Prolonged Exposure

Practise Prolonged Exposure for PTSD either way round: take one patient through a whole course of treatment in the right order (rationale, distress scale and the list of avoided situations, telling the memory aloud and its repetitions, hot spots, and the ending), or step into a single session and practise that skill on its own. The case carries forward between sessions, and the treatment ends when the patient is ready rather than after a fixed number of hours.

What you practise

• Build the treatment rationale with the patient instead of delivering it at them.
• Establish one memory as the treatment target and hold it against competing material.
• Anchor the 0-100 distress scale in the patient's own life and build a graded list of avoided situations from it.
• Guide the patient through telling the memory aloud in the present tense, with concrete, one-at-a-time questions.
• Track distress often enough to steer the session and briefly enough not to break engagement.
• Adjust the intensity in both directions: neither push on when the patient has gone absent, nor retreat from distress.

Who you can meet

• Elias, 24 — Young man with ADHD and severe mistrust after being robbed at gunpoint in a forest by masked men after a friend set him up. Avoids friends, forests, night travel, and any situation where he cannot control exits.
• Johanna, 34 — A 34-year-old pharmacist with PTSD after a van ran a red light and struck her car eight months ago. A single trauma with no other diagnoses: motivated, precise, easy to interview, and quietly avoidant. She never resists out loud; she slips out of the memory into polite, fluent reporting.
• Vera, 51 — Licensed psychologist with fifteen years of Prolonged Exposure practice and a supervisor's calm. She takes you back through a memory in the present tense, asks for the same moment again, and does not reassure you out of it. Useful focus: notice what keeps you inside the memory, what pulls you out, and what the repetition does.

What the feedback looks at

• Rationale delivery
• Establishing the treatment target
• Anchoring the distress scale
• Building the in-vivo hierarchy
• Setting up and guiding the narrative
• Tracking distress
• Titration and pacing
• Hot spots

Rated against: Dimensions adapted from the session components of Prolonged Exposure as described in the PE therapist manual (Foa, Hembree, Rothbaum & Rauch), VA National Center for PTSD materials, and NICE NG116. No published competence instrument exists for PE — fidelity ratings used in trials come from an unpublished adherence and competence protocol — so this rubric is PsychBase's own work rather than an adaptation of a validated scale. Scores here are generated by an AI reviewer for practice feedback and are not equivalent to fidelity coding by a trained human rater. Nothing here is endorsed or certified by any manual author or issuing body.

This lab is for clinical training. The patient is generated by an AI language model from a written case; no real patient and no patient data are involved. Browsing is open; starting a session needs a free account.