Prolonged Exposure Therapy is considered one of the most effective treatments for anxiety disorders. Most national guidelines and treatment recommendation guidelines consider Exposure Therapy to be one of the first-line treatments of choice. Success rates for treatments of mental illnesses are difficult to gauge because of different definitions of “success,” however most estimates range from 60% to 90% of treatment completers either no remaining symptoms or “sub-clinical symptoms” (meaning if the anxiety were this mild in the first place, the individual probably would not have needed treatment).

Exposure Therapy

Exposure Therapy is an evidence-based psychological treatment for anxiety disorders. It involves slowly confronting the objects or situations that provoke your anxiety. As you begin to face your fears, your anxiety will naturally decrease during the “exposure”. After multiple exposures, the object or situation will evoke less and less anxiety each time, and patients then usually move up to more difficult or anxiety-producing objects or situations.

When is Exposure Therapy Used

PET is appropriate for anyone who has experienced or witnessed a traumatic event. Many people who experience a traumatic event do not develop PTSD, and PET is not necessary for those without a PTSD diagnosis. Additionally, given that the completion of PET requires a person to speak about the trauma and to encounter trauma-related thoughts, feelings, and objects, you may experience moderate distress. This distress is often brief, and people typically feel significantly better because of treatment.

What to Expect

PET is conducted by a single clinician through one-on-one therapy. Sessions typically last 90 minutes and occur once a week for approximately three months, though treatment can be shorter at two months or longer at 15 weeks. PET treatment involves Imaginal Exposure and In Vivo Exposure.

During Imaginal Exposure sessions, you will discuss some of the events of your trauma. The therapist might ask you to write down your traumatic experience, read the experience aloud—in and out of session. Your therapist will guide you through the retelling of your trauma. You will explore your thoughts and feelings, which is called processing. This will help you decrease the unwanted traumatic reminders, as well as feel less distress when recalling the trauma. In Vivo Exposure, meaning “in life,” sessions involve your real-life interaction with safe things that you have been avoiding. In these sessions, your therapist will first ask you to make a list of the things you have been avoiding (sounds and places, for example). You will create an “exposure hierarchy” by ranking these avoided things based on how much distress they cause you when you encounter them.

How It Works

PET is based on associative learning theory, when two things appear together, the brain learns to connect or associate them. Ivan Pavlov created the most famous associative learning experiment by repeatedly ringing a bell before presenting his dogs with food. The dogs began to salivate at the sound of the bell, as they learned to associate the bell with food. To break this association, Pavlov then repeatedly rang the bell without giving the dogs any food; the dogs eventually stopped salivating when they heard the bell. This same process is behind PTSD. When a trauma occurs, there are many things in the environment—smells, sights, sounds—that the brain associates with the trauma. When we encounter those things outside of the trauma, the brain expects danger, causing fear and anxiety.