This is because exposure therapy targets learned behaviors that people engage in most often the avoidance in response to situations or thoughts and memories that are viewed as frightening or anxiety-provoking. For example, a rape survivor may begin to avoid relationships or going out on dates for fear that she will be attacked again. It is important to recognize that this learned avoidance serves a purpose. When a person experiences a traumatic event , he may begin to act in ways to avoid threatening situations with the goal of trying to prevent that traumatic experience from happening again.
Avoidance is a safety-seeking or protective response. However, as this avoidance behavior becomes more extreme, a person's quality of life may lessen. He may lose touch with family or experience difficulties at work or in relationships.
In addition, avoidance can make PTSD symptoms stick around longer or even intensify. In addition, by avoiding thoughts, memories, and emotions, a person doesn't let himself fully process those experiences. The goal of exposure therapy then is to help reduce a person's fear and anxiety, with the ultimate goal of eliminating avoidance behavior and increasing quality of life. This is done by actively confronting the things that a person fears.
By confronting feared situations, thoughts, and emotions, a person can learn that anxiety and fear will lessen on its own. So, how does a person actively confront feared situations, thoughts, and emotions during exposure therapy? A number of methods may be used by a therapist. These are described below. In vivo exposure refers to the direct confrontation of feared objects, activities or situations by a person under the guidance of a therapist.
For example, a woman with PTSD who fears the location where she was assaulted may be assisted by her therapist in going to that location and directly confronting those fears as long as it is safe to do so.
Likewise, a person with social anxiety disorder who fears public speaking may be instructed to directly confront those fears by giving a speech. In imaginal exposure, a client is asked to imagine feared images or situations. Imaginal exposure can help a person directly confront feared thoughts and memories.
Imaginal exposure also may be used when it is not possible or safe for a person to directly confront a feared situation. For example, it would not be safe to have a combat veteran with PTSD to directly confront a combat situation again. Therefore, he may be asked to imagine a feared combat situation that he experienced.
Interoceptive exposure was originally designed to treat panic disorder. However, there is evidence that interoceptive exposure may be successful in the treatment of PTSD as well. The therapist may assist this by having a person in a controlled and safe manner hyperventilate for a brief period of time, exercise, breathe through a straw or hold his breath. Prolonged exposure therapy is a combination of the above three methods.
Prolonged exposure has been found to be very effective for PTSD sufferers. Prolonged exposure therapy consists of education about trauma and what you will be doing, learning how to control your breathing interoceptive exposure , practicing in the real world in vivo exposure , and talking about your trauma imaginal exposure.
You will listen to a recording of this part of your session at home between sessions. Yes, you will practice doing some of the things you have avoided since your trauma. You will start with activities that are manageable for you, and you will work up to activities that are more challenging. You will also listen to a recording of your therapy sessions, including your imaginal exposure recording. Practicing these skills between sessions helps you get the most out of PE. Smaller VA facilities that do not offer PE may be able to use video-conferencing to have you receive PE from a provider at another location.
It a free download on most mobile devices. After your initial download, you will not be required to use your personal minutes or data.
This app does not share any information with the VA, so it is up to you if you want to show your provider your information. Trying to figure out which PTSD treatment is best for you? Go To Provider Version. Veterans Crisis Line: Press 1. Complete Directory. If you are in crisis or having thoughts of suicide, visit VeteransCrisisLine. Quick Links. Share this page. What Type of Treatment Is This? Providers describe PE in this 1 minute video. Video How PE works. Effectiveness of national implementation of prolonged exposure therapy in veterans affairs care.
JAMA Psychiatry 70, — Etkin, A. The neural bases of emotion regulation. Felmingham, K. Changes in anterior cingulate and amygdala after cognitive behavior therapy of posttraumatic stress disorder. Flanagan, J. Augmenting prolonged exposure therapy for PTSD with intranasal oxytocin: a randomized, placebo-controlled pilot trial. Foa, E. Prolonged exposure therapy: past, present and future.
Anxiety 28, — Emotional processing of fear: exposure to corrective information. Cognitive changes during prolonged exposure versus prolonged exposure plus cognitive restructuring in female assault survivors with posttraumatic stress disorder. Treatment of posttraumatic stress disorder in rape victims: a comparison between cognitive-behavioral procedures and counseling. Fonzo, G. PTSD psychotherapy outcome predicted by brain activation during emotional reactivity and regulation.
Fox, K. The wandering brain: meta-analysis of functional neuroimaging studies of mind-wandering and related spontaneous thought processes. NeuroImage , — Garfinkel, S. George, M. Mechanisms and state of the art of transcranial magnetic stimulation. ECT 18, — Daily left prefrontal repetitive transcranial magnetic stimulation for acute treatment of medication-resistant depression.
Gilbertson, M. Smaller hippocampal volume predicts pathologic vulnerability to psychological trauma. Gyurak, A. Explicit and implicit emotion regulation: a dual-process framework. Hariri, A. The amygdala response to emotional stimuli: a comparison of faces and scenes. NeuroImage 17, — Harris, D. Subjective and hormonal effects of 3,4-methylenedioxymethamphetamine MDMA in humans.
Hayes, J. Quantitative meta-analysis of neural activity in posttraumatic stress disorder. Mood Anxiety Disord. Helpman, L. Neuroimage Clin. PTSD remission after prolonged exposure treatment is associated with anterior cingulate cortex thinning and volume reduction.
