Prolonged Exposure Therapy for PTSD: What to Expect and Evidence

Author: Ukrainian Psychological Hub · Published: October 9, 2026 · Editorial Policy

Prolonged exposure therapy (PE) is a structured, trauma-focused form of cognitive behavioral therapy developed for posttraumatic stress disorder (PTSD). In collaboration with a trained clinician, a person gradually approaches trauma-related memories, emotions, and objectively safe situations that have become difficult to face. The purpose is to reduce persistent avoidance, improve functioning, and develop new learning about memories and present-day safety. PE is among the best-supported psychological treatments for adults with PTSD, as reflected in the 2023 VA/DoD clinical practice guideline, the American Psychological Association's 2025 treatment guidance, and NICE guideline NG116.

A typical course lasts approximately 8–15 individual sessions, often weekly and around 90 minutes each, although length and frequency can vary. Treatment includes education about PTSD, planned real-life exposure to safe reminders, imaginal revisiting of the trauma memory in the therapist's presence, discussion afterward, and collaborative between-session practice. Distress can rise temporarily during these tasks. A qualified clinician assesses whether PE fits the person's diagnosis, preferences, current risks, and capacity to participate; exposure to ongoing danger is never a therapeutic goal. This guide explains exactly what happens, which claims are supported by research, when adaptations matter, and which questions to ask before beginning. VA National Center for PTSD: patient overview.

What Is Prolonged Exposure Therapy?

PE is a manualized psychotherapy for PTSD, which means that its core activities, treatment rationale, and monitoring approach are described in a reproducible clinical protocol. The treatment is associated with the research program of Edna Foa and colleagues and has been studied in multiple civilian, veteran, and trauma-exposed populations. The therapist guides repeated, carefully selected contact with the memory and with safe situations that a person avoids because those situations remind them of the event. This is followed by reflection on the experience and its meaning. The clinical review by McLean and Foa (2024) synthesizes several decades of research.

The word prolonged refers to sustained and repeated therapeutic engagement rather than an expectation that distress must be endured indefinitely. PE does not require a person to return to the location of danger, contact an abusive person, recreate an assault, or prove that a genuinely unsafe situation is harmless. Its real-world component focuses on cues that are safe enough to approach, as identified through collaborative assessment. The distinction between realistic danger and a trauma reminder is fundamental to competent exposure planning. VA clinician guidance on PE.

Is PE the same as exposure therapy for a phobia or OCD?

Exposure is a family of behavioral methods used in several disorders, but PE has a PTSD-specific protocol that prominently includes therapeutic revisiting of traumatic memories. Exposure and response prevention (ERP) for obsessive-compulsive disorder instead focuses on feared triggers while reducing compulsions and ritualized attempts to neutralize uncertainty. Their indications, targets, and procedures differ. The English Hub comparison of OCD versus PTSD examines this diagnostic boundary; the present article is specifically about PE for PTSD.

Who Is PE Designed to Help?

The strongest clinical evidence concerns adults diagnosed with PTSD following qualifying traumatic exposure. Trauma exposure by itself does not establish PTSD, and many people experience stress responses without developing the disorder. Diagnosis considers the nature of the event, symptom clusters, duration, impairment, other conditions, and the possibility of ongoing threat. In the DSM-5-TR framework, PTSD symptoms generally persist for more than one month; acute stress disorder and early stress reactions have different clinical meanings and time frames. For a detailed diagnostic route, see Posttraumatic Stress Disorder: Symptoms, Diagnosis, and Treatment.

PE has been studied after sexual assault, combat, accidents, disasters, and other types of traumatic exposure. Research also includes participants with repeated trauma histories and accompanying depression, substance use problems, or dissociative symptoms, although the evidence is uneven across populations and clinical complexity. Selection depends on current assessment rather than on a simplified rule that a given trauma history always requires, or excludes, exposure. McLean and Foa (2024) identify both population coverage and remaining gaps, including less consistent representation of marginalized communities.

