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Prolonged Exposure Therapy And Posttraumatic Stress Disorder (PTSD)



Major symptoms of posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (Complex PTSD)  are fear, anxiety and even terror induced by :

– situations related to the traumatic experience

– people related to the traumatic experience

– places related to the traumatic experience

– activities related to the traumatic experience

Prolonged Exposure Therapy Involves Two Specific Types Of Exposure To Trauma-Related Phenomena :

a) In Vivo Exposure

b) Imaginal Exposure

In Vivo Exposure :

Prolonged exposure therapy works by encouraging the individual with PTSD / Complex PTSD, in a supportive manner, very gradually, to confront these situations/people/places/activities whilst, at the same time, feeling safe, secure and calm. Because this part of the therapy involves exposure to ‘real-life’ situations/people/places/activities it is called in vivo exposure.

This is so important because avoiding these situations/people/places/activities, whilst reducing the individual’s anxiety in the short-term, in the longer-term simply perpetuates, and, potentially, intensifies, his/her fear of these things.

Imaginal Exposure:

The therapy also involves the PTSD / Complex PTSD sufferer talking over details and memories of the traumatic experience in a safe environment and whilst in a relaxed frame of mind (the therapist can help to induce a relaxed frame of mind by teaching the patient/client breathing exercises and/or physical relaxation techniques; hypnosis can also be used to help induce a state of relaxation). Because this part of the therapy ‘only’ involves mental exposure to the trauma (i.e. thinking about it in one’s mind), it is called imaginal exposure and can help alleviate intense emotions connected to the original trauma (e.g. fear and anger).

Both in vivo and imaginal exposure to the trauma-related stimuli are forms of desensitizing and habituating the patient/client to them, thus reducing his/her symptoms of PTSD /Complex PTSD.

How Effective Is Prolonged Exposure Therapy?

Prolonged exposure therapy is a type of cognitive behavioural therapy (CBT) and research into the treatment of PTSD suggests it is the most effective treatment currently available.

What Is The Duration Of The Treatment?

The length of time a patient/client spends in treatment varies in accordance with his/her needs and his/her therapist’s particular approach. However, the usual duration of the treatment is between two and four months, comprising weekly sessions of approximately ninety minutes each.

On top of this, the patient/client will need to undertake some therapeutic exercises/activities in his/her own time, set by the therapist as ‘ homework assignments’. These assignments will include listening to recordings of imaginal exposure therapy sessions.

Common Reactions To Trauma That Might Be Discussed During Prolonged Exposure Therapy :

Understanding that one may have an extensive range of symptoms but that all of these symptoms may be related to one fundamental cause (i.e. the traumatic experience) helps one to gain insight into one’s condition which, in turn, is likely to facilitate recovery. Common reactions to trauma that might be discussed with the therapist during prolonged exposure therapy include :

Emotions include:

– fear 

– sadness / depression

– anxiety

– feelings of numbness/emptiness

– feelings of being in a trance/dissociation

– feelings of guilt

– feelings of shame

Avoidance of things that remind one (on either a conscious or unconscious level) of the trauma, including :

– attempting to banish thoughts connected to the trauma from one’s mind

– avoiding people, places, situations etc. that remind one of the trauma

Fundamental changes in one’s view of the world and of other people:

– loss of ability to trust others

– self-blame

– viewing the self as ‘weak’

– losing faith that the world is a reasonably safe place and, instead, seeing danger everywhere and constantly feeling under threat / in a state of fight/flight.

Physiological changes, including :

– hypervigilance

– insomnia / nightmares / night terrors

– loss of libido

– hypersensitive startle response.




David Hosier BSc Hons; MSc; PGDE(FAHE).

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