Outline, Explanation, and Critique of Prolonged Exposure Therapy (Essay Sample)

Outline, Explanation, and Critique of Prolonged Exposure TherapyStudent's NameInstitutional AffiliationCourseProfessor's NameDate Abstract The aim of this paper was to assess and critique PE, one of the trauma interventions. PE is pegged on the theoretical principles of the emotional processing theory and learning theories. The use of such an intervention is justified by its effectiveness in the treatment of PTSD by allowing patients to re-tell and confront their trauma in a safe environment. In terms of the outline, PE involves an assessment of the patient and then subsequently helps them undergo imaginal and in vivo exposure. However, the special considerations that have to be made are whether the patient's PTSD is associated with other conditions such as drug abuse and dependence on substance abuse and Axis II disorders, which should first be addressed. The benefits of PE are that it provides a safe environment for patients to confront their traumas and enhance their quality of life. However, the limitation is that PE may not be effective for patients with complex PTSD symptoms. Nevertheless, when compared with other interventions such as CPT, DBT, and STAIR, PE is more effective. Based on the critique of the intervention, the recommendation for future use is that it should be combined with other approaches for maximum effectiveness in patients with PTSD. Outline, Explanation, and Critique of Prolonged Exposure Therapy Traumatic experiences, when not effectively handled, can lead to behavioral and chronic physical and mental health conditions. Furthermore, substance abuse and risky behaviors can occur due to traumatic experiences. When responses to trauma are delayed, the victims can experience various symptoms, including sleep disorders, nightmares, anxiety, depression, and fear of recurrence, among others (Herman, 2015). Therefore, it is important that appropriate trauma interventions are adopted to address the traumatic experiences. In past traumatic stress psychology, errors and mistakes were made with the assumption that all survivors were required to express their emotions and talk about the trauma. However, recent research has shown that there are different interventions that can be deployed while respecting the individuals' preferred styles of coping and valuing their choices and decisions (Holder et al., 2020). One of the trauma interventions for victims is prolonged exposure (PE) therapy. While PE has the benefits of allowing survivors to work through painful memories in a safe and supportive environment, the limitations are that patients with severe trauma-related cognitions may become worse after PE, and it is inappropriate for cases of complex PTSD. 1 Theoretical Perspective * Theoretical Principles PE is premised on the theoretical principles of emotional processing theory (EPT) and learning theories. Ideally, the fundamental tenets of the EPT are that people with post-traumatic stress disorder (PTSD) experience diverse fear structures such as stimulus, meaning elements, and response. Such structures exist to assist the survivors of trauma in response to situations of both threat and anger (Cooper, Clifton, & Feeny, 2017). According to EPT, people have a natural, normal, and rational response to stimuli. However, after the occurrence of trauma, there is an additional unhelpful fear and other emotional structures that develop in order to represent the stimuli, meaning elements, and response. Nevertheless, such structures are not representative of the actual threat or danger outside of the specific trauma context (Cooper, Clifton, & Feeny, 2017). Therefore, the role of PE is to ensure that there is an optimal level of activation of all elements of the trauma structure in order to provide successful treatment. However, the learning theory principles of classical conditioning provide a good explanation of the fear response. In specific, the principles state that traumatic events cause unconditional stimuli that produce an unconditioned response characterized by fear, helplessness, or horror (Cooper, Clifton, & Feeny, 2017). As such, survivors of trauma normally avoid any stimuli that will evoke a similar emotional response to what they experienced during a traumatic event. Therefore, PE comes in to ensure that survivors are gradually exposed to their trauma-related memories and feelings so that they understand that such events do not need to be avoided. * Justification/Support for Use There is a huge wealth of evidence that justifies and supports the use of PE in the treatment of PTSD. For instance, a study by Rossouw et al. (2022) on the impact of PE on 63 adolescents with PTSD established that such adolescents continued to experience a greater benefit from the prolonged exposure treatment. Additionally, Booysen and Kagee's (2021) study to determine the preliminary effectiveness of brief prolonged exposure therapy for PTSD in South Africa