prolonged-exposure-protocol

id	611c72f6-2e06-5a28-8736-a34661e8519a
name	Prolonged Exposure Protocol
description	A structured, evidence-based macro-level treatment framework for PTSD involving repeated imaginal and in vivo exposure to trauma memories and avoided stimuli.
version	0.1.0
tags	["PTSD","exposure","trauma_recovery","behaviorism","manualized","行为主义","profile:psychology::行为主义","axis:疗法","kind:parent"]
triggers	["Client has confirmed PTSD diagnosis","Client is psychologically stable enough for exposure work","Client consents to trauma memory reprocessing"]
examples	[{"input":"Client endorses daily flashbacks, avoids driving past earthquake site, reports panic when hearing sirens","output":"Therapist introduces PE rationale, co-constructs in vivo hierarchy (e.g., drive 1 block near site → sit in car at site → walk 5 min there), assigns first exposure task with SUDS tracking","notes":"First in vivo assignment prioritizes control and predictability"}]

Prolonged Exposure Protocol

A structured, evidence-based macro-level treatment framework for PTSD involving repeated imaginal and in vivo exposure to trauma memories and avoided stimuli.

Prompt

Deliver as a manualized 8–15 session protocol: begin with psychoeducation and breathing retraining; conduct imaginal exposure (recounting trauma aloud with present-tense detail) for 30–45 min per session, followed by processing; assign in vivo exposure homework targeting real-world avoided situations; review adherence and distress ratings weekly; monitor habituation across sessions using SUDS. Maintain fidelity via session checklists and audio review.

Objective

Reduce PTSD symptoms through habituation and emotional processing of trauma memories

Applicable Signals

• Client reports persistent avoidance of trauma reminders
• Client endorses intrusive memories or flashbacks
• Client shows physiological reactivity during trauma narrative

Contraindications

• Active suicidal ideation without safety plan
• Acute dissociation or psychosis
• Client refuses exposure components

Intervention Moves

• Psychoeducation about PTSD and PE rationale
• Breathing retraining for arousal regulation
• Imaginal exposure with present-tense recounting
• In vivo exposure hierarchy development and practice
• Processing time after imaginal exposure

Workflow Steps

• 1. Assess eligibility and obtain informed consent
• 2. Conduct baseline assessment (e.g., CAPS-5, PCL-5)
• 3. Deliver psychoeducation and breathing retraining (Sessions 1–2)
• 4. Introduce and conduct imaginal exposure (Sessions 3–10+)
• 5. Introduce and assign in vivo exposure (Sessions 3–15)
• 6. Review progress, adjust hierarchy, reinforce gains (weekly)

Constraints

• Must not proceed to imaginal exposure before establishing grounding skills and therapeutic alliance
• Imaginal exposure must be conducted within client's window of tolerance—pause if dissociation or extreme distress occurs
• In vivo exposure must be collaboratively graded and never coercive

Cautions

• Monitor for emotional flooding or retraumatization
• Avoid exposure if client lacks current safety (e.g., ongoing abuse)