Avoidance makes sense after trauma. If a memory, a place, or a feeling hurts, the mind steers away from it. In the short term, that feels like relief. Over time, it keeps trauma symptoms in place.
Prolonged exposure therapy, often called PE, works on that pattern. It helps a person approach what they have been avoiding, with a trained clinician guiding the pace.
What Prolonged Exposure Therapy Is
PE is an individual psychotherapy for post traumatic stress disorder (PTSD). It is a type of cognitive behavioral therapy. BrainLine’s overview explains the core idea: avoiding trauma related memories, feelings, and situations keeps PTSD symptoms going. PE treats this by helping the person face those things gradually.
The American Psychological Association’s clinical practice guideline for PTSD in adults strongly recommends prolonged exposure. Cognitive behavioral therapy, cognitive processing therapy, and cognitive therapy also earned a strong recommendation.
What Happens in Treatment
PE usually runs about 8 to 15 weekly sessions, each around 90 minutes. A clinician works with one person at a time. The main parts include:
- Education. The clinician explains how trauma affects the body and mind, and teaches a breathing technique for managing anxiety.
- Real world practice. Around the second session, the person and clinician build a list of places, people, and activities the person has avoided since the trauma. The person works through the list step by step, starting with manageable items.
- Revisiting the memory. After a few sessions, the person talks through the trauma in detail while the clinician tracks distress and sets the pace. Sessions are recorded, and the person listens between visits.
- Talking it through. The clinician and client discuss what came up. This often eases fear, anger, and sadness tied to the memory.
The goal is not to relive the worst day of someone’s life. The goal is to teach the mind that the memory is not the same as the event, and that the person can handle it.
Where PE Fits in Addiction Treatment
Trauma and substance use often show up together. Many people use substances to manage trauma symptoms, so treating only one side can leave the other pulling at recovery. Our post on trauma informed care explains why programs take this link seriously.
Research supports treating both together. A randomized trial of 110 adults with PTSD and a substance use disorder, called the COPE study, compared three groups over 12 weeks:
- Concurrent treatment with prolonged exposure for PTSD and substance use (COPE)
- Relapse prevention therapy for substance use alone
- An active monitoring control group
Both treatment groups reduced PTSD symptoms and substance use more than the control group. Among people with full PTSD, COPE reduced PTSD symptoms more than relapse prevention alone. Relapse prevention held a small edge on substance use at the end of treatment, and gains held at three months. The authors concluded that prolonged exposure did not worsen substance use.
One study cannot settle every question. It does show that people with both conditions can do trauma focused work while staying in recovery, with the right support.
Is PE the Right Fit?
PE is one option, not the only one. A good fit depends on a person’s history, symptoms, stability, and goals. Some people need more stabilization before trauma processing begins. Others do well starting sooner.
If you are exploring trauma treatment for yourself or someone else, consider asking:
- Does the program offer evidence based trauma therapies, and which ones?
- Are the clinicians trained in PE or similar approaches?
- How does the team coordinate trauma care with addiction treatment?
- What happens if a session brings up strong feelings?
The Bottom Line
Prolonged exposure therapy gives people a structured, researched way to stop letting avoidance run their lives. It works step by step, at a pace set with a trained clinician. For people in recovery, it can fit alongside substance use treatment instead of replacing it.
If you are ready to talk about trauma and addiction care, learn about our treatment programs or complete our online pre-assessment form. Our admissions team can help you find the right next step.