--- title: "PPRNet Clinical summary: To Expose or Not to Expose When Treating PTSD" description: The director of the Psychotherapy Practice Research Network (PPRNet) is Dr. Giorgio Tasca. Dr. Tasca is an Associate Professor with the School of Psychology, in the Faculty of Social, University of Ottawa. His research focus is on psychotherapy process, mechanisms of change, and outcomes, as well as eating disorders. image: https://collabzium.com/hubfs/chub_backup/iStock-13.jpg --- [![FAC_SOCIAL_SCIENCE_HEADER_BAR](https://collabzium.com/hubfs/FAC_SOCIAL_SCIENCE_HEADER_BAR.svg "FAC_SOCIAL_SCIENCE_HEADER_BAR")](https://www.uottawa.ca/faculty-social-sciences/) [![Collabzium](https://collabzium.com/hubfs/CollabziumLogoEnglish(Name)-COLOUR.svg "Collabzium")](https://collabzium.com/) - Articles - [Collabzium Guide](https://collabzium.com/en/articles/author/collabzium-guide) - [All articles](https://collabzium.com/en/articles) - Research - [Chairs and Labs](https://collabzium.com/en/chair-and-labs) - [About](https://collabzium.com/collabcrew) [Subscribe](https://20500402.hubspotpagebuilder.com/subscribe-now) [Subscribe](https://20500402.hubspotpagebuilder.com/subscribe-now) [PPRNET](https://collabzium.com/en/articles/tag/pprnet) # PPRNet Clinical summary: To Expose or Not to Expose When Treating PTSD [Dr. Giorgio Tasca](https://collabzium.com/en/articles/author/dr-giorgio-tasca) calendar icon Dec 03, 2025 · Reading time 2 min read [mailto:?subject=Check%20out%20https://collabzium.com/en/articles/pprnet-clinical-summary-to-expose-or-not-to-expose-when-treating-ptsd&utm_medium=social&utm_source=email%20&body=Check%20out%20https://collabzium.com/en/articles/pprnet-clinical-summary-to-expose-or-not-to-expose-when-treating-ptsd&utm_medium=social&utm_source=email](mailto:?subject=Check%20out%20https://collabzium.com/en/articles/pprnet-clinical-summary-to-expose-or-not-to-expose-when-treating-ptsd&utm_medium=social&utm_source=email%20&body=Check%20out%20https://collabzium.com/en/articles/pprnet-clinical-summary-to-expose-or-not-to-expose-when-treating-ptsd&utm_medium=social&utm_source=email) Posttraumatic Stress Disorder (PTSD) can be a debilitating and chronic condition affecting as many as 8% of the [population](https://trk.cp20.com/click/gs5t-2zqro3-921t4-l89bayk0/) in the U.S. Treatment [guidelines](https://trk.cp20.com/click/gs5t-2zqro3-921t5-l89bayk1/) state that controlled exposure to traumatic memories is a common element of effective treatments for PTSD. Exposure refers to the deliberate and systematic confrontation of feared objects or memories in a safe context. A modern variant of exposure therapy derives from a fear-based model of PTSD that comes out of Pavlovian conditioning theory, which also informs behavioural therapy for anxiety disorders. Prolonged exposure therapy ([PE](https://trk.cp20.com/click/gs5t-2zqro3-921t6-l89bayk2/) ) for PTSD provides the most sustained and intensive exposure to trauma memories or cues. However, more than 50% of patients with PTSD in clinical trials [drop out](https://trk.cp20.com/click/gs5t-2zqro3-921t7-l89bayk3/) of exposure-based treatments, and many patients retain residual symptoms. The results are even worse in [military](https://trk.cp20.com/click/gs5t-2zqro3-921t8-l89bayk4/) veterans. Some writers view exposure as potentially [damaging](https://trk.cp20.com/click/gs5t-2zqro3-921t9-l89bayk5/), especially for multiply traumatized patients. In this paper, Rubenstein and colleagues review the history and research related to exposure-based therapies for PTSD to address whether in-session prolonged exposure is necessary to treat PTSD. The concept of exposure in a safe context as a treatment dates back to Janet and Freud in the 19th century and was systematized by [Kardiner](https://trk.cp20.com/click/gs5t-2zqro3-921ta-l89bayk5/), a psychoanalyst who treated military personnel during World War II. Kardiner’s treatment tended to leave the intensity and duration of exposure up to the patient. PTSD was first conceptualized as a variant of anxiety disorder by classical conditioning behaviour therapists, like Wolpe, in the 1960s, during which the notion of prolonged exposure, response prevention, and habituation was advanced. However, prolonged exposure alone as a theory of therapy for PTSD has met with limited empirical support. [New theories](https://trk.cp20.com/click/gs5t-2zqro3-921tb-l89bayk6/) of PE suggest that cognitive changes, rather than duration of exposure, are necessary to reduce symptoms. Consistent with this idea and early 20th -century psychoanalytic models, “newer” treatments that do not require within-session prolonged exposure have been tested with good results. For example, present-centred therapy ([PCT](https://trk.cp20.com/click/gs5t-2zqro3-921tc-l89bayk7/)) focuses on establishing a supportive therapeutic relationship, providing psychoeducation, and engaging in problem-solving. Interpersonal psychotherapy ([IPT](https://trk.cp20.com/click/gs5t-2zqro3-921td-l89bayk8/) ) addresses the interpersonal consequences of trauma and helps patients access social support. Acceptance and commitment therapy ([ACT](https://trk.cp20.com/click/gs5t-2zqro3-921te-l89bayk9/)) reduces experiential avoidance and emphasizes acceptance rather than reduction of symptoms to increase tolerance of distress.  