Prolonged Exposure Therapy (PE)
If you are interested in counseling using PE, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.
What is Prolonged Exposure Therapy?Prolonged Exposure, usually shortened to PE, is a specific, structured form of cognitive behavioral therapy developed to treat posttraumatic stress disorder. It was created by Dr. Edna Foa at the University of Pennsylvania, and it is built on decades of research into how fear and avoidance work. PE is one of the most studied trauma treatments in existence and carries the strongest level of recommendation in every major clinical practice guideline for PTSD.
The name describes the method. In PE, you gradually and repeatedly approach the memories, feelings, and situations you have been avoiding since the trauma, in a deliberate and supported way, until they lose their power over you. It is a direct approach, and it asks something real of the people who do it, but the reason it has lasted and spread is simple: for a great many people, it works. How PE WorksAfter a trauma, avoidance is a natural and understandable response. You stay away from the places, people, conversations, and reminders that bring the experience back, and you push down the memories and feelings when they surface. In the short term, that avoidance brings relief. The problem is what it costs over time. Avoidance teaches the brain that all of these reminders are dangerous and that the only way to stay safe is to keep avoiding, which keeps the fear alive and slowly shrinks a person's world.
PE interrupts that cycle by reversing it. Instead of avoiding, you approach, in a planned and gradual way, with your therapist alongside you. Two things happen as you do. The fear that felt permanent begins to come down on its own, because a feeling that is faced rather than fled does not keep escalating forever. And you gather new information that contradicts what avoidance had taught you: that the memory is a memory and not the event happening again, that you can handle the distress, that the situation you were avoiding is in fact safe. This is the heart of what PE calls emotional processing, and it is why approaching the trauma, rather than working around it, is the thing that produces lasting change. What Does the Evidence Say?PE is among the most thoroughly researched psychological treatments for PTSD, with a large body of randomized trials behind it across many kinds of trauma and many populations, including combat veterans, survivors of sexual and physical assault, and survivors of accidents and disasters. It is strongly recommended as a first-line treatment for PTSD by the American Psychological Association's 2017 Clinical Practice Guideline and by the Department of Veterans Affairs and Department of Defense.
The improvements people make in PE tend to hold after treatment ends. That is consistent with how the therapy works, because PE is not managing symptoms from the outside. It is changing the underlying pattern of fear and avoidance that was keeping PTSD in place. |
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What PE Looks Like in Practice
PE is structured and time-limited by design. The core protocol runs about 12 to 16 weekly sessions and many people notice some improvement within the first several. As with any trauma treatment, the real-world timeline can run longer when there is more than one concern in the picture, and the PE work may sit within a somewhat longer course of therapy.
Treatment rests on a few components that build on each other. It begins with education about how PTSD and avoidance work, so the approach makes sense before the harder parts start, along with a breathing technique to help you manage anxiety.
From there, PE uses two kinds of exposure. The first is in vivo exposure, which means approaching real-life situations you have been avoiding. Early in treatment, you and your therapist build a list of those situations and rank them from least to most distressing, and you work up the list gradually, starting with what is manageable. Crucially, these are situations that are objectively safe but that trauma has taught you to fear, a crowded store, driving, being alone at home, rather than anything that would put you at genuine risk.
The second is imaginal exposure. Here you revisit the trauma memory itself, describing it aloud with your therapist guiding you and tracking your distress as you go, at a pace you can handle. Sessions are often recorded so you can listen back between appointments as part of your practice, and your therapist will talk with you about keeping those recordings private and secure. After each imaginal exposure, you and your therapist discuss what came up, which is where much of the new perspective takes hold.
Practice between sessions is central to PE, not optional. Approaching avoided situations and listening to the recordings is where a lot of the change actually happens, and people who engage with the practice tend to get more out of treatment.
Treatment rests on a few components that build on each other. It begins with education about how PTSD and avoidance work, so the approach makes sense before the harder parts start, along with a breathing technique to help you manage anxiety.
From there, PE uses two kinds of exposure. The first is in vivo exposure, which means approaching real-life situations you have been avoiding. Early in treatment, you and your therapist build a list of those situations and rank them from least to most distressing, and you work up the list gradually, starting with what is manageable. Crucially, these are situations that are objectively safe but that trauma has taught you to fear, a crowded store, driving, being alone at home, rather than anything that would put you at genuine risk.
