Prolonged Exposure Therapy PE

Trauma induced suffering makes the survivors put their best efforts to delete their traumatic memories
Distorted memories that was formed through cognitive avoidance
Time to confront and recall the memories thoroughly and radically
The completion of emotional processing would heal the scars of the trauma

Primary Symptoms

Post-traumatic stress disorder / acute stress disorder

History of PE

Prolonged Exposure Therapy Workshop with Edna Foa in 2005

Publication

Publication of Prolonged Exposure Therapy Therapist Guide and Workbook 1st Edition in 2011
Publication of Prolonged Exposure Therapy Therapist Guide and Workbook 2nd Edition in 2022
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Scientific Evidence & Benefits

Prolonged Exposure Therapy (PE) was developed by Edna B. Foa at the University of Pennsylvania. It is an evidence-based short-term treatment for post-traumatic stress disorder (PTSD) followed by a traumatic event such as a sexual assault, natural disaster, violent crime, torture, etc.  

 

The treatment helps clients to confront trauma-related memories systematically with emotional processing procedures. They could overcome PTSD symptoms by facing anxiety-provoking situations instead of avoiding them. 

Edna B. Foa, Ph.D.

Dr. Edna Foa is a professor of clinical psychology at the University of Pennsylvania and the director of the Center for the Treatment and Study of Anxiety. She has dedicated her research to developing treatment for anxiety disorders, post-traumatic stress disorder, obsessive-compulsive disorder, and social phobia; she is one of the leading professionals in the area of psychology.  

 

She was the chair of the DSM-IV Subcommittee for OCD and co-chaired the DSM-IV Subcommittee for PTSD. Edna Foa has also been the chair for the Treatment Guidelines Task Force of the International Society of Traumatic Stress Studies; she has published over 250 articles and books and has been recognized with numerous awards and honors for her extensive research. 

Prolonged Exposure Therapy for post-traumatic stress disorder has been recognized
by the Substance Abuse and Mental Health Service Administration

PE has been recognized as an effective treatment by the Substance Abuse and Mental Health Services Administration (SAMHSA) and has helped victims all over the world cope with their post-traumatic experiences. The treatment has been proven to be effective in reducing symptoms related to PTSD and those related to anxiety and depression as well. 

 

Dr. Cho and the Tree Group have implemented PE since 2003 and have invited Professor Edna Foa for Prolonged Exposure Therapy workshop. In 2011, Dr. Cho and the Tree Group translated and published the Prolonged Exposure Therapy Therapist Guide and Workbook. 

Prolonged Exposure Therapy for PTSD
: Emotional Processing of Traumatic Experiences-Therapist Guide

Edna Foa et al., Translated by Yong Cho
the Tree Group Press

Prolonged Exposure Therapy for Post-traumatic Stress Disorder Treatment

The clinicians at the Tree Group have been helping clients with many different traumatic experiences such as sexual assault, school violence, family violence, and violent crime. They had been suffering from PTSD symptoms and serious interpersonal issues. Most of them were dependent on alcohol, drugs or anti-anxiety medication. 12-weeks of PE program reduce their PTSD symptoms significantly. 

 

PE is a structured therapy and consists of 10-15 sessions over 3 to 6 months. During the initial phase of treatment, clients learn their current reaction to the traumatic experience, learn how to reduce arousal through a breathing retraining exercise, and learn the theoretical background of how the treatment works.  

 

After this initial phase, the clients then identify any person, place, or situation they have been avoiding because of the traumatic experience and slowly process their traumatic thoughts and feelings by visualizing the experience through imaginal exposure.  

 

During the middle phase of treatment, the clients gradually expose themselves to the person, place, or situation that they have been avoiding due to anxiety and other PTSD-related symptoms. This allows them to overcome their fear. The later part of treatment focuses on practicing the skills they have learned to prevent the recurrence of the symptoms. 

Prolonged Exposure Therapy for Sexual Assault Survivor

The number of people who report having experienced sexual assault has been increasing over the past years. There has been an increase in online sexual violence and the age of sexual violence victims has been lowering. It is estimated that approximately 25% of the victims are under age 20 and 10% under age 15 in Korea (Supreme Prosecutor’s Office, The studies of crime Analysis, 2021). 

Childhood sexual abuse and chronic suffering of PTSD
Traumatic experience seems never-ending; it is the present tense.

Survivors of childhood sexual abuse are experiencing severely detrimental symptoms that include PTSD related symptoms, suicidal crisis, anger and emotion dysregulation, sexual disorder, family relationship issue, conduct disorder, borderline personality disorder, battered child syndrome and sexual abuse accommodation syndrome.  
 