For children and adolescents, PTSD assessment, developmental stage, caregiver involvement, and available pediatric protocols require separate consideration. Evidence for adult PE cannot simply be transferred to children; NICE recommends developmentally appropriate trauma-focused CBT for young people according to age and clinical circumstances. For adults with a childhood trauma history, treatment is still selected according to their current presentation; see therapy for childhood trauma in adults and NICE recommendations for different age groups.

How Does Prolonged Exposure Work?

Avoidance can maintain PTSD symptoms

Avoidance can offer immediate relief after trauma. Someone may stop visiting ordinary public places, driving, talking about the experience, sleeping without lights, or encountering reminders that appear dangerous because of their association with the event. Over time, this narrowing of activity can prevent the person from discovering that some reminders belong to the past and that distress, although uncomfortable, can change. PE addresses this maintained pattern while remaining attentive to genuine risks in the person's current circumstances. VA's explanation of the treatment rationale.

New learning about memories and cues

PE was developed in the context of emotional processing theory. Exposure creates opportunities to encounter trauma-related information while experiencing outcomes that differ from feared expectations: a memory may be painful without signifying that the event is occurring again, and a safe situation can be approached without the anticipated catastrophe. Researchers also describe inhibitory learning and changes in appraisals or meaning, but no single laboratory mechanism fully explains every clinical improvement. Mechanistic interpretations are supported to differing degrees and should not be presented as proof that a particular brain circuit has been permanently 'reset.' The 2024 state-of-the-science review discusses the theoretical basis and evidence.

Treatment is evaluated by changes in symptoms and functioning rather than a requirement to stop feeling sadness, anger, grief, or fear. People can remember the event accurately and still recover substantially. PE does not aim to erase autobiographical memory, recover supposedly hidden memories, force forgiveness, or certify the historical truth of a disputed recollection.

What Happens Before Exposure Begins?

A competent first appointment includes clinical assessment and shared treatment planning. The clinician asks about the event or events, intrusive memories, avoidance, negative mood and beliefs, sleep, arousal, dissociative experiences, current safety, medical issues, substance use, suicidal thoughts, available support, and daily responsibilities. The clinician also considers whether another condition, including panic disorder, obsessive-compulsive disorder, psychosis, bipolar disorder, traumatic brain injury, or an active substance-related condition, changes the treatment plan. Standardized instruments such as the PTSD Checklist for DSM-5 (PCL-5) can monitor symptoms, while structured interviews such as CAPS-5 may support diagnosis; a questionnaire score alone does not diagnose PTSD. VA/DoD assessment and treatment guideline.

The therapist explains what the sessions involve, what between-session work looks like, how progress will be measured, what information may be recorded, and what happens if distress becomes difficult to manage. Treatment should include informed discussion of alternatives, confidentiality, fees and insurance where relevant, practical accessibility, and how to reach urgent assistance. A person's consent and the opportunity to ask questions remain important throughout care.

The Typical PE Session-by-Session Process

Early sessions: education, rationale, and breathing

At the beginning of PE, therapist and patient review PTSD reactions and the relationship between avoidance and symptoms. The clinician may teach slow or paced breathing as one tool for managing arousal. Breathing retraining is supportive rather than the primary treatment mechanism. The team agrees on objectives such as being able to use public transit, sleep more consistently, attend medical appointments, return to a workplace, or reconnect with relationships. VA National Center for PTSD: professional protocol overview.

Building an in vivo exposure hierarchy

Often around the second session, the therapist and patient construct a list of avoided situations, objects, people, activities, or places that are objectively safe but evoke trauma-related distress. These are organized by anticipated difficulty and practical relevance. In vivo means in real life: the person approaches selected situations according to the agreed plan and reviews the experience with the therapist. A hierarchy is individualized, and progress is judged by increasing functional freedom as well as changes in fear or distress. The therapist distinguishes appropriate safety precautions from avoidance that has become excessive.

