Prolonged exposure therapy (PET)

What is exposure therapy?

Exposure therapy is a type of talking therapy that helps people gradually face their fears. Prolonged exposure (PE) therapy is an exposure-based type of cognitive behavioural therapy (CBT) used to treat post-traumatic stress disorder (PTSD), which could develop after a traumatic event. 

Trauma can make the brain feel like it’s under constant threat and has become stuck in ‘high alert’ mode. Living in this state constantly could leave a person feeling on edge, anxious, and distressed. So, to avoid these feelings, people often begin avoiding reminders of the trauma. However, this can actually make recovery much more difficult. 

PE therapy aims to gently interrupt this cycle of fear and avoidance by helping a person gradually face memories or situations they’ve been avoiding. It’s called ‘prolonged exposure’ because it requires someone to focus on their traumatic memories and feared situations for extended periods of time. 

How does prolonged exposure therapy work?

PE therapy helps you discover that although trauma memories and reminders can be painful, they are not dangerous in themselves. Prolonged exposure therapy typically has four main elements, which are:

1. Psychoeducation: Learning about how PE works and common reactions to trauma.
2. Breathing exercises: Practising calm, slow breathing to manage anxiety and help your body relax in challenging moments. 
3. In-vivo exposure: Gradually facing everyday places or activities that you’ve been avoiding but are objectively safe.
4. Imaginal exposure: Retelling the story of your trauma out loud to your therapist in a safe environment, paying attention to your thoughts and feelings at the time. Then, you listen to an audio recording of this memory at home. 

Together, these techniques can reduce fear, build confidence, and help trauma reminders feel less overwhelming.

What issues can prolonged exposure therapy help with?

PE therapy is one of the treatments recommended by NICE for PTSD.

For instance, PE therapy could be used to support the following groups of people:

• Members of the military with PTSD symptoms that come from combat exposure.
• Accident survivors, such as those who experience PTSD from being involved in car crashes, workplace incidents, or natural disasters.
• People who have lived through childhood abuse. 
• Those who have been sexually assaulted and experience trauma-related distress and avoidance.
• People with complex PTSD (CPTSD).

Prolonged exposure therapy may also help reduce the symptoms of anxiety and depression, as these often occur alongside PTSD.

What happens in a prolonged exposure session?

Prolonged exposure therapy is usually delivered over 9-12 sessions, with appointments lasting around 90 minutes. While each prolonged exposure therapist works slightly differently, treatment generally follows a structured approach.

In your first few sessions, you’ll spend time getting to know your therapist and talking about your experiences, your symptoms, and what you hope to gain from therapy. You’ll also learn about common trauma responses and may practise simple breathing techniques to help manage anxiety when it arises.

As therapy progresses, you’ll begin facing trauma memories and situations you may have been avoiding in everyday life. Together, you and your therapist might create a list of places, situations, or activities that feel difficult for you, before deciding which ones to work on.

During sessions, you’ll also begin talking through your traumatic memories in detail. This is known as ‘imaginal exposure’. These sessions are often recorded so that you can listen to them between appointments, helping the memory feel less overwhelming over time. 

Who might benefit from prolonged exposure therapy?

PE therapy may be a helpful approach if you:

• Find yourself avoiding places, people, or situations that remind you of a traumatic experience;
• Feel as though memories of trauma continue to affect your daily life;
• Experience intense distress when you’re reminded of what happened;
• Feel constantly on edge or alert, even when you are safe;
• Want to feel less controlled by fear or avoidance;
• Are looking for an evidence-based treatment for PTSD.

Prolonged exposure therapy is commonly used to treat PTSD, but it may also help people experiencing trauma-related anxiety, avoidance, or emotional distress following a traumatic event. 

When is exposure therapy not recommended?

While prolonged exposure therapy can be very effective for many people, it isn’t necessarily the right approach for everyone. 

Because it involves revisiting traumatic memories, sessions may feel emotionally challenging at times, particularly in the beginning. Also, if you’re currently experiencing overwhelming distress, are in immediate crisis, or are finding it difficult to manage your day-to-day safety and wellbeing, your therapist may recommend focusing on stabilisation before beginning any exposure work. 

Similarly, if you’re experiencing active psychosis or dealing with substance misuse, another form of support may be more appropriate in the early days of treatment. 

If you’re not sure whether PE therapy is the best choice for you, a qualified therapist can work with you to decide whether it feels like the right fit for your needs right now. If it isn’t, they can discuss other therapeutic approaches that may be more suitable. 

Finding a prolonged exposure therapist

Prolonged therapy may be worth exploring if you’re looking for a different way to understand your experiences or work toward meaningful change. Every person’s needs are different, and a qualified therapist can help you decide whether this approach feels like the best option for you. 

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