Prolonged Exposure Therapy (PE) for PTSD

Post-Traumatic Stress Disorder (PTSD) is a trauma-related condition that occurs when the brain and nervous system remain locked in a state of threat after a traumatic experience has ended. It is not a personal weakness or a failure to cope. PTSD reflects a survival system that learned danger very effectively and has difficulty recalibrating once safety returns.

PTSD can develop after experiencing or witnessing events such as accidents, medical trauma, assault, abuse, combat, sudden loss, or other situations involving actual or perceived threat. For some individuals, PTSD follows a single traumatic event; for others, symptoms emerge after repeated or prolonged exposure to stress or trauma. The impact of trauma is subjective, and PTSD can occur even when others believe the event “shouldn’t” have been traumatic.

At its core, PTSD is driven by fear-based learning. During trauma, the brain forms strong associations between danger and specific memories, sensations, emotions, or situations. These associations are meant to protect you. When PTSD develops, the brain continues to react to trauma reminders as if the threat is still present, even when it is not.

As a result, trauma-related cues—such as intrusive memories, bodily sensations, places, sounds, or emotional states—can trigger intense fear, distress, or physical arousal. The nervous system responds automatically, often outside of conscious control, leading to persistent feelings of danger, hypervigilance, or emotional overwhelm.

PTSD is best understood as a condition of a nervous system that has not yet learned that the trauma is over.

Post-Traumatic Stress Disorder (PTSD) affects the brain’s fear and safety systems, leading to predictable patterns of symptoms. These symptoms reflect a nervous system that remains oriented toward threat, even when danger is no longer present.

Common signs and symptoms of PTSD include:

Intrusive symptoms

• Unwanted or distressing memories of the traumatic event
• Nightmares related to the trauma
• Flashbacks or moments when the trauma feels as though it is happening again
• Intense emotional or physical reactions to trauma reminders

Avoidance patterns

• Avoiding thoughts, memories, or conversations about the trauma
• Avoiding people, places, activities, or situations associated with the event
• Emotional avoidance or numbing to prevent distress
   

Changes in mood and thinking

• Persistent guilt, shame, fear, or anger
• Negative beliefs about oneself, others, or the world
• Feeling detached, disconnected, or emotionally numb
• Loss of interest in activities that were previously meaningful
   

Increased arousal and reactivity

• Hypervigilance or feeling constantly on guard
• Difficulty sleeping or staying asleep
• Irritability or anger outbursts
• Problems with concentration
• Exaggerated startle response
   

PTSD symptoms can vary in intensity and presentation, but they share a common purpose: keeping the individual safe from perceived danger, even when the trauma is no longer occurring.

Post-Traumatic Stress Disorder is diagnosed using criteria outlined in the DSM-5. A licensed mental health professional evaluates whether some or all of the following symptom categories are present, how they interact, and whether they cause clinically significant distress or impairment. Not every individual experiences every symptom listed below, and the presence of these features is considered together rather than in isolation.

The following are potential criteria considered when evaluating for PTSD:

Exposure to trauma

• Directly experiencing a traumatic event
• Witnessing a traumatic event happening to others
• Learning that a traumatic event occurred to a close family member or friend
• Repeated or extreme exposure to details of traumatic events
   

Intrusion symptoms

• Recurrent, involuntary, and distressing memories of the trauma
• Distressing dreams or nightmares related to the event
• Flashbacks or dissociative reactions
• Intense psychological or physical distress in response to trauma reminders
   

Avoidance

• Avoiding trauma-related thoughts, memories, or feelings
• Avoiding external reminders such as people, places, conversations, or activities
   

Negative changes in mood and cognition

• Persistent negative beliefs about oneself, others, or the world
• Distorted blame of self or others related to the trauma
• Ongoing fear, guilt, shame, anger, or horror
• Diminished interest in activities
• Feelings of detachment or emotional numbness
   

Alterations in arousal and reactivity

• Irritability or aggressive behavior
• Hypervigilance
• Exaggerated startle response
• Difficulty concentrating
• Sleep disturbance
   

Duration and impact

• Symptoms last longer than one month
• Symptoms cause significant distress or interfere with daily functioning
• Symptoms are not better explained by substance use or medical conditions
   

A formal PTSD diagnosis is made by a licensed mental health professional who evaluates how these criteria present together over time.

 Avoidance plays a central role in how Post-Traumatic Stress Disorder (PTSD) is maintained over time. After a traumatic experience, the brain becomes highly sensitive to anything it associates with danger. Avoidance develops as a natural attempt to prevent distress, fear, or emotional overwhelm. In the short term, it often works.

When trauma-related thoughts, memories, sensations, or situations are avoided, anxiety tends to decrease quickly. This immediate relief teaches the brain that avoidance is helpful. Over time, the nervous system learns that the only way to stay safe is to keep avoiding anything that might trigger fear.

The problem is that avoidance prevents corrective learning. When reminders of the trauma are consistently avoided, the brain never has the opportunity to learn that these cues are no longer dangerous. As a result, the fear response remains intact and often grows stronger.