For example, after a collision a person might avoid all daytime driving even on ordinary safe routes. The treatment could address safe, legal driving situations only after taking account of medical fitness, current traffic conditions, and the person's actual ability to drive. An individual who remains under threat from an abusive person should never be encouraged to approach that person as an exposure task. These examples illustrate clinical decision making, not exercises to undertake independently.

Imaginal exposure: talking through the traumatic memory

In standard PE, imaginal exposure often begins around the third session. With the therapist present, the person deliberately revisits and narrates the relevant traumatic memory in detail, usually for a sustained period. The clinician helps keep the activity focused, monitors distress and orientation, and then facilitates discussion of the experience and its meanings. Recordings of the imaginal work may be used for assigned listening between sessions, with privacy protections discussed in advance. These procedures should be undertaken in professional treatment rather than copied as an unsupervised intensive memory-recounting exercise. VA patient explanation and VA clinician description.

An imaginal exposure session can feel emotionally demanding. Some people cry or experience temporary increases in fear, shame, or bodily arousal. Others notice numbness, disconnection, or shifting emotional intensity. The therapist's role includes noticing these patterns, assessing safety, and adjusting the clinical approach while maintaining the therapeutic purpose. A person may pause to discuss serious concerns or reconsider treatment; meaningful informed consent is continuous.

Processing, homework review, and completion

After imaginal exposure, therapist and patient reflect on what occurred, including feared consequences, feelings, beliefs about blame and safety, and differences between the past event and the present moment. Between-session activities may include planned in vivo exercises and listening to the recorded narrative. Homework is part of the standard evidence-based protocol, yet its form, feasibility, security, and pace must be negotiated realistically around disability, caring duties, transportation, language, and other constraints.

Later sessions review progress and remaining avoidance, consolidate what has changed, prepare for future reminders and stressors, and discuss whether further care is needed. Completion can involve reduced PTSD symptoms, restored participation in important activities, or both; the endpoint is not a promise of zero distress. NICE guidance includes attention to functioning, preparing for treatment endings, and considering booster sessions when clinically indicated.

How Long Does Prolonged Exposure Therapy Take?

Standard PE is generally described as 8–15 sessions of approximately 60–90 minutes, often close to 90 minutes for full imaginal exposure and subsequent processing. A course delivered once weekly therefore often spans about three months. The exact number of appointments depends on clinical response, scheduling, the protocol being used, and practical constraints. NICE describes a broader family of trauma-focused CBT treatments typically delivered in 8–12 sessions, with more when clinically appropriate; its range and the PE protocol range refer to related but different levels of treatment description. VA patient guidance; NICE NG116.

Twice-weekly and intensive formats have been investigated, but these are service-specific adaptations, not guarantees of faster or easier recovery. The 2024 PE evidence review summarizes studies of massed treatment, telehealth, and other delivery models, and emphasizes that access, attrition, and patient outcomes still require careful study. Clinicians should consider symptom burden, patient preference, time, service capacity, and safety before altering the usual cadence.

Does Prolonged Exposure Therapy Actually Work?

Clinical guideline recommendations

The 2023 VA/DoD guideline gives a strong recommendation for individual, manualized PE, cognitive processing therapy (CPT), or eye movement desensitization and reprocessing (EMDR) for PTSD. It also recommends those individual trauma-focused psychotherapies over pharmacotherapy for primary treatment, while recognizing clinical choice and access. The 2025 APA PTSD guideline places prolonged exposure among its strongly recommended CBT-based interventions. NICE includes prolonged exposure within recommended individual trauma-focused CBT for adults presenting more than a month after trauma. Agreement across these independently developed guidelines is important, although their evidence reviews and grading systems are not identical. VA/DoD; APA; NICE.

What randomized trials show

Trials consistently find meaningful average PTSD symptom improvements with PE, often beyond wait-list or minimal-treatment conditions. In a randomized study of 171 female assault survivors, PE alone and PE combined with cognitive restructuring both improved PTSD and depression compared with a wait-list, without clear additional benefit from the cognitive restructuring component. That trial provides direct causal evidence for the studied population and protocol, not a universal success percentage. Foa et al. (2005).

