APA's Clinical Practice Guideline strongly recommends four interventions for treating posttraumatic stress disorder, and conditionally recommends another four.
The information below about the recommended interventions is intended to provide clinicians with a basic understanding of the specific treatment approach. Clinicians are encouraged to become familiar with each of the different interventions to determine which of these might be consistent with their practice, to develop a plan for additional training and professional development, and to become informed about the range of evidence-based treatment options in order to help patients with decision making and any necessary referrals. The information contained herein is not sufficient to enable one to become proficient in delivering these treatments. Clinicians are encouraged to pursue training opportunities and, to become fully competent in new interventions, receive consultation or supervision while first delivering the intervention.
Four interventions are strongly recommended, all of which are variations of cognitive behavioral therapy (CBT). The category of CBT encompasses various types and elements of treatment used by cognitive behavioral therapists, while Cognitive Processing Therapy, Cognitive Therapy and Prolonged Exposure are all more specialized treatments that focus on particular aspects of CBT interventions.
Cognitive behavioral therapy focuses on the relationships among thoughts, feelings and behaviors; targets current problems and symptoms; and focuses on changing patterns of behaviors, thoughts and feelings that lead to difficulties in functioning.
Cognitive behavioral therapy notes how changes in any one domain can improve functioning in the other domains. For example, altering a person’s unhelpful thinking can lead to healthier behaviors and improved emotion regulation. It is typically delivered over 12-16 sessions in either individual or group format.
Cognitive processing therapy is a specific type of cognitive behavioral therapy that helps patients learn how to modify and challenge unhelpful beliefs related to the trauma.
CPT is generally delivered over 12 sessions and helps patients learn how to challenge and modify unhelpful beliefs related to the trauma. In so doing, the patient creates a new understanding and conceptualization of the traumatic event so that it reduces its ongoing negative effects on current life.
Several published CPT case examples exist in the literature, but many find the one in this chapter to be very helpful:
Monson, C. M., Resick, P. A., & Rizvi, S. L. (2014). Posttraumatic stress disorder. In D. H. Barlow (Ed.), Clinical handbook of psychological disorders (5th ed.). New York, NY: Guilford.
Additional CPT case examples include:
Difede, J., & Eskra, D. (2002). Cognitive Processing Therapy for PTSD in a Survivor of the World Trade Center Bombing: A Case Study. Journal of Trauma Practice, 1(3-4), 155-165.
König, J. (2014). Thoughts and Trauma – Theory and Treatment of Posttraumatic Stress Disorder from a Cognitive Behavioral Therapy Perspective. Intervalla: platform for intellectual exchange, 2, 13- 19.
Wachen, J. S., Dondanville, K. A., Pruiksma, K. E., Molino, A., Carson, C. S., & Blankenship, A. E … Resick, P. A. (2015). Implementing Cognitive Processing Therapy for Posttraumatic Stress Disorder With Active Duty U.S. Military Personnel: Special Considerations and Case Examples. Cognitive and Behavioral Practice, 23(2), 133-147.
Waltman, S. H. (2015). Functional Analysis in Differential Diagnosis: Using Cognitive Processing Therapy to Treat PTSD. Clinical Case Studies, 14(6), 422-433.
- Cognitive Processing Therapy Course: An overview of CPT, including the research support and information about delivering the treatment, produced by the VA. No CE credit.
- Cognitive Processing Therapy for PTSD: A Comprehensive Manual: A Guilford Press publication, by Patricia A. Resick, PhD, Candice M. Monson, PhD, and Kathleen M. Chard, PhD.
Derived from cognitive behavioral therapy, cognitive therapy entails modifying the pessimistic evaluations and memories of trauma, with the goal of interrupting the disturbing behavioral and/or thought patterns that have been interfering in the person’s daily life.
Treatment entails modifying the pessimistic evaluations and memories of trauma, with the goal of interrupting the disturbing behavioral and/or thought patterns that have been interfering in the person’s daily life. It is typically delivered in weekly sessions over three months individually or in groups.
Prolonged exposure is a specific type of cognitive behavioral therapy that teaches individuals to gradually approach trauma-related memories, feelings and situations. By facing what has been avoided, a person presumably learns that the trauma-related memories and cues are not dangerous and do not need to be avoided.
Typically provided over a period of about three months with weekly individual sessions. Sixty- to 120-minute sessions are usually needed in order for the individual to engage in exposure and sufficiently process the experience.
Brief eclectic psychotherapy combines elements of cognitive behavioral therapy with a psychodynamic approach. It focuses on changing the emotions of shame and guilt and emphasizes the relationship between the patient and therapist.
As conducted in research studies, treatment consists of 16 individual sessions, each lasting between 45 minutes and one hour. Sessions are typically scheduled once per week. Each of the 16 sessions has a specific objective. This intervention is intended for individuals who have experienced a single traumatic event.
A structured therapy that encourages the patient to briefly focus on the trauma memory while simultaneously experiencing bilateral stimulation (typically eye movements), which is associated with a reduction in the vividness and emotion associated with the trauma memories.
EMDR is an individual therapy typically delivered 1-2 times per week for a total of 6-12 sessions. It differs from other trauma-focused treatments in that it does not include extended exposure to the distressing memory, detailed descriptions of the trauma, challenging of beliefs, or homework assignments.
Narrative exposure therapy helps individuals establish a coherent life narrative in which to contextualize traumatic experiences. It is known for its use in group treatment for refugees.
NET is distinct from other treatments in its explicit focus on recognizing and creating an account or testament of what happened, in a way that serves to recapture the patient’s self-respect and acknowledges their human rights. Often, small groups of individuals receive four to 10 sessions of NET together, although it also can be provided individually.
Summary & Case Example
Four medications received a conditional recommendation for use in the treatment of PTSD: sertraline, paroxetine, fluoxetine and venlafaxine.
Currently only the SSRIs sertraline (Zoloft) and paroxetine (Paxil) are FDA-approved for the treatment of PTSD. While SSRIs are typically the first class of medications used in PTSD treatment, exceptions may occur for patients based upon their individual histories of side effects, response, comorbidities, and personal preferences.
This website is for informational and educational purposes only. It does not render individual professional advice or endorse any particular treatment for any individuals. APA recommends that individuals consult with a mental health professional in order to obtain an accurate diagnosis and to discuss various treatment options. When you meet with a professional, be sure to work together to establish clear treatment goals and to monitor progress toward those goals. Even treatments that have scientific support will not work for everyone, and carefully monitoring your progress will help you and your mental health professional decide if a different approach should be tried. Feel free to print information from this website and take it with you to discuss with your mental health professional.