Practice Implications  As 19th and early 20th century clinicians concluded, exposure does not always result in PTSD remission; rather, psychological and social changes and a trusting therapeutic relationship are key. Recent theories challenge the idea that PTSD is solely a fear-based disorder. Non-exposure-based therapies can be effective because patients likely engage in spontaneous, self-directed exposure outside of therapy sessions and because they experience a sense of safety with a warm, trustworthy therapist during sessions. As Rubenstein and colleagues conclude, a one-size-fits-all model of treating PTSD is ill-advised, and treatments should address the “[holistic](https://trk.cp20.com/click/gs5t-2zqro3-921tf-l89bayk0/) ” needs of the patient rather than targeting trauma memories alone.  >  Rubenstein, A., Duek, O., Doran, J., & Harpaz-Rotem, I. (2024). To expose or not to expose: A comprehensive perspective on treatment for posttraumatic stress disorder. *American Psychologist, 79*(3), 331–343. [https://doi.org/10.1037/amp0001121](https://trk.cp20.com/click/gs5t-2zqro3-921tg-l89bayk1/)   calendar icon Dec 03, 2025 · Reading time 2 min read [mailto:?subject=Check%20out%20https://collabzium.com/en/articles/pprnet-clinical-summary-to-expose-or-not-to-expose-when-treating-ptsd&utm_medium=social&utm_source=email%20&body=Check%20out%20https://collabzium.com/en/articles/pprnet-clinical-summary-to-expose-or-not-to-expose-when-treating-ptsd&utm_medium=social&utm_source=email](mailto:?subject=Check%20out%20https://collabzium.com/en/articles/pprnet-clinical-summary-to-expose-or-not-to-expose-when-treating-ptsd&utm_medium=social&utm_source=email%20&body=Check%20out%20https://collabzium.com/en/articles/pprnet-clinical-summary-to-expose-or-not-to-expose-when-treating-ptsd&utm_medium=social&utm_source=email) --- ### [By Dr. Giorgio Tasca](https://collabzium.com/en/articles/author/dr-giorgio-tasca) The director of the Psychotherapy Practice Research Network (PPRNet) is Dr. Giorgio Tasca. Dr. Tasca is an Associate Professor with the School of Psychology, in the Faculty of Social Sciences at the University of Ottawa. His research is centered around psychotherapy process, mechanisms of change, and outcomes, as well as eating disorders. ## Also Read - [PPRNet Clinical summary: Long-Term Effects of Psychotherapies for Depression](https://collabzium.com/en/articles/pprnet-clinical-summary-long-term-effects-of-psychotherapies-for-depression) - [PPRNet Clinical summary: Self-Compassion as a Protective Factor Against Burnout in Psychologists](https://collabzium.com/en/articles/pprnet-clinical-summary-self-compassion-as-a-protective-factor-against-burnout-in-psychologists) - [PPRNet Clinical summary: The Therapeutic Alliance in Internet-Based Interventions](https://collabzium.com/en/articles/pprnet-clinical-summary-1.-the-therapeutic-alliance-in-internet-based-interventions) - [PPRNet Clinical summary: What Do Individuals With Borderline Personalities Want From Treatment?](https://collabzium.com/en/articles/pprnet-clinical-summary-what-do-individuals-with-borderline-personalities-want-from-treatment) #### RELATED NEWS ![PPRNet Clinical summary: Therapists Are Unable to Identify Patients Who Get Worse](https://collabzium.com/hs-fs/hubfs/iStock-1206150255-1.jpg?width=600&name=iStock-1206150255-1.jpg) [PPRNET](https://collabzium.com/en/articles/tag/pprnet) ## [PPRNet Clinical summary: Therapists Are Unable to Identify Patients Who Get Worse](https://collabzium.com/en/articles/clinical-summary-which-patients-benefit-most-from-being-matched-to-a-therapist-0-3-1-0-1-2-0-0-0-1) Psychotherapy is effective in helping patients to reduce their symptoms. However, approximately 5%... Dec 04, 2024Reading time 2 min read ![Clinical summary: Therapists and Patients Who Agree on Their Experience of the Therapeutic Alliance](https://collabzium.com/hs-fs/hubfs/George%20Tasca-2.jpg?width=600&name=George%20Tasca-2.jpg) [PPRNET](https://collabzium.com/en/articles/tag/pprnet) ## [Clinical summary: Therapists and Patients Who Agree on Their Experience of the Therapeutic Alliance](https://collabzium.com/en/articles/clinical-summary-which-patients-benefit-most-from-being-matched-to-a-therapist-0-3-1) The therapeutic alliance is the agreement between the psychotherapist and the patient on the tasks... 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