A much larger trial involving 916 U.S. veterans compared PE with CPT. Both produced clinically important improvements in PTSD symptoms. PE showed a statistical advantage on the primary PTSD measure, but the between-treatment difference did not reach the investigators' prespecified threshold for clinical importance. This is evidence that both are effective options in the studied health system, and that patient preferences, access, and fit should remain central to treatment choice. Schnurr et al. (2022), JAMA Network Open.

How strong are conclusions across populations?

The overall evidence is strongest for adults with diagnosed PTSD receiving clinician-delivered, protocol-based treatment. The McLean and Foa (2024) review reports a broad research base across trauma types and settings, while identifying gaps in representation and questions around augmented, brief, and nonstandard delivery. Comparing studies also requires care: samples differ in baseline severity, trauma history, medication use, comorbidities, completion rates, definition of improvement, follow-up duration, and outcome measure. A change in mean questionnaire score cannot be converted into an individual prediction of remission.

How Many People Drop Out, and Why?

Dropout is an important part of evaluating PE because treatment can be demanding. In a systematic review of 116 randomized trials of psychological therapies for adult PTSD, the pooled dropout rate across therapies was 16% (95% confidence interval 14%–18%), with substantial study variation. For the subset of 22 PE trials, the pooled estimate was 22% (95% CI 16%–28%). These are research-trial estimates, not a forecast that one in five patients in every clinic will discontinue PE. Reasons for stopping are not uniformly measured and can include practical burdens, preferences, clinical deterioration, dissatisfaction, or improvement sufficient to end early. Lewis et al. (2020).

Retention also varies with treatment schedule, setting, population, and how dropout is defined. In the large PE-versus-CPT veteran trial, attrition was substantial in both arms, and PE had more protocol-defined dropout than CPT. The study illustrates why results from completers must be interpreted alongside analyses of all randomized participants. Schnurr et al. (2022). A clinician should invite candid discussion of transportation, cost, privacy, accessibility, competing responsibilities, and symptom-related barriers instead of labeling missed sessions as lack of motivation.

Can PE Make Symptoms Worse? What Are the Risks?

Temporary increases in distress are expected during exposure to difficult memories or reminders. Some patients experience a difficult interval between sessions, disturbed sleep, fatigue, or concern about listening to recorded narratives. Clinicians should monitor sustained worsening, new safety concerns, self-harm thoughts, escalating substance use, dissociation, and impairment. Emotional discomfort by itself does not establish treatment harm, and serious deterioration should not be dismissed as simply part of the process. The VA patient guidance explicitly describes temporary discomfort and recording-related privacy risks.

Available clinical research does not support the blanket claim that therapist-guided exposure inevitably destabilizes people with PTSD. In a randomized study of 71 veterans with co-occurring PTSD and substance use disorders, an integrated exposure-based intervention did not produce more reliably measured symptom exacerbations than a non-exposure substance-use intervention. The finding concerns that particular program and selected participants; it is not evidence that every clinical risk profile is suitable for immediate standard PE. Study report.

If a person has current suicidal intent, active psychosis or mania, severe intoxication or withdrawal, acute instability, or immediate danger at home, clinical priorities may first involve crisis care, stabilization, medication management, or safeguarding. This calls for individualized judgment rather than a universal contraindication list. In specialized settings, modified trauma-focused protocols have been investigated even for patients with significant self-injury histories, including small trials of DBT with a PE component; these protocols require specialist assessment and their results cannot be generalized to routine unsupervised exposure. Harned et al. (2014).

Dissociation, Complex PTSD, and Co-Occurring Conditions

PTSD with dissociative symptoms

Depersonalization and derealization may occur within the DSM PTSD dissociative subtype. They also require evaluation when arising from another psychiatric or neurological condition. Persistent dissociation can affect memory narration, orientation, and a person's ability to remain engaged during an exposure session. The clinician should assess and monitor these features, adapt pacing and support when indicated, and reconsider the plan if a person repeatedly loses orientation or experiences clinically significant deterioration. The existence of dissociative symptoms alone does not establish that PE can never work. VA's clinical PE overview.

