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Prolonged Exposure Therapy for PTSD


New research has found that one common treatment for PTSD, prolonged exposure therapy, can be effective in a shorter, more intense format, making it potentially more acceptable and accessible to more people needing treatment.

June is PTSD Awareness Month, focusing attention on posttraumatic stress disorder (PTSD) that affects an estimated 7 percent of U.S. adults in their lifetime. (2)

While PTSD is often thought of in relation to combat veterans, it affects people of all ages and from many circumstances. For example, experiencing a natural disaster, a car crash or personal violence can all lead to PTSD, but not everyone that experiences a traumatic event will experience symptoms of PTSD.

Reaction to a traumatic event is normal, but people with PTSD continue to have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares; they may feel sadness, fear or anger. (Learn more about PTSD symptoms and treatment.)

PTSD is treated with a variety of medications and other therapies. Prolonged exposure therapy is an evidence-based treatment that reduces symptoms by helping people to gradually approach and confront trauma-related memories and feelings. People with PTSD often avoid things that remind them of the trauma, but avoiding these can actually hold back recovery.


The therapy uses two types of exposure therapy: imaginal exposure and in vivo exposure. In vivo exposure involves repeatedly engaging in activities or behaviors that a person has avoided because of the trauma, but which are not actually dangerous. For example, if a person had been avoiding crowds, he or she would work with the provider to gradually experience crowded situations in the community. Over time, this can help reduce fear and distress associated with the activity or behavior and build the ability to cope effectively. (1)

Imaginal exposure involves repeatedly revisiting the memory and describing the traumatic experience. The person is recorded making the description and then he or she listens to the recording between therapy sessions. This revisiting helps people process the trauma memory and understand that they can cope with the distress associated with the memory. (1)

Prolonged exposure therapy has been shown in more than 20 years of research to be effective for many with PTSD. It reduces symptoms of PTSD along with related symptoms of depression, anxiety and anger. About 80 percent of people with chronic PTSD improve with the therapy. (2) The process typically takes about three months of weekly 60 to 90-minute sessions.

Prolonged exposure therapy requires commitment, and facing the memories of the trauma can be very difficult. However, most people who undertake the therapy find that the benefits outweigh the discomfort. (2)

Recent research has found that a brief, more intense form of prolonged exposure therapy can be effective in treating PTSD. (3) Researchers in the Netherlands conducted a study of patients with chronic PTSD who had a history of multiple unsuccessful treatment attempts.

The intensive prolonged exposure treatment included an intensive phase of three daily 90-minute sessions over four days, using imaginal and in vivo exposures. Participants then received four weekly 90-minute booster sessions along with homework assignments.

The researchers found that in 71 percent of participants symptoms improved and gains continued through a six-month follow-up. Notably, none of the participants dropped out during the intensive phase and only 5 percent dropped out during the booster phase. The authors conclude that this brief, intense prolonged exposure therapy is safe and effective in people with chronic, complex PTSD.


1. Uniformed Services University, Center for Deployment Psychology. Prolonged Exposure Therapy for PTSD

2. U.S. Department of Veterans Affairs, National Center for PTSD.

3. Hendriks, L, et al. Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts. European Journal of Psychotraumatology. Vol. 9, 2018.

4. Clinicians Trauma Update CTU-Online. Issue 12(2) April 2018.


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