Baseer Maroof, LCSW · Raleigh, NC · Adults 21+
Treatments & guidelines
Two guidelines, one message: trauma-focused therapy works. Here’s how they rate each option.
In short
- Both major U.S. guidelines put trauma-focused psychotherapy at the top.
- VA/DoD 2023 strongly recommends CPT, EMDR and PE, and recommends them over medication.
- APA 2025 makes CPT, PE and trauma-focused CBT its first-line picks, with cognitive therapy, EMDR and narrative exposure therapy second-line.
- Both advise against benzodiazepines. Video sessions work for CPT and PE.
Guideline compare
Guideline compare
Tap a treatment to see how each guideline rates it.
VA/DoD: strong for, suggested (weak for), insufficient, against. APA: strong for (first line), conditional for (second line), insufficient, against.
The sessions
What the sessions look like
Tap a therapy.
Good to know
Trauma-focused means it deals with the trauma
These therapies work directly with the memory of the trauma or what it means to you. That’s different from general support or coping skills alone. (National Center for PTSD)
Video works
The VA/DoD recommends secure video for its recommended therapies when the therapy has been validated by video or other options aren’t available. Trials found CPT and PE by video noninferior to face-to-face. (VA/DoD 2023)
Short options exist
Written exposure therapy is five sessions. In a trial of 126 adults, it was noninferior to CPT, and only 6% dropped out versus 40% for CPT. (Sloan et al. 2018)
Pick the one you’ll finish
The guidelines don’t crown a single winner among the top therapies. Fit matters: whether you’d rather work on beliefs (CPT), face memories and situations (PE), or follow EMDR’s structure.
Sources
All sources, linked8 references⌄
- Schnurr PP et al. (2024). The Management of Posttraumatic Stress Disorder and Acute Stress Disorder: synopsis of the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Annals of Internal Medicine (2024). doi:10.7326/M23-2757. www.healthquality.va.gov/guidelines/MH/ptsd/PTSD-in-Annals-2024.pdf
- American Psychological Association (2025). Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults. www.apa.org/ptsd-guideline
- National Center for PTSD. Cognitive Processing Therapy for PTSD (for providers). www.ptsd.va.gov/professional/treat/txessentials/cpt_for_ptsd_pro.asp
- National Center for PTSD. Prolonged Exposure for PTSD (for providers). www.ptsd.va.gov/professional/treat/txessentials/prolonged_exposure_pro.asp
- National Center for PTSD. Prolonged Exposure for PTSD (for patients). www.ptsd.va.gov/understand_tx/prolonged_exposure.asp
- National Center for PTSD. Eye Movement Desensitization and Reprocessing (EMDR) for PTSD. www.ptsd.va.gov/understand_tx/emdr.asp
- Sloan DM et al. (2018). A brief exposure-based treatment vs cognitive processing therapy for posttraumatic stress disorder: a randomized noninferiority clinical trial. JAMA Psychiatry. pubmed.ncbi.nlm.nih.gov/29344631/
- Thompson-Hollands J, Marx BP, Sloan DM (2019). Brief novel therapies for PTSD: written exposure therapy. Current Treatment Options in Psychiatry. pmc.ncbi.nlm.nih.gov/articles/PMC6594556/
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