ICD-11 complex PTSD

ICD-11 complex PTSD includes PTSD symptoms together with disturbances in self-organization affecting emotion regulation, self-concept, and relationships. Complex PTSD is a separate ICD-11 diagnosis and does not appear as a distinct diagnosis in DSM-5-TR. A history of multiple events is neither a sufficient diagnostic criterion nor proof that standard PE is appropriate or inappropriate. Clinicians consider the symptom profile, preferences, functional priorities, and whether additional interventions for emotion regulation or interpersonal difficulties are needed. See the existing Complex PTSD clinical guide for its independent diagnostic and treatment intent.

Depression, substance use, and other comorbidities

Depression and substance use disorders commonly overlap with PTSD and need coordinated assessment. A 2024 research review concludes that evidence-based trauma-focused approaches can be effective with co-occurring PTSD and substance use disorders and that blanket requirements for full abstinence before any PTSD treatment are not supported by the broader research. However, intoxication, acute withdrawal, unstable medical illness, and serious safety risks can change immediate treatment readiness and require active clinical management. Back et al. (2024).

PE does not replace indicated care for bipolar disorder, psychotic symptoms, substance withdrawal, sleep apnea, severe depression, chronic pain, or other psychiatric and medical conditions. Coordination across clinicians can be essential. The patient and clinician may reasonably select PE, another evidence-based PTSD treatment, or an integrated care plan depending on what is most impairing and what can be delivered safely.

PE Compared With CPT, EMDR, Medication, and Other Therapies

PE versus cognitive processing therapy

PE places particular emphasis on gradual engagement with avoided safe situations and extended therapeutic revisiting of traumatic memories. CPT is a structured cognitive therapy focused on trauma-related interpretations and beliefs, including self-blame, danger, trust, and power. Some CPT formats can be delivered without a detailed written trauma account. Both have strong support in VA/DoD guidance, and the largest direct comparison found improvement in both groups with a difference too small to meet the trial's threshold for clinical significance. Schnurr et al. (2022).

PE versus EMDR

EMDR involves attention to targeted traumatic memories with a structured sequence that may include bilateral stimulation. PE uses explicitly prolonged imaginal and in vivo exposure as defining features. Both are recommended by VA/DoD; clinical guidance and comparative evidence do not support declaring one universally best for every patient. Preference, treatment access, clinician competence, and the fit of the protocol to the patient's situation are consequential. VA treatment overview.

PE versus medications and supportive care

The 2023 VA/DoD guideline favors individual trauma-focused psychotherapies for PTSD when available and acceptable, while supporting certain medications when indicated or preferred. Sertraline, paroxetine, and venlafaxine are among the medications with PTSD-specific evidence; medication decisions require consideration of other conditions, adverse effects, interactions, and patient preference. General supportive counseling, relaxation, exercise, social support, and sleep practices can contribute to care but should not automatically be represented as equivalent substitutes for manualized PE in treating established PTSD. For a broader comparison, consult the published PTSD Treatment: Evidence-Based Therapy and Medication Options and VA/DoD guideline.

Can Prolonged Exposure Therapy Be Done Online?

PE has been tested through secure clinician-led video appointments. In a randomized noninferiority trial involving 132 veterans, home-based telehealth PE was noninferior to in-person PE for PTSD symptom reduction at treatment completion and at three- and six-month follow-up. The study was conducted within a particular clinical network and does not prove equivalence for every patient, technology, or psychiatric presentation. Acierno et al. (2017).

Online sessions require a private space, stable connection, an agreed plan for disconnection and emergencies, and particular care over storage of recorded imaginal sessions. A therapist should confirm the patient's location and emergency contacts where relevant, discuss privacy risks, and decide whether remote treatment is appropriate. Therapist-guided telehealth PE is different from an unguided app, a scripted chatbot, or independent exposure exercises; effectiveness evidence for one format cannot be transferred to another.

