Skip to main content
SpringerLink
Log in

Evidence-Based Cognitive-Behavioral Treatments for PTSD in Adults

Comprehensive Guide to Post-Traumatic Stress Disorder

  • 550 Accesses

Abstract

Treatment guidelines consistently identify cognitive-behavioral interventions as among the most effective treatments for posttraumatic stress disorder (PTSD). This chapter reviews evidence-based cognitive-behavioral therapies for PTSD, including exposure therapy (with an emphasis on prolonged exposure), cognitive therapy (with an emphasis on cognitive processing therapy), and stress inoculation training/stress management. For each type of cognitive-behavioral intervention, we review the relevant theory, treatment procedures, and key research studies. The chapter concludes with practice considerations covering factors related to treatment outcome, implementation, and adaptation of these evidence-based treatments.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Abbreviations

AHRQ:

Agency for Healthcare Research and Quality

APA:

American Psychiatric Association

BA:

Behavioral activation

CPT-C:

Cognitive processing therapy-cognitive only

CR:

Cognitive restructuring

DCS:

d-Cycloserine

EMDR:

Eye movement desensitization and reprocessing

IOM:

Institute of Medicine

ISTSS:

International Society for Traumatic Stress Studies

ITT:

Intent to treat

MST:

Military sexual trauma

NHMRC:

Australian National Health and Medical Research Council

NICE:

United Kingdom’s National Institute for Health and Clinical Excellence

PCT:

Present-centered therapy

PE:

Prolonged exposure

PTSD:

Posttraumatic stress disorder

RCT:

Randomized controlled trial

SIT:

Stress inoculation training

TAU:

Treatment as usual

TF-CBT:

Trauma-focused cognitive-behavioral therapy

TMT:

Trauma management therapy

VA/DoD:

Department of Veterans Affairs/Department of Defense

References

  • Agency for Healthcare Research and Quality. Comparative effectiveness review number 92. Psychological and pharmacological treatments for adults with posttraumatic stress disorder (PTSD). Publication No. 13-EHC011-EF Apr 2013. http://www.ncbi.nlm.nih.gov/books/NBK137702

  • American Psychiatric Association. Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. Arlington: American Psychiatric Association; 2004.

    Google Scholar 

  • Australian National Health and Medical Research Council. Australian guidelines for the treatment of adults with acute stress disorder and posttraumatic stress disorder. Melbourne: Australian National Health and Medical Research Council; 2007.

    Google Scholar 

  • Barrera TL, Mott JM, Hofstein RF, et al. A meta-analytic review of exposure in group cognitive behavioral therapy for posttraumatic stress disorder. Clin Psychol Rev. 2013;33(1):24–32.

    Article  PubMed  Google Scholar 

  • Beidel DC, Frueh C, Uhde TW, et al. Multicomponent behavioral treatment for chronic combat-related posttraumatic stress disorder: a randomized controlled trial. J Anxiety Disord. 2011;25:224–31.

    Article  PubMed Central  PubMed  Google Scholar 

  • Bisson JI, Ehlers A, Matthews P, et al. Psychological treatments for chronic post-traumatic stress disorders. Systematic review and meta-analysis. Br J Psychiatry. 2007;190:97–104.

    Article  PubMed  Google Scholar 

  • Blanchard EB, Hickling EJ, Devineni T, et al. A controlled evaluation of cognitive behavioral therapy for posttraumatic stress in motor vehicle accident survivors. Behav Res Ther. 2003;41:79–96.

    Article  PubMed  Google Scholar 

  • Bradley R, Greene J, Russ E, et al. A multidimensional meta-analysis of psychotherapy for PTSD. Am J Psychiatry. 2005;162(2):214–27.

    Article  PubMed  Google Scholar 

  • Bryant RA, Moulds ML, Guthrie RM, et al. A randomized controlled trial of exposure therapy and cognitive restructuring for posttraumatic stress disorder. J Consult Clin Psychol. 2008;76:695.

