Trauma-Focused Psychotherapy for PTSD

What is trauma-focused psychotherapy? 

National and international clinical practice guidelines have identified certain types of trauma-focused psychotherapy as the most effective approach for treating PTSD.  
Trauma-focused (TF) psychotherapy uses different techniques to help people process traumatic experiences. Some involve visualizing, talking or thinking about the traumatic memory. Others focus on changing unhelpful beliefs about the trauma. TF therapies usually last about 8-16 sessions.
Almost half (49%) of studies included in the PTSD-Repository are psychotherapy trials. As shown here, the majority (n=358, 72%) of study arms in those psychotherapy studies tested trauma-focused psychotherapies. See the specific types of therapies by clicking the bars in the figure to the right and then hovering over each individual bar.
For more information about how studies were chosen for inclusion in the PTSD Repository, read about the development of the platform.

Which trauma-focused psychotherapies are in the PTSD Repository? 

Below you can see a pie chart with the 12 of the most frequently studied trauma-focused psychotherapies. In general, the treatments that have been studied most frequently are also those that have also been identified as the most effective: Prolonged Exposure (PE; 17% of study arms), Cognitive Processing Therapy (CPT; 10% of arms), and Eye Movement Desensitization and Reprocessing (EMDR; 10% of arms), and other trauma-focused cognitive-behavioral therapy (14% of study arms). PE, CPT and EMDR are described in more detail below. The “Other" category includes trauma-focused psychotherapies included in only 1 or 2 study arms, most typically just 1 study arm. Some of these "other" treatments include combinations such as PE plus a medication. Because of this, CPT and PE have been studied more often than indicated above, if considering them in combination with other treatments. Click on "View Source Data" in the lower right corner of the figure to see the full list of treatment names. You can find more information about trauma-focused psychotherapies below and on the National Center for PTSD website Talk Therapy.

PE

  • Duration of treatment: PE usually takes 8-15 weekly sessions, so treatment lasts about 3 months. Sessions are usually 1.5 hours each.
  • What to expect:  PE teaches you to gradually approach trauma-related memories, feelings and situations that you have been avoiding since experiencing trauma. By confronting these challenges, you can decrease your PTSD symptoms.

CPT

  • Duration of treatment:  CPT usually takes about 12-sessions.  Sessions are 60 minutes.
  • What to expect: CPT teaches you how to evaluate and change the upsetting thoughts you have had since experiencing a traumatic event. By changing your thoughts, you can change how you feel. You will use worksheets in session and at home that help you learn this strategy.

EMDR

  • Duration of treatment:  EMDR usually takes about 1-3 months of weekly 50-90-minute sessions.
  • What to expect:  EMDR can help you process upsetting memories, thoughts and feelings related to the trauma you went through. By processing these experiences, you can get relief from PTSD symptoms.

Learn about some of the most effective trauma-focused therapies





How is trauma-focused psychotherapy usually delivered?

Trauma-focused psychotherapy is primarily delivered in 1-on-1 format
Traditionally, psychotherapy is delivered in 1-on-1 meetings between the patient and the provider. This format offers privacy and individual attention. The patient and provider can focus on the things that are most important to the patient. It also allows the patient to work at their own pace.
The majority of the trauma-focused treatments that have been studied (n=331 study arms) have examined individual psychotherapy. PE and EMDR, for example, are delivered in a 1-on-1 manner. CPT can be delivered in either an individual or group format, although group CPT group has been shown to be less effective than CPT delivered individually.
Studies have also examined the effectiveness of PTSD treatments delivered to couples or in “mixed” formats where some of the sessions are delivered in one format and others are delivered in another format.

Most studies examined trauma-focused psychotherapy delivered in person
Many trauma-focused treatments can be done face-to-face in a provider’s office or over telemedicine (e.g., by video).
Most trauma-focused psychotherapy study arms in the PTSD-Repository have examined therapy delivered in person with a provider (= 334 study arms). Fewer studies have examined trauma-focused interventions delivered over video (n = 11 study arms) or via writing alone without provider contact (n = 5 study arms). Another way trauma-focused psychotherapies can be delivered is with assistance from technology-based tools, such as digital apps (n = 4 study arms). 

What is telemedicine for PTSD?
The increase in demand for mental health services, the limited availability of PTSD treatments in many geographic areas and the rapid growth in technology have led to innovative technology- based methods being studied. This only increased during and after the COVID-19 pandemic. Most of the research examining the efficacy of PTSD treatments delivered via telemedicine has been conducted with Veteran populations.  These findings are promising and give providers and patients flexibility to determine where and how care is provided. 

Who is included in studies of trauma-focused psychotherapy?

Trauma-focused psychotherapies have been studied among many different groups of people. Understanding who participates in these studies helps us understand to what extent the research findings apply to the rest of the population or to ourselves if we are considering treatment. Below are some sample characteristics that are frequently asked about. 

Military status

Among the studies of trauma-focused psychotherapy that reported participants' military status, most study arms have included community samples (59%), with a large minority (25%) including military Veterans. Smaller numbers of studies have examined trauma-focused psychotherapies in mixed samples and among active-duty military service members. 

Trauma type

Most studies (89%) reported the type(s) of traumas experienced by participants. Of those that reported trauma type, most (61%) included a variety of types of trauma (i.e., mixed). Some studies included participants who experienced a specific type of trauma such as military combat (the most common, 18% of studies).

Gender 

Most studies of trauma-focused psychotherapy (96%) reported the gender of the participants. The figure below shows that 15% of studies included only women and 10% included only men. The "Other" slice shows that 75% of studies included some combination of men and women.
For more information on who is included in studies of PTSD treatments of all types, see Who Has Been Studied in PTSD Clinical Trials?


What to know...

PTSD treatment research continues around the globe, to investigate the best chance of recovery for all who have experienced a trauma. The good news is that trauma-focused treatments work for most people who have been studied.  These treatments have been well studied, with many groups of people and in many formats. For more information about PTSD treatment, visit the National Center for PTSD website.