The second is imaginal exposure. Here you revisit the trauma memory itself, describing it aloud with your therapist guiding you and tracking your distress as you go, at a pace you can handle. Sessions are often recorded so you can listen back between appointments as part of your practice, and your therapist will talk with you about keeping those recordings private and secure. After each imaginal exposure, you and your therapist discuss what came up, which is where much of the new perspective takes hold.
Practice between sessions is central to PE, not optional. Approaching avoided situations and listening to the recordings is where a lot of the change actually happens, and people who engage with the practice tend to get more out of treatment.
Facing the Trauma: What That Actually Involves
The hardest part of PE to consider from the outside is the part where you talk through the trauma in detail. It is worth being honest about what that is and is not.
It is not being forced to relive the worst day of your life with no support. It is a structured, paced process in which you revisit the memory in a safe room with a clinician who is tracking how you are doing and keeping the work within what you can manage. The discomfort is real, and it is usually strongest early on, but for most people it eases as the work continues, and that easing is itself part of the point. The whole method is built so that the memory becomes something you can hold and put down, rather than something that ambushes you. You set the pace, and a good PE therapist will prepare you for each step rather than springing it on you.
It is not being forced to relive the worst day of your life with no support. It is a structured, paced process in which you revisit the memory in a safe room with a clinician who is tracking how you are doing and keeping the work within what you can manage. The discomfort is real, and it is usually strongest early on, but for most people it eases as the work continues, and that easing is itself part of the point. The whole method is built so that the memory becomes something you can hold and put down, rather than something that ambushes you. You set the pace, and a good PE therapist will prepare you for each step rather than springing it on you.
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PE at OakHeartSeveral of our trauma clinicians are formally trained in PE and deliver the full protocol. Others draw on exposure principles, the gradual approach to avoided situations and reminders, as part of a broader and more individualized course of trauma treatment rather than the standard protocol. In addition, many of our trauma specialists attend a Trauma and PTSD specific professional consultation group alongside their formal training, to keep their work faithful to the model and to make sure complex cases get the benefit of experienced peer input.
During your assessment, your clinician will talk with you about whether PE is the right fit for you, or whether another trauma-focused therapy such as Cognitive Processing Therapy, or a combination of approaches, makes more sense given your history and what you are looking for. You can read more about the concerns this work addresses on our PTSD and Trauma pages. PE is an individual therapy. You will meet one-to-one with your clinician for each session. |
What PE Can Help With
PE was built to treat PTSD, and that is its primary use. It works across the full range of traumas that lead to PTSD, including combat, sexual and physical assault, childhood abuse, serious accidents, and disasters, and whether the trauma was a single event or something repeated over time. It does not matter whether the trauma happened recently or many years ago.
The principle underneath PE, that facing what you have been avoiding reduces fear over time, is also the foundation of exposure-based treatment for other anxiety conditions. At OakHeart, the same family of methods runs through our work with OCD, where it takes the form of Exposure and Response Prevention, and with specific phobias and other anxiety disorders. PE itself, though, refers specifically to the protocol for PTSD.
The principle underneath PE, that facing what you have been avoiding reduces fear over time, is also the foundation of exposure-based treatment for other anxiety conditions. At OakHeart, the same family of methods runs through our work with OCD, where it takes the form of Exposure and Response Prevention, and with specific phobias and other anxiety disorders. PE itself, though, refers specifically to the protocol for PTSD.
How PE Differs from Other Trauma Treatments
PE is one of several trauma-focused therapies with strong research support, and the differences between them come down to mechanism and emphasis.
Cognitive Processing Therapy (CPT) is also strongly recommended for PTSD. It works mainly on the meaning a person has made of the trauma, examining and shifting the stuck beliefs that keep the distress going. PE works mainly on the fear and avoidance side, helping you approach the memory and the avoided situations until the fear comes down. Both are effective, and the better choice often depends on the person and what fits them.
EMDR (Eye Movement Desensitization and Reprocessing) is another trauma-focused approach that the APA suggests and the VA/DoD recommends. It involves processing trauma memories while engaging in guided eye movements or other forms of bilateral stimulation.
PE also differs from general Cognitive Behavioral Therapy in that it is a specific, manualized protocol built for PTSD, rather than the broad family of cognitive and behavioral techniques that CBT refers to. PE is a member of that family, refined and tested for one job.