found that for the survivors undergoing the PE therapy, there was a downward trend in symptoms, hence the conclusion that the six-session brief PE interventions had positive outcomes for depression, anxiety, and PTSD. Furthermore, Foa et al.'s (2020) study on military servicemen who had experienced trauma found that PE, when coupled with post-workshop consultation, had the effect of improving the self-efficacy of delivery, leading to a faster PTSD reduction and lowering the severity of depression and anxiety among other emotions. These studies justify the use of PE because they show that such an intervention has been highly efficacious for survivors who have experienced combat and noncombat trauma. Moreover, a study by Bourassa et al. (2020) established that individuals who successfully completed PE had a greater reduction of PTSD, and, in fact, they were found to be 1.8 times more likely to no longer meet the diagnostic criteria for PTSD. This wealth of evidence provides support and justification for the use of PE as an intervention for trauma. 2 Intervention Strategy * Intervention Outline PE is provided over three months, with the survivors undergoing weekly individual sessions, which results in a total number of 15 sessions overall. There is a need for 60-120-minute sessions so that the individuals can effectively engage in exposure and have sufficient processing of the traumatic experiences (Schnurr et al., 2022). The first step in PE is for the therapists to have an overview of the treatment and understand the patients' past experiences. There is an initial assessment and a preliminary session whereby therapists provide psychoeducation and generally teach breathing techniques that will help the patients manage their anxiety before the beginning of the exposure (Back et al., 2014). Ideally, this therapy is very anxiety-provoking for most patients; therefore, the therapist has to work hard to make sure that a relationship based on trust is created and the therapy environment is perceived to be a safe space whereby patients can experience very scary stimuli. In the actual PE, the therapists utilize both imaginal and in vivo exposure. In the imaginal exposure, the patient during the first sessions describes their traumatic event in detail and in the present tense, of course, with guidance from the therapist. The description is then recorded so that the patient can listen to the recording before sessions for them to process the emotions and practice breathing techniques. In in vivo exposure, patients are assigned homework for them to confront the feared stimuli (traumatic event) (Oprel et al., 2021). The patients are then encouraged to challenge themselves in a gradual manner so that they can successfully confront the feared stimuli and cope with their emotions. * Special Considerations The special considerations that should be made when using PE include the presence of drug abuse and dependence on substance abuse, living or working in a high-risk environment, the incidence of dissociative symptoms, the presence of Axis II disorders, and if the PTSD is accompanied by prominent guilt or shame. If the patient who wishes to undergo PE therapy has drug or alcohol abuse and dependence issues, they will need to first seek treatment for such disorders and then return for PE therapy (Back et al., 2014). Additionally, it is critical to consider whether the patient is working or living in a high-risk environment because there is a reasonable doubt whether PE will be effective for someone residing in a dangerous area or undertaking a hazardous job whereby, they are more likely than not to face the same stimuli and traumatic experiences (Bourassa et al., 2020). The consideration here is whether the client will benefit from the PE or it will just be an exercise in futility as they will be faced with the same traumatic experience all over again. Moreover, therapists should consider whether the patient wishing to recover PE has Axis II disorder so that they can be excluded from the treatment for safety reasons (Back et al., 2014). Ideally, individuals who have high degrees of personality disorder, such as borderline personality disorder with current self-injurious or destructive behaviors, may need additional help. Finally, there is a special consideration of whether the PTSD being treated with PE is accompanied by prominent guilt or shame so that they dedicate adequate time to addressing the guilt before they can start undergoing the PE. 3 Critique * Benefits and Limitations of Use The benefits of PE therapy are that it allows PTSD survivors to work through their painful memories and participate in activities they have previously avoided because of a traumatic experience. Through imaginal exposure, people with PTSD are allowed to work through any traumatic and painful memories in a safe and supportive environment. Additionally, with in vivo and imaginal exposure, which are the two primary activities in PE therapy, the benefit is that pat...