Learn the top-recommended therapies for PTSD, plus how and why they work.
I haven’t come across a mental health condition that has more myth and misunderstanding around it than post-traumatic stress disorder (PTSD). Here are some common things I hear:
Myth: PTSD takes years to treat
Myth: Only veterans get PTSD
Myth: All trauma leads to PTSD
Myth: Avoiding trauma triggers helps with PTSD
Myth: PTSD is the same as having trauma
Myth: PTSD never completely goes away
Myth: PTSD cannot be treated by talk (cognitive) therapy
In actuality, there are multiple psychotherapy treatments shown to be effective for PTSD. In many cases, they can completely eliminate symptoms of the disorder. While they don’t work for everyone, many therapies can help people move on from PTSD symptoms and get back to regular life.
Looking for some resources to help with treating PTSD? Skip ahead to our mental health downloads, consistent with effective therapies for PTSD.
Article Highlights
What is PTSD?
Research-Based Therapies
Cognitive behavioral therapy (CBT)
Cognitive processing therapy (CPT)
Prolonged exposure therapy (PE)
Trauma-focused CBT (TF-CBT)
Eye movement desensitization and reprocessing (EMDR)
Support for PTSD
What is PTSD, specifically?
I don’t want to wander too far off-topic, but understanding PTSD treatments requires understanding the condition itself. As you might have caught onto from the list of myths, PTSD is not the same as having trauma. And it’s not the only possible negative result of trauma.
When someone goes through a trauma, they’re likely to be shaken up a bit. The simplest way to understand this is to think of a fender-bender car accident. Even if no one got hurt, you’re likely to feel a bit shaken up for a few days to a week or so.
You might feel a bit on edge and jumpy, not want to ride in a car, or have a hard time understanding what happened. This is normal. Your nervous system is trying to figure out if the danger is ongoing or if you’re back in a safe place.
That feeling will likely go away fairly quickly. For more serious traumas, it may take up to a few weeks to feel better. But within a fairly short amount of time, your day to day life will go back to normal.
It doesn’t mean that you’re not still affected by the trauma, but your nervous system is no longer on high alert for danger. For example, you might still feel sad or hurt by what happened, but you won’t be watching your back every day or having frequent nightmares.
When trauma turns into PTSD
However, in some cases that state of high alert sticks around, for months to years. That’s when it becomes PTSD. PTSD is a set of symptoms that follow a trauma, including feeling anxious, on-edge, avoiding reminders of the trauma, and blaming yourself or the world itself for what happened.
So what can you do about it? Researchers have found one thing in common among everyone with PTSD. They all have negative thoughts, often self-blame, that cause them to have trouble making sense of the trauma.
It goes something like this:
The trauma occurs
I wonder if it’s my fault, and/or if the whole word is just dangerous and always will be
This sends the message to my nervous system to watch out–more danger is on the way!
My symptoms continue, and I start to avoid any reminders of the trauma and eventually any situation that feels out of control
This doesn’t work, only making my symptoms worse and causing my nervous system to be even more confused
PTSD symptoms persist
How Cognitive Therapies Work for PTSD
The most-researched and effective treatments for PTSD are cognitive therapies. They get at #2 above, helping people look at the trauma in a new way. They have to come to terms with two thoughts that seem like they don’t go together–that they couldn’t have stopped what happened, and that they are now safer, away from danger.
There’s a lot of talk in recent years about how trauma only resides in the body. That’s half true. The body’s response and your thoughts have to work together to heal. There’s a highway that connects your conscious brain with your survival brain. That highway needs to be flowing both ways.
I notice that many who work in somatic (body)-only based therapies tend to dismiss cognitive therapies, to the point that they outright state that it can’t treat trauma. This is objectively and scientifically incorrect, and not based in fact nor research.
Dozens of studies support cognitive (CBT) therapies as a treatment for PTSD. Very few rigorous studies have looked at somatic therapies that don’t include thought-based work. Some experts have even called out ethical concerns about stating otherwise.
