Exposure in PE-IOP

Intensive Outpatient ◽

The Individual

This chapter presents in-depth details of how to implement the exposure component of the Prolonged Exposure-Intensive Outpatient Program (PE-IOP), including places where variation is acceptable and why. The authors present the logistics and rationale for individual sessions that include imaginal exposure and individualized trauma emotional processing. In addition, the authors present in vivo group exposure session logistics and rationale. The in vivo group includes the general psychoeducation components of PE, the in vivo exposure hierarchy creation, and the practice of in vivo exposure. The exposures may occur in a group or individually, escorted or non-escorted, as clinically indicated for the individual patient.

Variations and How to Decide

Prolonged Exposure for PTSD in Intensive Outpatient Programs (PE-IOP) ◽

10.1093/med-psych/9780190081928.003.0008 ◽

2020 ◽

pp. 115-122

Author(s):

Sheila A. M. Rauch ◽

Barbara O. Rothbaum ◽

Erin R. Smith ◽

Edna B. Foa

Keyword(s):

Program Design ◽

Prolonged Exposure ◽

Imaginal Exposure ◽

Outpatient Program ◽

This therapist guide presents the scaffold and structure for the Prolonged Exposure-Intensive Outpatient Program (PE-IOP). The program is focused on exposure as provided through individual imaginal exposure and group in vivo exposure. The format presented is based primarily on the model used in the Emory Healthcare Veterans Program (EHVP), but this chapter provides a focus on the most common variations in program design with a discussion of how to decide between the different potential variations. Relevant inclusions and exclusions are presented along with rationales.

Foundations of Prolonged Exposure

Prolonged Exposure for PTSD in Intensive Outpatient Programs (PE-IOP) ◽

10.1093/med-psych/9780190081928.003.0001 ◽

2020 ◽

pp. 1-10

Author(s):

Sheila A. M. Rauch ◽

Barbara O. Rothbaum ◽

Erin R. Smith ◽

Edna B. Foa

Keyword(s):

Primary Care ◽

Patient Care ◽

Emotional Processing ◽

Prolonged Exposure ◽

Mechanisms Of Change ◽

Alternative Treatments ◽

Processing Theory ◽

Outpatient Program ◽

This chapter presents the foundations for prolonged exposure (PE) therapy as they have been developed in emotional processing theory to immerse the provider in theory that will guide all decisions during PE, whether they are using the intensive outpatient program (PE-IOP) in this manual or another model (e.g., PE-Primary Care, or standard PE). The authors present a discussion on how PE works and on the research supporting the theorized mechanisms of change. In addition, alternative treatments are described, including medication and considerations for patients who are already on medications when they are engaged in PE-IOP. The chapter ends with a discussion of why this PE-IOP model was developed and when it may be indicated for patient care.

Introduction

Reclaiming Your Life from a Traumatic Experience ◽

10.1093/med-psych/9780190926892.003.0001 ◽

2019 ◽

pp. 1-10

Author(s):

Barbara Olasov Rothbaum ◽

Edna B. Foa ◽

Elizabeth A. Hembree ◽

Sheila A. M. Rauch

Keyword(s):

Emotional Processing ◽

Stress Disorder ◽

Prolonged Exposure ◽

Perceived Threat ◽

Imaginal Exposure ◽

Loved One ◽

Processing Theory ◽

Therapy Program ◽

Threat To Life

Posttraumatic stress disorder (PTSD) is a fear and stress disorder that may develop after an event that is experienced or witnessed and involves actual or perceived threat to life or physical integrity to oneself or a loved one. This chapter discusses the characteristics of the disorder and explains both prolonged exposure (PE) therapy and Emotional Processing Theory. Readers will learn about the benefits and risks of the treatment as well as what is involved. The main tools of this therapy program, imaginal exposure and in vivo exposure, are presented.

Intensive Outpatient Program Using Prolonged Exposure for Combat-Related PTSD: A Case Study

Cognitive and Behavioral Practice ◽

10.1016/j.cbpra.2021.06.001 ◽

2021 ◽

Author(s):

Casey L. Straud ◽

Tabatha H. Blount ◽

Carmen P. McLean ◽

Cindy A. McGeary ◽

Lauren M. Koch ◽

...

Keyword(s):

Prolonged Exposure ◽

Outpatient Program ◽

Daily Session Schedule

Prolonged Exposure for PTSD in Intensive Outpatient Programs (PE-IOP) ◽

10.1093/med-psych/9780190081928.003.0007 ◽

2020 ◽

pp. 101-114

Author(s):

Sheila A. M. Rauch ◽

Barbara O. Rothbaum ◽

Erin R. Smith ◽

Edna B. Foa

Keyword(s):

Prolonged Exposure ◽

Daily Session ◽

Improve Efficiency ◽

Outpatient Program ◽

This chapter presents how all the pieces of the Prolonged Exposure-Intensive Outpatient Program (PE-IOP) fit together to form a program. The authors discuss areas for variations and ways to improve efficiency. Each day of the PE-IOP program is described, with each component noted and the detailed specifics outlined. Suggested time markers for sessions are presented.

Foundations of Prolonged Exposure

Prolonged Exposure Therapy for PTSD ◽

10.1093/med-psych/9780190926939.003.0001 ◽

2019 ◽

pp. 1-22

Author(s):

Edna B. Foa ◽

Elizabeth A. Hembree ◽

Barbara Olasov Rothbaum ◽

Sheila A. M. Rauch

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Emotional Distress ◽

Emotional Processing ◽

Stress Disorder ◽

Prolonged Exposure ◽

Traumatic Events ◽

Ptsd Symptoms ◽

Imaginal Exposure

Foundations of prolonged exposure (PE) include (1) education about common reactions to trauma, what maintains trauma-related symptoms, and how PE reduces posttraumatic stress disorder (PTSD) symptoms; (2) repeated in vivo confrontation with situations, people, or objects that the patient is avoiding because they are trauma-related and cause emotional distress such as anxiety, shame, or guilt; and (3) repeated, prolonged imaginal exposure to the trauma memories followed by processing the details of the event, the emotions, and the thoughts that the patient experienced during the trauma. The aim of in vivo and imaginal exposure is to enhance emotional processing of traumatic events by helping the patient face the trauma memories and reminders and process the emotions and thoughts, as well as the details of the trauma that emerge during revisiting experiences.

Integrative Interventions

Prolonged Exposure for PTSD in Intensive Outpatient Programs (PE-IOP) ◽

10.1093/med-psych/9780190081928.003.0006 ◽

2020 ◽

pp. 93-100

Author(s):

Sheila A. M. Rauch ◽

Barbara O. Rothbaum ◽

Erin R. Smith ◽

Edna B. Foa

Keyword(s):

Patient Population ◽

Prolonged Exposure ◽

The Core ◽

Normal Part ◽

Positive Coping ◽

Outpatient Program ◽

In addition to the core of prolonged exposure in the Prolonged Exposure-Intensive Outpatient Program (PE-IOP), the program also includes integrative interventions designed to encourage positive coping, wellness, and maintenance of gains from PE-IOP. These integrative interventions can vary based on availability, cost, patient population, etc. While they can vary, program implementers should be cautious that the chosen interventions have a general rationale that fits the overall PE-IOP milieu by supporting approaching and not avoiding trauma memories and reminders and that emotions are not dangerous but a normal part of life. The authors discuss the rationale for inclusion of interactive interventions as well as how to decide what interventions to use.