Prolonged Exposure Therapy (PE) for PTSD


This intensive 2-day module provides training in Prolonged Exposure (PE) Therapy, an evidence-based treatment for PTSD described in the manual, Prolonged Exposure Therapy for PTSD – Therapist Guide, by Foa et al., 2007. It covers the empirical and theoretical support for PE and reviews the main clinical techniques used in this structured protocol. Step-by-step instructions for conducting PE therapy sessions, including in vivo and imaginal exposure, along with strategies for working with over- and under-engaged patients and other difficult cases, are shared. Videotaped examples of PE cases are used to demonstrate therapist skills. Participants are expected to do role-plays in class to practice PE techniques, and they must attend both days.

This module includes DVD / video clips that may be distressing to some audience members. Speaker will disclose this to the audience prior to the presentation. This module requires breakout sessions for participants to do role-plays, so room should be large enough to allow a minimum of 8 inch separation between breakout groups of two or three participants each.

Learning Objectives:

  1. Develop a theoretical conceptualization of a client’s PTSD symptoms to guide treatment planning.

  2. Communicate a rationale for Prolonged Exposure Therapy that builds rapport, improves client motivation, and increases treatment adherence.

  3. Teach clients how common reactions to trauma relate to the symptoms of PTSD and demonstrate how these reactions impact their current functioning.

  4. Teach clients a method of breathing that reduces their arousal and promotes distress tolerance.

  5. Construct an individualized avoidance hierarchy designed to systematically confront core fears.

  6. Implement in vivo exposure to block trauma related avoidance.

  7. Facilitate imaginal exposure to reduce the intensity and frequency of PTSD symptoms.

  8. Manage the client’s emotional engagement to increase the effectiveness of imaginal exposure.

  9. Structure homework assignments that deepen exposure based learning and further treatment goals.

  10. Focus on “hot spots” in the memory to more efficiently reduce the intensity of symptoms.

  11. Analyze exposure exercises to facilitate new learning and modify client's unhelpful, trauma-based cognitions.

  12. Incorporate new learning to revise unhelpful cognitions that promote avoidance and maintain symptoms.

  13. Assess Prolonged Exposure Therapy outcomes using standardized procedures, and use assessment data to refine treatment planning.

  14. Adapt exposure techniques in a theoretically consistent manner to improve accessibility and clinical outcomes for specific patients.


I. Introduction and Course Overview

A. Epidemiology
B. Symptoms
C. Functional Impact

II. What is PE?

A. How is PE different from other treatments?
B. What is exposure?
C. How is exposure helpful?

III. Will PE work with my clients? What the research says...

A. Evidence-based Clinical Practice Guidelines
B. Body of Evidence

1. Clinical Impact
2. Applicability
3. Comparisons with other treatments
4. Common Concerns

IV. Basic assumptions: How does PE Work?

A. How do People Respond to Trauma?

1. Post-trauma outcomes
2. Natural Recovery vs. PTSD
3. Classical conditioning

B. How is natural recovery derailed?

1. Operant conditioning

C. How does PE promote recovery?

1. Emotional Processing Theory
2. Inhibitory Learning

V. Who is appropriate for PE?

A. Assessment
B. Treatment Planning

VI. What does a PE therapist do?

A. Therapeutic Alliance
B. Treatment Fidelity
C. Treatment Procedures and Techniques
D. Monitor Treatment Progress

VII. Sequential Components of the PE protocol

A. Session 1: Introducing the treatment

1. Overall treatment Rationale
2. Imaginal Exposure and In vivo exposure
3. Index Trauma/Trauma Interview
4. Relaxed breathing
5. Importantance of Homework

B. Session 2: Common reactions/Introducing in vivo exposure

1. Common Reactions Discussion
2. Rationale for in vivo exposure
3. Generating in vivo targets
4. Developing the SUDs rating scale
5. Refining the in vivo hierarchy
6. Preparing the client for their first in vivo exposure

C. Session 3: Introducing imaginal exposure

1. Rationale for imaginal exposure
2. Implementing imaginal exposure
3. Client instructions
4. Therapist instructions
5. Processing

D. Sessions 4-5: Shaping Engagement

1. Under-engagement
2. Over-engagement
3. Anger

E. Assessing progress to improve outcome

1. Using self-reports
2. Functional indicators
3. Maximizing Learning

F. Session 6-7: Introducing Hotspots

1. Rational for Hotspots
2. Identification of hotspots
3. Exposure and Processing

G. Final Session

1. Discontinuing PE: When is PE "done"?
2. Final Session Summary
3. Relapse Prevention

VIII. Improving the Accessibility of PE

IX. Workshop Summary and Discussion