Prolonged Exposure Therapy For PTSD (Second Edition): Therapist Guide

Prolonged Exposure Therapy For PTSD is a structured, evidence-based cognitive behavioral therapy (CBT) program for post-traumatic stress disorder (PTSD). This therapist guide provides clinicians with step-by-step instructions for implementing prolonged exposure (PE) therapy, a highly effective treatment that reduces trauma-related distress and avoidance behaviors. A client workbook is downloadable separately.

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Chapter 1: Foundations of Prolonged Exposure

Chapter 2: Assessing Trauma Survivors and Implementing PE in Practice

Chapter 3: Session 1

Chapter 4: Session 2

Chapter 5: Session 3

Chapter 6: Intermediate Sessions (From 4 up to 14)

Chapter 7: Final Session

Chapter 8: Tailoring Treatment to the Individual – Promoting Effective Engagement

Appendix

References

Front Matter

Overview

Prolonged exposure (PE) is a first-line treatment for post-traumatic stress disorder (PTSD), recommended by the American Psychiatric Association (APA) and the UK National Institute for Health and Care Excellence (NICE). The Prolonged Exposure Therapy For PTSD: Therapist Guide (Second Edition) is written by Edna Foa, Elizabeth Hembree, Barbara Rothbaum and Sheila Rauch and provides therapists with all the tools they need to deliver effective, evidence-based psychological treatment for PTSD. Part of the Treatments That Work™ series, it provides therapists with a background to the foundations of prolonged exposure as well as step-by-step instructions for guiding clients through key interventions and teaching them the skills they need to overcome PTSD.

Why Use This Resource?

Prolonged exposure (PE) therapy is one of the most empirically validated treatments for PTSD and has been proven effective across diverse populations, including combat veterans, sexual assault survivors, and people who have experienced accidents or natural disasters.

Provides a structured, step-by-step treatment framework.
Reduces PTSD symptoms by targeting avoidance behaviors.
Incorporates both imaginal and in vivo exposure strategies.
Backed by extensive clinical research and randomized controlled trials.
Compatible with different trauma types and client presentations.

Key Benefits

Structured

Offers a clear session-by-session treatment plan for clinicians.

Effective

Research-supported approach to reducing PTSD symptoms.

Engagement

Encourages active participation through structured exposure exercises.

Versatile

Adaptable for use with various trauma survivors.

Who is this for?

Post-Traumatic Stress Disorder (PTSD)

Persistent distress following a traumatic event.

Complex Post-Traumatic Stress Disorder (CPTSD)

Trauma-related symptoms combined with emotional dysregulation and interpersonal difficulties.

Military-Related PTSD

Symptoms arising from combat exposure or military trauma.

Sexual Assault Survivors

Trauma-related distress and avoidance stemming from sexual violence.

Accident Survivors

PTSD symptoms following car crashes, workplace incidents, or natural disasters.

Childhood Abuse Survivor

PTSD symptoms from early-life trauma.

Integrating it into your practice

Assessment

Identify the client’s trauma history and evaluate PTSD severity.

Psychoeducation

Educate clients about PTSD symptoms and the role of avoidance.

Exposure

Implement imaginal and in vivo exposure exercises to reduce trauma-related fear.

Processing

Facilitate post-exposure processing to help clients make sense of traumatic experiences.

Monitoring

Use structured worksheets to track client progress.

Relapse Prevention

Equip clients with long-term coping strategies.

Theoretical Background & Therapist Guidance

Traumatic events occur frequently, with up to 60% of the US population exposed to at least one traumatic event in their lifetime (Kessler et al, 1995). The National Comorbidity Survey (2005) found lifetime rates of PTSD in the general US population of 3.6% for men and 9.7% for women.