How Progress and Recovery Are Measured

At baseline and during treatment, clinicians often track the frequency and severity of intrusion, avoidance, negative mood and beliefs, hyperarousal, sleep problems, and their impact on relationships and daily life. The PCL-5 may be used repeatedly as a symptom measure; a clinician may use interviews and other instruments to reassess diagnosis or impairment. Trends over time are more informative than interpreting a single questionnaire total in isolation. Some people notice improvement early, others later, and some need another treatment strategy or continued care after a standard course.

A meaningful outcome can involve taking part in ordinary activities, maintaining close relationships, improved sleep, less avoidance, reduced distress from reminders, and greater control over choices. Residual symptoms can occur without negating progress. Follow-up plans may address anniversaries, new stressors, depression, pain, substance use, or other needs; there is no evidence-based fixed series of recovery stages through which every patient must pass. NICE clinical recommendations.

How to Choose a Qualified PE Therapist

A helpful first question is whether the clinician has formal training, ongoing supervision or consultation, and experience delivering the complete PE protocol for PTSD. Ask how diagnosis is established, whether sessions are long enough for the protocol, what in vivo and imaginal work involves, how homework is selected, what happens when dissociation or distress rises, and how symptoms and functioning are monitored. Ask which alternatives the clinician offers when PE is a poor fit or personal preference favors another supported therapy.

A competent clinician can explain their approach in ordinary language and invite questions without promising a cure or implying that discomfort proves progress. People may ask about telehealth safeguards, recording security, cultural and language fit, accommodations for disability, treatment cost, insurance, session availability, and coordination with other mental health or medical providers.

Frequently Asked Questions

Do I have to describe the traumatic event in detail?

Detailed imaginal revisiting is a central component of standard PE, usually beginning after orientation and preparation. A person should know this before consenting. If recounting is unacceptable, a clinician can discuss other evidence-based PTSD approaches such as CPT or EMDR and their different procedures. VA patient treatment overview.

Is PE the same as reliving the trauma?

PE involves intentionally remembering and describing an event within the present-day therapeutic setting. The clinician helps distinguish remembering from present danger. It does not involve physically recreating the traumatic event or confronting an ongoing perpetrator.

Will the therapist ask me to do exposures alone?

Between-session practice is normally part of PE, but each assignment should be designed collaboratively, address objectively safe situations, and fit individual circumstances. Extended imaginal memory work and other intensive procedures should follow a supervised clinical plan rather than internet instructions.

Is prolonged exposure therapy painful or retraumatizing?

PE may be emotionally difficult and can temporarily heighten distress. This differs from a conclusion that it inevitably causes new trauma. Research supports average benefit, while dropout, transient discomfort, and individual adverse responses make monitoring and responsive care necessary. Persistent deterioration should be assessed, not dismissed.

Can PE help after multiple traumatic experiences?

PE has been evaluated with people exposed to different and repeated trauma types. The clinician selects appropriate treatment targets, assesses current symptoms and safety, and determines whether additional care is required. Multiple exposures alone do not decide treatment suitability. McLean and Foa (2024).

Can PE work if I also have depression or substance use problems?

It may, and clinical research includes patients with important comorbidities. The best approach depends on current safety, medical and psychiatric status, and availability of integrated treatment. Active withdrawal, suicidality, or other acute concerns need timely specialist attention. Back et al. (2024).

What if PE does not help enough?

The clinician should reconsider the diagnosis, ongoing threats, treatment dose, adherence barriers, missed comorbidities, medication interactions, and therapeutic fit. Options include completing an appropriately adapted course, another first-line PTSD psychotherapy, medication when appropriate, or coordinated care for associated problems. Lack of full response is a reason for reassessment and shared planning.

Can I do PE entirely on my own?

