There are so many types of Post Traumatic Stress Disorder (PTSD) treatments and it can be difficult to pull apart the differences in order to decide which one is best for you. The great thing about there being so many types of PTSD treatment is that there are so many heavily researched options for people who are experiencing these symptoms. One fantastic option is Prolonged Exposure Therapy, referred to as “PE” for short.
PE helps treat PTSD symptoms through active engagement with the things that we have been avoiding that remind us of the traumatic experience or trigger unpleasant feelings related to the traumatic experience (emotions, thoughts, memories, situations, people, places, objects). That is– active engagement with those things that are objectively safe even though our brain is telling us that the things are unsafe.
Trauma & PTSD
The American Psychological Association (APA) defines trauma as “an emotional response to a terrible event.” Just because someone experiences a trauma does not mean that they will automatically develop PTSD symptoms (which is great news!!). The human brain is amazing, and many people heal from traumatic events on their own- which is so cool.
Sometimes, our brains need some extra support going through the natural healing process (i.e. engaging with the memories and emotions when they arise rather than avoiding them). If you are someone who needs extra support with this natural healing process- that is okay. You are in the right place!
The development of PTSD symptoms happens through avoidance. Avoidance helps us in the short term by decreasing immediate discomfort. Think about walking in the rain without a rain jacket — most of us walk fast or jog to avoid being in the rain as much as possible.
Will the rain hurt us? Probably not; but the immediate relief when we make it to our destination feels so good.
What this might teach our brain, however, is that being caught in the rain is always a bad thing. Sometimes, it can even teach our brain that being caught in the rain is dangerous. Or that we can’t handle being caught in the rain because it is just too unpleasant.
There are things that we should objectively avoid — being really close to the edge when we are on something tall, walking alone in dangerous areas at night, swimming in a thunderstorm, walking on an interstate, and not wearing a seatbelt — just to name a few.
PE is not trying to get rid of the fear of objective dangers, rather, the intense fear of objectively safe situations such as the smell of a cologne/perfume, a handshake, going into a grocery store, sitting with your back to the door, a picture of someone, certain words or phrases, watching a specific movie, a memory, etc.
Why Engage in PE?
As you read above, PTSD can lead to avoidance of emotions, thoughts, memories, physical locations, people, reminders, sensations, etc. This means that PTSD can lead us to isolate ourselves, avoid activities that we used to enjoy, or avoid important daily tasks. What we know about the development of PTSD symptoms is this: symptoms develop through avoidance, so to treat PTSD, we have to avoid avoiding (this is one of the healthy kinds of avoidance!).
In order to avoid avoiding, we need to teach our brain the difference between subjective and objective danger. We want our brain to be able to understand that driving is not going to lead to an accident every time I get in the car. That not all interstates are dangerous just because I got into a car accident on one interstate. Not all people with curly brown hair are going to cause harm. Wearing tight clothes does not mean I am going to be sexually assaulted. Being in a room with a man does not automatically mean I will be harmed.
On the other side of this, walking down the street alone at night CAN BE dangerous and we SHOULD have a healthy amount of fear about this situation. When we avoid objectively safe situations, we aren’t able to live a full life. When we avoid objectively dangerous situations, we keep ourselves safe.
Who Can Benefit from PE?
In order to determine if PE is a good fit for you, start by asking your therapist!
A common way mental health professionals assess PTSD symptom severity is through the PTSD Checklist for DSM-5 (PCL-5). PE works with clients who have experienced a Criterion A trauma which is defined in the Diagnostic and Statisitcal Manual of Mental Disorders (DSM-5) as exposure to “death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s): Direct exposure, Witnessing the trauma, Learning that the trauma happened to a close relative or close friend, or Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)”.
What Can I Expect with PE?
As a client, you will learn a lot about how trauma impacts the brain, our behaviors, and our belief systems. You will also learn in detail what to expect during all of your PE sessions, including the following:
- Trauma interview: discuss your history and identify the traumatic event that led up to PTSD treatment
- Exposure hierarchy: identify a list of situations, people, places, thoughts, things, smells, etc. that you have stopped engaging with since the traumatic event
- In vivo exposure: engaging in the exposure hierarchy starting with the least distressing exposures
- Imaginal exposure: Verbally walking through the memory (remember- we are avoiding avoidance)
- Processing: discussing thoughts, emotions, and sensations after you complete the imaginal exposure
The process of PE is no joke (it’s emotionally difficult), but neither is losing the life you had due to PTSD symptoms. You and your therapist are on one side and PTSD is on the other; you don’t have to face PTSD alone.
Find a Prolonged Exposure Therapist
For starters, you can always reach out to us! I received Prolonged Exposure training through Emory’s Consultant Training Program, where I worked with adolescents in a residential facility.
You can find other PE trained therapists in your area through Emory’s Provider Directory. You can also find more information about Prolonged Exposure Therapy through the Department of Veterans Affairs.
About the Author
Sloan Strickland, LCSW, is a licensed therapist at Montgomery County Counseling Center in Rockville, MD. She earned her master’s degree in Social Work from the University of Tennessee and is trained in Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT) and Prolonged Exposure.
Among her many strengths, Sloan offers expertise in anxiety, depression, trauma, and OCD treatment and specializes in teen and young adult therapy. She provides a nurturing environment for clients to explore their inner strength and realign their habits with personal values.
