Prolonged Exposure Therapy (PET) is a therapy designed to treat Post Traumatic Stress Disorder (PTSD) and trauma. PET was developed and initially studied by Dr. Edna Foa in 1991, and is one of the leading treatments for PTSD.
When used in conjunction with Dialectical Behavior Therapy, PET has been found effective in treating trauma in people diagnosed with Borderline Personality Disorder.
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How Prolonged Exposure Therapy Works
Prolonged Exposure Therapy is based on the theory that PTSD is maintained by two factors:
- Avoidance of thoughts, memories, and situations associated with trauma, and
- Problematic beliefs about oneself and the world.
For example, a belief that the world is dangerous leads a person to avoid various events and situations. The more a person avoids, the scarier these situations become, which further confirms the belief and perpetuates avoidance.
Prolonged Exposure Therapy aims to eliminate avoidance and challenge problematic beliefs. This is done using two types of exposure procedures: imaginal exposure and in vivo exposure. Imaginal exposure occurs during therapy sessions and involves gradual, repeated retelling of traumatic memories. In vivo exposure includes developing a hierarchy of real-life situations a person avoids, and gradually engaging in those tasks.
The PET therapist serves as a guide throughout this process, offering support, structure, and instilling hope. Both types of exposure procedures are a mechanism to process emotions, test problematic beliefs, and get a healthier perspective.
Who Is Prolonged Exposure Therapy Appropriate For?
Prolonged Exposure Therapy is appropriate for individuals who have been diagnosed with Post Traumatic Stress Disorder. PET is appropriate to treat all forms of trauma, including childhood physical or sexual abuse, bullying, military trauma, sexual assault, terrorist attacks, violent crimes, and natural disasters.
Evidence Behind Prolonged Exposure Therapy
The American Psychological Association considers Prolonged Exposure Therapy an empirically validated treatment for PTSD. Prolonged Exposure Therapy has been found effective for reducing PTSD across approximately 13 randomized controlled-trial studies. Findings show that PET reduces symptoms of PTSD, and these gains are maintained when followed up after treatment ends.
Given the high comorbidity of PTSD and personality disorders, newer research has examined whether Prolonged Exposure Therapy works to treat trauma in individuals who also have Borderline Personality Disorder (BPD). This research has included PET as part of Dialectical Behavior Therapy (DBT), and found that PET effectively reduces symptoms of PTSD for suicidal individuals with BPD.
Prolonged Exposure Therapy and DBT
The integration of Prolonged Exposure Therapy and DBT is on the cutting edge of trauma and BPD treatment, and initial research on this model has been promising. The DBT PET model was developed by Drs. Marsha Linehan and Edna Foa, with attention paid to combining these treatments in a way that adheres to the fidelity of both models.
Within the DBT PET model, Prolonged Exposure Therapy is implemented after clients in DBT have had ample time to stabilize and work on life-threatening behaviors. Additionally, DBT skills are used to cope ahead for challenges associated with trauma-focused exposure therapy.
Clients engage in weekly PET sessions, with concurrent once-weekly DBT sessions. Diary cards continue to be reviewed in each session, as are DBT commitment, validation, and motivation strategies. Upon completion of Prolonged Exposure Therapy, DBT sessions continue to assist clients in wrapping up trauma-focused work and shifting focus to building a life worth living, including discharge planning.
Implementation of Prolonged Exposure Therapy at Clearview Women’s Center
At Clearview Women’s Center, many of our therapists have extensively trained in Prolonged Exposure Therapy with experts in the field. Our women’s residential treatment program can accommodate the DBT PET model with clients who have adequately stabilized in life-threatening behaviors. Stabilization typically takes 30 days, but may vary depending on client needs.
The DBT PET model provides intensive trauma-focused individual therapy for clients who wish to work on their PTSD symptoms while in the support and structure of residential treatment. At Clearview Women’s Center, clients have twice-weekly PET sessions and once-weekly DBT sessions. This allows clients with emotion dysregulation difficulties to work on trauma while continuing to use DBT skills and practices.
The DBT PET protocol takes an additional 60 days of treatment, or a total of 90 days of treatment. Again, however, it may take longer given individual client needs and trauma history.
When Prolonged Exposure Therapy May Not Be Appropriate
Prolonged Exposure Therapy may not be the treatment of choice for individuals who have little to no memory of their trauma. PET is not appropriate for individuals who are actively psychotic.
Individuals with PTSD may experience suicidal ideation, self-harm, or substance abuse. People who are suicidal or self-harming will need to learn adequate coping skills prior to beginning PET. This includes, but is not limited to, the skills learned within DBT.
People may find Prolonged Exposure Therapy more effective after first receiving treatment for substance abuse, or may require concurrent substance abuse treatment.