Anxiety 33, — Institute of Medicine. Jerud, A. The effects of prolonged exposure and sertraline on emotion regulation in individuals with posttraumatic stress disorder. Johansen, J. Molecular mechanisms of fear learning and memory. Cell , — Jovanovic, T. How the neurocircuitry and genetics of fear inhibition may inform our understanding of PTSD.
Karsen, E. Review of the effectiveness of transcranial magnetic stimulation for post-traumatic stress disorder. Brain Stimul. Keding, T. Abnormal structure of fear circuitry in pediatric post-traumatic stress disorder. Neuropsychopharmacology 40, — King, A. Koch, S. Aberrant resting-state brain activity in posttraumatic stress disorder: a meta-analysis and systematic review. Kohn, N. NeuroImage 87, — Lambert, J. Ledgerwood, L. D-cycloserine facilitates extinction of learned fear: effects on reacquisition and generalized extinction.
Psychiatry 57, — LeDoux, J. Emotion circuits in the brain. Lee, J. Reconsolidation and extinction of conditioned fear: inhibition and potentiation. Liberzon, I. Context processing and the neurobiology of post-traumatic stress disorder. Neuron 92, 14— Lindauer, R. Effects of psychotherapy on hippocampal volume in out-patients with post-traumatic stress disorder: a MRI investigation. Lindgren, L. Longitudinal evidence for smaller hippocampus volume as a vulnerability factor for perceived stress.
Cortex 26, — Lissek, S. Beck and D. Sloan Oxford: Oxford University Press , — Litz, B. A randomized placebo-controlled trial of D-cycloserine and exposure therapy for posttraumatic stress disorder. Lopresto, D. Neural circuits and mechanisms involved in fear generalization: implications for the pathophysiology and treatment of posttraumatic stress disorder.
Maninger, N. Maren, S. Synaptic plasticity in the basolateral amygdala induced by hippocampal formation stimulation in vivo. The contextual brain: implications for fear conditioning, extinction and psychopathology.
Marx, C. Laskowitz and G. McLaughlin, A. Patterns of therapeutic alliance: rupture-repair episodes in prolonged exposure for posttraumatic stress disorder. Milad, M. Estrous cycle phase and gonadal hormones influence conditioned fear extinction.
Neuroscience , — Presence and acquired origin of reduced recall for fear extinction in PTSD: results of a twin study. Neurobiological basis of failure to recall extinction memory in posttraumatic stress disorder. Psychiatry 66, — Mithoefer, M. MDMA-assisted psychotherapy for the treatment of posttraumatic stress disorder: a revised teaching manual. Lancet Psychiatry 5, — Mowrer, O.
Learning and its Symbolic Processes. Negash, S. Relationship of contextual cueing and hippocampal volume in amnestic mild cognitive impairment patients and cognitively normal older adults.
New, A. A functional magnetic resonance imaging study of deliberate emotion regulation in resilience and posttraumatic stress disorder.
Norberg, M. A meta-analysis of D-cycloserine and the facilitation of fear extinction and exposure therapy. Psychiatry 63, — Ochsner, K. Rethinking feelings: an fMRI study of the cognitive regulation of emotion. Functional imaging studies of emotion regulation: a synthetic review and evolving model of the cognitive control of emotion. N Y Acad. Oehen, P. Olff, M. A psychobiological rationale for oxytocin in the treatment of posttraumatic stress disorder. CNS Spectr.
Osuji, I. Pregnenolone for cognition and mood in dual diagnosis patients. Psychiatry Res. Paul, S. Neuroactive steroids. Peres, J. Cerebral blood flow changes during retrieval of traumatic memories before and after psychotherapy: a SPECT study.
Philip, N. Network mechanisms of clinical response to transcranial magnetic stimulation in posttraumatic stress disorder and major depressive disorder. Psychiatry 83, — Pitman, R. Biological studies of post-traumatic stress disorder. Powers, M. A meta-analytic review of prolonged exposure for posttraumatic stress disorder.
Quirk, G. The role of ventromedial prefrontal cortex in the recovery of extinguished fear. Rabinak, C. Focal and aberrant prefrontal engagement during emotion regulation in veterans with posttraumatic stress disorder. Anxiety 31, — Ramchand, R. Prevalence of, risk factors for and consequences of posttraumatic stress disorder and other mental health problems in military populations deployed to Iraq and Afghanistan.
Rasmusson, A. Neuroactive steroids and PTSD treatment. Rauch, S. Stress 22, 60— Trials 64, — Acute psychosocial preventive interventions for posttraumatic stress disorder.
Mind Body Med. Neurocircuitry models of posttraumatic stress disorder and extinction: human neuroimaging research—past, present and future. Psychiatry 60, — Liberzon, and K. Riaza Bermudo-Soriano, C.
New perspectives in glutamate and anxiety. Rothbaum, B. Stress 18, — Augmentation of sertraline with prolonged exposure in the treatment of posttraumatic stress disorder. Traumatic Stress 19, — Applying learning principles to the treatment of post-trauma reactions. A randomized, double-blind evaluation of D-cycloserine or alprazolam combined with virtual reality exposure therapy for posttraumatic stress disorder in Iraq and Afghanistan war veterans.
CNS Neurosci. Rubin, M. Greater hippocampal volume is associated with PTSD treatment response. Neuroimaging , 36— Scioli-Salter, E.