    Article  PubMed  Google Scholar 

  • Chard KM, Schumm JA, McIlvain SM, et al. Exploring the efficacy of a residential treatment program incorporating cognitive processing therapy-cognitive for veterans with PTSD and traumatic brain injury. J Trauma Stress. 2011;24:347–51.

    Article  PubMed  Google Scholar 

  • Cook JM, O’Donnell C, Dinnen S, et al. A formative evaluation of two evidence-based psychotherapies for PTSD in VA residential treatment programs. J Trauma Stress. 2013;26:56–63.

    Article  PubMed Central  PubMed  Google Scholar 

  • Cook JM, Dinnen S, Thompson R, et al. Changes in implementation of two evidence-based psychotherapies for PTSD in VA residential treatment programs: a national investigation. J Trauma Stress. 2014;27:137–43.

    Article  PubMed Central  PubMed  Google Scholar 

  • Department of Veterans Affairs and Department of Defense. VA/DoD clinical practice guideline for the management of post-traumatic stress. Version 2.0. Washington, DC: Veterans Health Administration, Department of Defense; 2010.

    Google Scholar 

  • Diehle J, Schmitt K, Daams JG, et al. Effects of psychotherapy on trauma-related cognitions in posttraumatic stress disorder: a meta-analysis. J Trauma Stress. 2014;27:108.

    Article  Google Scholar 

  • Falsetti SA, Resnick HS, Davis J, et al. Treatment of posttraumatic stress disorder with comorbid panic attacks: combining cognitive processing therapy with panic control treatment techniques. Group Dyn. 2001;5:252–60.

    Article  Google Scholar 

  • Foa EB, Kozak MJ. Emotional processing of fear: exposure to corrective information. Psychol Bull. 1986;99(1):20–35.

    Article  PubMed  Google Scholar 

  • Foa EB, Keane TM, Friedman MJ, Cohen J (eds.). Effective treatments for PTSD: Practice guidelines from the international society for traumatic stress studies (2nd ed.). New York: Guilford Press; 2008.

    Google Scholar 

  • Foa EB, Rothbaum BO, Riggs DS, et al. Treatment of posttraumatic stress disorder in rape victims: a comparison between cognitive-behavioral procedures and counseling. J Consult Clin Psychol. 1991;59(5):715–23.

    Article  PubMed  Google Scholar 

  • Foa EB, Dancu CV, Hembree EA, et al. A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims. J Consult Clin Psychol. 1999;67(2):194–200.

    Article  PubMed  Google Scholar 

  • Foa EB, Zoellner LA, Feeny NC, et al. Does imaginal exposure exacerbate PTSD symptoms? J Consult Clin Psychol. 2002;70:1022–28.

    Article  PubMed  Google Scholar 

  • Foa EB, Hembree EA, Cahill SP, et al. Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: outcome at academic and community clinics. J Consult Clin Psychol. 2005;73(5):953.

    Article  PubMed  Google Scholar 

  • Foa EB, Hembree EA, Rothbaum BO. Prolonged exposure therapy for PTSD: emotional processing of traumatic experiences: therapist guide. New York: Oxford University Press; 2007.

    Google Scholar 

  • Galovski TE, Blain LM, Mott JM, et al. Manualized therapy for PTSD: flexing the structure of cognitive processing therapy. J Consult Clin Psychol. 2012;80(6):968–81.

    Article  PubMed Central  PubMed  Google Scholar 

  • Goodson J, Helstrom A, Halpern JM, et al. Treatment of posttraumatic stress disorder in US combat veterans: a meta-analytic review. Psychol Rep. 2011;109(2):573–99.

    Article  PubMed  Google Scholar 

  • Hembree EA, Foa EB, Dorfan NM, et al. Do patients drop out prematurely from exposure therapy for PTSD? J Trauma Stress. 2003;16:555–62.

