Prolonged Exposure Therapy Online

What Is Prolonged Exposure Therapy?

PE is a form of Cognitive Behavioral Therapy (CBT) developed by psychologist Edna Foa and colleagues. It’s built on a simple observation: avoiding trauma reminders brings short-term relief but stops your brain from learning that the memory isn’t dangerous and that you can handle it. PE reverses that pattern.

PE is one of the most strongly supported PTSD treatments:

• The U.S. Department of Veterans Affairs and Department of Defense (VA/DoD) Clinical Practice Guideline for PTSD (2023) recommends PE as a first-line treatment, along with Cognitive Processing Therapy (CPT) and Eye Movement Desensitization and Reprocessing (EMDR).
• The American Psychological Association (APA) Clinical Practice Guideline for the Treatment of PTSD strongly recommends PE.

How PE Works

PE usually involves 8 to 15 weekly sessions, often about 90 minutes each, though some programs use 60-minute sessions. It has four main parts.

1. Education. You learn how PTSD works, why avoidance keeps symptoms going, and what to expect in treatment.

2. Breathing retraining. You learn a simple slow-breathing skill to help manage anxiety day to day.

3. In-vivo exposure (real-life practice). You and your clinician build a list of situations you’ve been avoiding because they feel dangerous, even though they’re objectively safe, such as driving, crowds, or certain places. Then you gradually practice approaching them, starting with easier items. Your anxiety naturally decreases with practice, and your confidence grows.

4. Imaginal exposure. In session, you revisit the trauma memory by describing it out loud, in the present tense, for an extended period. Then you and your clinician talk through what came up. Sessions are recorded so you can listen between sessions. Repeatedly approaching the memory in a safe setting helps it become a painful memory instead of a present-tense threat.

Between sessions, you’ll practice real-life exposures and listen to the recordings. That practice is a key part of PE’s results.

What Does a PE Session Look Like Online?

PE translates well to video. A typical online session includes:

• Checking in and reviewing your practice from the past week
• Imaginal exposure with your clinician guiding and supporting you
• Processing, where you talk about thoughts and feelings that came up
• Planning the next week’s real-life exposures

Research supports PE by telehealth. Studies, including a randomized trial in which PE was delivered by video into patients’ homes, have found that it works about as well as in-person PE. Your clinician will help you set up a private space and a plan for staying grounded. Learn how our teletherapy works.

Who Can Benefit from PE?

PE can help adults with PTSD after many types of trauma, among others:

• Combat or military trauma
• Line-of-duty trauma for police, firefighters, and paramedics (see our first responder therapy page)
• Sexual or physical assault
• Car accidents, disasters, and medical emergencies
• Witnessing violence or sudden death

PE is often an especially good fit when avoidance is shrinking your life. Read more about our trauma and PTSD therapy.

Prolonged Exposure vs. EMDR vs. CPT

	Prolonged Exposure	EMDR	Cognitive Processing Therapy
Main focus	Facing memories and avoided situations	Reprocessing memories with bilateral stimulation	Changing stuck beliefs
Talking about the trauma	Yes, in detail, out loud	Limited	Optional written account
Practice at home	Daily	Light	Daily worksheets
Typical length	8–15 sessions	Varies	About 12 sessions

Studies comparing these treatments generally find similar overall results. PE may suit you best if avoidance is your biggest problem and you’re ready to approach the memory directly. Learn more about EMDR and Cognitive Processing Therapy.

Is PE Right for Me?

PE is often a strong fit if:

• You avoid people, places, or activities that remind you of the trauma
• Intrusive memories or nightmares are a big part of your day
• You’re ready to approach the memory directly with support
• You can commit to weekly sessions and daily practice for a few months

PE may need to wait, or be combined with other care, if you’re in immediate danger (for example, still living with an abusive partner), actively misusing alcohol or drugs in a way that interferes with treatment, or having suicidal thoughts that need attention first. Your clinician will assess this with you and adjust the plan. Many people with depression, anxiety, or a long trauma history still do very well with PE.

What Makes PE Effective

Researchers think PE works for three main reasons:

• Learning safety. By staying with the memory or situation, your brain learns that the reminder isn’t dangerous and that anxiety comes down on its own.
• Organizing the memory. Repeatedly telling the story helps a fragmented, chaotic memory become a coherent one that feels like the past.
• Building confidence. Each exposure you complete is evidence that you can handle hard things, which chips away at beliefs like “I’m weak” or “I can’t cope.”

What Real-Life Exposure Practice Looks Like

You and your clinician build an exposure list together and rate each item from 0 to 100 for how distressing it feels. For someone after a car accident, the list might be:

1. Sitting in a parked car (30)
2. Riding as a passenger on quiet streets (50)
3. Driving around the neighborhood (65)
4. Driving on the highway (85)
5. Driving past the crash site (95)

You start in the middle range and stay in each situation long enough for your anxiety to drop noticeably, usually 30 to 45 minutes, and repeat it several times before moving up. You’re always in control of the pace.

Insurance Coverage

PE is billed as standard outpatient psychotherapy, so most plans with mental health benefits cover it. We’re in-network with Aetna, Optum and UnitedHealthcare, Oscar (through the UnitedHealthcare network), Anthem and Carelon (through Headway), Blue Cross Blue Shield, Ambetter, and others.

We do not accept Medicare or Medicare Advantage plans.

Where We Offer PE

Our clinicians are licensed across 20 states, and we have in-person offices throughout the US. See California, Texas, Florida, and New York, among others. You need to be located in a state where your clinician is licensed during each session.

Frequently Asked Questions

How long does Prolonged Exposure therapy take? Most people complete PE in 8 to 15 weekly sessions. Many notice improvement within the first several weeks.

Is Prolonged Exposure better than EMDR? Neither is better for everyone. Both are first-line PTSD treatments in the VA/DoD guideline, and research generally shows similar results. The best choice depends on your symptoms and preferences.

Is Prolonged Exposure therapy hard? It can be challenging, especially at first, because you approach things you’ve avoided. PE is carefully paced, though, and most people find their distress drops noticeably as they practice.

What are the side effects of Prolonged Exposure? Some people feel more anxious or tired early in treatment, or have more vivid memories for a while. That’s usually temporary, and your clinician will help you manage it.

Does Prolonged Exposure work over video? Yes. Research has found PE delivered by telehealth, including into patients’ homes, works about as well as in-person treatment.

Is Prolonged Exposure covered by insurance? Usually, yes. Insurance typically covers it as outpatient psychotherapy. We’ll check your benefits first. We do not accept Medicare or Medicare Advantage plans.

If you are in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline) or call 911.