Posttraumatic Stress Disorder (PTSD) is a mental health condition that can occur after experiencing or witnessing a life-threatening event, such as a serious accident, assault, natural disaster, or combat exposure. After a traumatic event, most people may have some initial difficulty resuming their typical activities, but will usually begin to feel better after a few weeks. However, for some people, they have recurrent and persistent thoughts and emotions about the traumatic event for more than a month after the event, which cause significant distress and interfere with their functioning. Symptoms like nightmares, feeling on guard constantly, and others make it challenging to focus on work/school, maintain relationships, and trust others or feel safe. That’s when PTSD may be present (APA, 2013).
Living with PTSD can feel overwhelming and draining, but recovery is possible. There are evidence-based trauma-focused therapies that have helped individuals with PTSD reclaim their lives again and move forward with greater confidence and clarity.
In this article, we’ll explore two of the first line, science-backed therapies for PTSD: Cognitive Processing Therapy (CPT) and Prolonged Exposure Therapy (PE). CPT and PE are evidence-based, meaning they have been tested in many clinical studies and found to be safe and effective for many people. Using an evidence-based therapy approach combines the best available research data with the clinician’s expertise in regards to the client’s culture, characteristics, and preferences (Cook, Schwartz, & Kaslow, 2017). Understanding your therapy options for how PTSD is treated can help you make informed choices about your recovery, whether you’re starting to seek professional help or looking for a different therapy approach.
What is PTSD and why therapy for PTSD matters
PTSD refers to experiencing a variety of persistent and distressing trauma-related symptoms for at least a month after experiencing or witnessing a life-threatening event. The symptoms can cause issues with daily functioning. The symptoms are divided into 4 symptom clusters:
Intrusion symptoms, including nightmares, intrusive memories, and significant or prolonged emotional or physiological reactions to reminders of the trauma.
Avoidance of things that remind you of the trauma, such as thoughts, emotions, memories, people, situations, and activities.
Negative alterations in mood and cognition, including negative views of self, others, or the world (such as “I can’t trust others” or “Nowhere is safe”), feelings of guilt, shame, or blame for the trauma.
Alterations in arousal and reactivity, such as feeling on guard constantly, being jumpy or easily startled, or difficulty falling or staying asleep.
If PTSD goes untreated, it can lead to more severe symptoms, poorer daily functioning, and negatively impact overall quality of life.
PTSD is treatable. There are effective, short-term, trauma focused therapies that can reduce symptoms short-term and long-term (Resick et al., 2012). With the right kind of social support and professional help, reclaiming your life from PTSD, one step at a time is possible. Evidence-based trauma-focused therapies for PTSD, like CPT and PE, dive deep to target the root of the traumas, not just manage symptoms.
Consistent first-line, evidence-based therapies for PTSD
Evidence-based therapies are treatments for mental health conditions that are supported by rigorous scientific research. The studies demonstrate the treatments that are effective for certain conditions and populations. Evidence-based therapies are considered the gold-standard treatments because they can reduce symptoms as well as improve functioning and quality of life.
CPT and PE are consistently identified as first-line, evidence-based therapies for PTSD. They have been studied for more than 30 years in various clinical trials and shown to be effective. They are strongly recommended by the American Psychological Association’s and the VA/Department of Defense’s Clinical Practice Guidelines for the Treatment of PTSD (2025 and 2023, respectively). Thus, CPT and PE are strongly recommended for use with civilians, veterans, and active duty members who have experienced various numbers and types of traumas.
While CPT and PE are typically available in Veterans Affairs settings, they are not widely available to civilians. I aim to increase civilian awareness and access to CPT and PE – at least in NE Ohio.
Furthermore, CPT and PE are structured, time-limited, and goal-oriented. There are specific topics or skills covered in each therapy session, as the information covered builds upon information presented in the previous session. CPT and PE both have a predetermined number of sessions, but there can be flexibility with that depending on the client’s needs while providing the therapy as intended. Finally, CPT and PE help you understand and process the trauma(s) and move forward with a greater sense of control, confidence, and clarity.
You may be thinking, isn’t EMDR the therapy for PTSD? Isn’t it an option?
Yes, EMDR is a treatment option for PTSD, but not the only option. EMDR has been widely used with civilians so far. The strength of recommendation for using EMDR to treat PTSD varies by organization. The VA/DoD Clinical Practice Guidelines for PTSD (2023) list EMDR as a first-line treatment, whereas the APA Clinical Practice Guideline for Treatment of PTSD in Adults (2025) does not.
What is Cognitive Processing Therapy (CPT)?
CPT (Resick, Monson, & Chard, 2024) is a cognitive behavior therapy designed to address PTSD. CPT was originally created for use with survivors of sexual violence and research has since shown it to be effective for various types of trauma. CPT examines how traumatic events can impact your thoughts.
How CPT works
CPT helps you identify thoughts that interfere with recovery – called “stuck points.” The thoughts can include what we tell ourselves about why the traumas occurred and how the traumas have impacted our views about safety, trust, power/control, esteem, and intimacy.
