We all live different lives. We all have unfortunate experiences at one point or another, how we react to it also differs from person to person. Regardless of the incident, there are times when an individual’s coping mechanism prevents them from being a functional member of society.
Prolonged exposure therapy is an intervention strategy to help individuals confront their fears and cope with trauma-related memories, feelings, and situations.
What is Prolonged Exposure Therapy (PE)
There are many types of behavioral adjustment therapy. Prolonged Exposure definition or PE is a method that goes against most theories by attacking the problem at its source.
A lot of popular approaches to deal with trauma-related behavioral problems revolve around adjusting the coping method.
Therapies such as system desanitation, cognitive behavior therapy, and the like works around the individual’s responses to trauma-related memories and modifies those responses into harmless or less-destructive habits.
Prolonged exposure therapy training directly attacks the trauma by gradually reintroducing the traumatic event in a controlled environment. It works by directly confronting the fears and asserting control over the situation.
Why Prolonged Exposure Therapy works
The idea behind is PE is based on reprogramming the subconscious reaction to particular stimuli. Most people fear the unknown; people suffering PTSD fear stimuli that they know leads to harm. They know it because they have personally experienced it.
The experience, coupled with imaginary unknown factors, lead to phobias and dysfunctional behavior.
If, for example, a person is afraid of dogs after being bitten as a child. Their subconscious would consider all dogs as dangerous animals.
It would trigger a defense mechanism response on all dogs based on traumatic memories. They would relate dogs to pain, and that is a classical Pavlovian response.
PE works by reprogramming Pavlovian responses. It is merely using classical conditioning to change previous behavior, also set by classical conditioning on a stimulus.
Rewriting a behavioral mindset is harder than imprinting them. That is why it requires “prolonged exposure” to achieve the imprinting.
Prolonged exposure therapy for PTSD is a direct approach in rehabilitating patients who prefer to solve their problems at its roots instead of alleviating symptoms.
Prolonged Exposure Therapy manual
It is crucial to conduct PE in a controlled environment supervised by a licensed professional. It typically consists of 12-15 sessions that last approximately 90 minutes each. After this, it is continued for a long time “in vivo” monitored by the psychiatrist.
Here are the stages of a typical PE:
Imaginal exposure – Session start with patients reliving the experience in their head over and over for the psychiatrist to determine what are the stimulus and what defense mechanism response are activated.
PE focuses on the traumatic event and slowly saturates the mind to reduce the adverse reactions to it. It is difficult for patients to remember such events forcefully; there are even temporary amnesia cases to protect the brain.
Professionals and patients have to work together to push the thresholds and stop when necessary.
Imaginary exposures are done in a safe and controlled environment. There are PTSD cases that result in a complete mental breakdown. Imaginary exposure gives the therapist a deeper understanding of the root cause and how bad it affects the patient.
At the end of the 12-15 session, If prolonged exposure therapy is successful, the patient is expected to have reduced reactions to memories related to the traumatic incident.
Stimulus exposure – Memories are triggered by a stimulus. They can be words, names, things, or places. Triggered conditioned responses can skip the memory altogether, especially in amnesia cases.
PE attempts to find stimuli related to the traumatic experience that may trigger conditioned responses.
It attempts to desensitize and disconnect that stimulus from the traumatic event and help the patient lead normal and healthy lives.
In Vivo exposure – Living in a typical environment and gradually introducing stimuli that prevent the patient from living normal lives are presented systematically. It is the final step in PE therapy. It hopes that patients, particularly PTSD cases, no longer have crippling reactions to such stimuli.
The therapists continue to monitor the patient’s progress to prevent relapses. Over time, by using PE to reprogram Pavlovian classical conditioning. It hopes to help patients recover from phobias, PTSD, and other neurological and behavioral problems.
Requirements for Prolonged Exposure Therapy
A lot of professionals do not recommend PE, in spite of its logical ability to help patients resolve their ailments. According to the US Department of Veteran Affairs, PE has the possibility of increasing depression, suicide thoughts, and has a high drop-out rate.
It is a natural and expected result. Individuals suffering from PTSD do not have the coping mechanism to “soldier on” after their traumatic experience. That is why they are suffering from PTSD in the first place.
However, its long-lasting effects for patients successfully treated through PE cannot be ignored. Attacking the root source of the problem as a treatment is appealing to the Department of Veteran Affairs. It uses it as the preferred method of treatment.
But not everyone is built for PE. It requires a willing patient and a support group. It is easy to find these requirements for Combat-related PTSD patients.
Soldiers have higher mental fortitude due to their training. Fellow soldiers/veterans can act as a support group if they lack family and friends to be there during their treatment.
It is difficult to find willing patients outside the military circle. Responsible licensed counselors inform the patient and their families about the dangers of PE.
Patients and their families selecting a treatment that could aggravate symptoms and worsen the condition is a minority.
In spite of the potential complications involved, It is still a viable treatment. Behavioral therapy treatments is not an exact science. Batting averages are expected to remain low.
Prolonged exposure therapy poses a risk, but when successful, it has fewer cases of relapses. Lower relapse cases are appealing to patients, their families, and therapists. The promise of permanent, or at the very least, long-lasting effects make it worth the risk.