Prolonged exposure therapy
Prolonged Exposure Therapy (PET) is a psychological treatment primarily used to address extreme anxiety and post-traumatic stress disorder (PTSD). The therapy involves helping patients relive traumatic experiences in a controlled and safe environment, aiming to reduce their anxiety and help them recognize that the trauma no longer poses a threat. This approach is grounded in associative learning theory, where repeated exposure to a feared object or situation is intended to desensitize the patient over time.
Sessions typically last between one to two hours and occur weekly over a span of eight to fifteen weeks. Therapists utilize two main techniques: imaginal exposure, where patients discuss and recount their traumatic experiences, and in vivo exposure, where they confront the feared situations directly. While PET is widely endorsed by organizations such as the American Psychiatric Association, its effectiveness has been debated. Some critics argue that for certain individuals, especially veterans, the therapy may exacerbate symptoms rather than alleviate them. This highlights the importance of individual differences in trauma experiences, suggesting that PET may not be a universal solution for all who suffer from trauma-related conditions.
Prolonged exposure therapy
Prolonged exposure therapy,or PET, is a form of psychological treatment. It is also known as prolonged exposure, or PE. It is used to treat conditions such as extreme anxiety, and it is frequently used to treat the mental health condition known as post-traumatic stress disorder. PET involves having the patient relive the experience that caused the trauma in multiple ways in controlled and safe environments. By exposing the patient to the object of the trauma in this way, PET is said to condition them to understand that the trauma no longer represents a threat. It is also believed to help patients cope with situations that remind them of the original trauma. PET is a widely accepted treatment for patients experiencing the aftereffects of trauma. However, some people have challenged its effectiveness and alleged that it leaves some patients worse off than they had been before.
Background
PET was originally developed to help patients deal with conditions that cause extreme anxiety. For example, a patient with a fear of flying might undergo PET therapy to help cope with the fear. For many years, psychologists conducted experiments with animals where they trained the animals to develop fears connected to things that were not inherently dangerous. For instance, they would train a mouse to avoid a certain color light by administering a small shock every time the animal encountered the light. This is known as conditioning, and researchers learned it could also be used in reverse to help animals unlearn behaviors that they had previously been conditioned to do. During the 1960s and 1970s, scientists began experimenting with variations of this technique with the idea it could be used to help people unlearn fears.
Researchers believed that many fears and anxieties were the result of being conditioned to see the source of the fear as a danger, even if it was not dangerous. They investigated the idea that if people could be conditioned to be afraid, then they could also be reconditioned to not be afraid. This led to the concept of conditioning people by prolonged exposure to the objects of their fear.
The PET concept is most associated with Israeli-born psychology professor Edna B. Foa. Foa initially researched therapies to help those recovering from the trauma of rape, using aspects from a number of psychological approaches. In 2000, while on a sabbatical in Israel, the uprising known as the second intifada broke out. This fighting between the Palestinians and Israelis began in September 2000 and would last until 2005, leading to the loss of thousands of lives on both sides.
Foa became interested in finding ways to help the soldiers stricken with post-traumatic stress syndrome, or PTSD. PTSD is a mental health condition that sometimes occurs after a person experiences a traumatic event. Symptoms include extreme anxiety, depression, and the inability to participate in normal activities. People who experience PTSD are often inappropriately on guard in situations that are not dangerous, and they have an increased risk of suicide. Foa developed a method of using gradual exposure to an experience that triggers anxiety as a way of conditioning the person to face the experience. This became the treatment known as PET.
Overview
PET is based on a psychological concept known as associative learning theory. This theory proposes that repeatedly connecting two events will cause a person to associate them. The experiments done in the 1890s by Russian physiologist Ivan Pavlov, where he conditioned dogs to salivate at the sound of a bell by feeding them when the bell was rung, are examples of associative conditioning. The dogs learned to associate the bell with food, which made them salivate. In time, they would salivate every time they heard the bell.
A similar process occurs with people who have anxiety related to specific circumstances. However, it may only take a single event for a person to be condition to anxiety or fear. A person who encounters a vicious dog may be unable to enter the home of a friend who has a dog, even if the dog is restrained and friendly. Someone who has lost his or her home in a flood may become anxious and fearful whenever it rains. To counter this, therapists using prolonged exposure therapy will help patients encounter the thing or experience that causes them fear.
People undergoing PET will meet with the same therapist over a course of eight to fifteen weeks, usually once a week. The sessions can be between one and two hours in length. During the sessions, therapists help patients understand that they are in a safe place where what they fear cannot cause harm. Once this is established, therapists will help their patients explore the fear.
This happens in two main ways: imaginal exposure and in vivo exposure. Imaginal exposure involves talking about the fear. In cases where patients have had traumatic experiences that triggered their fears, therapists will help their patients retell the story of their experiences. This occurs repeatedly while therapists help patients explore the feelings and thoughts that accompany the experience and the retelling. Therapists will also help their patients with in vivo exposure. In vivo means "in life." During in vivo exposure, patients have real-life experiences of what is feared or are exposed to situations that result in reminders of their trauma. For instance, a person who is afraid of dogs might visit a friend who has a dog. Later, the person may pet that dog, visit a pet store, or walk through a dog park.
Through this prolonged time of exposure, psychology experts believe that people are desensitized to the things that cause anxiety or bring back memories of their trauma. This, in turn, alleviates their symptoms and allows patients to return to normal function. Many believe it is especially effective for PTSD. The American Psychiatric Association and the Department of Veterans Affairs and Defense have endorsed the therapy.
Not everyone agrees that PET is an effective therapy, especially for PTSD. While acknowledging that it does help a majority of veterans, some veterans who have undergone the therapy have reported that the forced reminders of experiences that left them traumatized triggered worse reactions than they had before therapy. Some studies have shown that the treatment might make some veterans' symptoms worse. Some experts also point out that while there are similarities, not every trauma is the same and the effects on war-traumatized veterans may not be the same as those who have undergone other traumatic experiences.
Bibliography
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"Prolonged Exposure." American Psychological Association, June 2020, www.apa.org/ptsd-guideline/treatments/prolonged-exposure.aspx. Accessed 14 Nov. 2024.
"Prolonged Exposure Therapy." Psychology Today, www.psychologytoday.com/therapy-types/prolonged-exposure-therapy. Accessed 14 Nov. 2024.
"Prolonged Exposure Therapy for PTSD (PE)." Uniformed Services University Center for Deployment Psychology, deploymentpsych.org/treatments/prolonged-exposure-therapy-ptsd-pe. Accessed 14 Nov. 2024.
"PTSD: National Center for PTSD." US Department of Veterans' Affairs, 2 Jan. 2024, www.ptsd.va.gov/understand/what/ptsd‗basics.asp. Accessed 14 Nov. 2024.
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