Prolonged Exposure (PE) Therapy is a behavioral treatment for post-traumatic stress disorder (PTSD). It helps clients gradually confront trauma-related memories and situations in a safe, structured way.

Through imaginal exposure (retelling the trauma story) and in vivo exposure (approaching avoided but safe situations), clients reduce avoidance, build tolerance for difficult emotions, and lessen the distress tied to trauma. PE is typically delivered in 8–15 sessions and has been shown to significantly decrease PTSD symptoms and improve daily functioning.

The primary goal of Prolonged Exposure Therapy is to reduce PTSD symptoms by decreasing avoidance behaviors and diminishing the intense emotional distress tied to trauma memories. Through repeated, safe exposure, clients gradually learn that trauma reminders are tolerable and not inherently dangerous.

Over time, PE helps people reclaim parts of their life they’ve been avoiding, restore daily functioning, and improve their sense of safety and control.

Prolonged Exposure primarily treats PTSD and other trauma-related disorders, including:

• Combat trauma
• Sexual assault
• Accidents
• Natural disasters
• Other traumatic experiences

It is also sometimes used for:

• Specific phobias
• Panic disorder with agoraphobia

While there are no fully separate “subtypes” of Prolonged Exposure (PE), there are important adaptations of the standard PE model designed for particular settings or age groups. These include:

• PE-A (Prolonged Exposure for Adolescents): tailored to younger populations (often ages 13–18), this adaptation maintains core elements like imaginal and in vivo exposure, supplemented with psychoeducation and developmental sensitivity.
• PE-PC (Prolonged Exposure for Primary Care): a briefer version adapted for primary care settings, typically delivered over 4–8 shorter (≈ 30-minute) sessions, integrated into general healthcare.

Some emerging formats push even further in flexibility, including massed/intensive PE (compressed delivery over days or weeks) and telehealth formats to increase accessibility.

Prolonged Exposure Therapy was developed by Dr. Edna Foa and her colleagues at the University of Pennsylvania in the 1980s and 1990s. Dr. Foa built on earlier work in exposure therapy and systematic desensitization, specifically adapting these techniques for trauma treatment and creating the structured prolonged exposure protocol that became widely used.

Prolonged Exposure Therapy is highly evidence-based and considered one of the most researched and effective treatments for PTSD. It has been validated through numerous studies over several decades, consistently showing significant reductions in PTSD symptoms.

Prolonged exposure is recommended as a first-line treatment by major organizations including the American Psychological Association, the Department of Veterans Affairs, and the World Health Organization, and is included in most clinical practice guidelines for PTSD treatment.

Prolonged Exposure Therapy works by breaking the cycle of avoidance that maintains PTSD symptoms. The process involves several key elements:

• Repeated, controlled exposure to trauma memories and safe but avoided situations, which helps the brain reprocess traumatic experiences and reduce intense fear.
• Habituation, where emotional and physical arousal gradually decline as clients revisit reminders in a safe setting.
• Supportive strategies such as psychoeducation and breathing or anxiety management tools to aid emotional regulation.
• Cognitive change, as clients update beliefs about safety and danger, which helps generalize gains to everyday life.
• In vivo exposures, or approaching avoided real-life situations, which are crucial for transferring improvements from therapy into the real world.

Early sessions involve psychoeducation about PTSD and treatment planning, while later sessions typically include:

• 30–45 minutes of imaginal exposure (recounting the trauma in detail with eyes closed)
• Discussion and processing with your therapist afterward
• In vivo exposure assignments, where you gradually approach avoided but safe situations between sessions

Sessions are often recorded so you can listen to them as homework to reinforce the exposure work.

It’s important to note that Prolonged Exposure Therapy sessions can be emotionally difficult, especially during imaginal exposure where you’ll recount your trauma in detail. You may experience:

• Increased anxiety or distress
• Physical symptoms of arousal
• A temporary sense of “feeling worse before you feel better”

The in vivo assignments can also feel intimidating at first. However, your therapist will prepare you thoroughly by teaching coping skills and explaining what to expect. You’ll start gradually, at a manageable pace, and most people find their distress levels drop substantially as treatment progresses.

The structured, predictable nature of Prolonged Exposure Therapy helps many clients feel more in control of their recovery. Throughout treatment, your therapist will monitor your progress closely and adjust the approach if needed.

Prolonged Exposure Therapy typically involves 8–15 weekly sessions, each lasting about 90 minutes. The therapy follows a highly structured protocol:

• Sessions 1–2: Assessment and psychoeducation about PTSD and the treatment process
• Sessions 3–4: Introduction of imaginal exposure and in vivo exposure techniques
• Subsequent sessions: Continued exposure work with close monitoring of progress

Each session follows a clear format that includes:

• Specific components and goals
• Homework assignments to reinforce in-session work
• A systematic progression through planned exposure exercises designed to gradually reduce trauma-related distress and avoidance behaviors