What is Typically the Best Treatment for PTSD?
What Is Typically the Best Treatment for PTSD? A Guide for the Top Rated Options
Posttraumatic Stress Disorder (PTSD) is a serious mental health condition that can develop after a traumatic event such as military service, sexual assault, or natural disasters. PTSD symptoms can be distressing and long-lasting, interfering with daily life, relationships, and even physical health. If you or a loved one has experienced a traumatic event, or recently received a PTSD diagnosis, you're likely wondering: What is typically the best treatment for PTSD?
As a trauma-focused psychotherapist, I'll share both my knowledge and experience to help you understand this crucial topic when seeking professional help. Spoiler alert, there is no single "best" treatment for PTSD. There are however a range of evidence-based trauma-focused psychotherapies, all with their own pros and cons, and each option works best when matched with individual preferences and needs. The top recommendations include:
Eye Movement Desensitization and Reprocessing (EMDR)
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
Cognitive Processing Therapy (CPT)
Prolonged Exposure Therapy (PE)
In this guide, we’ll explore these evidence-based treatments for PTSD, including how they work, what is involved, and how to begin your healing journey.
Understanding PTSD and Its Symptoms
PTSD can affect people of all ages and backgrounds. While it's often associated with combat veterans, anyone who has experienced a traumatic experience may develop PTSD. The symptoms can appear in the short term immediately after the trauma or surface months or even years later. Common symptoms of PTSD include:
Intrusive thoughts or flashbacks of a trauma memory
Avoidance of trauma-related triggers
Negative changes to your thoughts, beliefs, and mood
Negative emotions such as fear, guilt, or anger
Heightened startle response or hypervigilance
Sleep disturbances or nightmares
Difficulty concentrating or relaxing
Dissociative symptoms like feeling detached from your body or surroundings
Substance use disorder or suicidal thoughts
Trauma-related memories and emotional responses can interfere with work, relationships, and a sense of safety in the world. It’s important to note that PTSD differs from acute stress disorder, which can occur in the first month after trauma but often resolves on its own. PTSD is more persistent and chronic over time. PTSD can frequently co-occur with mood and anxiety disorders, and having an anxiety disorder prior to experiencing trauma can be a risk factor for PTSD.
What Is Typically the Best Treatment for PTSD?
According to the National Institute of Mental Health, the American Psychiatric Association, and the National Center for PTSD, the most effective treatments for PTSD are trauma-focused psychotherapies. These therapies are considered first-line treatments in clinical practice guidelines and are supported by decades of clinical trials and systematic reviews.
While medications can play a role in some treatment plans, trauma-focused therapy is typically the main recommendation for the treatment of PTSD.
Trauma-Focused Psychotherapies: The Gold Standard for the Treatment of PTSD
Trauma-focused psychotherapy targets the root of PTSD: unprocessed traumatic memories and the physical, psychological, and emotional reactions to them. These therapies use structured, evidence-based approaches to help individuals reprocess trauma in a safe, supportive manner. Weekly sessions are often recommended, and many clients see long-term benefits.
The following therapies are among the top recommended treatments for PTSD by the American Psychiatric Association, the American Psychological Association, the US Department of Veterans Affairs, and World Health Organization.
1. Eye Movement Desensitization and Reprocessing (EMDR)
What is EMDR?
EMDR therapy is a powerful, evidence-based treatment that helps the brain reprocess traumatic memories using exposure combined with bilateral stimulation (typically eye movements). Unlike talk therapy, EMDR doesn’t require clients to discuss the traumatic event in detail. This makes it especially helpful for individuals healing from sexual assault or complex trauma. EMDR is unique in that neurobiological research has demonstrated measurable changes in the brain following treatment.
What evidence supports EMDR for PTSD?
Numerous randomized controlled trials (RCTs) have established EMDR's effectiveness. A study by Kaiser Permanente reported that 100% of single event trauma survivors and 77% of multi-event trauma survivors no longer met criteria for PTSD after a mean of 6 50-minute EMDR sessions.
How is EMDR delivered?
EMDR is typically delivered in weekly 60-90 minute sessions with the total length of therapy varying from as little as 3 sessions for a single event to 12 or more sessions for complex or developmental trauma. In general, the greater the amount of trauma and complexity of the trauma, the longer therapy takes for lasting and stable recovery. EMDR is unique in that it doesn't require any homework or writing assignments in between sessions. The work is done in session. Relaxation, grounding, and coping skills are taught for use between sessions to maintain stability.
2. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
What is CBT?
CBT is a well-known psychological therapy used to treat a wide range of mental health conditions, including PTSD. It focuses on the connection between thoughts, emotions, and behaviors. By identifying and challenging negative thoughts, CBT helps clients develop healthier cognitive patterns and coping strategies.
