This resource is part of our Treatment Navigator, a comprehensive guide to common behavioral/mental health diagnoses and the evidence based practices (EBPs) that help these conditions.
Overview
Posttraumatic Stress Disorder (PTSD) is a trauma- and stressor-related disorder that develops after exposure to actual or threatened death, serious injury, or sexual violence. Symptoms typically include intrusive memories or flashbacks, avoidance of reminders, negative changes in mood and cognition, and heightened arousal or reactivity. PTSD can follow a single event or repeated trauma and often co-occurs with depression, anxiety, and substance use disorders. Treatment aims to reduce distress, restore a sense of safety, and help clients integrate traumatic memories through structured, evidence-based interventions.
Indicated Evidence-Based Practices (EBPs)
- Prolonged Exposure Therapy (PE) – repeated, systematic exposure to trauma memories and reminders to reduce fear and avoidance
- Cognitive Processing Therapy (CPT) – identifies and restructures trauma-related beliefs (“stuck points”)
- Eye Movement Desensitization and Reprocessing (EMDR) – bilateral stimulation combined with cognitive processing of trauma memories
- Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) – primarily for children and adolescents but adaptable for adults with complex trauma
- Skills Training in Affective and Interpersonal Regulation (STAIR) – builds emotional regulation and relational skills prior to trauma processing
- Brief Eclectic Psychotherapy (BEP) – integrates exposure, cognitive restructuring, and meaning-making
- Narrative Exposure Therapy (NET) – reconstructs a chronological trauma narrative, useful for multiple or complex traumas
When to Choose What
PE and CPT are first-line treatments for adult PTSD with the strongest empirical support and manualized protocols recommended by the U.S. Department of Veterans Affairs (VA) and the Department of Defense (DoD).
EMDR is equally effective and may be preferred for clients who respond well to experiential or sensory-based processing.
STAIR or phase-based approaches are recommended for individuals with complex trauma, emotion dysregulation, or significant relational difficulties prior to direct trauma exposure work.
BEP and NET are appropriate alternatives when cultural or contextual factors make traditional CBT-based approaches less accessible.
Combination with pharmacotherapy (SSRIs or SNRIs) may be indicated for severe or chronic presentations.
Core Components of Treatment
- Psychoeducation about trauma, safety, and the treatment rationale
- Development of coping and grounding skills to manage arousal
- Gradual exposure or memory processing to reduce avoidance and reactivity
- Cognitive restructuring or meaning-making to address guilt, shame, or distorted self-blame
- Reconnection with values, relationships, and daily functioning
- Relapse prevention and planning for ongoing self-regulation
Measures and Monitoring
Screening and diagnostic tools
- PCL-5 (PTSD Checklist for DSM-5): 20-item self-report measure; ≥31–33 indicates probable PTSD
- CAPS-5 (Clinician-Administered PTSD Scale for DSM-5): gold-standard structured interview for diagnosis and severity rating
- Life Events Checklist for DSM-5 (LEC-5): identifies exposure to potentially traumatic events
- IES-R (Impact of Event Scale–Revised): assesses subjective distress related to traumatic events
- MINI or SCID-5 PTSD module: structured diagnostic assessment for research or comprehensive evaluation
Monitoring and outcome tools
- PCL-5 or IES-R administered every 3–4 sessions to track treatment progress
- PHQ-9 or DASS-21 when depression or anxiety are comorbid
- Dissociation scales (DES-II) for complex trauma presentations
- SRS/ORS (Session Rating/Outcome Rating Scales) for alliance and global progress
Adaptations and Special Considerations
Complex trauma: Implement phase-based treatment (safety/stabilization → trauma processing → integration). Begin with skills such as grounding, mindfulness, and emotion regulation before trauma exposure.
Culture and context: Assess culturally specific expressions of trauma and distress; adapt metaphors and examples to align with client identity and meaning-making systems.
Comorbidities: Address substance use, psychosis, or acute suicidality before initiating trauma exposure.
Telehealth: Use secure platforms; offer preparatory psychoeducation and distress tolerance skills before remote trauma processing.
Group format: Group CPT and group PE are effective in structured clinical settings; ensure strong containment and confidentiality guidelines.
References
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).
Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2007). Prolonged Exposure Therapy for PTSD: Emotional Processing of Traumatic Experiences. Oxford University Press.
Resick, P. A., Monson, C. M., & Chard, K. M. (2017). Cognitive Processing Therapy for PTSD: A Comprehensive Manual. Guilford Press.
Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures (3rd ed.). Guilford Press.
Cloitre, M., Koenen, K. C., Cohen, L. R., & Han, H. (2002). Skills training in affective and interpersonal regulation followed by exposure: A phase-based treatment for PTSD related to childhood abuse. Journal of Consulting and Clinical Psychology, 70(5), 1067–1074.
Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319–345.