    Article  PubMed  Google Scholar 

  • Hourani LL, Kizakevich PN, Hubal R, et al. Predeployment stress inoculation training for primary prevention of combat-related stress disorders. J Cyber Ther Rehabil. 2011;4:101–16.

    Google Scholar 

  • Institute of Medicine. Treatment of PTSD: assessment of the evidence. Washington, DC: National Academies Press; 2007.

    Google Scholar 

  • Institute of Medicine. Treatment of posttraumatic stress disorder: an assessment of the evidence. Washington, DC: National Academies Press; 2008.

    Google Scholar 

  • Jeffreys MD, Reinfeld C, Nair PV, et al. Evaluating treatment of posttraumatic stress disorder with cognitive processing therapy and prolonged exposure therapy in a VHA specialty clinic. J Anxiety Disord. 2014;28:108–14.

    Article  PubMed  Google Scholar 

  • Kaysen D, Lindgren K, Zangana GAS, et al. Adaptation of cognitive processing therapy for treatment of torture victims: experience in Kurdistan. Iraq Psychol Trauma. 2013;5:184–92.

    Article  Google Scholar 

  • Kaysen D, Schumm J, Pedersen ER. Cognitive processing therapy for veterans with comorbid PTSD and alcohol use disorders. Addict Behav. 2014;39(2):420–7.

    Article  PubMed  Google Scholar 

  • Litz BT, Salters-Pedneault K, Steenkamp MM, et al. A randomized placebo-controlled trial of d-cycloserine and exposure therapy for posttraumatic stress disorder. J Psychiatr Res. 2012;46:1184–90.

    Article  PubMed  Google Scholar 

  • McCann IL, Sakheim DK, Abrahamson DJ. Trauma and victimization: a model of psychological adaption. Counsel Psychol. 1988;16:531–94.

    Article  Google Scholar 

  • Meichenbaum D. Cognitive behavior modification. Morristown: General Learning Press; 1974.

    Google Scholar 

  • Meichenbaum D. Stress inoculation training: a preventative and treatment approach. In: Lehrer PM, Woolfolk RL, Sime WE, editors. Principles and practice of stress management. New York: Guilford Press; 2007.

    Google Scholar 

  • Monson CM, Schnurr PP, Resick PA, et al. Cognitive processing therapy for veterans with military-related posttraumatic stress disorder. J Consult Clin Psychol. 2006;74:898.

    Article  PubMed  Google Scholar 

  • Nacasch N, Foa EB, Hupper JD, Tzur D, Fostiek L, Dinstein Y, Polliack M, Zohar J. Prolonged exposure therapy for combat- and terror-related posttraumatic stress disorder: a randomized control comparison with treatment as usual. J Clin Psychol. 2010;72(9):1174–80.

    Google Scholar 

  • Najavits LM. Seeking safety: a treatment manual for PTSD and substance abuse. New York: Guilford Press; 2002.

    Google Scholar 

  • National Institute for Health and Clinical Excellence. Post-traumatic stress disorder. London: Royal College of Psychiatrists and the British Psychological Society; 2005.

    Google Scholar 

  • Powers MB, Halpern JM, Ferenschak MP, et al. A meta-analytic review of prolonged exposure for posttraumatic stress disorder. Clin Psychol Rev. 2010;30:635–41.

    Article  PubMed  Google Scholar 

  • Resick PA, Schnicke MK. Cognitive processing therapy for sexual assault victims. J Consult Clin Psychol. 1992;60:748.

    Article  PubMed  Google Scholar 

  • Resick PA, Nishith P, Griffin MG. How well does cognitive-behavioral therapy treat symptoms of complex PTSD? An examination of child sexual abuse survivors within a clinical trial. CNS Spectr. 2003;8:340–55.

    PubMed Central  PubMed  Google Scholar 

  • Resick PA, Galovski TE, Uhlmansiek MOB, et al. A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence. J Consult Clin Psychol. 2008a;76:243–58.

