Prolonged Exposure for Post-Traumatic Stress Disorder

Status: Strong Research Support


Prolonged exposure therapy involves the gradual confrontation of the traumatic memory, including thoughts, objects, environments, and situations that remind the patient of the trauma. Typically, exposure to the traumatic memory begins in session, and the patient is asked to listen to their traumatic memory for homework. The purpose of this imaginal exposure is to allow the patient to fully process the traumatic event, and to teach the patient that 1) memories/ reminders the trauma are not in themselves dangerous, and are not the same as experiencing the trauma again, 2) anxiety can be controlled without escaping or avoiding the feared stimuli, and 3) anxiety and PTSD symptoms can be experienced without the loss of control. Typically, hierarchical in vivo (i.e., in person) exposures are also part of prolonged exposure therapy, which involves confronting trauma reminders, including people, places, and objects. Prolonged exposure therapy last approximately 16 sessions and is often delivered twice-weekly or weekly; it is often used alongside other cognitive-behavioral techniques.

Key References (in reverse chronological order)

Foa, E. B., Hembree, E. A., Cahill, S. P., Rauch, S. A. M., Riggs, D. S., Feeny, N. C., et al. (2005). Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics. Journal of Consulting and Clinical Psychology, 73, 953-964.

Resick, P. A., Nishith, P., Weaver, T. L., Astin, M. C., & Feuer, C. A. (2002). A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. Journal of Consulting and Clinical Psychology, 70, 867-879.

Foa, E. B., Dancu, C. V., Hembree, E. A., Jaycox, L. H., Meadows, E. A., & Street, G. P. (1999). A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims. Journal of Consulting and Clinical Psychology, 67, 194-200.

Foa, E.B., Rothbaum, B.O., Riggs, D.,& Murdock, T. (1991). Treatment of post-traumatic stress disorder in rape victims: A comparison between cognitive-behavioral procedures and counseling. Journal of Consulting and Clinical Psychology, 59, 715-723.

Keane, T. M., Fairbank, J. A., Caddell, J. M., & Zimering, R. T. (1989). Implosive (flooding) therapy reduces symptoms of PTSD in Vietnam combat veterans. Behavior Therapy, 20, 245-260.

Clinical Resources

Foa, E., Hembree, E., & Rothbaum, B. (2007). Prolonged Exposure Therapy for PTSD: Emotional Processing of Traumatic Experiences Therapist Guide. New York: Oxford University Press.

Training Opportunities

National Center for PTSD
Educational Division (323EI 12)
Palo Alto VA Medical Center
Palo Alto, CA 94304

Behavioral Science Division (I 16B-2)
Boston VA Medical Center
Boston, MA 02130

Women's Health Sciences Division (I 16B-3)
Boston VA Medical Center
Boston, MA 02130

National Crime Victims Research and Treatment Center
Department of Psychiatry and Behavioral Sciences
Medical University of South Carolina
171 Ashley Avenue
Charleston, SC 29425

Center for Treatment and Study of Anxiety
University of Pennsylvania
3535 Market Street, 6th floor
Philadelphia, PA 19104