Trauma-Focused CBT is a form of CBT combining exposure and cognitive therapy designed specifically for PTSD. It involves learning psychoeducation on the CBT model, relaxation and grounding skills, strategies for challenging cognitive distortions, processing the trauma narrative, and using exposure to desensitize memories and triggers.
What evidence supports TF-CBT for PTSD?
Numerous RCTs have established TF-CBT's effectiveness, particularly showing the exposure and cognitive restructuring (changing thoughts and beliefs) components to be more effective than learning relaxation alone. Statistics from these trials show 61% to 82% of participants no longer had PTSD after TF-CBT treatment.
How is TF-CBT delivered?
TF-CBT is typically delivered during 60-90 minute weekly sessions ranging from 12-16 sessions in most cases, and up to 25 sessions in more complex cases. TF-CBT involves extensive homework and self-monitoring activities between sessions.
3. Cognitive Processing Therapy (CPT)
What is CPT?
CPT could be considered a specific type of CBT developed for treating PTSD. It focuses on helping individuals challenge and modify unhelpful beliefs related to the trauma. CPT involves cognitive restructuring, shifting deeply ingrained negative beliefs or "stuck points" resulting from the trauma to support a balanced and healthy view. CPT at one time involved exposure to a trauma narrative, but has since been updated to be delivered without any exposure at all.
What evidence supports CPT?
Numerous systematic reviews and meta-analyses have established CPT's effectiveness, with rates of participants no longer meeting criteria for PTSD after treatment ranging from 30% to 97%. Long-term follow-up studies found reductions in symptoms to be durable up to 5-10 years post treatment.
How is CPT delivered?
CPT is delivered in a manualized fashion with specific agenda and extensive homework for each session across 12 weekly sessions.
4. Prolonged Exposure Therapy (PE)
What is PE?
PE is a type of exposure therapy. This approach helps individuals gradually desensitize trauma-related memories and reduce avoidant behaviors. By confronting these painful experiences in a controlled and safe space, clients often experience a reduction in anxiety and PTSD symptoms. PE is especially helpful for individuals who developed PTSD after military service or natural disasters.
What evidence supports PE?
Numerous RCTs have established PE's effectiveness. It was found to be superior when compared to supportive counseling, relaxation training, and medications. Results ranged from 41% to 95% of participants no longer meeting criteria for PTSD after treatment.
How is PE delivered?
PE is typically delivered in 8-15 weekly sessions. Sessions involve education about PTSD, learning breathing techniques to regulate the nervous system, and two types of exposure: imaginal (imagining the trauma) and in vivo (real life exposure to triggers). A key homework assignment is making an audio recording recounting the trauma narrative and listening to it repeatedly between sessions.
Medications for PTSD
While psychotherapy is the best treatment for PTSD, medication may also be helpful, particularly for individuals with severe symptoms, depression, or co-occurring conditions like substance use disorders.
The most commonly prescribed medications are Selective Serotonin Reuptake Inhibitors (SSRIs) such as sertraline and paroxetine. These medications can help regulate mood and reduce anxiety, though they may have possible side effects and are not a stand-alone cure.
Medication should always be managed by a qualified healthcare provider or mental health professional with prescribing privileges. This information is for educational purposes only and should not be taken as a recommendation for treatment.
New and Emerging Treatments
Researchers continue to explore innovative therapies for PTSD, including:
Magnetic e-Resonance Therapy (MeRT) is a type of transcranial magnetic stimulation (TMS) recently granted breakthrough device status by the FDA for the treatment of PTSD.
Brainspotting and Accelerated Resolution Therapy have similarities with EMDR and are gaining evidence of effectiveness.
Virtual reality exposure therapy for immersive trauma reprocessing.
Stellate ganglion block, a procedure being studied for its calming effect on the nervous system.
Psychedelic-assisted therapies are currently in clinical trials.
These are not yet considered first-line treatments but may offer valuable alternatives for those who don't respond to established therapies. Mental health treatment is always evolving and some of these innovations may prove highly effective.
Supportive Therapies and Resources
In addition to individual therapy, the following supports may be helpful:
Group therapy and peer support groups
Family therapy to educate and support loved ones
Neurofeedback and Biofeedback
Trauma Informed Yoga
Breathwork for relaxation
Community-based mental health services
Crisis support via the Crisis Lifeline (988) for 24/7 support and connection to resources.
These options provide connection and reinforce healing outside of formal therapy.
