written by: Mercedes Hamshar
• edited by: Paul Arnold
• updated: 12/12/2010
Prolonged exposure therapy for PTSD is an effective treatment. It is superior when compared to treatments that do not involve exposure and on par with CBT, a well respected treatment that also involves exposure.
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Post traumatic stress disorder (PTSD) is an anxiety disorder that develops as a response to the experience of a traumatic event. Patients with PTSD present with three groups of symptoms; re-experiencing of the traumatic event, avoidance of stimuli associated with the traumatic event and increased arousal symptoms. These symptoms must be present for at least a month in order for a diagnosis of post traumatic stress disorder to be made. Otherwise, a diagnosis of acute stress disorder may be given. There is a consensus among psychological practitioners that exposure is an essential element in any treatment for post traumatic stress disorder. Therefore, prolonged exposure therapy for PTSD has been found to be an effective treatment.
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What is Prolonged Exposure Therapy?
Prolonged exposure therapy for PTSD involves a number of sessions in which the patient must engage in imaginal exposure; that is, they must purposely re-experience the event. As already mentioned, it is common for patients to re-experience the event involuntarily through flashbacks and nightmares for example. This is out of their control and is accompanied by feelings of anxiety. Re-living the traumatic event in the safety of the therapeutic environment allows the patient to face their fears and work through their feelings of anxiety. The therapist encourages the patient to close their eyes and re-live the event just as it happened. The patient must describe each detail of the event to the therapist in the present tense - this encourages full emotional re-experiencing and processing.
Prolonged exposure therapy also involves homework for the patient. The patient must listen to the recordings of the sessions, causing further exposure to the traumatic event. They practice breathing and relaxation techniques that are taught as part of the therapy to allow them to work through the feelings of anxiety that accompany memories of the event; making it so traumatic. They also complete in vivo (real life as opposed to imagined) exposure tasks based on their behavioural hierarchy. That is to say, they begin with engaging in the least anxiety provoking of stimuli from the traumatic event, for example listening to sounds that are associated with the event and build up to the most anxiety provoking instances associated with the traumatic event, for example re-visiting the site of the event.
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How Effective is Prolonged Exposure Therapy?
Numerous studies have been conducted to ascertain the effectiveness of prolonged exposure therapy for PTSD. Of the studies that have been conducted symptom reduction rates of between 50% and 80% have been reported post-treatment. Follow up studies report that 75% of patients no longer meet the diagnostic criteria for PTSD 6 months after treatment, and none of the patients met the diagnostic criteria for PTSD after a year.
When compared to treatments that do not involve exposure, prolonged exposure therapy has been found to be far superior. Studies have also compared prolonged exposure therapy to cognitive behavioural therapy for PTSD, which includes an exposure component in treatment of anxiety disorders, and have found prolonged exposure therapy to be equal to it. This is high praise for prolonged exposure therapy as CBT is a well respected treatment for a number of mental health disorders.
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Ironson, G. et al. (2002) Comparison of two treatments for traumatic stress: a community based study of EMDR and prolonged exposure. Journal of Clinical Psychology, 58 (1), 113-128.
Post traumatic stress disorder is a severe anxiety disorder that develops as a response to a traumatic event. These articles outline the available treatments for post traumatic stress disorder and their effectiveness.