Exposure reconceptualized as transtheoretical approach: Commentary on Rubenstein et al. (2024)

This commentary on Rubenstein et al. (2024) appreciates how they advance the debate on exposure therapy and best practices in posttraumatic stress disorder treatment. Their historical analysis, though, points to a way forward they fail to explore-reconceptualizing exposure as transtheoretical approach. This reconceptualization shows that diverse theoretical traditions converge on exposure/approach clinical practices, which should bolster our confidence in these interventions. Moreover, this reconceptualization could help address issues with provider uptake and patient dropout. Rubenstein and colleagues also miss that prolonged exposure contains opportunities for therapeutic memory reconsolidation through processing and that non-trauma-focused therapies do not offer patients the opportunity to process and change trauma-specific, maladaptive, posttraumatic cognitions in the ways that approach-based treatments do. Finally, it is argued that Rubenstein and colleagues' discussion of dropout in exposure and possible uses of non-trauma-focused treatments could be better grounded in (a) meta-analytic results, which find comparatively similar dropout rates among trauma-focused treatments, and (b) major treatment guidelines, which support approach-based treatments as frontline options. (PsycInfo Database Record (c) 2026 APA, all rights reserved).