When you have PTSD or anxiety, the lane running from your thoughts to your instincts is clogged up.
Your thoughts help you make sense of the world and draw new conclusions. That’s one thing that makes us different from animals with smaller brains. And it’s what makes it possible for us to work through trauma via our thoughts.
The most effective therapies today target your thoughts about the trauma. If you can reconcile the two ideas–that you did the best you could, and that you are now safe–your symptoms will begin to subside.
Therapies based in cognitive behavioral therapy (CBT) do exactly that. In reality, the treatments all work fairly similarly. And if you’ve read this far you now understand PTSD better than many medical professionals!
Nevertheless, I’ll provide a rundown of five specific therapies and how they work. Four are types of CBT therapy, and another overlaps CBT techniques with body techniques.
Research-based therapies for PTSD
Here are five of the most effective and recommended treatments for PTSD. In all cases, how quickly symptoms improve varies. Treatments may range from around 8 weeks to a few months. Here are more details.
1. Cognitive behavioral therapy (CBT)
CBT is a type of therapy that targets thoughts, feelings, and behaviors. These three areas tie strongly together. Most effective trauma therapies are based in this method.
Our thoughts influence how we feel and respond to a situation. For example, if someone thinks, “I can’t stand my boss,” they’re likely to feel frustrated and annoyed by much of what their boss does. They might then avoid work or complain to anyone who will listen.
On the other hand, if they think, “My boss and I clash sometimes, but we are still able to work together,” they are likely to respond differently. They’ll be less frustrated, more accepting, and feel better about going to work.
CBT also targets behaviors directly. In this case, a therapist might ask their client to “experiment” by initiating more friendly conversations with their boss. Through having better experiences, someone can think and feel better about a situation.
So, CBT as a whole is one of the most effective treatments for PTSD, because it gets at those thoughts we talked about. Several specific treatments have branched off of CBT, using the basic techniques in a way that more specifically targets trauma. Here’s more on those.
2. Cognitive Processing Therapy (CPT)
Cognitive processing therapy (CPT) is a type of CBT therapy. It uses all of the strategies above, and in fact starts out by reviewing the same concepts. Then it targets trauma thoughts and memories in specific ways (Resick, et al.)
Some elements of CPT include:
Reviewing CBT concepts
Practicing relaxation, mindfulness, and self-soothing
Identifying negative thoughts about the trauma (called stuck points)
Challenging thoughts of self-blame and ongoing danger
Writing about the trauma (sometimes, and if you chose to)
As you begin to challenge the thoughts that make you feel you’re in danger, your symptoms will typically improve.
3. Trauma-focused CBT (TF-CBT)
Trauma-focused CBT (TF-CBT) is similar, and some people describe it as the “kid’s version of CPT” and vice versa. CBT uses a specific set of strategies, developed to address negative effects of trauma in children (De Arellano, et al., 2014).
They’re summed up with the acronym PRACTICE. These include:
P = Education for the child and parent about trauma and behavior
R = Relaxation, such as mindfulness activities
A = Affect regulation, such as managing anxiety and anger responses
C = Cognitive coping, such as learning about the CBT triangle
T = Trauma narrative and processing, including telling the story of the trauma and challenging thoughts of self-blame and ongoing danger
I = In-vivo exposure, such as facing non-dangerous situations that are causing anxiety (if needed)
C = Conjoint sessions, including parents (or another caretaker) in some sessions throughout the process and following the trauma narrative (as appropriate)
E = Enhancing safety, by ensuring ongoing situations in the child’s life is safe (sometimes this is necessary at the beginning of therapy
4. Prolonged Exposure
Prolonged exposure, also called PE, is another popular and effective method for treating trauma. It was one of the earlier-developed treatments for PTSD (Foa, et al., 1991). It’s also based on CBT and similar to other therapies. However, in PE there’s a stronger focus on exposure.
