Prolonged Exposure Therapy Online
After a trauma, avoiding reminders feels like protection. You skip the highway, leave the TV off, or push the memory away. Over time, though, avoidance keeps fear alive and your world gets smaller. Prolonged Exposure (PE) therapy is a well-researched treatment for posttraumatic stress disorder (PTSD) that helps you face what you’ve been avoiding, gradually and safely, so the memories lose their power. Select clinicians are trained in PE and offer it online by secure video in the states where they’re licensed; ask when you book.
What Is Prolonged Exposure Therapy?
PE is a form of Cognitive Behavioral Therapy (CBT) developed by psychologist Edna Foa and colleagues. 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 (some programs use 60 minutes), with four main parts.
1. Education. How PTSD works and why avoidance keeps symptoms going.
2. Breathing retraining. A simple slow-breathing skill for day-to-day anxiety.
3. In-vivo exposure (real-life practice). You and your clinician list situations you avoid because they feel dangerous, even though they’re objectively safe, such as driving or crowds, then gradually approach them, starting with easier items.
4. Imaginal exposure. In session, you revisit the trauma memory out loud, in the present tense, for an extended period, then talk through what came up. Sessions are recorded so you can listen between sessions, which helps the memory become painful rather than a present-tense threat.
Between sessions, you’ll practice real-life exposures and listen to the recordings, a key part of PE’s results.
What Does a PE Session Look Like Online?
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, including a randomized trial delivering PE by video into patients’ homes that found it works about as well as in person. Your clinician will help you set up a private space and a grounding plan. 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 a 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 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, living with an abusive partner), 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; many people with depression, anxiety, or a long trauma history do very well with PE.
What Makes PE Effective
Researchers think PE works for three main reasons:
- Learning safety. Staying with the memory or situation teaches your brain it isn’t dangerous and that anxiety comes down on its own.
- Organizing the memory. Retelling helps a fragmented memory become a coherent one that feels like the past.
- Building confidence. Each exposure is evidence that you can handle hard things.
What Real-Life Exposure Practice Looks Like
You and your clinician build an exposure list and rate each item from 0 to 100 for distress. After a car accident, it might be:
- Sitting in a parked car (30)
- Riding as a passenger on quiet streets (50)
- Driving around the neighborhood (65)
- Driving on the highway (85)
- Driving past the crash site (95)
You start in the middle range, stay until your anxiety drops noticeably (usually 30 to 45 minutes), and repeat before moving up. You’re always in control of the pace.
Insurance Coverage
We’re in-network with Aetna, Optum and UnitedHealthcare, Oscar (through the UnitedHealthcare network), Blue Cross Blue Shield, Ambetter (in Washington only), and others. Depending on the clinician and state, some of our clinicians also accept Anthem.
We do not accept Medicare or Medicare Advantage plans.
Where We Offer PE
Psychological Healing has 40 clinicians, offering in-person sessions in 20 states and video sessions in 44 states. 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? Usually 8 to 15 weekly sessions, with many people improving within the first several weeks.
Is Prolonged Exposure therapy hard? It can be challenging at first because you approach what you’ve avoided, but PE is carefully paced and distress usually drops noticeably with 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.
Is Prolonged Exposure covered by insurance? Usually, yes. Insurance typically covers it as outpatient psychotherapy. We’ll check your benefits first.
If you are in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline) or call 911.
Clinically reviewed by Karan Singh, Ph.D.
Last reviewed October 16, 2026