How to Choose the Right PTSD Treatment Plan
Mental health care is complex and every person’s trauma and recovery process is unique. Trauma and PTSD symptoms are often only one factor among many to consider when deciding on a treatment approach. A qualified mental health professional can help you build a treatment plan based on your individual symptoms, history, preferences, and goals.
More specifically, it's important to discuss your options with a trauma-focused psychotherapist who can assess your trauma history and current symptoms to help determine a trauma-specific treatment strategy. Most mental health professionals are not extensively trained in this area. Factors such as childhood trauma, complex and prolonged trauma, attachment based trauma, dissociative symptoms, and dissociative disorders can all have significant impacts on treatment planning. Many of the evidence based treatments require significant modification and more extensive training on the part of the therapist to address these conditions safely. Make sure to give your therapist as much information as possible so they can understand your needs.
Your preferences are also vital for helping a professional understand what may help you the most. Some simple questions to consider when comparing evidence-based trauma therapies include:
Are you willing and able to complete homework, writing, or exposure assignments outside of session?
In my experience, clients who were star students in school find those skills lend themselves to daily completion of worksheets, logs, and writing assignments. Other clients find this overwhelming on top of all the other stressors in their life and feel guilty if they fall short.
TF-CBT and CPT require extensive homework.
PE requires listening to a trauma narrative between sessions.
EMDR does not require homework other than using and practicing coping skills for nervous system regulation.
Do you feel like you can tolerate intense repeated exposure to your trauma?
In my experience, clients have widely varying degrees of tolerance for exposure to trauma memories. Jumping in too soon or overexposure can lead to overwhelm, dissociative responses, or abreactions that can be highly dysregulating. Assessing your window of tolerance and matching the dose of exposure to what can be tolerated is a vital part of trauma therapy.
PE has the highest degree of prolonged repeated exposure to trauma memories and requires exposure between sessions. Regulation strategies such as deep breathing help to keep you regulated for it.
TF-CBT requires less exposure but this is still a key ingredient in it’s effectiveness.
EMDR is highly flexible and exposure can be adjusted in real time using multiple strategies to keep you in your window of tolerance. No exposure outside of session is required. Supplemental therapies such as Internal Family Systems (IFS) or Ego State Therapy can help address dissociation and defenses that block processing.
CPT requires no direct exposure to memories, however working with negative beliefs associated with trauma typically brings up some emotions and memories as a side effect.
Would you prefer to focus on thoughts, emotions, and beliefs about your trauma or include the body and somatic healing as well?
In my experience, the most debilitating aspects of PTSD aren’t always centered around thoughts and beliefs, it’s often a very physical experience of muscle tension, stomach upset, unpleasant sensations and panic reactions. I often meet clients who say they consciously know they are not in danger, they know they are not a bad person, but their body won’t cooperate and they continue to feel as if they are.
TF-CBT, CPT, and PE are all considered cognitive therapies, meaning they are focused on conscious mental processes and modifying them to update your thinking and reactions to present circumstances.
TF-CBT and PE involve exposure to memories which can desensitize somatic (physical) responses, but this is not an explicit focus.
EMDR actively involves the body and physical sensations in the targeting and processing of traumatic memories. Somatic EMDR is a variation that specifically focuses on the body when mental processes are not as prominent or accessible. EMDR requires minimal talking about or discussing trauma to be effective.
With so many things to consider, it can feel overwhelming to decide. All of these therapies have similar levels of evidence for effectiveness, so your preference and the guidance of a professional can help narrow the options. The important thing is to simply get started and take it one step at a time. Many therapists offer a free consultation. This is your opportunity to see how you feel with this person and get a sense of their expertise with trauma.
Trauma-focused psychotherapists are highly trained and understand the need to help you feel safe and confident prior to jumping into deep work. If you feel comfortable after consultation, it’s worth making the leap of faith. The treatment of posttraumatic stress disorder often leads to more than just a reduction of symptoms. It's possible to regain control of your current life stressors, begin experiencing positive emotions again, and move forward with confidence.
Final Thoughts
So, what is typically the best treatment for PTSD? Trauma-focused therapy in the form of EMDR, TF-CBT, CPT, and PE is considered the gold standard, and many supportive therapies and activities can enhance these treatments. These treatments help reprocess traumatic memories, reduce PTSD symptoms, and restore hope and resilience. As an EMDR specialist, I’m partial to EMDR due to its flexibility and adaptability to each client’s unique needs. However, this is no evidence it’s superior to any of the other therapies listed. There is no “best” treatment, and a skilled therapist often draws upon multiple approaches. If you’re interested in learning more, take a look at some of my other blogs. If you found this article helpful or feel it would be helpful for someone else, feel free to share it.
Alex Penrod, MS, LPC, LCDC
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