Prolonged Exposure (PE)

Rationale and Therapeutic Engagement

Prolonged Exposure is a first-line intervention for PTSD, supported by a strong scientific evidence base.

Its premise is that avoidance of the traumatic memory maintains the disorder by preventing the brain from processing the experience and distinguishing between past danger and present safety.

This technique requires significant commitment, as it involves voluntarily confronting the distress.

The therapist should explain that the process is gradual and respectful of the patient's limits. It is not a matter of "jumping into the void", but of climbing a ladder step by step.

Patience is key, as habituation (the decrease in anxiety from repeated exposure) does not occur instantaneously, but through persistence.

Hierarchization and Imaginal Exposure

The procedure begins with the creation of a hierarchy of memories or parts of the traumatic event, ordered by level of distress (SUDs).

Unlike live exposure to external situations (such as going to a place), PD focuses on imaginal exposure.

The patient is asked to close his or her eyes and narrate the event in the present tense, describing sensory details, thoughts, and emotions.

For example, if the trauma was an accident, the patient is asked to describe the sound of impact, the smell of gasoline, and the exact thought "I'm going to die."

This narrative is repeated multiple times during the session to activate the fear network and allow the anxiety to subside naturally without escape.

Inter-session Processing and Tasks

A distinctive component is the recording of the exposure session. The patient should listen to this recording daily at home as homework.

This maximizes habituation and dismantles the belief that remembering the trauma is dangerous or unbearable.

After the exposure, processing is performed to analyze what the patient learned (e.g., "I felt a lot of anxiety at first, but then it went down and I did not disintegrate").

In addition, regulatory strategies, such as diaphragmatic breathing, are taught to manage residual arousal, al