Prolonged exposure (PE) emerged from the adaptation and extension of Emotional Processing Theory (EPT) to PTSD. The overall aim of the treatment is to help trauma survivors to emotionally process their traumatic experiences to diminish or eliminate PTSD and other trauma-related symptoms. PE has been tested in hundreds of efficacy studies which have demonstrated that PE is highly effective at ameliorating the symptoms of PTSD, depression, anxiety, guilt, and suicidal behavior.

Prolonged Exposure Therapy For PTSD is a comprehensive program to assist clinicians in delivering effective PE for PTSD. The program includes two books:

Prolonged Exposure Therapy For PTSD: Therapist Guide details the step-by-step treatment of PTSD using PE.
Reclaiming Your Life From A Traumatic Experience: Workbook is the companion to this therapist guide. It will help your patients to become active participants in their treatment and to learn to manage panic attacks, panic anxiety, and avoidance of panic and agoraphobic situations.

Authored by leading psychologists including David Barlow, Michelle Craske and Edna Foa, Treatments That Work™ is a series of manuals and workbooks based on the principles of cognitive behavioral therapy (CBT). Each pair of books – therapist guide and client workbook – contains step by step procedures for delivering evidence-based psychological interventions and will help you to provide the best possible care for your clients.

What's inside

Session-by-session therapist instructions.
Psychoeducational materials on PTSD and exposure therapy.
In vivo exposure hierarchy worksheets.
Guidelines for conducting imaginal exposure.
Therapist checklists and progress monitoring tools.
Strategies for relapse prevention.

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FAQs

PE therapy uses structured exposure exercises to help clients confront and process traumatic memories, reducing avoidance and fear responses over time.

Imaginal exposure involves recounting the trauma memory in detail, while in vivo exposure involves gradually confronting real-life situations that act as reminders of the trauma.

PE is effective for most individuals with PTSD but may require adaptations for clients with severe dissociation or who are presenting with high levels or risk.

Therapists should provide support, monitor distress levels, and adjust exposure tasks to maintain a manageable level of engagement. Therapists should ensure that they are adequately supervised to help them maintain treatment fidelity.

Yes, PE is often used alongside pharmacological treatments such as SSRIs for PTSD.

How This Resource Improves Clinical Outcomes

By integrating PE therapy into clinical practice, therapists can:

Reduce PTSD symptoms and associated distress.
Help clients regain control over their trauma-related experiences.
Strengthen emotional processing and cognitive flexibility.
Improve overall psychological resilience and quality of life.

Clients benefit from:

Decreased fear and avoidance.
Increased confidence in coping with trauma-related distress.
Improved emotional well-being and daily functioning.

References And Further Reading

Cusack, K., Jonas, D. E., Forneris, C. A., Wines, C., Sonis, J., Middleton, J. C., ... Gaynes, B. N. (2016). Psychological treatments for adults with posttraumatic stress disorder: A systematic review and meta-analysis. Clinical Psychology Review, 43, 128–141.
Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048–1060.
Lee, D. J., Schnitzlein, C. W., Wolf, J. P., Vythilingam, M., Rasmusson, A. M., & Hoge, C. W. (2016). Psychotherapy versus pharmacotherapy for posttraumatic stress disorder: Systematic review and meta-analysis to determine first-line treatments. Depression and Anxiety, 33(9), 792–806.
Resick, P. A., Pallavi, N., Weaver, T. L., Astin, M. C., & Feuer, C. A. (2002). A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. Journal of Consulting and Clinical Psychology, 70, 867–879.
Rothbaum, B. O., Astin, M. C., & Marsteller, F. (2005). Prolonged exposure versus eye movement desensitization and reprocessing (EMDR) for PTSD rape victims. Journal of Traumatic Stress, 18, 607–616.
Watts, B. V., Schnurr, P. P., Mayo, L., Young-Xu, Y., Weeks, W. B., & Friedman, M. J. (2013). Meta-analysis of the efficacy of treatments for posttraumatic stress disorder. Journal of Clinical Psychiatry, 74(6), e551–e557.

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