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Prolonged exposure therapy (PE) is a form of behavior therapy and cognitive behavioral therapy designed to treat post-traumatic stress disorder. It is characterized by re-experiencing the traumatic event through remembering and engaging with reminders (triggers) of the trauma, as opposed to avoiding them. Sometimes, this technique is referred to as flooding.

Contents

   1 Overview
   2 Components
   3 See also
   4 References
   5 Research information
   6 External links

Overview

Prolonged exposure therapy was developed by Edna B Foa, PhD, Director of the Center for the Treatment and Study of Anxiety. Prolonged exposure therapy (PE) is a theoretically-based and highly effective [citation needed] 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.

Dr. Edna Foa

Exposure-based therapies focus on confronting the harmless triggers of trauma/stress in order to dissociate them from the feelings of anxiety and stress. Prolonged exposure is a flexible therapy that can be modified to fit the needs of individual clients. It is specifically designed to help clients psychologically process traumatic events and reduce trauma-induced psychological disturbances. Prolonged exposure produces clinically significant improvement in about 80% of patients with chronic PTSD.[citation needed]

Over years of testing and development, prolonged exposure has evolved into an adaptable program of intervention to address the needs of varied trauma survivors. In addition to reducing symptoms of PTSD, prolonged exposure instills confidence and a sense of mastery, improves various aspects of daily functioning, increases the client's ability to cope with courage when facing stress, and improves their ability to discriminate safe and unsafe situations.

In 2001, Prolonged Exposure for PTSD received an Exemplary Substance Abuse Prevention Program Award from the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA). Prolonged exposure was selected by SAMHSA and the Center for Substance Abuse Prevention as a Model Program for national dissemination.

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. 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. Both components work by facilitating emotional processing so that the problematic traumatic memories and avoidance habituate (desensitize). 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 8-15 sessions of an hour or more).

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 suffering from co-occurring PTSD and substance abuse when combined with substance abuse treatment. Studies have also reflected that prolonged exposure therapy aids patients who suffer from both PTSD and borderline personality disorder when the treatment is coupled with dialectical behavior therapy. Some were concerned that PE would negatively affect the treatment of patients with substance use disorder (SUD) as purposefully and intentionally exposing them to their reminders and triggers may worsen their state; however, randomized control trial studies exist which indicate that there are no negative effects of using PE for patients with SUD. 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.  6 month follow ups revealed that PE had also lessened psychotic and schizophrenic issues. Furthermore, in Israel, the symptoms of in a small group of female methadone users in Israel had decreased after PE treatment. PE therapy was also found to be superior to supportive therapy in sexually abused women with PTSD in a randomized controlled trial.

See also

   Post-traumatic stress disorder
   Exposure therapy
   Behavior therapy
   Cognitive behavioral therapy
   Edna B. Foa
   Barbara Rothbaum

References

Joseph, J.S. & Gray, M.J. (2008). Exposure Therapy for Posttraumatic Stress Disorder. Journal of Behavior Analysis of Offender and Victim: Treatment and Prevention, 1(4), 69–80 BAO Eftekhari, A.; Stines, L.R. & Zoellner, L.A. (2006). Do You Need To Talk About It? Prolonged Exposure for the Treatment of Chronic PTSD. The Behavior Analyst Today, 7(1), 70–83 BAO Center for the Treatment and Study of Anxiety: Treatment of PTSD at the CTSA Williams, M.; Cahill, S.; Foa, E. Psychotherapy for Post-Traumatic Stress Disorder. In Textbook of Anxiety Disorders, Second Edition, ed. D. Stein, E. Hollander, B. Rothbaum, American Psychiatric Publishing, 2010.

   Kazi, A.; Freund, B. & Ironson, G. (2008). Prolonged Exposure Treatment for Posttraumatic Stress Disorder following the 9/11 attack with a person who escaped from the Twin Towers. Clinical Case Studies, 7, 100–16.

Research information

   Prolonged Exposure Therapy for PTSD: Emotional Processing of Traumatic Experiences, Therapist Guide by Edna B. Foa, Elizabeth A. Hembree, Barbara Olasov Rothbaum, March 2007, Oxford University Press, "Treatments that work".
   Reclaiming Your Life From a Traumatic Experience, Workbook, Barbara Olasov Rothbaum, Edna B. Foa, Elizabeth A. Hembree, March 2007, Oxford University Press, "Treatments that work".
   Prolonged Exposure Therapy for Posttraumatic Stress Disorders SAMHSA Model Programs.
   Center for the Treatment and Study of Anxiety, University of Pennsylvania Edna B. Foa, PhD, Director.
   Beyond the manual: The insider's guide to Prolonged Exposure therapy for PTSD E.A. Hembree, S.A.M. Rauch and E.B. Foa. Cognitive and Behavioral Practice (2003) 10:22–30.
   Cognitive Behavioral Therapy for Posttraumatic Stress Disorder in Women: A Randomized Controlled Trial, Paula P. Schnurr, Matthew J. Friedman, Charles C. Engel, Edna B. Foa, et al. Journal of the American Medical Association, February 28, 2007; 297: 820–30. "Prolonged exposure is an effective treatment for PTSD in female veterans and active-duty military personnel. It is feasible to implement prolonged exposure across a range of clinical settings."
   Treatment of PTSD: An Assessment of The Evidence, Institute of Medicine, October 17, 2007. "The committee reviewed 53 studies of pharmaceuticals and 37 studies of psychotherapies used in PTSD treatment and concluded that because of shortcomings in many of the studies, there is not enough reliable evidence to draw conclusions about the effectiveness of most treatments. There are sufficient data to conclude that exposure therapies—such as exposing individuals to a real or surrogate threat in a safe environment to help them overcome their fears—are effective in treating people with PTSD. But the committee emphasized that its findings should not be misread to suggest that any PTSD treatment ought to be discontinued or that only exposure therapies should be used to treat PTSD."

External links

   Exposure therapy for PTSD at Epigee Women's Health
   Intensive Training Program in Dr. Foa's Prolonged Exposure Therapy
   Information about PTSD and Prolonged Exposure Therapy

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Cognitive behavioral therapy (list)

   Acceptance and commitment therapy Applied behavior analysis Behavioral activation Behavior therapy Clinical behavior analysis Cognitive analytic therapy Cognitive therapy Compassion focused therapy Contingency management Dialectical behavior therapy Direct therapeutic exposure Exposure and response prevention Functional analytic psychotherapy Habit reversal training Inference-based therapy Metacognitive therapy Method of levels Mindfulness-based cognitive therapy Multimodal therapy Prolonged exposure therapy Rational emotive behavior therapy Reality therapy Relapse prevention Schema therapy Self-control therapy Social skills training Systematic desensitization

Categories:

   Cognitive behavioral therapyBehavior therapyBehaviorismPsychotherapy

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   This page was last edited on 6 May 2018, at 19:01 (UTC).