Avoidance can take many forms. It may look like steering clear of certain places or people, distracting constantly, suppressing memories, emotionally shutting down, or relying on safety behaviors to reduce anxiety. While these strategies are understandable, they reinforce the belief that trauma-related cues are unsafe and unmanageable.

Over time, avoidance leads to a shrinking life. Activities, relationships, and environments become increasingly restricted in an effort to control fear. PTSD remains active not because the trauma is ongoing, but because the brain has not yet learned that the threat has ended.

Understanding the role of avoidance helps explain why effective PTSD treatment focuses on reducing avoidance rather than reinforcing it.

 Prolonged Exposure Therapy (PE) is an evidence-based treatment specifically designed for Post-Traumatic Stress Disorder (PTSD). It helps individuals gradually confront trauma-related memories, thoughts, emotions, and situations that have been avoided since the traumatic experience. The goal of Prolonged Exposure therapy is not to erase the trauma, but to help the brain learn that the trauma is over and that trauma reminders are no longer dangerous.

Prolonged Exposure therapy is based on decades of research on fear conditioning and emotional processing. PTSD persists when the brain continues to respond to trauma-related cues as if a threat is still present. PE therapy directly targets this process by creating repeated, intentional, and safe exposure to these cues in a structured way.

In Prolonged Exposure therapy, avoidance is gently reduced rather than reinforced. Through repeated exposure, fear naturally rises and falls, allowing the nervous system to recalibrate. Over time, trauma memories become less distressing, triggers lose their intensity, and the individual gains confidence in their ability to tolerate emotions and sensations associated with the trauma

.

PE therapy is structured, time-limited, and collaborative. Sessions follow a clear framework, and individuals are never forced to move faster than they are ready to. The focus remains on helping the brain update its fear responses so that PTSD symptoms no longer dictate behavior or limit daily life.

Prolonged Exposure therapy is considered one of the most effective, gold-standard treatments for PTSD and can be delivered effectively through in-person sessions or secure telehealth therapy.

Prolonged Exposure Therapy (PE) is a structured, evidence-based treatment for PTSD that follows a clear and intentional framework. Each component plays a specific role in reducing avoidance, updating fear-based learning, and helping the nervous system respond more accurately to trauma-related cues.

Psychoeducation
Prolonged Exposure therapy begins with education about PTSD and how fear is learned and maintained. Individuals learn why symptoms occur, how avoidance keeps PTSD going, and how exposure leads to long-term symptom reduction. This foundation helps reduce confusion and increases confidence in the treatment process.

Breathing and grounding skills
PE therapy includes simple breathing or grounding strategies that support emotional regulation outside of exposure of the exposure practice. These skills are not used to suppress fear, but to help individuals remain present and engaged while allowing anxiety or distress to naturally rise and fall.

Imaginal exposure
Imaginal exposure involves intentionally revisiting the trauma memory in session, in a controlled and therapeutic way. The memory is approached repeatedly rather than avoided, allowing the brain to process it differently over time. This reduces the emotional intensity of the memory and weakens its ability to trigger PTSD symptoms.

In-vivo exposure
In-vivo exposure focuses on gradually confronting real-life situations, activities, or environments that have been avoided due to trauma-related fear. These exposures are planned collaboratively and completed at a manageable pace, helping individuals reclaim areas of life that PTSD has restricted.

Together, these components work to reduce avoidance, modify fear responses, and restore a sense of safety and control without relying on avoidance or safety behaviors.

 Prolonged Exposure Therapy (PE) works by helping the brain update fear responses that were learned during trauma but never fully recalibrated afterward. PTSD persists when the nervous system continues to react to trauma-related memories and situations as if the danger is still present. Prolonged Exposure therapy directly targets this process through repeated, intentional exposure to what has been avoided.

When trauma-related cues are approached rather than avoided, fear naturally rises and then falls on its own. Through repetition, the brain begins to learn that these cues are not actually dangerous and do not need to be escaped or controlled. This process weakens the automatic fear response that drives PTSD symptoms.

In Prolonged Exposure therapy, exposure is done in a structured and gradual way. Trauma memories are revisited in session, and avoided situations are approached in daily life. Over time, the nervous system becomes less reactive, and trauma reminders lose their ability to trigger intense distress.

As this learning takes place, individuals gain confidence in their ability to tolerate emotions, bodily sensations, and memories associated with the trauma. The brain updates its expectations, and the fear system becomes more flexible and accurate.

Rather than relying on avoidance for relief, Prolonged Exposure therapy helps create lasting change by allowing new learning to replace trauma-based fear responses.

Prolonged Exposure Therapy (PE) follows a structured, collaborative format that is designed to be both effective and predictable. Sessions typically occur on a weekly basis and follow a clear framework, allowing individuals to know what to expect as treatment progresses.

Early sessions focus on building an understanding of PTSD, identifying patterns of avoidance, and establishing a shared treatment plan. Individuals work with the therapist to identify trauma-related memories and real-life situations that have been avoided, and these become the focus of exposure work over time.

During sessions, imaginal exposure is conducted by revisiting the trauma memory in a guided and intentional way. This process is done at a pace that feels manageable, with the goal of staying present with the memory long enough for fear to naturally rise and fall. Sessions also include time to reflect on what was experienced and how the fear response changed.

