Prolonged exposure (PE) is a specific type of cognitive behavioral therapy that teaches individuals to gradually approach and metabolize trauma-related memories, feelings and situations. Most people want to avoid anything that reminds them of the trauma they experienced but doing so only reinforces their fear. By facing what has been avoided, a person can decrease symptoms of PTSD by actively learning that the trauma-related memories and cues are not dangerous and do not need to be avoided. This is accomplished through in vivo and imaginal exposure.
In vivo exposure involves repeatedly engaging in activities, situations, or behaviors that have historically been avoided because of the trauma. Over time, In vivo exposure reduces excessive fear and other distressing emotions. It encourages the recognition that the avoided situations are not excessively dangerous, and the client learns that they are in fact capable of coping effectively, even when distressed and triggered.
Imaginal exposure involves repeatedly revisiting the stored memories of the traumatic experience and describing the event aloud in detail. Their spoken narrative is recorded and the client then listens to the recording between sessions to maximize therapeutic value. Revisiting the event in this way promotes processing of the trauma memory by activating the thoughts and emotions associated with the trauma in a safe and affirming context. Imaginal exposure also helps the client realize that he/she can cope with (and over time diminish) the distress associated with the memory.
Cognitive processing therapy (CPT)
CPT is based on the idea that PTSD symptoms stem from a conflict between pre-trauma beliefs about the self and the world writ large, and how the person receives information and processes those same beliefs post-trauma. For example, a pre-trauma belief could be "the world is a safe place, and nothing bad will happen to me", while post-trauma information may now suggest that "the world is in fact dangerous, and bad things will absolutely happen to me".
These conflicts are called "stuck points" and are addressed through various techniques such as writing about the traumatic event and through trauma-focused cognitive behavior therapy (TF-CBT). This specific form of therapy is an evidence based treatment for children and adolescents only. However, various concepts derived from this modality can also be modified and used when treating adults as well. This therapy helps address/alleviate inaccurate beliefs and unhealthy behavior patterns.
CPT is a highly structured treatment approach. It consists of 12 weekly sessions, each approximately an hour in length. These sessions can take place in a group setting, one-on-one, in a combined group or an individual format. They may also be delivered either in-person or online. Sessions are divided into separate phases that deal with different components of the designed therapeutic program.
Eye movement desensitization and reprocessing (EMDR)
This form of treatment involves using rhythmic left-right (bilateral) stimulation to help release emotions that have been blocked by trauma.
How is EMDR therapy different from other therapies? EMDR therapy does not require talking in detail about the distressing issue or completing homework between sessions. Rather, EMDR focuses on changing the emotions, thoughts or behaviors attached to the memories of the trauma. This metabolizes the trauma and allows the brain to resume its natural healing process.
EMDR therapy is designed to resolve unprocessed traumatic memories in the brain. For many clients, EMDR therapy can be completed in fewer sessions than other psychotherapies
PE and CPT are the front-line treatments for trauma as massive amounts of evidence based research has proven their effectiveness. Both treatment modalities can work equally as effectively in-person as well as online.