Prolonged Exposure Therapy: An Integrated Approach that Incorporates Coping Techniques and Trauma Confrontation

Trauma is an overwhelming emotional response experienced by an individual who has experienced a threatening event. The emotional response of trauma could have a long lasting effect and presence within an individual long after the threat is gone, leaving the individual to experience those high emotional responses in the absence of such threat where they originated from. This persistence of trauma symptoms is identified as Post Traumatic Stress Disorder in which “an individual gets stuck chronically in a stress and trauma response – either because of chronic stress and trauma or because the mind and body lose the capacity to accurately assess a true threat of danger” (Rousseau 2019).

Although there are many approaches to trauma therapy I believe that The Prolonged Exposure Therapy Approach truly targets the issue in individuals who are suffering from PTSD as it helps individuals gradually revisit traumatic memories to help process and manage the emotional response associated with that experience. Other therapy approaches focus on the development of coping methods and emotion recognition/ self awareness to essentially suppress the emotional response when presented with a traumatic trigger. However through prolonged exposure therapy the root of the problem is addressed and that is the threat of the specific event.

When an individual is presented with a situation it is the brain’s job to detect it and organize it. Sensory information comes in through the senses (eyes, ears, nose, and skin) these sensations then reach the thalamus in the brain which essentially “ stirs all the input from our perceptions into a fully blended autobiographical soup, an integrated, coherent experience of  “this is what’s happening to me””(Van der Kolk p.60 2015) These sensations are then passed to the amygdala and the frontal lobes. The amygdala is located in the unconscious brain and upon receiving the input its function is to determine whether that input is relevant for survival, if so it initiates a fight or flight response for preservation even before the input reaches consciousness. The frontal lobes receive the input and interpret its context based on past experiences and knowledge in order to further carry out a response (Van der Kolk 2015) .

Peter Tuerks elaborates on the organizing function of the brain as it provides evolutionary predictability in disorganized situations. He states that it is the purpose of the human mind to process their surroundings in order to make sense of it and develop a response. Tuerks uses the example of a routine activity such as grocery shopping, when an individual is familiar with a routine or schema it becomes a mindless unmemorable task. However if that schema is interrupted by an unusual  event such as an elephant in the back aisle , the brain actively searches for a similar schema which would make the information at hand make sense. If the brain is unable to organize and make sense of this information it remains readily accessible in the mind. This applies to trauma in which an individual experiences a new and heightened emotional response, that of which is not familiar to the brain. As a result of this situation that has not been categorized an put away in the mind, when an individual is presented with a similar triggering situation, that hyper aroused emotional response becomes cued and reactivated. The heightened emotions experienced by the individual in the triggering situation interrupt the peace of the individual. Therefore it is natural for individuals to avoid such similar and triggering situations that may elicit the same emotional response. This avoidance prevents the individual from being able to process and revisit the situation in order to make sense of it and put it away.

Prolonged Exposure Therapy is typically provided over a period of three months with weekly individual sessions. In the primary sessions the therapist goes over past experiences with the patient to form a relationship, and then also teaches coping techniques such as breathing those of which are to be practiced while revisiting the traumatic experience. These techniques are taught to manage anxiety and to avoid further traumatization as they help patients maintain control of their emotions that may be overwhelming. Once these calming techniques are practiced and understood the therapist them proceeds to initiate exposure of the traumatic experience with the client. This exposure can be done on two ways, imaginal exposure in which the patient describes in detail the events of the experience in present tense with the guidance of the therapist. This present tense guided description is recorded and allowed for the client to take home to further listen and revisit the experience while using calming techniques at home.  The second method is usually approached later in the sessions, in vivo exposure, in which the client and therapist agree on which stimuli to confront outside of therapy as homework. The client works with the therapist to devise a plan on how this exposure is approached (Prolonged Exposure 2019).

I believe that Prolonged Exposure Therapy theoretically checks out as it incorporates hyper arousal suppression techniques and education which is used while confronting and processing traumatic memories and new seemingly similar situations or triggers. Through Prolonged Exposure Therapy the client not only learns new techniques to help them in potentially threatening and stressful situations in the future but it also gives them the tools to gradually confront their traumatic memories giving them the time to process the actuality of the situation little by little resulting in their ability to become more familiar with the situation allowing for processing and putting away of the event.


Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder: Prolonged Exposure (PE) Retrived April 27, 2019

Rousseau, D. 2019 Trauma and Crisis Intervention Module 1 : Introduction to Trauma / Module 4: Pathways to Recovery

Van der Kolk, B.  A. (2015). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York, NY: Penguin.

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