Posttraumatic stress disorder (PTSD) is an anxiety disorder that develops in some individuals following exposure to a traumatic event such as combat, sexual or physical assault, a serious accident, or the witnessing of someone being injured or killed (American Psychiatric Association, 1994). The classification of PTSD as an anxiety disorder reflects the longstanding recognition that anxious arousal plays a prominent role in people who experience pathological responses to trauma. However, research and theory into the nature of PTSD have documented that pathological reactions to trauma incorporate many emotions other than anxiety. Accordingly, in addition to reducing trauma-related anxiety and avoidance, treatments for PTSD are expected to modify other negative emotions such as guilt, shame, depression, and general anxiety.
Anxiety has played an especially important role in the development of many treatment programs that target PTSD. These programs tend to focus on reducing or managing anxiety in PTSD patients. In particular, exposure therapy—a form of treatment that encourages clients to recall their traumatic memories and confront traumatic reminders—owes a great deal to the conceptualization of PTSD as an anxiety disorder (although, as noted above, other emotions are also targeted). The term "exposure therapy" is used here to refer to a general treatment strategy for reducing anxiety that involves confronting situations, activities, thoughts, and memories that are feared and avoided even though they are not inherently harmful. Prolonged exposure (PE), a specific treatment protocol that has been developed and evaluated as a treatment for PTSD (Foa, Rothbaum, Ruggs, & Murdock, 1991; Foa et al., 1999; Foa & Rothbaum, 1998), has adopted techniques that are used in exposure therapies for other anxiety disorders, such as obsessive-compulsive disorder, panic disorder, and phobias.
In the present chapter we examine the theoretical underpinnings of PE for PTSD as well as the empirical support for its efficacy in treating trauma survivors. We then discuss concerns that have been raised about exposure therapy and summarize research findings relevant to these concerns. Finally, we describe recent attempts to disseminate PE to clinicians who regularly provide mental health services to trauma survivors.
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