Many sexual abuse victims do not get opportunities for proper treatment and suffer from chronic emotional and behavioral disorders. Living a normal life is beyond their reach. It is not uncommon to find survivors visiting our clinic in their 20’s and 30’s after so many years of painful suffering of childhood sexual abuse. In some cases, adult female clients visit our clinic for other symptoms and found they are the secondary or tertiary symptoms of untreated PTSD.

The sadden reasons of the delayed report of childhood sexual abuse 'Sexual Abuse Accommodation Syndrome'

Childhood sexual abuse victims often grow up without acknowledging the fact that they were abused. Some of them did not have a chance to report their abuse and were exposed to repetitive sexual abuse. The abusers are often their family members or neighbors who the victims have trusted; the psychological damages are very severe and detrimental.  

 

The child victims often believe that people would not believe their stories and are fearful of consequences after reporting the incident. They keep it a secret with a vague hope that things will get better until their emotional distress which was induced by PTSD symptoms become intolerable.  

 

They finally share their secret with their parents and guardians who are shocked and confused about the whole story, which often leads to the delay in proper care of the victims. If the initial care of the parents is not adequate, the victims often feel that they have brought big trouble and agonizing pain to the family. They sometimes feel ashamed and alienated and get hurt by others. They would experience relationship difficulties with family and others, and even revoke their reports of being abused.  

Exposure Therapy, sounds like too difficult…

A small step, courage needed for Exposure Therapy

The NBC Dateline News interviewed Professor Edna Foa and reported that prolonged exposure therapy is an extremely effective psychotherapy. However, it has also mentioned that the therapy process is not easy. The manual of the PE treatment states that although the treatment is effective within a short period, the procedure of exposure therapy can make people experience tentative psychological discomfort. 
 
People have some concerns about the concept of ‘exposure’ of prolonged exposure therapy which makes the procedure sound very difficult. The clients may indeed feel tentative discomfort in the process of PE treatment that reduces their symptoms and helps them get back to their normal self. However, clinicians titrate the level of exposure slowly and progressively for the clients by monitoring the clients’ Subjective Units of Discomforts, SUDS.  

They need ‘a little courage’ to face the traumatic stimuli that induces emotional distress. But with a single successful exposure experience, this can overcome their pain and fear. The clients gain ‘big courage’ to deal with fearful experiences and build confidence about themselves and the world. Clients who completed this treatment always recall that this experience of overcoming the trauma changed their life. 

 

Clients who start PE treatment need that courage to reclaim their original life. They will experience a reduction of symptoms within 3-6 months. PE therapists will assist them to overcome their trauma throughout the whole treatment procedure. 

Prolonged Exposure Therapy for Trauma Survivor

Around the world, many people are suffering from traumatic incidents such as crimes, accidents, natural disasters, school violence, and torture. A study in the US shows more than 60% of the population has been exposed to one or more traumatic incidents in their lifetime. The lifetime occurrence rate of PTSD is reported about 8-14%; females’ exposure to PTSD is twice more than that of males. Some people will be able to overcome the trauma without intervention; this would take about 3 months. However, if the symptoms persist for more than a year, the victims may need immediate treatment intervention.

Adults and young adult clients who visit our clinic often describe their child/adolescent traumatic experiences in school. Their exposure to school violence and systematic peer group alienation changes their life trajectory; unresolved emotional issues and subsequent interpersonal difficulties keep haunting them constantly. Based on an annual school violence study in Korea, about 1-2%, more than 30,000-60,000 children and adolescents are experiencing school violence. Considering unreported cases, it is likely that more children are currently exposed to school violencerelated trauma. 
 

A study of torture victims of 5.18 democratic movement in Korea reveals that the trauma affects both victims themselves and their next generations. Most of the victims suffered from PTSD symptoms, depression and alcohol issues. Some of them committed suicide which then led to their offspring not having a proper educational opportunity and suffering from psychosocial and financial difficulties. 
 
PTSD leaves serious and detrimental conditions to the trauma survivors; it changes their life and value system. In the U.S., Prolonged Exposure Therapy is a treatment of choice for veterans who are suffering from PTSD. Prolonged Exposure Therapy is a scientifically proven treatment, and evidence supports that the early intervention could minimize the survivors’ psychological damage. Trauma survivors are always trying to avoid their emotional pain and suffering; it is important for the family members and friends to understand their avoidance tendencies and support them to start PE treatment. With this support and care, the survivors can recover from PTSD.