PTSD: National Center for PTSD

Prolonged Exposure (PE): Helping During Treatment

Available en Español

What is Prolonged Exposure (PE)?

Prolonged Exposure (PE) is an evidence-based treatment for posttraumatic stress disorder (PTSD). This means that it has been studied by many researchers and found to be effective in treating PTSD. Most people who complete PE show a noticeable improvement in PTSD symptoms. PE involves weekly individual sessions and lasts approximately 8-15 weeks.

PE helps people approach the memory of their trauma and process their emotions to work toward recovery. It also allows them to approach situations, places, and activities they have been avoiding because of their trauma. By approaching previously avoided memories, feelings, and situations, your loved one will work toward getting their life back.

What happens in PE?

PE has 3 main parts:

• Education about PTSD and PE
• In-vivo exposure
• Imaginal exposure

1. Education about PTSD and PE

PE starts with education about PTSD, treatment, and common ways people respond to trauma. The therapist will ask your loved one about symptoms, explain how PTSD develops, how PE works, and discuss the goals of treatment. During this phase of treatment, your loved one will be encouraged to share handouts about PTSD and PE with you. They will also learn a breathing technique that they can use as needed.

You can help by:

• Reading these handouts and learning about trauma, PTSD, and PE. Knowing the basics is a great place to start. The resources listed at the end of this page can help.
• Asking your loved one to share information about PTSD. You can also ask about treatment goals.

2. In-vivo exposure

As treatment progresses, they move into the exposure phase, which includes in-vivo and imaginal exposure. In-vivo exposure means taking part in real life situations your loved one has been avoiding because of their trauma. They will work with a therapist to make a list (called a "hierarchy") of situations that are safe but remind your loved one of the trauma. This part of treatment will help your loved one gradually get their life back by doing the things that are meaningful and important to them. There will be daily assignments between sessions. Sometimes the assignments may involve going into situations with you or others, and sometimes your loved one will do the assignment alone. At first, these situations may cause your loved one to experience more distress. However, by sticking with it, your loved one will learn that they can approach these situations with less distress.

You can help by:

• Giving your loved one time to practice going into the situations.
• Being available to be a part of the exposure assignments as needed. For example, at first you may be asked to go to the store with your loved one. Later on, your loved one may need to do it alone. Having both experiences is very helpful.
• Encouraging your loved one to approach things that make them uncomfortable or distressed, including activities that are part of treatment.
• Giving encouragement if your loved one gets distressed about doing exposure homework.
• Reminding yourself that it is ok if your loved one gets distressed during the exposure homework.
• Understanding that your loved one may want to do things alone that you had come to enjoy helping with.

3. Imaginal exposure

Imaginal exposure is the part of treatment where your loved one will approach their trauma memory during sessions, in a safe place. Doing so allows them to work through the memory by working through (or processing) their thoughts and feelings related to the trauma. During sessions, your loved one will make recordings while revisiting their traumatic memory. They will listen to these recordings daily, alone and in a private space. At first, this can be difficult. However, as your loved one continues, they will gain greater meaning and have less distress.

You can help by:

• Understanding that your loved one may not want to talk with you about trauma memories. This can change as treatment goes on.
• Giving them a private space is very important. Not asking to listen to the recordings. You may be curious about what is on the recordings but know that most people prefer to keep these private.
• Reminding yourself it is ok if your loved one gets distressed or upset after listening to the recordings. Just like the in-vivo assignments, the listening exercises will get easier over time. Encouraging your loved one to approach the difficult feelings will help with their recovery process.

Wrap Up

Prolonged Exposure (PE) is effective in treating PTSD. Your loved one's decision to start or consider PE is a great first step in recovery. Understanding the basics of PE will help you support your loved one during the treatment process.

Printable Handout

Prolonged Exposure: Helping During Treatment

Download a PDF of this page (PDF) which discusses what to expect and how you can support your loved one during PE treatment.

Additional Resources

There are more videos and programs to support family members or help you learn about trauma, PTSD, and PTSD treatments like Prolonged Exposure. We recommend:

• Read more about Prolonged Exposure (PE) for PTSD.
• PTSD Treatment Decision Aid: An online tool to explore and compare effective treatment options for PTSD. The decision aid includes a section For Loved Ones to learn about more tips to offer support to someone with PTSD.
• Understanding PTSD: A Guide for Family and Friends (PDF) | Available en Español (PDF): Booklet that includes what you need to know to help yourself and your loved one with PTSD.
• PTSD Family Coach Mobile app: designed to provide support for concerned family members of those with PTSD.
• Animated Videos: Short videos that describe PTSD and effective treatments, including PE.
• AboutFace: Learn about PTSD from Veterans who've experienced it. Listen to their stories and find out how treatment turned their lives around. Hear from family members and clinicians as well.
• VA Caregiver Support: Programs to help you care for the Veteran you love and for yourself.