Exposure-based cognitive behavior therapy (CBT) is strongly proven to treat anxiety, trauma, and mood. It has the most extensive research for generalized anxiety, obsessive compulsive disorder, social anxiety, panic, post-traumatic stress disorder, and depression. It falls under the umbrella of CBT with a focus on behavioral experiments to approach one’s fears and emotions.

Examples of exposure based cognitive behavior therapy treatments:
1. Prolonged exposure (PE) for trauma.
2. Exposure response prevention (ERP) for OCD.
3. Behavior activation (BA) for depression.

How prolonged exposure therapy works:

• In-vivo exposure: Individuals confront real life situations that are avoided due to the trauma, as well as the aftereffects of the trauma (including unwanted emotions, such as depression, shame, anxiety). This helps reduce behavioral avoidance.
• Imaginal exposure: People will re-tell the traumatic event in detail while imaging it in their mind. This helps a person approach and organize the difficult memory and reduce cognitive avoidance.
• Emotional processing: The traumatic experience is processed to help organize and manage emotions and thoughts related to the event. This helps change the unhelpful beliefs that often develop after trauma.

Throughout prolonged exposure therapy, you will receive other skills to support you. DBT skills can help tolerate the distress associated with trauma treatment. You will also learn how to increase mindfulness and self-compassion.

Is prolonged exposure therapy (PE) the same as CBT: No, PE and CBT are not the same. PE is a type of CBT to treat PTSD. PE is a specialized exposure based therapy to decrease avoidance related to trauma reminders and to increase the ability to tolerate difficulty emotions associated with trauma.

When is prolonged exposure therapy not recommended: Previous research would exclude those with suicidal behaviors and psychosis from treatment. DBT-PE was developed to treat those with suicidal symptoms. DBT-PE is an emotionally focused adaption to PE and is for those with PTSD and other concerns. And more recent research supports the delivery of PE for those with active psychosis.

What is the best thing for PTSD: PE and cognitive processing therapy are the most leading evidence based treatments for PTSD. It is common to avoid trauma reminders, and this is more likely to increase PTSD symptoms. Exposure based therapy is the front line treatment for from PTSD.

What are the side effects of prolonged exposure treatment (PE): PE is highly effective in treating PTSD. There can be intense side effects that are generally short-term, including extreme emotional and physical distress. It is difficulty to approach and process traumatic experiences.

How long is PE: Often an individual can treat one traumatic event in 16-20 sessions. When people have multiple traumas, they may participate in treatment for each trauma (up to three events before there is general reduction in PTSD across all traumas).