Here are a few example thoughts that interfere with recovery:
-
- The trauma was my fault.
-
- If I had/hadn’t done X, then the trauma(s) wouldn’t have happened.
-
- I have to be in control at all times.
-
- Because of the traumas, I’m not good enough.
-
- I can’t trust anyone/myself.
Then, you learn to ask yourself questions about the accuracy and helpfulness of the thoughts. This can lead to shifts in the thoughts, to ones that are more realistic and/or helpful. As a result, this process can gradually get you “unstuck” and clear a path forward for true recovery.
What to expect with CPT
CPT includes daily practice of the skills between sessions. You can practice the skills daily by filling out a worksheet on a stuck point or completing a form in the CPT Coach application on your smartphone.
You’ll work closely with a CPT provider in sessions and fill out worksheets to identify and explore stuck points and generate more realistic or helpful views outside of sessions. You’ll focus on how your thoughts about the trauma – how you’ve made sense of it in your mind – influences your emotions and behaviors. With practice, these steps get easier to do. You’ll start to take responsibility only for what is yours (and not someone else’s), feel less guilt and shame, and feel a greater sense of control over your life going forward.
The benefits of CPT
A major benefit of CPT is that the skills can be applied to thoughts about daily life, not just trauma-related thoughts. CPT can also reduce symptoms of co-occurring issues, such as depression (Resick et al., 2024) and guilt (Meade et al., 2022; Resick et al., 2017). Another benefit is that CPT provides lasting results – individuals maintained their treatment gains up to 10 years after finishing CPT (Resick et al., 2012). Furthermore, you have a choice on whether you do a written account of your traumatic event. The decision depends upon your individual needs and preferences that you and your CPT provider can collaboratively discuss.
CPT duration
CPT has 12 sessions, so approximately 3 months total if done once weekly. There is increasing evidence showing significant PTSD symptom reduction and less dropout from CPT when individuals do a “massed” or “accelerated” version of the therapy, in which there are more frequent sessions in a shorter timeframe (see Resick et al., 2024 for more information on various studies of massed or accelerated versions of CPT). Massed or accelerated versions of CPT that have been tested have ranged from 5 days to 3 weeks. In fact, a journalist shared her experience of completing CPT in 10 days. Listen to her experience with CPT here: https://www.thisamericanlife.org/682/ten-sessions
What is Prolonged Exposure (PE) Therapy?
PE (Foa & Rothbaum, 1998; Rothbaum, Foa, & Hembree, 2007) is another short-term treatment that is designed to address PTSD. PE has individuals gradually face trauma-related memories, emotions, and situations that they have avoided. Although avoidance provides relief in the short-term, it actually maintains the anxiety, making it worse in the long-term.
How PE works
PE has you practice imaginal exposure, which is retelling the trauma memory out loud in a safe setting (your clinician’s office), which you and your clinician mutually agree to audio record so you can then listen to it between sessions for practice. PE also has you practice in-vivo exposure, which is gradually facing safe situations/activities you’ve avoided since the trauma. Through daily practice of listening to the imaginal exposure recording and in-vivo exposures between sessions (in other words, repeatedly facing the memories, emotions, and situations in safe and controlled environments), you can recalibrate your perceptions of what is objectively dangerous (an actual threat/danger) and what is being perceived as dangerous, but is actually lower risk/safe (a false threat/danger).
Using The PE Coach app as you do PE makes this process simpler. It can keep the audio recordings, information from in-vivo exposures, psychoeducation, and breathing retraining all in one (password-protected if you opt into it) place.
What to expect with PE
You’ll work closely with a PE provider to create a list of activities and situations you’ve avoided since the trauma that are interfering with your daily life (aka the in-vivo exposure hierarchy). Your provider will also guide you retelling the trauma memory in a structured and helpful way, so you can process it (aka the imaginal exposure). Outside of sessions, you’ll begin to face the activities and situations on your in-vivo exposure hierarchy, step by step, starting with ones that are less distressing and gradually working up to more distressing ones. You’ll also listen to the imaginal exposure audio recording between sessions. With practice, these steps get more manageable. You’ll start to take responsibility only for what is yours (and not someone else’s), feel less guilt and shame, and feel a greater sense of control over your life going forward.
The benefits of PE
PE has many benefits. Clients’ symptoms of depression and trauma-related guilt reduce with PE (Foa et al., 2005; McLean et al., 2019). Clients can use the principles of the therapy to reduce avoidance in other areas of their lives too. Another benefit is that PE provides lasting results – individuals maintained their treatment gains 6 years after finishing PE (Resick et al., 2012).
PE duration
PE has 12-15 sessions that can be done at least once a week. Similar to CPT, there is a growing body of research showing less dropout from PE and is also effective when delivered in a massed or intensive format – more frequent sessions in a shorter timeframe (see McLean et al., 2024 for more information on various studies of massed or intensive PE). Massed or intensive versions of PE that have been tested have ranged from 2-3 weeks.
