Prolonged Exposure for PTSD in Washington state
When Avoidance Becomes Your Prison
Since the trauma, you've been doing everything you can to avoid being reminded of what happened. You stay away from certain places. You avoid people, conversations, movies, or news stories that might trigger memories. You keep yourself busy, distracted, numb. You push the thoughts away when they come. You do whatever it takes not to feel what you felt that day.
And it makes sense. Of course you want to avoid reminders of the worst thing that ever happened to you. Of course you want to protect yourself from that pain, that fear, that helplessness. Avoidance feels like safety.
But somewhere along the way, avoidance stopped protecting you and started controlling you.
Your world has gotten smaller. The list of things you can't do, places you can't go, and feelings you can't tolerate keeps growing. Maybe you can't drive on highways, or go to crowded places, or be alone, or sleep in the dark. Maybe you've lost relationships, quit jobs, or given up activities you once loved—all to avoid being reminded of your trauma.
And despite all this avoidance, the trauma is still with you. The nightmares still come. The flashbacks still hijack your body. The panic still rises out of nowhere. You've rearranged your entire life around avoiding your trauma, and somehow it's still the center of everything.
You're exhausted from running, but you don't know how to stop.
The Paradox of Avoidance
Here's what we know about trauma and the brain: avoidance feels protective in the moment, but over time it actually strengthens your fear. Every time you avoid something that reminds you of your trauma, your brain learns that the reminder is dangerous. The fear grows bigger, the list of things to avoid grows longer, and you become more convinced that you can't handle these memories or feelings.
But here's the truth your trauma won't let you see: remembering is not the same as re-experiencing. A reminder is not the same as the actual event. And you are much stronger than your fear tells you.
Your trauma happened in the past. It's not happening now, even when the memories make it feel like it is. And your brain can learn this—but only if you stop running long enough to let it.
This is the foundation of Prolonged Exposure Therapy.
What Is Prolonged Exposure Therapy?
Prolonged Exposure, or PE, is one of the most researched and effective treatments for PTSD. It's been tested with thousands of trauma survivors—combat veterans, sexual assault survivors, accident survivors, victims of violence, and people who've experienced natural disasters. The research is clear: PE significantly reduces PTSD symptoms and helps people reclaim their lives.
PE works on a straightforward but powerful principle: the way to overcome fear is through it, not around it. By gradually and repeatedly confronting trauma memories and avoided situations in a safe, controlled way, with the support of your therapist, you teach your brain that these reminders are not actually dangerous. You learn that you can handle the feelings that arise. And slowly, the memories lose their power to control you.
This might sound terrifying. But PE isn't about throwing you into the deep end. It's a carefully structured, gradual process where you're in control every step of the way, and your therapist is with you throughout.
How Prolonged Exposure Works
PE typically involves 8 to 15 weekly sessions, each lasting 60-90 minutes. The therapy has several core components that work together to help you process your trauma and reclaim the life avoidance has taken from you.
Learning About Trauma and Treatment
The first sessions focus on education. You'll learn why you're experiencing the symptoms you're experiencing, and why avoidance keeps PTSD going. You'll learn how PE works and why confronting your fears—though it sounds counterintuitive—is actually the path to healing. Understanding the "why" behind the treatment helps you commit to doing the hard work ahead.
In Vivo Exposure: Facing Situations You've Been Avoiding
"In vivo" means "in real life." With your therapist, you'll create a list of situations, places, people, or activities you've been avoiding because they remind you of your trauma—things that are actually safe but feel dangerous.
Then, starting with items that feel moderately challenging (not the hardest ones), you'll gradually begin approaching these situations. You might start by driving past a location you've been avoiding, then parking near it, then eventually going inside. Or you might begin by looking at photos related to your trauma, then watching videos, then visiting similar places.
The key is that you stay in these situations long enough for your anxiety to naturally decrease. At first, your fear will spike—that's expected. But if you stay with it instead of escaping, your anxiety will eventually come down on its own. Your brain begins to learn: "This is uncomfortable, but I can handle it. And I'm actually safe."
Between sessions, you'll practice these exposures repeatedly. Repetition is what teaches your brain the new lesson: these reminders aren't dangerous, and you're capable of tolerating difficult feelings.
Imaginal Exposure: Processing the Trauma Memory
This is often the component people fear most, and it's also one of the most powerful. In imaginal exposure, you'll revisit your trauma memory by describing it aloud to your therapist in detail. You'll include what you saw, heard, smelled, felt physically, and felt emotionally, including the parts you've been trying hardest not to think about.
You will record these sessions, and you'll listen to the recording daily at home.
This probably sounds unbearable. You might be thinking, "I can't do this. This will destroy me. I've been trying not to think about this—why would I deliberately go back there?"
Here's why: right now, the trauma memory has power over you because it's fragmented, unprocessed, and tangled up with overwhelming emotions. Every time you push it away or avoid it, it stays frozen in time, maintaining its emotional intensity. Your brain never gets to learn that the trauma is over, that you survived, and that you can handle the memory.
