The exposure continuum model: A theoretical framework for understanding exposure across trauma-centered psychotherapies.

Résumé

Exposure techniques are foundational in trauma treatment, yet their application varies significantly across psychotherapies. This theoretical paper introduces the Exposure Continuum Model (ECM), a novel comprehensive framework that classifies trauma-centered therapeutic approaches along two key dimensions: Closeness (implicit to explicit or indirect to direct exposure) and Standardized Cumulative Dose (repetition and duration) of exposure. These dimensions provide a map that spans across evidence-based trauma-focused therapies (e.g., Prolonged Exposure [PE], Cognitive Processing Therapy [CPT], Eye Movement Desensitization and Reprocessing [EMDR]) and other, trauma-informed modalities (e.g., Interpersonal Psychotherapy [IPT], Somatic Experiencing [SE]). The paper reviews the clinical, cognitive, and neurobiological mechanisms that underpin exposure therapy, highlighting the diversity of its application across different therapeutic modalities. It also offers a detailed description of how these therapies incorporate exposure components and locate them within the model. By offering a structured framework for understanding the exposure component matrix across therapies, this cornerstone paper lays the foundation for future research and practice. These future data-driven explorations will help clinicians refine treatment approaches based on variables such as trauma type, time from trauma, symptom severity, and individual differences among patients, therapists, and therapeutic settings.