The evidence discussed here concerns manualized clinician-delivered PE. A general self-help worksheet or app is not the same intervention, and unsupervised intensive trauma-memory exposure can carry avoidable risks. Seek an appropriately trained clinician for PE itself.

When should I seek urgent help instead of waiting for a therapy session?

If there is immediate danger, an imminent intention to harm yourself or another person, severe disorientation, psychosis, or an acute medical emergency, seek local emergency services or urgent clinical help. PE is an ongoing treatment plan, not a replacement for crisis assessment.

Related Articles

Posttraumatic Stress Disorder (PTSD): Symptoms, Diagnosis, and Treatment — the clinical diagnostic overview and pathway to PTSD treatment.

PTSD Treatment: Evidence-Based Therapy and Medication Options — a comparative overview of evidence-based interventions.

Complex PTSD (CPTSD): Symptoms, Diagnosis, and Treatment — the ICD-11 diagnosis and its specific clinical considerations.

Therapy for Childhood Trauma in Adults: Evidence-Based Approaches and How They Differ — the separate intent covering adult presentations associated with childhood adversity.

References

Acierno, R., et al. (2017). A non-inferiority trial of prolonged exposure for posttraumatic stress disorder: In person versus home-based telehealth. Behaviour Research and Therapy. PubMed record.

American Psychological Association. (2025). Clinical practice guideline for the treatment of posttraumatic stress disorder in adults: Treatments for PTSD. Official guidance.

Back, S. E., Jarnecke, A. M., Norman, S. B., Zaur, A. J., & Hien, D. A. (2024). State of the science: Treatment of comorbid posttraumatic stress disorder and substance use disorders. Journal of Traumatic Stress, 37, 803–813. DOI: 10.1002/jts.23049.

Foa, E. B., Hembree, E. A., Cahill, S. P., et al. (2005). Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics. Journal of Consulting and Clinical Psychology, 73(5), 953–964. DOI: 10.1037/0022-006X.73.5.953.

Harned, M. S., Korslund, K. E., & Linehan, M. M. (2014). A pilot randomized controlled trial of dialectical behavior therapy with and without the dialectical behavior therapy prolonged exposure protocol for suicidal and self-injuring women with borderline personality disorder and PTSD. Behaviour Research and Therapy, 55, 7–17. DOI: 10.1016/j.brat.2014.01.008.

Lewis, C., Roberts, N. P., Gibson, S., & Bisson, J. I. (2020). Dropout from psychological therapies for post-traumatic stress disorder in adults: Systematic review and meta-analysis. European Journal of Psychotraumatology, 11(1), 1709709. DOI: 10.1080/20008198.2019.1709709.

McLean, C. P., & Foa, E. B. (2024). State of the science: Prolonged exposure therapy for the treatment of posttraumatic stress disorder. Journal of Traumatic Stress, 37, 535–550. DOI: 10.1002/jts.23046.

National Institute for Health and Care Excellence. (2018, current online recommendations). Post-traumatic stress disorder (NG116). Official guideline.

Schnurr, P. P., Chard, K. M., Ruzek, J. I., et al. (2022). Comparison of prolonged exposure vs cognitive processing therapy for treatment of posttraumatic stress disorder among US veterans: A randomized clinical trial. JAMA Network Open, 5(1), e2136921. DOI: 10.1001/jamanetworkopen.2021.36921.

U.S. Department of Veterans Affairs / Department of Defense. (2023). VA/DoD clinical practice guideline for management of posttraumatic stress disorder and acute stress disorder. Official guideline.

U.S. Department of Veterans Affairs, National Center for PTSD. (n.d.). Overview of psychotherapy for PTSD. Clinical treatment overview.

U.S. Department of Veterans Affairs, National Center for PTSD. (n.d.). Prolonged exposure for PTSD: Professional overview. Clinical protocol summary.

U.S. Department of Veterans Affairs, National Center for PTSD. (n.d.). Prolonged exposure (PE) for PTSD. Patient guidance.