Prolonged exposure therapy (PE) is a cognitive behavioral therapy intervention that is used to help individuals recover from post-traumatic stress or specific phobias. Unwanted thoughts, nightmares, hypervigilance, increased startle response, hopelessness, and feeling unsafe can all be symptoms of unresolved trauma. After experiencing a traumatic event, we tend to create associations between qualities of the trauma environment to our current, safe reality. Through these associations, we tend to avoid all reminders of the trauma, which can inhibit daily functioning and well-being.

As you can imagine, the process of exposure can feel incredibly scary. One of the most fundamental parts of prolonged exposure therapy is creating a safe and secure environment, within which you can work through your associations. Once a safe environment and relationship have been carefully established, your therapist will begin the process of exposure, which can happen in two different ways.

Imagined Exposure

During this form of prolonged exposure therapy, you will work with your therapist to recount the traumatic event in detail, and in the present tense. As you move through this experience, you will be guided to notice the emotions and thoughts that are prompted by the recollection. While you work through this exposure, you are provided with various tools to work through the thoughts, emotions, and sensations that come up — this is called processing.

Real-Life Exposure

Also called In Vivo Exposure, real-life exposure involves creating an exposure hierarchy that outlines the trauma reminders you may have been avoiding, such as sounds, places, or people. You will work with your therapist to identify the stimuli and circumstances that you have associated with your past trauma. You then collaborate to create a plan where you can safely confront some of these stimuli. Naturally, this is a challenge for any trauma survivor. You will work with your practitioner to make sure the steps are safe and productive, though they may feel confronting. Your practitioner is there to support you every step of the way.

Throughout exposure of either kind, your therapist may invite you to begin processing your trauma through journaling, processing in session, or other homework activities. Through gradual and intentional exposure to fears that are associated with trauma, you are able to decrease your reaction to them and recreate a sense of safety in your life. Prolonged exposure therapy helps to unwire the brain connections that you have between certain stimuli and your trauma, based on the associative learning theory. Through this unwiring, the fears that once dominated your life through avoidance patterns and behaviors will begin to dwindle. Simultaneously, your comfort will begin to increase. Through exposure, you are able to gain the confidence needed to rebuild a normal, thriving life. You are finally able to move beyond the challenging restrictions that trauma creates.

Prolonged exposure therapy is used to treat forms of PTSD. Treatment usually extends over a period of three months, although this can vary depending on the patient. Colorado CBT is a Denver clinic with practitioners trained in PE. To discuss PTSD and how prolonged exposure therapy can support you, please reach out to make an appointment.