A continuum is not a hammer: Response to Lowell and Markowitz (2026) on the exposure continuum model

The Exposure Continuum Model (ECM; Rubinstein et al., 2026) is a framework for identifying and measuring the exposure component across diverse trauma-centered psychotherapies. We respond to Lowell and Markowitz's (2026) commentary on the ECM, which raises important concerns about exposure-centrism in PTSD treatment, concerns we share. However, their commentary critiques a claim the ECM does not make: that exposure is the sole mechanism of PTSD recovery or that this component supersedes other therapeutic processes. We clarify what the ECM does and does not claim, address the extended discussion of Interpersonal Psychotherapy, and argue that identifying a component is not equivalent to replacing a therapy's theory of change. We welcome this debate as part of building shared, empirically testable language for trauma treatment research. The ECM advances this effort by operationalizing two exposure dimensions, Closeness and Standardized Cumulative Dose, which can be empirically tested across treatment modalities.