What is prolonged exposure therapy?

Prolonged exposure therapy, often called PET or PE, is a type of therapy used to help people heal from trauma and post-traumatic stress disorder (PTSD). It teaches you how to face the memories, feelings, and situations you’ve been avoiding because they feel scary or overwhelming. PE is one of the most effective treatments for PTSD, with research showing symptom improvement of up to 80% ^[1].

Instead of pushing traumatic memories away, PE helps you approach them slowly and safely with support from a trained therapist. Over time, many people notice fewer triggers, less fear, and a greater sense of confidence in their daily lives.

How prolonged exposure therapy works

Prolonged exposure (PE) therapy is based on the idea that avoiding trauma reminders keeps fear in place ^[2]. In other words, the more you avoid a trigger, the more powerful the fear becomes.

PE helps you slowly face the thoughts, memories, and situations you’ve been avoiding so your brain can learn that you’re safe now. Over time, this process can help reduce fear, trauma symptoms, and emotional distress.

Core principles of prolonged exposure therapy

PE is built on a few key ideas about how trauma affects the brain. One of the biggest principles is that avoidance keeps fear alive ^[2]. When you stay away from trauma reminders — thoughts, memories, places, or sensations — your brain never gets the chance to learn that those things are no longer dangerous. This keeps anxiety high and makes it harder to heal.

Another core principle is that facing fears reduces distress ^[3]. When you safely approach what you’ve been avoiding, your brain slowly learns the difference between past danger and present safety. The more you practice this, the less intense the fear response becomes.

PE also teaches that you can handle more than you think. With support and coping skills, people are often able to face difficult memories without shutting down. Over time, this builds confidence and reduces the power trauma holds over daily life.

How prolonged exposure therapy differs from other trauma therapies

There are several effective trauma therapies, and each one works in a different way. Here are some simple definitions to help you see how PE compares to other types of therapy:

• Prolonged exposure (PE) therapy: This type of therapy helps you face the trauma memories, situations, and sensations you’ve been avoiding. By approaching these reminders in a safe, structured way, your brain learns that you’re no longer in danger, which can reduce fear and help you feel more grounded in the present.

• Eye movement desensitization and reprocessing (EMDR): This approach uses bilateral stimulation — like eye movements or tapping — while you recall traumatic experiences. It helps your brain process traumatic memories in a new, less distressing way.

• Cognitive processing therapy (CPT): In this type of therapy, you focus on your beliefs about the trauma. It helps you identify and shift unhelpful thoughts — like guilt, shame, or self-blame — so you can see the experience more clearly and compassionately.

Each approach can be effective, and a therapist can help you decide which one best fits your needs and goals.

Techniques used in prolonged exposure therapy

PE uses several structured techniques to help you face avoided memories and situations at a safe, steady pace. Each technique helps your brain learn that you’re in the present, not in the trauma anymore. 

Common PE techniques ^[4] include:

• Imaginal exposure: You revisit the trauma memory in detail during sessions while your therapist guides you. Over time, the memory becomes less overwhelming because your brain learns that it no longer signals danger.

• In-vivo exposure: You slowly face real-life situations, places, or activities you’ve been avoiding. These steps are planned ahead of time and always done in a way that feels safe for you.

• Breathing retraining: You practice slow, controlled breathing ^[5] to calm your body and help you stay grounded during exposure work.

• Homework practice: You repeat exposure exercises between sessions, either in your imagination (imaginal) or in real-life situations (in vivo). This helps your brain build new learning and strengthens your sense of safety.

Some PE programs also include interoceptive exposure, which means facing physical sensations like a racing heart or tightness. Others use cued exposure, which helps you approach external reminders — like sounds, smells, or images — tied to the trauma.

What is a SUDS rating in prolonged exposure therapy?

PE uses a simple tool called the Subjective Units of Distress Scale ^[6] (SUDS). It ranges from 0 to 100, where:

• 0 = No distress

• 100 = The highest distress you can imagine

People use SUDS ratings during exposure exercises to track their level of distress. Over time, the same memory or situation usually leads to lower SUDS scores. This shows that the nervous system is healing and the fear response is decreasing.

Benefits of prolonged exposure therapy

Most people notice that PE helps them experience:

• Fewer symptoms: Intrusive memories, nightmares, and tension often decrease over time.

• Less avoidance: You may feel more able to go places or do things you once avoided.

• Reduced triggers: Trauma reminders usually feel less overwhelming or intense.

• Better daily functioning: Sleep, focus, and day-to-day routines often improve.

• More emotional strength: Facing difficult feelings becomes easier and less frightening.

• Stronger coping skills: You gain tools that help you stay steady during stress.

• Greater sense of safety: You begin to feel more grounded and present in your body and environment.

PE can be challenging at times, but it’s one of the most effective PTSD treatments ^[1] available. With steady practice and the support of a trained therapist, many people find that PE helps them reclaim their lives and move forward with more strength and stability.

When prolonged exposure therapy is used

Prolonged exposure therapy (PE) is most commonly used to treat PTSD. It’s one of the leading evidence-based treatments for PTSD and is often recommended when trauma symptoms make daily life feel overwhelming. Many people find PE helpful when they’re dealing with strong fear, avoidance, or distress connected to past trauma.

PE can support people who are coping with:

• PTSD from accidents, assault, violence, or medical trauma

• Childhood trauma or chronic traumatic experiences

• Combat-related trauma

• Sexual abuse or relationship-based trauma

• Traumatic grief and loss

• Fear and avoidance after a frightening event

• Anxiety that’s tied to specific trauma reminders

PE is especially useful when someone avoids thoughts, places, people, or situations that bring up memories of the trauma. PE is a good fit for people who:

• Are ready to talk about their trauma in a safe, structured way

• Want to reduce fear, avoidance, or strong trauma reactions

• Can attend weekly sessions and complete between-session practice

• Have enough stability and support to work through difficult emotions

Many people feel nervous about starting PE. That’s normal. A trained therapist will go at a pace that feels manageable and help you build coping skills before beginning exposure work.

What to expect in PET sessions

PE is a short-term therapy. Most people have 8 to 15 weekly sessions ^[4] that last about an hour. Some people feel small changes early on, but the full program brings the most progress.

At your first visit, your therapist will explain how PE works. They’ll ask about your symptoms and help you learn basic coping skills. Early sessions focus on planning which memories or situations you want to work on. Later sessions include imaginal exposure (telling the trauma story in a safe way) and in-vivo exposure (facing avoided situations in real life).

PE can feel challenging ^[7]. Many people feel tired or emotionally drained after sessions, which is often called trauma fatigue. Therapists help you pace the work and teach grounding skills so you can stay steady and supported throughout the process.

Homework is part of PE. You may listen to session recordings or practice facing avoided situations between visits. These steps help your brain learn that you’re safe now and support healing over time.

Starting prolonged exposure therapy

If you’re thinking about trying prolonged exposure therapy, the first step is to connect with a mental health professional who’s trained in PE. You can start by searching for a trauma-focused provider, asking your primary care doctor for a referral, or checking online directories that list therapists by specialty.

When choosing a PE therapist, look for someone experienced in treating PTSD and trained in evidence-based trauma care. It can also help to find a therapist you feel comfortable with, as trust and safety are key parts of the work. A good provider will explain the process, answer your questions, and help you decide if PE is the right fit for your needs.

Clinician’s take

A common misunderstanding is that trauma therapy will move too fast or force you to relive everything right away. In reality, good trauma work is paced, collaborative, and focused on building safety first.

Brandy Chalmers, LPC

Clinical reviewer