Common Challenges in Conducting Prolonged Exposure Therapy With Active Duty Service Members: Case Discussion and Strategies for Intervention

Brooke Fina, Edward C. Wright, Tracey K. Lichner, Adam Borah, Edna B. Foa

Research output: Contribution to journalArticle


Prolonged Exposure (PE) Therapy receives most of its empirical support from trials conducted with civilian posttraumatic stress disorder (PTSD) populations. There has been only limited research on its use with military personnel with combat-related PTSD, and as a consequence, there has been less clinical discussion detailing its application with active duty service members. The purpose of this paper is to highlight two challenges that commonly arise when conducting PE with active duty service members: 1) selecting the most appropriate index event to focus on in imaginal exposure out of the numerous traumas an active duty patient is likely to have experienced, and 2) patients’ tendency to engage in “safety behaviors,” which undermine the effectiveness of in vivo exposure. The nature of these challenges is explored from a theoretical perspective, along with two case examples to illustrate their presentation in treatment. Specific strategies for addressing them are reviewed.

Original languageEnglish (US)
Pages (from-to)482-499
Number of pages18
JournalSocial Work in Mental Health
Publication statusPublished - Nov 7 2014



  • PTSD
  • Prolonged Exposure therapy
  • case study
  • cognitive behavioral therapy
  • mental health
  • military

ASJC Scopus subject areas

  • Social Sciences (miscellaneous)
  • Public Health, Environmental and Occupational Health

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