patients responded better to PE than to eye movement desensitization and reprocessing (EMDR) treatment. == See also ==