Exposure Therapy

Rating

Category: Allied Health Options

What is it?

Exposure therapy is a form of trauma-focused cognitive behavioral therapy which is used for a variety of conditions including PTSD. During sessions, the therapist encourages the client to talk about the traumatic event and to re-experience the associated reactions and emotions. The goal is to reduce PTSD symptoms by confronting the person with the traumatic memories and helping lessen the emotional response.

Ways in which exposure therapy may be delivered include:

  • Imagery exposure therapy where the exposure to the traumatic memories happens in the client’s imagination
  • 'In vivo' exposure where the client is encouraged to gradually expose themselves to actual situations which remind them of the traumatic event and which they usually avoid
  • Prolonged exposure therapy which combines imagery exposure, “in vivo” exposure plus daily listening to recordings of their trauma story
  • Narrative exposure therapy which was developed specifically for war and torture survivors
  • Eye movement desensitization and reprocessing uses some elements of exposure therapy

How does it work?

People with PTSD may try to avoid situations which provoke unpleasant feelings or memories, however this provides only short term relief and prevents the person dealing with the problem in a positive way. Exposure therapy works from the theory that PTSD can be reduced by exposing the person to corrective information, which modifies the fear.

Is it effective?

Evidence suggests exposure therapies are generally effective in reducing PTSD symptoms, however not enough studies have been done to date to show those most effective.
A 2005 review found 13 studies which focused on exposure therapies for PTSD. Given the relatively small number of studies, the review was unable to compare different types of exposure therapy. When compiled, these results found that exposure therapy was effective, with 40%–70% of patients in the controlled clinical trials able to reduce their symptoms substantially or render them no longer diagnosable with PTSD.

A 2007 randomised controlled trial of 284 female veterans with war-related PTSD found that prolonged exposure therapy was an effective treatment and was significantly more effective than present centered therapy.

Are there any disadvantages?

Some studies report high drop-out rates although adverse outcomes were not specifically reported. This may indicate that exposure therapy is not well tolerated by some people. Exposure therapy may not suit participants with insufficient cognitive and communication skills to engage meaningfully with the therapist. It may be offered as part of, or in combination with, other interventions for PTSD.

Where do you get it?

Exposure therapy for PTSD should only be administered by specifically trained registered mental health practitioners.

What are the evidence limitations?

Some of the studies in the 2005 review included individuals with traumatic stress symptoms who were diagnosed using different criteria from DSM-IV.

Recommendations

Based on current evidence, exposure therapies are a reliable first line intervention to achieve symptom relief in clients with PTSD and should be administered to these clients.
Insufficient evidence exists at present to recommend one form of exposure therapy over another.

Key References

Bradley, R, Greene, J, Russ, E, Dutra, J, Westen, D 2005. ‘A multidimensional meta-analysis of psychotherapy for PTSD’, American Journal of Psychiatry, vol.162, pp. 214–227.

Schnurr, P, Friedman, M, Engel, C, Foa, E, Shea, T, Chow, B, Resick, P, Thurston, V, et al. 2007, ‘Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial’, JAMA, vol. 297, pp. 820-830.

Van Etten, M & Taylor, S 1998, ‘Comparative efficacy of treatments for post-traumatic stress disorder: a meta-analysis’, Clinical Psychology and Psychotherapy, vol. 5, pp. 126-144.

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