Prolonged Exposure (PE) Therapy

Placement on the Continuum of Evidence Effective-RCT Download icon Download PDF
Target Population: 
Adults
Sector: 
Community-Based
Topic: 
PTSD
Military Sector: 
All Branches, Veterans Affairs
Target Audience 

This program is for adults who have Post-Traumatic Stress Disorder.

Summary 

Prolonged Exposure (PE) Therapy is a one-on-one therapeutic treatment for adults who have experienced significant trauma and have consequently received a diagnosis of Post-Traumatic Stress Disorder (PTSD).  Treatment focuses on reducing trauma symptoms, such as hypervigilance, hyperarousal, flashbacks, and related depression and anxiety symptoms.

Evidence 

Numerous randomized clinical trials, including several external replications of PE Therapy, have demonstrated its effectiveness as a treatment for PTSD.  Studies consistently reveal that individuals who participated in PE Therapy, compared to various control conditions (e.g., wait-list/delayed treatment, relaxation therapy, person-centered therapy, typical treatment, dynamic therapy), showed the following improvements:  significant reduction in their PTSD symptoms at immediate post-treatment and at follow-up (i.e., ranging from 6- to 17-months post-treatment), significant reduction in secondary depressive and anxiety symptoms, and overall significant increases in measures of global functioning.  These results are found in individuals with a wide variety of traumatic exposures (e.g., robberies, sexual assaults, domestic violence, childhood abuse, combat- and terrorism-related traumas) with differences in degree of exposure, single and chronic, and with wide ranges in time from last trauma exposure (i.e., from 3 months to no upper limit).  The efficacy of PE Therapy has been demonstrated in civilian and military populations.

Components 

PE Therapy is designed to help individuals who have PTSD caused by traumas, such as rape, childhood sexual abuse, combat, motor vehicle accidents, or natural disasters.  This program has three components:

  1. Psychoeducation:  Increase the patient’s level of understanding of his or her diagnosis and the symptoms he or she is experiencing.
  2. Imaginal exposure:  Encourage patients to repeatedly recount the traumatic memory, help participants retrieve missing information about the event, and assist them as they increase their ability to create an organized narrative of the event.
  3. In vivo exposure:  Expose patients, gradually, to situational aspects related to their trauma.  The impact of the trauma is reduced through the use of systematic desensitization techniques.
Previous Use 

PE Therapy is widely implemented by clinical psychologists across the United States and internationally.  Currently, PE Therapy is being implemented in numerous Veterans’ hospitals.

Training 

Licensed mental health professionals facilitate this program, and they are required to attend a training workshop.  The training takes 4 days and is offered twice annually during the fall and spring semesters by faculty from the Center for the Treatment and Study of Anxiety at the University of Pennsylvania.  The cost to attend the workshop, including training and support materials (e.g., workshop binder, intervention therapist guide, client workbook), is $1500 per person.  For more information, please visit the website located in the Contact section.

Considerations 

Considerations for implementing this program include securing professionals to facilitate the program and ensuring they attend the workshop, gaining buy-in from participants, understanding that therapist burn-out may occur, and understanding funds for program training and implementation may need to be acquired.

The Clearinghouse can help address these considerations. Please call 1-877-382-9185 or email Clearinghouse@psu.edu

Implementation 

If you are interested in implementing PE Therapy, the Clearinghouse is interested in helping you!
Please call 1-877-382-9185 or email Clearinghouse@psu.edu

Time 

PE Therapy requires between 8 and 20 sessions.  Each session lasts 90 minutes.

Cost 

Costs to implement PE Therapy are built into the fees associated with training the therapists.

Evaluation Plan 

The Clearinghouse can help you develop an evaluation plan to ensure the program components are meeting your goals. Please call 1-877-382-9185 or email Clearinghouse@psu.edu

Contact 

Contact the Clearinghouse with any questions regarding this program.
Phone: 1-877-382-9185 Email: Clearinghouse@psu.edu

You may also contact the Center for the Treatment and Study of Anxiety by mail at the Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 600, Philadelphia, PA 19104-3309, phone 1-215-746-3327, fax 1-215-746-3311, or visit www.med.upenn.edu/ctsa/workshops_pet.html

References
References - Used For Placement 

Bryant, R. A., Mastrodomenico, J., Felmingham, K. L., Hopwood, S., Kenny, L., Kandris, E., … Creamer, M. (2008). Treatment of acute stress disorder: A randomized controlled trial. Archives of General Psychiatry, 65, 639-667.

Eftekhari, A., Ruzek, J. I., Crowley, J. J., Rosen, C. S., Greenbaum, M. A., & Karlin, B. E. (2013). Effectiveness of national implementation of prolonged exposure therapy in Veterans Affairs care. JAMA Psychiatry, 70, 949-955.

Gilboa-Schechtman, E., Foa, E. B., Shafran, N., Aderka, I. M., Powers, M. B. Rachamim, L., … Apter, A. (2010). Prolonged exposure versus dynamic therapy for adolescent PTSD: A pilot randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 1034-1042.

Nacasch, N., Foa, E. B., Huppertt, J. D., Tzur, D., Fostick, L., Dinstein, Y., ... Zohar, J. (2010). Prolonged exposure therapy for combat- and terror-related posttraumatic stress disorder: A randomized control comparison with treatment as usual. Journal of Clinical Psychiatry, 72, 1174-1180

Schnurr, P. P., Friedman, M. J., Engel, C. C., Foa, E. B., Shea, M. T., Chow, B. K., … Bernardy, N. (2007). Cognitive behavioral therapy for posttraumatic stress disorder in women: A randomized controlled trial. Journal of the American Medical Association, 297, 820-830.

Tuerk, P. W., Yoder, M., Grubaugh, A., Myrick, H., Hamner, M., & Acierno, R. (2011). Prolonged exposure therapy for combat-related posttraumatic stress disorder: An examination of treatment effectiveness for veterans of the wars in Afghanistan and Iraq. Journal of Anxiety Disorders, 25, 397-403.

*Resources and associated costs reflect those identified at the time of fact sheet publication.