Through repeated, prolonged revisiting of the memory in a safe environment, something remarkable happens. The memory begins to feel less immediate, less overwhelming. It starts to feel more like a bad thing that happened in the past rather than something that's still happening. The emotions become less intense. You begin to process not just what happened, but what it means—and what it doesn't mean about you, your safety, or your future.
You won't forget what happened. But you'll be able to remember it without being consumed by it.
Processing and Integration
After each imaginal exposure, you and your therapist will process what came up. You'll explore what you learned about your ability to handle difficult feelings. You'll identify and challenge beliefs that might have surfaced—beliefs about your guilt, your worth, or your safety. Over time, you'll begin to integrate this experience into your life story in a way that's less traumatic and more manageable.
What to Expect During Treatment
PE is hard work. Let's be honest about that. You'll face things you've been running from, sometimes for years. Some sessions will be emotionally exhausting.
But you'll also start to notice changes, often sooner than you expect. You might find yourself able to do something you've been avoiding without even planning for it. You might notice that a trigger doesn't affect you as strongly as it used to. You might sleep better. You might feel less on guard, less trapped, more present in your life.
Your therapist will monitor your progress closely and adjust the pace to match what you can handle. You're never forced to do anything. PE is collaborative—you're in the driver's seat, and your therapist is the guide.
Addressing Your Fears About PE
"What if I get overwhelmed and can't handle it?" You'll learn skills to manage anxiety, and you'll build up gradually. Your therapist won't push you beyond what you're ready for. Most importantly, thousands of trauma survivors have done this work successfully. You're stronger than you think, and you won't be doing this alone.
"What if it makes my symptoms worse permanently?" Temporary increases in distress are normal at the beginning, but research shows PE doesn't cause lasting harm. In fact, it's one of the safest and most effective PTSD treatments available. The short-term discomfort leads to long-term relief.
"I'm afraid I'll lose control or fall apart." Feelings—even very intense ones—are not dangerous. They're uncomfortable, but they can't actually harm you. Part of what PE teaches you is that you can experience strong emotions and survive them. Many people discover they're more resilient than they believed.
"What if the trauma wasn't 'bad enough' for this kind of treatment?" If you're experiencing PTSD symptoms, your trauma was bad enough. There's no hierarchy of suffering. If it's affecting your life, you deserve effective treatment, regardless of whether your trauma "seems" as severe as someone else's.
"Can I do PE if I have multiple traumas?" Yes. You'll typically focus on one trauma at a time, often the one causing the most distress. Skills learned while processing one trauma often help with others. For complex or chronic trauma, treatment may be longer, but PE can still be effective.
Frequently Asked Questions
Do you provide Prolonged Exposure for Adolescents?
Yes, DBT Center of Tacoma has clinicians who specialize in treating adolescents and adults with PTSD.
What if I can’t drive to your office? Can you really do Prolonged Exposure via telehealth?
Yes, DBT Center of Tacoma provides Prolonged Exposure via telehealth for clients located across the state of Washington, in addition to in-person at our Ruston office. There is research to show that Prolonged Exposure can be as effective when delivered by telehealth compared to in-person.
What if I’m not sure what treatment would be most effective to help my PTSD?
That makes sense. There are a number of treatment options! We are happy to conduct an initial assessment to get to know you and your PTSD symptoms, and to describe treatment options and help you make an informed decision about how you’d like to proceed in treatment. You don’t have to have it all figured out before you start the work with us.
Life After Prolonged Exposure
The goal of PE isn't just symptom reduction, though most people experience significant relief from nightmares, flashbacks, hypervigilance, and avoidance. The deeper goal is freedom.
Freedom to go where you want to go. To do things you've been putting off. To be present with people you love. To sleep peacefully. To experience joy without guilt or numbness. To make decisions based on what you want rather than what you fear.
PE helps you take back the parts of your life that trauma stole. It doesn't erase what happened—nothing can do that. But it changes your relationship with what happened. The trauma becomes something you carry differently, something that no longer defines every moment of your present and future.
You learn that you're not broken. You're not weak. You're someone who survived something terrible and had normal reactions to an abnormal event. And you're someone who can heal.
Taking the First Step
Choosing to start PE takes courage. You've been avoiding for good reasons, and deciding to stop avoiding means facing what you've been running from.
But consider this: you've already survived the worst day. The actual trauma is over. What PE offers is a chance to finally let it be over—not just factually, but emotionally. To stop living as if the danger is still present. To move from surviving to truly living.
You don't have to stay trapped in avoidance. You don't have to keep running. There's another way, and we can walk this path with you.
Your trauma is part of your story, but it doesn't have to be the story that keeps you stuck. Let's help you turn the page.
Ready to get started?
We make it easy to begin your healing journey. You don't have to do this alone anymore.
Book a free phone consultation with our intake specialist, Zoe, through our secure calendar. You can ask questions to help figure out the best next step.
You can also give us a call at 253-434-4220. Leave a message, and we’ll get back to you within 1 business day.