Between sessions, individuals complete in-vivo exposure exercises by gradually approaching avoided situations in daily life. These exercises are planned collaboratively and are designed to build confidence and reduce reliance on avoidance. Homework is an essential part of Prolonged Exposure therapy and supports continued learning outside of sessions.

Throughout treatment, progress is regularly reviewed and adjusted. The focus remains on reducing PTSD symptoms, increasing a sense of safety, and restoring participation in meaningful activities without avoidance or safety behaviors.

 Prolonged Exposure Therapy (PE) is one of the most well-researched and effective treatments available for Post-Traumatic Stress Disorder (PTSD). Decades of clinical research show that PE therapy leads to significant and lasting reductions in PTSD symptoms for many individuals across a wide range of trauma experiences.

PE therapy is considered a gold-standard, evidence-based PTSD treatment by major professional and medical organizations. Studies consistently demonstrate that Prolonged Exposure therapy reduces intrusive memories, avoidance behaviors, emotional distress, and trauma-related hyperarousal. Many individuals also experience improvements in mood, daily functioning, and overall quality of life.

The effectiveness of Prolonged Exposure therapy is tied to its direct focus on avoidance and fear-based learning. By repeatedly and safely approaching trauma-related memories and situations, the brain is able to update its threat responses. This leads to durable change rather than temporary symptom relief.

Research also shows that Prolonged Exposure therapy can be delivered effectively through telehealth, producing outcomes comparable to in-person treatment. This makes PE therapy accessible to individuals seeking PTSD treatment throughout California and other regions where specialized trauma care may be limited.

While no single treatment works for everyone, Prolonged Exposure therapy remains one of the most reliable, evidence-based options for reducing PTSD symptoms and helping individuals regain a sense of control over their lives.

Prolonged Exposure Therapy (PE) is well suited for individuals whose PTSD symptoms are maintained by avoidance of trauma-related memories, emotions, or situations. It is most effective for people who want to reduce the impact of trauma on their daily life and are willing to gradually approach what has been avoided in a structured, supportive way.

PE therapy is often a good fit for individuals who experience intrusive memories, nightmares, or strong emotional or physical reactions to trauma reminders. It is also appropriate for those whose lives have become increasingly restricted due to avoidance, safety behaviors, or persistent fear responses related to past trauma.

Prolonged Exposure therapy can be effective for PTSD stemming from a wide range of experiences, including single-incident trauma, repeated trauma, medical trauma, assault, combat, or other life-threatening events. The approach focuses on how the trauma is currently affecting the nervous system rather than the specific details of what occurred.

A good candidate for PE therapy is someone who is able to engage in treatment consistently and tolerate temporary increases in distress in service of long-term relief. Motivation to reduce PTSD symptoms and reclaim avoided areas of life is often more important than the type or severity of trauma.

Suitability for Prolonged Exposure therapy is determined through a careful clinical assessment, ensuring that the treatment approach aligns with the individual’s needs, safety, and readiness for trauma-focused work.

There are several effective, evidence-based approaches for treating Post-Traumatic Stress Disorder (PTSD). While they share the same goal—reducing trauma-related distress—they differ in how they work and what they ask of the individual. Understanding these differences can help clarify whether Prolonged Exposure (PE) therapy is the right fit.

Prolonged Exposure (PE) Therapy
Prolonged Exposure therapy focuses directly on reducing avoidance. Individuals intentionally and repeatedly approach trauma-related memories and real-life situations that have been avoided. Through this process, the brain learns that the trauma is over and that fear responses no longer need to be activated. PE is highly structured, time-limited, and centered on emotional processing through exposure.

EMDR (Eye Movement Desensitization and Reprocessing)
EMDR also targets trauma memories but does so using bilateral stimulation, such as eye movements or tapping, while recalling aspects of the trauma. The emphasis is on reprocessing memories rather than sustained exposure. Some individuals prefer EMDR because it may involve less prolonged focus on the trauma memory, while others find the structure of PE clearer and more predictable.

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
Trauma-focused CBT combines cognitive strategies with elements of exposure. It places greater emphasis on identifying and restructuring trauma-related beliefs alongside gradual exposure. PE, by contrast, relies less on cognitive restructuring and more on experiential learning through repeated exposure.

Which approach is best?
No single trauma therapy is right for everyone. Prolonged Exposure therapy is often a strong fit for individuals whose PTSD is maintained by avoidance and who want a clear, evidence-based approach that directly targets fear responses. Other trauma therapies may be more appropriate depending on individual preferences, symptom patterns, and clinical needs.

Choosing the right PTSD treatment involves collaboration, careful assessment, and alignment between the individual and the therapeutic approach.

 Specialized treatments like Prolonged Exposure therapy typically cost more than general talk therapy due to the advanced training, structure, and clinical expertise involved. Fees reflect the intensity of treatment, session length, and the therapist’s specialization. Many clients find that evidence-based, targeted treatment leads to faster and more durable improvement, reducing long-term therapy costs overall. 

For specific rates and insurance information, please visit the Fees & Insurance page.