Prolonged Exposure Therapy Videos Resources

Prolonged Exposure Therapy (PE) is an evidence-based psychotherapy for PTSD. These videos demonstrate delivery of standard PE protocol elements (e.g., rationale, in vivo hierarchy development) with a relatively straightforward patient presentation, as well as examples with somewhat difficult patient presentations such as anger or significant emotional numbing.

Prolonged Exposure: PE Session 1 - Treatment Rationale & Index Trauma - Ryan: This video demonstrates the rationale for Prolonged Exposure as presented in session 1, followed by identification of the index trauma during the trauma discussion. In this case the therapist must help the client identify an index trauma from among many events which seem similar and equally distressing. Additionally, the client presents with anger as a predominant emotion.

Prolonged Exposure: PE Session 1 - Treatment Rationale & Index Trauma - Melissa: This video demonstrates the rationale for treatment presented in session 1 followed by identification of the index trauma during the trauma discussion. This client presents as depressed and numb as predominant emotional experiences. In this case the therapist must help the client sort out one event from among many which seem similar and equally distressing.​

Prolonged Exposure: PE Session 2A - Common Reactions to Trauma - Melissa: This video demonstrates a brief discussion of the common reactions to trauma as presented in session 2, or 2a, of Prolonged Exposure Therapy. Despite the brevity of the discussion, the therapist is able to engage the client in a discussion about her own symptoms, and to facilitate additional disclosure rather than simply presenting the reactions as a didactic lecture.

Prolonged Exposure: PE Session 2A - Common Reactions to Trauma - Ryan: This video demonstrates a discussion of the common reactions to trauma. The therapist begins by focusing on the presenting problem and proceeds through some of the symptoms mentioned initially by the client, eventually covering most of the reactions listed in the protocol though not in the order listed in the protocol. This discussion provides information and validation for the client while also encouraging additional and more specific disclosure about the client’s PTSD symptoms.
 

Prolonged Exposure: PE Session 2B - In vivo Rationale, In vivo Hierarchy - Melissa: This video demonstrates the rationale for In vivo exposure, construction and refinement of the In Vivo hierarchy, development of the Subjective Units of Distress (SUDs) scale, and collaborative selection and assignment of initial In Vivo activities that the client will complete for homework. In Vivo exposure is generally introduced in session 2 or 2b of Prolonged Exposure therapy.​

Prolonged Exposure: PE Session 2B - In vivo Rationale, In vivo Hierarchy - Ryan: This video demonstrates the rationale for In vivo exposure, construction and refinement of the In Vivo hierarchy, development of the Subjective Units of Distress (SUDs) scale, and collaborative selection and assignment of initial In Vivo activities that the client will complete for homework. In Vivo exposure is generally introduced in session 2 or 2b of Prolonged Exposure therapy.
 

Prolonged Exposure: PE Session 3 - Imaginal Rationale & Imaginal Exposure Processing - Ryan: This video demonstrates the rationale for imaginal exposure, instruction and set-up for the first imaginal exposure, and implementation of imaginal exposure. The client is well engaged even though this is the first exposure and the therapist responses and prompts are accordingly minimal, though she maintains occasional supportive statements and calm, solicitous voice tone to maintain connection with the client. After a break, processing at the end of the clip focuses on validating the client’s efforts and normalizing distress reactions to the memory. The therapist also discusses using the imaginal recording for homework.​

Prolonged Exposure: PE Session 3 - Imaginal Rationale & Imaginal Exposure Processing - Melissa: This video demonstrates the rationale for imaginal exposure to the trauma memory. Following the rationale, the therapist provides specific instructions and set-up prior to implementing imaginal exposure. One iteration of the trauma narrative is shown followed by a break in the dialogue. The video resumes at the end of imaginal exposure and is followed by brief emotional processing.​
 

Prolonged Exposure: PE Session 3 - Imaginal Rationale & Imaginal Exposure Processing - James: This video demonstrates the rationale for imaginal exposure as presented in Session 3, followed by a portion of the client’s imaginal exposure of a combat related trauma. One iteration of the narrative is shown followed by a break in the dialogue after which, the video resumes at the end of imaginal exposure. Imaginal exposure is followed by emotional processing.​

Prolonged Exposure: PE Session 5 - Imaginal Exposure - Melissa: This video demonstrates imaginal exposure when the client presentation is predominantly numb or anhedonic. To help the client increase engagement, the therapist increases verbal prompts and focuses the client’s attention on important details, emotions and cognitions that are present in the memory of the event.

Prolonged Exposure: PE Session 6 - Imaginal Exposure, Processing - James: This video demonstrates a way to discuss the function of anger in PTSD, and the importance of helping the client look beyond the anger to work with other emotions that may be present as well. Both the imaginal exposure and the processing demonstrate increased therapist activity that occurs in later sessions as the therapist prompts and focuses the client’s attention on important details and cognitions.
 

Prolonged Exposure: PE Session 6 - Introduce Hot Spots, Hot Spot Imaginal Exposure, Processing - Ryan: This video demonstrates a short rationale for hot spots, selection of hot spot portions of the memory, and implementation of the first hot spot. After a break, processing focuses on cognitions related to guilt and responsibility for the trauma. Processing in this clip is informal, and the therapist is not at this point challenging the client’s cognitions directly, but frequently restates and emphasizes details and cognitions that lay the groundwork for processing in future sessions.

Prolonged Exposure: PE Final Session: This video demonstrates review of successful treatment in the final session, including the final imaginal exposure and changes in the in vivo hierarchy. The client is able to discuss how his cognitions about the event and his role in the event have changed.