Prolonged Exposure Therapy: A Path to Healing Trauma

How Confronting the Past Can Empower Your Future

Post-Traumatic Stress Disorder (PTSD) and trauma-related conditions can leave individuals stuck in cycles of fear, avoidance, and emotional numbing. Even long after a traumatic event, the nervous system may stay in a state of high alert—constantly scanning for danger and reacting to reminders of past harm.

Prolonged Exposure (PE) Therapy is a gold-standard, evidence-based treatment for PTSD that helps individuals process traumatic memories, reduce avoidance, and regain a sense of safety and control in their lives. At City Behavioral Health, PE is one of the many trauma-informed modalities we offer as part of our flexible, personalized care.

What Is Prolonged Exposure Therapy?

Prolonged Exposure Therapy is a form of cognitive-behavioral therapy (CBT) developed by psychologist Dr. Edna Foa. It helps individuals gradually and safely confront trauma-related thoughts, feelings, and situations they’ve been avoiding—allowing them to process the memory rather than remain overwhelmed by it.

According to the U.S. Department of Veterans Affairs, PE has the strongest evidence base of any psychotherapy for PTSD. Source: https://www.ptsd.va.gov/understand_tx/prolonged_exposure.asp

How PE Works

PE typically includes 8–15 weekly sessions and is composed of four key components:

1. Psychoeducation
Clients learn about PTSD symptoms and how avoidance maintains the disorder. This knowledge empowers them to approach treatment with clarity and purpose.

2. Breathing Retraining
Clients are taught diaphragmatic breathing techniques to help reduce physiological arousal and manage anxiety during and between sessions.

3. In Vivo Exposure
Clients create a hierarchy of feared but safe situations they’ve been avoiding—such as crowded places, driving, or specific locations. They gradually confront these situations in real life, reducing fear through repeated exposure and experience-based learning.

4. Imaginal Exposure
Clients repeatedly recount the traumatic memory aloud, in detail, during therapy sessions. These exposures are recorded and assigned as homework to be listened to daily. Over time, the distress associated with the memory diminishes.

Why Avoidance Keeps Trauma Alive

Avoidance may feel protective in the short term, but it often reinforces the brain’s belief that trauma-related cues are dangerous. PE helps shift this narrative by showing that feared thoughts and memories—though painful—are not threats in themselves.

This process of habituation reduces emotional reactivity and promotes healing.

What PE Is Not

It’s not flooding or re-traumatizing. PE is delivered with care, at a pace tailored to the client’s readiness.
It’s not about forgetting the trauma—it’s about changing the way it’s stored in the brain.
It’s not exposure without support. The therapist provides grounding, structure, and skill-building every step of the way.

The Evidence Behind PE

Multiple large-scale studies have shown that PE significantly reduces PTSD symptoms across diverse populations, including survivors of assault, accidents, combat, and natural disasters.

According to the American Psychological Association’s Clinical Practice Guidelines, PE is a strongly recommended treatment for PTSD, with benefits including:

Reduced flashbacks and nightmares
Decreased anxiety and depression
Improved daily functioning and interpersonal relationships
Lower risk of relapse when compared to supportive counseling alone

Research has shown that clients often experience meaningful symptom improvement within just 10 sessions.Source: https://www.apa.org/ptsd-guideline/treatments/prolonged-exposure

How PE Is Delivered at City Behavioral Health

Our trauma-trained clinicians offer Prolonged Exposure in several formats:

As part of individual therapy
Integrated into The Nimble Track for clients requiring 4–10 hours/week
In combination with mindfulness, emotion regulation, and grounding skills from DBT
With additional support through therapy intensives or in-home clinical work

Treatment plans are customized to each person’s trauma history, current functioning, and goals. Clients are never rushed or pressured to move faster than they’re ready for.

A Client-Centered Path to Healing

We believe that healing from trauma is possible—and that confronting the pain is not a sign of weakness but an act of courage. Prolonged Exposure Therapy helps you face what once felt unbearable and reclaim the present moment from the past.

Whether your trauma stems from a single incident or complex, repeated events, our team at City Behavioral Health is here to support you with expertise, compassion, and a commitment to safety.