Through exposure sessions, which include describing details of the trauma, the client becomes more desensitized to it. This also leads the person into thinking more about their related thoughts and feelings.
By bringing the thoughts and feelings to the surface, they are more able to open up and process them with the therapist. During this point the thoughts are naturally challenged.
PE also includes in-vivo exposure (real life facing of fears) sessions throughout the process. For example, if someone avoids crowded gas stations, they may begin to gradually face that fear. They might start by going to less-busy stations, and working their way up to busier times of day.
5. Eye Movement and Desensitization and Reprocessing (EMDR)
EMDR is a very popular type of therapy often used to treat PTSD. Early sessions focus on becoming comfortable and getting used to the process.
During trauma-focused sessions, a client thinks about their memories or experiences of the trauma. They stay in that feeling, while moving their eyes back and forth (by activities like watching moving lights or the therapist’s fingers move).
The idea is that the eye movement activates more areas of the brain, improving the processing and healing. Sometimes other methods of brain stimulation are used, such as tapping both sides of the body.
EMDR is not always called an “exposure” therapy because it is typically categorized as a mind-body treatment rather than the CBT category. However, in my experience more exposure and processing are completed during an EMDR session than any of the other therapies.
This might be why it works so quickly for some people. However, EMDR isn’t for everyone, and some people find that it brings up memories they’re unable to process. For this reason it is sometimes recommended conditionally for PTSD (APA, 2020).
It’s important that any EMDR therapist who uses the method for trauma have advanced training in PTSD and its causes and symptoms. I would also recommend that they have a good grasp on CBT concepts to help further with processing when needed.
Other Treatments
Remember when I mentioned above that there’s a bit of disagreement about the best categories of therapy for PTSD? There are some other therapy methods that are becoming more popular, although there’s less evidence for them as compared to CBT treatments.
Some newer therapies focus not on thoughts and feelings, but exclusively on the physical experiences someone has relating to their trauma. Indeed, addressing physical sensations is an important part of healing.
That’s where that two-way highway between our higher-level thoughts and instinctual brain comes in. It needs to move both ways.
However, body-based-only therapies do not always include cognitive processing of the trauma memories and thoughts themselves.
I believe one reason people are drawn to body-based therapies is the perception that they won’t have to think about their trauma, or experience the difficult feelings relating to it. This makes perfect sense since avoidance is a main symptom of PTSD.
However, avoidance also allows the PTSD to continue. And not learning strategies to process and work through difficult feelings may make someone more vulnerable for future mental health struggles.
I do believe body-based treatments can be particularly helpful when they’re combined with CBT strategies. However, I become concerned when evidence-based therapies are dismissed as not effective or even harmful, when they could significantly help people are struggling to cope and get through each day.
Support for PTSD
If you’d like to find a research-backed therapist for PTSD, you can start by looking in your area or region. I’d recommend a therapist who practices CPT or EMDR, or TF-CBT for kids and teens. If you’re unable to find a specialist, look for a CBT therapist with experience in addressing trauma.
Meanwhile, we offer worksheets and tools that support and are consistent with CBT-based therapies. You can learn more about our tools and downloads here.
Sources
APA. (2020). Clinical Guidelines for the Treatment of PTSD.
De Arellano, M. A., Lyman, D. R., Jobe-Shields, L., George, P., Dougherty, R. H., Daniels, A. S., Ghose, S. S., Huang, L., & Delphin-Rittmon, M. E. (2014). Trauma-focused cognitive-behavioral therapy for children and adolescents: assessing the evidence. Psychiatric services (Washington, D.C.), 65(5), 591–602.
Resic, et al. (n.d.) Cognitive Processing Therapy for PTSD.
Foa, E. B., Rothbaum, B. O., Riggs, D. S., & Murdock, T. B. (1991). Treatment of posttraumatic stress disorder in rape victims: A comparison between cognitive-behavioral procedures and counseling. Journal of Consulting and Clinical Psychology, 59(5), 715–723.