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May 9, 2024

What's The Best Therapy For PTSD?

Discover the best therapies for treating PTSD including CPT, the front-line treatment, EMDR, medications and PE. Plus, explore how CPT offers distinct advantages.

Sofia Noori, MD, MPH
What's The Best Therapy For PTSD?

Living with post-traumatic stress disorder (PTSD) can be an isolating and overwhelming experience. Fortunately, several therapeutic interventions are available to aid in the healing process. While a range of treatments exist, Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) are the most effective evidenced-based treatment modalities. Notably, both are recommended as first-line treatments in every major practice guideline, including those of the VA, DOD, APA, and WHO. But how do they compare to other treatments, so one can  make an informed choice? Let's delve deeper.

First-Line  Therapies:  Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE)

Both PE and CPT fall under the cognitive-behavioral umbrella, but employ different techniques:

Cognitive Processing Therapy (CPT): CPT addresses maladaptive beliefs, also known as stuck points about the trauma.  One notable aspect of CPT is its focus on cognitive restructuring, which helps individuals develop a healthier perspective on the actual traumatic event and the impact it has on their current life,  By challenging and modifying these distorted beliefs, individuals can become unstuck from the trauma, so they can  get on with living their lives peacefully. 

Research on CPT has demonstrated its effectiveness in reducing symptoms of Post Traumatic Stress Disorder (PTSD), depression, and anxiety among trauma survivors. Not only does CPT reduce these symptoms, but it helps people improve general coping skills and enhances their quality of life. 

Studies have indicated that the benefits of CPT are often sustained over time, with many individuals experiencing continued symptom improvement even after completing the therapy. 

As a result, CPT has become widely recognized as a valuable therapeutic approach for addressing the psychological effects of trauma.

Prolonged Exposure (PE): As the name implies, PE involves controlled and repeated exposure to thoughts, feelings, and situations related to the trauma. 

The goal is to gradually reduce the fear and avoidance associated with these traumatic memories. Research studies have consistently shown the effectiveness of PE in reducing PTSD symptoms and improving overall functioning in individuals who have experienced various types of trauma, including combat, sexual assault, and natural disasters. 

Furthermore, PE has been found to produce long-lasting benefits, with many individuals maintaining symptom reduction even after treatment has ended. The success of PE has led to its widespread adoption as a first-line treatment for PTSD in both civilian and military populations.

Second-line options: EMDR and medication

While PE and CPT are considered the gold standard of trauma treatment, other treatments have demonstrated success. 

1. Eye Movement Desensitization and Reprocessing (EMDR): This therapy entails recalling trauma accompanied by specific eye movements. Although successful for many, certain guidelines regard it as a second-line option, especially when juxtaposed against the extensive evidence underpinning PE and CPT.

2. Medications: While not a primary psychotherapeutic intervention, medications can help alleviate PTSD symptoms for many, especially when paired with therapy. Medications are not considered a first-line treatment for PTSD because they are generally less effective and only address symptoms related to the trauma, they do not help the person recover from the trauma.   symptoms. 

The 3 FDA-approved medications for PTSD include paroxetine (Paxil), sertraline (Zoloft), and venlafaxine (Effexor). 

CPT's Unique Advantages

Each therapy has its strengths, yet CPT offers distinct advantages:

  • Telehealth evidence: CPT has the most substantial evidence supporting its efficacy when delivered via telehealth—a paramount consideration in our increasingly digital era.
  • No mandatory trauma exposure: Unlike PE and EMDR, CPT doesn't require direct exposure to traumatic memories. This attribute can be preferable for those hesitant about re-experiencing their trauma during sessions.
  • Preferred by many: Both in research and in practice, many survivors prefer CPT when given a choice of trauma therapies—likely due to its emphasis on changing thoughts and feelings, the absence of an exposure component, and because the skills can be applied to situations in everyday life.

PTSD recovery is highly individualized, and therapy choices often hinge on individual preferences and needs. There is no research to guide matching patients to specific therapies, so the choice of therapy is personal. However, PE and CPT aren't just top-tier options by merit—they are consistently endorsed as first-line treatments by respected organizations such as the VA, DOD, APA, and WHO. With CPT's unique advantages, especially in telehealth and its non-exposure-based approach, it presents itself as a favored choice for many. Consult with a professional, weigh the options, and embark on the path that resonates with you.

If PTSD challenges you or someone close to your heart, Nema is here with open arms. Our approach to treatment is both compassionate and evidence-based, ensuring trauma survivors can embark on a healing journey that’s both effective and filled with supportive care. Click here to schedule a free consultation to see how we can help.