Prolonged Exposure
Core Mechanism
Repeated imaginal and in-vivo exposure to trauma-related stimuli activates fear structure and provides corrective information
Ontology
Fear structure with pathological associations; avoidance prevents emotional processing
Therapeutic Voice
"I want you to close your eyes and tell me what happened, in the present tense, as if it's happening right now."
View of the Person
A being whose pathological fear structure contains correctable associations activated through confrontation
Evidence
VA/DoD 2023: Recommended (strong). NICE: recommended. APA: Strongly recommended. WHO: recommended
30+ RCTs
Powers et al. (2010); Cochrane reviews
Gold standard for PTSD alongside CPT and EMDR.
Conditions
Epistemology
Blind Spots
Dropout rates are significant; not suited for unstabilized clients; may underemphasize relational and meaning dimensions
Contraindications
Active suicidality with imminent risk, active psychosis, current domestic violence, severe dissociation during trauma narration, active substance dependence requiring stabilization first, significant self-harm behaviors
Training
PE workshop (4 days) + consultation calls. Manualized (Foa et al.)
UPenn Center for Treatment and Study of Anxiety; VA dissemination
Workshop: 28 hrs + 6 months consultation
$1.5K-3K
Philosophical Roots
Foa & Kozak (emotional processing theory); Lang (fear structure); Craske (inhibitory learning update); empiricist tradition
Related Modalities
Test Yourself
Why repeatedly narrate the trauma?
Show answer
Activates fear structure while providing corrective information.