Choosing what is right for you
Trauma-focused treatment/therapy takes a deeper approach to get at the roots of the traumatic event(s) instead of addressing the surface level symptoms. Deciding which option – CPT, PE, another evidence-based therapy, or no therapy at all – is the best fit for you is a personal decision. It depends upon your needs, characteristics, preferences, and evaluating the benefits and risks of each option.
It’s important to think about which one you may feel the most comfortable with. Here are some things to consider that may help you decide:
-
- Do you prefer to write down your thoughts about the trauma or retell the trauma memory outloud?
-
- Do you typically learn better when you see information or when you hear it?
-
- Are you avoiding situations or activities that are causing problems in your daily life?
It’s okay to feel uncertain. You don’t have to have all the answers. You can speak with your healthcare providers (PCP, mental health providers, etc.) and support persons about these options so you can make an informed decision.
Keep in mind that you are not alone in this process. It’s okay to seek social support and professional help. Recovery from PTSD is possible. (There’s 30 years worth of data from various studies of CPT and PE as well as anecdotal evidence from various clinicians around the world that CPT and PE work!)
Takeaways
CPT and PE have a wealth of data behind them showing they can significantly reduce PTSD symptoms in the short-term and long-term and improve quality of life. If you are considering doing either of these therapies, I encourage you to seek social support from loved ones and take the first step to seek professional help from a CPT and/or PE clinician. The results of the therapies are worth the effort. Reclaiming your life from PTSD, one step at a time is not only possible, but expected with the right treatment for you.
CPT and PE are not widely available to civilians, and I am here to change that (at least in NE Ohio). Understanding the various therapy options for PTSD is a step towards recovery.
References
American Psychiatric Association, DSM-5 Task Force. (2013). Diagnostic and statistical manual of mental disorders: DSM-5™ (5th ed.). American Psychiatric Publishing, Inc.. https://doi.org/10.1176/appi.books.9780890425596
APA Clinical Practice Guideline. (2025). Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults. Washington, DC.
Cook, S. C., Schwartz, A. C., & Kaslow, N. J. (2017). Evidence-Based Psychotherapy: Advantages and Challenges. Neurotherapeutics, 14 (3), 537-545. doi: 10.1007/s13311-017-0549-4
Foa, E. B., Hembree, E. A., Cahill, S. P., Rauch, S. A. M., Riggs, D. S., Feeny, N. C., & Yadin, E. (2005). Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics. Journal of Consulting and Clinical Psychology, 73(5), 953–964. https://doi.org/10.1037/0022-006X.73.5.953
Foa, E. B., & Rothbaum, B. O. (1998). Treating the trauma of rape: Cognitive-behavioral therapy for PTSD. Guilford Press.
McLean, C. P., & Foa, E. B. (2024). State of the science: Prolonged exposure therapy for the treatment of posttraumatic stress disorder. Journal of Traumatic Stress, 37 (4), 535-550. https://doi.org/10.1002/jts.23046
McLean, C. P., Zandberg, L., Brown, L., Zang, Y., Benhamou, K., Dondanville, K. A., Yarvis, J. S., Litz, B. T., Mintz, J., Young-McCaughan, S., Peterson, A. L., Foa, E. B., & the STRONG STAR Consortium. (2019). Guilt in the treatment of posttraumatic stress disorder among active duty Military Personnel. Journal of Traumatic Stress, 32(4), 616–624. https://doi.org/10.1002/jts.22416
Meade, E. A., Smith, D. L., Montes, M., Norman, S. B., & Held, P. (2022). Changes in guilt cognitions in intensive PTSD treatment among veterans who experienced military sexual trauma or combat trauma. Journal of Anxiety Disorders, 90, 102606. https://doi.org/10.1016/j.janxdis.2022.102606
Resick, P. A., LoSavio, S. T., Monson, C. M., Kaysen, D. L., Wachen, J. S., Galovski, T. E., Wiltsey Stirman, S., Nixon, R. D. V., & Chard, K. M. (2024). State of the science of Cognitive Processing Therapy. Behavior Therapy, 55, 1205-1221. https://doi.org/10.1016/j.beth.2024.04.003
Resick, P. A., Monson, C. M., & Chard, K. M. (2017). Cognitive processing therapy for PTSD: A comprehensive manual. The Guilford Press.
Resick, P. A., Monson, C. M., & Chard, K. M. (2024). Cognitive processing therapy for PTSD: A comprehensive therapist manual (2nd ed.). The Guilford Press.
Resick, P. A., Williams, L. F., Suvak, M. K., Monson, C. M., & Gradus, J. L. (2012). Long-term outcomes of cognitive-behavioral treatments for posttraumatic stress disorder among female rape survivors. Journal of Consulting and Clinical Psychology, 80(2), 201-210. https://doi.org/10.1037/a0026602
Rothbaum, B. O., Foa, E. B., & Hembree, E. A. (2007). Reclaiming your life from a traumatic experience: A prolonged exposure treatment program. Oxford University Press.
VA/DoD Clinical Practice Guideline. (2023). Management of Posttraumatic Stress Disorder and Acute Stress Disorder Work Group. Washington, DC: U.S. Government Printing Office.
