Prolonged Exposure Therapy

One such intervention has decades of support, and is called Prolonged Exposure Therapy (PE). Developed by Dr. Edna Foa (1.) her protocols have been studied since the late 1980s, and continue to perform well in trauma-afflicted populations worldwide.

To appreciate the design of PE, the core symptoms that make up the diagnosis of PTSD should be reviewed. The main symptoms break down into 5 categories (2.):

Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:

1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others.
3. Learning that the traumatic event(s) occurred to a close family member or close friend.
4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s)

Plus:
Presence of 1 (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred

1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).
2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s).
3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring.
4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolise or resemble an aspect of the traumatic event(s).
5. Marked physiological reactions to internal or external cues that symbolise or resemble an aspect of the traumatic event(s).

Plus:
Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:

Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

1. Avoidance of or efforts to avoid external reminders
2. Negative alterations in cognitions and mood
3. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia, and not to other factors such as head injury, alcohol, or drugs).

Plus:
Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world:

1. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
2. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
3. Markedly diminished interest or participation in significant activities.
4. Feelings of detachment or estrangement from others.
5. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).

And lastly:
Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by 2 (or more) of the following

1. Irritable behaviour and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects.
2. Reckless or self-destructive behaviour.
3. Hypervigilance.
4. Exaggerated startle response.
5. Problems with concentration.
6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).

Dr. Foa created interventions specifically designed to destabilise the maladaptive behaviours, thoughts, and emotions associated with trauma. Her protocol can be as short as 4 sessions, or as long as 14-16 sessions depending on the needs of the person. Regardless of the amount of time spent in PE, each session compassionately teaches clients how to fearlessly address the trauma using both imaginal exposure and in-vivo exposure, in a stepwise fashion tailored to the needs of the client.