Exposure Therapy for PTSD
Exposure therapy is a structured, evidence-based approach for post-traumatic stress disorder (PTSD). It grew out of cognitive-behavioural therapy (CBT). It’s based on a simple idea: after trauma, avoiding memories, places, people and feelings connected to the event can bring short-term relief, but over time avoidance can keep fear and distress going. In exposure therapy, a trained therapist helps you approach these memories and reminders gradually and safely, so they can be processed rather than avoided.
The best-known form is Prolonged Exposure (PE), developed by Dr. Edna Foa. PE is typically delivered over about 8 to 15 weekly sessions, each around 60 to 90 minutes, though the number and length of sessions can vary.
Exposure therapy is a structured, evidence-based approach for post-traumatic stress disorder (PTSD). It grew out of cognitive-behavioural therapy (CBT). It’s based on a simple idea: after trauma, avoiding memories, places, people and feelings connected to the event can bring short-term relief, but over time avoidance can keep fear and distress going. In exposure therapy, a trained therapist helps you approach these memories and reminders gradually and safely, so they can be processed rather than avoided.
The best-known form is Prolonged Exposure (PE), developed by Dr. Edna Foa. PE is typically delivered over about 8 to 15 weekly sessions, each around 60 to 90 minutes, though the number and length of sessions can vary.
How Does Exposure Therapy Work in Practice?
Exposure therapy is an active, collaborative process. You and your therapist decide together what to work on and at what pace. Prolonged Exposure generally includes:
- Psychoeducation: learning about common trauma reactions and why avoidance keeps fear going.
- Breathing retraining: a simple calming skill to help manage everyday anxiety.
- Imaginal exposure: with your therapist’s support, you revisit the trauma memory by describing it aloud in session. Sessions are often recorded so you can listen to them between sessions.
- Processing: after imaginal exposure, you and your therapist talk about the thoughts and feelings that came up, such as guilt, shame or beliefs about safety.
- In-vivo (real-life) exposure: step by step, you approach situations, places or activities you’ve been avoiding that are reasonably safe, such as driving again, going to busy places or sleeping with the lights off. These steps are organised in a list from least to most difficult.
Related Exposure-Based Approaches
- Written Exposure Therapy (WET): a shorter protocol, usually about five sessions, in which you write about the trauma memory for about 30 minutes per session following specific instructions. It doesn’t include homework between sessions.
- Narrative Exposure Therapy (NET): you build a chronological account of your life story, including traumatic events. It’s often used for people who have experienced multiple or ongoing traumas.
- Trauma-focused CBT: many trauma-focused CBT approaches include exposure elements alongside work on thoughts and coping skills.
What Does Research Say About Exposure Therapy?
Prolonged Exposure is one of the most widely studied psychotherapies for PTSD. It is recommended as a treatment option in several clinical practice guidelines, including those of the American Psychological Association, the U.S. VA/DoD and the International Society for Traumatic Stress Studies. The U.K.’s NICE guidelines recommend trauma-focused CBT, which often includes exposure. Research shows that many people experience a reduction in PTSD symptoms. As with all mental health treatments, results vary from person to person, and exposure therapy isn’t the right fit for everyone.
Safety and Pacing
Facing painful memories can sound daunting. Exposure therapy is designed to be gradual and controlled:
- You set the pace. Exposure steps are planned together, and nothing is forced. You can pause, slow down or stop at any time.
- Preparation comes first. Your therapist will assess your current safety and stability before beginning, and teach coping skills first.
- Distress is expected but monitored. It’s common to feel more uncomfortable for a period before things ease. Your therapist checks in throughout using a simple distress rating scale and helps you settle before the session ends.
- Real-life exposures are reasonably safe situations. Exposure never means putting yourself in genuine danger or returning to an unsafe relationship.
How Does Exposure Therapy Differ from Other Therapies?
Exposure vs. Cognitive Processing Therapy (CPT): CPT focuses mainly on examining and changing “stuck points”, the beliefs about the trauma, and doesn’t require detailed retelling. Exposure therapy works more directly with the memory and with avoided situations.
Exposure vs. EMDR: EMDR uses bilateral stimulation while you briefly focus on a memory, without extended retelling. Exposure therapy involves revisiting the memory in more detail, with repetition.
Some people prefer one approach over another, and a therapist can help you weigh the options.
Is Exposure Therapy Right for You?
Exposure therapy may be an appropriate option if you:
- Have experienced a traumatic event and are struggling with intrusive memories, nightmares, avoidance, hypervigilance or feeling on edge
- Notice that avoidance is limiting your life, such as at work, in relationships, when driving or in going places
- Can identify a specific traumatic memory or memories to work with
- Are not currently in immediate crisis, at high risk of harm, still in an unsafe situation, or experiencing active psychosis
- Prefer a structured, time-limited, skill-based approach
A qualified, trauma-informed therapist can help you decide whether exposure therapy suits your needs. Therapy is not one-size-fits-all, and exposure therapy is one of several evidence-based paths for PTSD. Learn more on our PTSD therapy and trauma therapy and EMDR pages.
Moving Forward
Trauma can make the world feel smaller, as you avoid more and more to stay safe. Exposure therapy offers a structured way to approach what’s been avoided, with support, so the past may have less control over the present.
Exposure therapy at Kalm is offered by our founder, Kayla Schofield, RP, who is trained in Prolonged Exposure therapy for PTSD. She typically runs it over 8 to 15 sessions of 60 to 90 minutes, in person at our North York office and through virtual therapy across Canada. Visit Meet the Kalm Team or Book a free consultation. You can also call 647-250-4308.
All Kalm Wellness Therapy therapists are regulated by their respective professional colleges, such as the College of Registered Psychotherapists of Ontario (CRPO) and the Ontario College of Social Workers and Social Service Workers (OCSWSSW).
If you are in crisis or at risk of harm, call or text 9-8-8 or go to your nearest emergency department.