Cognitive Processing Therapy (CPT) is also strongly recommended for PTSD. It works mainly on the meaning a person has made of the trauma, examining and shifting the stuck beliefs that keep the distress going. PE works mainly on the fear and avoidance side, helping you approach the memory and the avoided situations until the fear comes down. Both are effective, and the better choice often depends on the person and what fits them.
EMDR (Eye Movement Desensitization and Reprocessing) is another trauma-focused approach that the APA suggests and the VA/DoD recommends. It involves processing trauma memories while engaging in guided eye movements or other forms of bilateral stimulation.
PE also differs from general Cognitive Behavioral Therapy in that it is a specific, manualized protocol built for PTSD, rather than the broad family of cognitive and behavioral techniques that CBT refers to. PE is a member of that family, refined and tested for one job.
Frequently Asked Questions
Will PE make my symptoms worse?
The most common risk is mild to moderate discomfort when approaching avoided situations or talking through the trauma. That discomfort is usually strongest early on and tends to ease as treatment continues. The large majority of people who complete PE find the benefits well worth the initial difficulty. If something feels like too much, that is information to bring to your therapist, who will adjust the pace with you.
My trauma happened a long time ago. Can PE still help?
Yes. PE does not depend on the trauma being recent. People who have lived with PTSD for many years respond to it.
What is the difference between PE and CPT?
Both are evidence-based, trauma-focused therapies for PTSD. PE works mainly by helping you approach trauma memories and avoided situations until the fear subsides. CPT works mainly by examining and changing the beliefs you have formed about the trauma. Your clinician can help you think through which is the better fit for you, and you can read more on our CPT page.
Is PE available via telehealth?
Yes. PE can be delivered effectively via telehealth, and OakHeart offers trauma treatment via telehealth throughout Illinois, in addition to in-person sessions at our North Aurora and Sycamore locations.
Our team of licensed psychologists, counselors, and social workers in North Aurora and Sycamore, Illinois provides evidence-based trauma treatment, including PE, to clients throughout Kane County, DeKalb County, DuPage County, and the surrounding Chicago suburbs, with in-person and telehealth options throughout Illinois.
The most common risk is mild to moderate discomfort when approaching avoided situations or talking through the trauma. That discomfort is usually strongest early on and tends to ease as treatment continues. The large majority of people who complete PE find the benefits well worth the initial difficulty. If something feels like too much, that is information to bring to your therapist, who will adjust the pace with you.
My trauma happened a long time ago. Can PE still help?
Yes. PE does not depend on the trauma being recent. People who have lived with PTSD for many years respond to it.
What is the difference between PE and CPT?
Both are evidence-based, trauma-focused therapies for PTSD. PE works mainly by helping you approach trauma memories and avoided situations until the fear subsides. CPT works mainly by examining and changing the beliefs you have formed about the trauma. Your clinician can help you think through which is the better fit for you, and you can read more on our CPT page.
Is PE available via telehealth?
Yes. PE can be delivered effectively via telehealth, and OakHeart offers trauma treatment via telehealth throughout Illinois, in addition to in-person sessions at our North Aurora and Sycamore locations.
Our team of licensed psychologists, counselors, and social workers in North Aurora and Sycamore, Illinois provides evidence-based trauma treatment, including PE, to clients throughout Kane County, DeKalb County, DuPage County, and the surrounding Chicago suburbs, with in-person and telehealth options throughout Illinois.
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References
American Psychological Association. (2017). Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. American Psychological Association.
Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99(1), 20-35.
Foa, E. B., Hembree, E. A., Rothbaum, B. O., & Rauch, S. A. M. (2019). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences, therapist guide (2nd ed.). Oxford University Press.
U.S. Department of Veterans Affairs, National Center for PTSD. Prolonged Exposure (PE) for PTSD. https://www.ptsd.va.gov/understand_tx/prolonged_exposure.asp
Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99(1), 20-35.
Foa, E. B., Hembree, E. A., Rothbaum, B. O., & Rauch, S. A. M. (2019). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences, therapist guide (2nd ed.). Oxford University Press.
U.S. Department of Veterans Affairs, National Center for PTSD. Prolonged Exposure (PE) for PTSD. https://www.ptsd.va.gov/understand_tx/prolonged_exposure.asp
