Prolonged exposure

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Prolonged Exposure ( PE , or prolonged exposure therapy ) was as a form of behavior therapy and cognitive behavioral therapy developed to posttraumatic stress disorder (PTSD, in English "Post Traumatic Stress Disease" PTSD). It essentially consists of three components:

  • "In Vivo" exposure means gradually exposing yourself to situations, places or other things that remind you of the trauma or feel dangerous (without being objectively dangerous, of course)
  • Imaginative exposure, i.e. the repeated intentional narration of the memory of the trauma
  • Cognitive processing of trauma memory

Summary

Dr. Edna Foa

Prolonged Exposure Therapy (PE) was developed by Dr. Edna Foa, director of the Center for the Treatment and Study of Anxiety (CTSA) at the University of Pennsylvania in Philadelphia. PE is an evidence-based and highly effective form of treatment for post-traumatic stress disorder (PTSD) and accompanying depressive symptoms and anxiety. PE is one of the exposure-based psychotherapy methods and is supported by numerous studies that have been able to demonstrate the positive effect on PTSD symptoms.

In exposure-based therapies, patients confront themselves with situations that are harmless in themselves, but which are cognitively linked to the traumatic situation and can therefore trigger great tension and fear. Through the repeated experience that the traumatic experience does not recur, one breaks the cognitive connection between the trauma and the situation. PE is a flexible therapy method that can be individually adapted to the circumstances and needs of the patient. It is specifically designed to help patients to process traumatic experiences psychologically and to reduce the disorders caused by trauma.

The therapy not only reduces PTSD symptoms, but PE also increases confidence and self-confidence and improves various everyday skills, especially being able to deal better with stressful situations and being able to differentiate between safe and unsafe situations.

Components of therapy

PTSD is characterized by reliving the traumatic event through shooting and harrowing memories, nightmares, flashbacks, and strong emotional and physical responses triggered by situations reminiscent of the trauma. Most people with PTSD try to stave off these intrusive thoughts by avoiding situations that remind them of the trauma, even if they are not dangerous in themselves. To manage the intrusions and avoidance behavior, exposure therapy consists of the following two main components:

  1. "In Vivo" exposure, i.e. H. repeated exposure to situations, activities, places that are avoided due to traumatic memories. These encounters reduce trauma-related fears and enable the patient to realize that avoided situations are not dangerous and that they can deal with the suffering.
  2. Imaginative exposure, i.e. H. the repeated revisiting, retelling and processing the traumatic experience. The imaginative exposure promotes the processing of the trauma memory and helps to gain a realistic perspective on the trauma.

The aim of the therapy is to process the trauma memory and to reduce the psychological stress and avoidance behavior. The therapy also supports depressed and emotionally dull patients in building positive activities.

Imaginative exposure occurs when the patient repeatedly recounts the trauma to the therapist during therapy sessions. In addition, sound recordings are made of the sessions, which the patients listen to between the sessions. For in vivo exposure, the therapist works with the patient to develop a hierarchy of avoided situations, places and activities to which the patient exposes himself as homework.

All three components facilitate the emotional processing of the trauma memory and reduce avoidance behavior. Randomized controlled studies showed that only 10–38% of PE patients discontinued therapy before it was stopped.

Studies

PE is used successfully around the world to treat patients with a variety of traumatic experiences such as rape, assault, child abuse, war, traffic accidents and natural disasters. A study from the Netherlands showed a better effect compared to EMDR. PE is also effective in patients with simultaneous substance dependence when treated in parallel. It could also be shown that PE has no negative effect on the addiction disorder. Further studies have shown that PE in combination with DBT also helps patients with an accompanying emotionally unstable personality disorder of the borderline type. If schizophrenia was present at the same time, a reduction in delusional and psychotic symptoms could be demonstrated after 6 months.

Individual evidence

  1. ^ Watkins L, Sprang K, Rathbaum B: Treating PTSD: A Review of Evidence-Based Psychotherapy Interventions . In: Frontiers in Behavioral Neuroscience . 12, 2018, p. 258. doi : 10.3389 / fnbeh.2018.00258 . PMID 30450043 . PMC 6224348 (free full text).
  2. ↑ a b c d Lancaster CL, Teeters JB, Gros DF, Back SE: Posttraumatic Stress Disorder: Overview of Evidence-Based Assessment and Treatment . In: Journal of Clinical Medicine . 5, No. 11, November 2016, p. 4. doi : 10.3390 / jcm5110105 . PMID 27879650 . PMC 5126802 (free full text).
  3. ↑ a b Granato HF, Wilks CR, Miga EM, Korslund KE, Linehan MM: The Use of Dialectical Behavior Therapy and Prolonged Exposure to Treat Comorbid Dissociation and Self-Harm: The Case of a Client With Borderline Personality Disorder and Posttraumatic Stress Disorder . In: Journal of Clinical Psychology . 71, No. 8, August 2015, pp. 805–15. doi : 10.1002 / jclp.22207 . PMID 26227284 .
  4. ↑ Eftekhari A, Stines LR, Zoellner LA: Do You Need To Talk About It? Prolonged Exposure for the Treatment of Chronic PTSD . In: The Behavior Analyst Today . tape 7 , no. 1 , January 1, 2006, ISSN  1539-4352 , p. 70-83 , doi : 10.1037 / h0100141 , PMID 19881894 , PMC 2770710 (free full text) - ( nih.gov [accessed June 12, 2020]).
  5. ↑ Williams, M, Cahill, S, Foa, E: Psychotherapy for Post-Traumatic Stress Disorder. In Textbook of Anxiety Disorders , Second Edition, ed. D. Stein, E. Hollander, B. Rothbaum, American Psychiatric Publishing, 2010.
  6. ↑ Kazi A, Freund B, Ironson G: Prolonged Exposure Treatment for Posttraumatic Stress Disorder Following the 9/11 Attack With a Person Who Escaped From the Twin Towers . In: Clinical Case Studies . tape 7 , no. 2 , April 2008, ISSN  1534-6501 , p. 100–117 , doi : 10.1177 / 1534650107306290 ( sagepub.com [accessed June 12, 2020]).
  7. ↑ a b c d Dixon LE, Ahles E, Marques L: Treating Posttraumatic Stress Disorder in Diverse Settings: Recent Advances and Challenges for the Future . In: Current Psychiatry Reports . 18, No. 12, December 2016, p. 108. doi : 10.1007 / s11920-016-0748-4 . PMID 27771824 . PMC 5533577 (free full text).
  8. ↑ Foa EB, McLean CP, Capaldi S, Rosenfield D: Prolonged exposure vs supportive counseling for sexual abuse-related PTSD in adolescent girls: a randomized clinical trial . In: JAMA . 310, No. 24, December 2013, pp. 2650-7. doi : 10.1001 / jama.2013.282829 . PMID 24368465 .
  9. ^ Joseph JS, Gray MJ: Exposure therapy for posttraumatic stress disorder. In: The Journal of Behavior Analysis of Offender and Victim Treatment and Prevention . tape 1 , no. 4 , 2008, ISSN  2155-8655 , p. 69–79 , doi : 10.1037 / h0100457 ( apa.org [accessed June 12, 2020]).
  10. ↑ Kemmis LK, Wanigaratne S, Ehntholt KA: Emotional Processing in Individuals with Substance Use Disorder and Posttraumatic Stress Disorder . In: International Journal of Mental Health and Addiction . 15, No. 4, 2017, pp. 900–918. doi : 10.1007 / s11469-016-9727-6 . PMID 28798555 . PMC 5529498 (free full text).

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