    Article  PubMed Central  PubMed  Google Scholar 

  • Resick PA, Monson CM, Chard KM. Cognitive processing therapy: veteran/military version. Washington, DC: Department of Veterans Affairs; 2008b. Retrieved from http://depts.washington.edu/hcsats/PDF/research/Cognitive%20Processing%20Therapy%20Manual%208.08.pdf

  • Schnurr PP, Friedman MJ, Engel CC, et al. Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial. JAMA. 2007;297:820–30.

    Article  PubMed  Google Scholar 

  • Seidler GH, Wagner FE. Comparing the efficacy of EMDR and trauma-focused cognitive-behavioral therapy in the treatment of PTSD: a meta-analytic study. Psychol Med. 2006;36(11):1515–22.

    Article  PubMed  Google Scholar 

  • Strachan M, Gros DF, Ruggiero KJ, et al. An integrated approach to delivering exposure-based treatment of symptoms of PTSD and depression in OIF/OEF veterans: preliminary findings. Behav Ther. 2012;43:560–9.

    Article  PubMed  Google Scholar 

  • Surís A, Link-Malcolm J, Chard K. A randomized clinical trial of cognitive processing therapy for veterans with PTSD related to military sexual trauma. J Trauma Stress. 2013;26.

    Google Scholar 

  • Taylor S, Fedoroff IC, Koch WJ, et al. Posttraumatic stress disorder arising after road traffic collisions: patterns of response to cognitive-behavior therapy. J Consult Clin Psychol. 2001;69:541–51.

    Article  PubMed  Google Scholar 

  • Taylor S, Thordarson DS, Maxfield L, et al. Comparative efficacy, speed, and adverse effects of three PTSD treatments: exposure therapy, EMDR, and relaxation training. J Consult Clin Psychol. 2003;71:33–338.

    Google Scholar 

  • Tuerk PW, Yoder M, Grubaugh A, et al. Prolonged exposure therapy for combat-related posttraumatic stress disorder: an examination of treatment effectiveness for Veterans of the wars in Afghanistan and Iraq. J Anxiety Disord. 2011;25:397–403.

    Article  PubMed  Google Scholar 

  • van Etten ML, Taylor S. Comparative efficacy of treatments for post-traumatic stress disorder: a meta-analysis. Clin Psychol Psychother. 1998;5(3):126–44.

    Article  Google Scholar 

  • van Minnen A, Arntz A, Keijsers GPJ. Prolonged exposure in patients with chronic PTSD: predictors of treatment outcome and dropout. Behav Res Ther. 2002;40:439–57.

    Article  PubMed  Google Scholar 

  • Watts BV, Schnurr PP, Mayo L, et al. Meta-analysis of the efficacy of treatments for posttraumatic stress disorder. J Clin Psychiatry. 2013;74(6):541–50.

    Article  Google Scholar 

  • Wilk JE, West JC, Duffy FF, et al. Use of evidence-based treatment for posttraumatic stress disorder in Army behavioral healthcare. Psychiatry. 2013;76(4):336–48.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Veterans Affairs National Center for PTSD- Executive Division, 215 North Main Street (116D), 05009, White River Junction, VT, USA

    Juliette M. Mott

  2. Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine, Michael E. DeBakey VA Medical Center, VA South Central Mental Illness Research, Education, and Clinical Center, 2001 Holcombe Boulevard, 77019, Houston, TX, USA

    Ellen J. Teng

Authors
  1. Juliette M. Mott
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ellen J. Teng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Juliette M. Mott .

Editor information

Editors and Affiliations

  1. Buckinghamshire New University, Uxbridge, Middlesex, United Kingdom

    Colin R. Martin

  2. Kings College, London, United Kingdom

    Victor R. Preedy

  3. University of Westminster, London, United Kingdom

    Vinood B. Patel

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this entry

Cite this entry

Mott, J.M., Teng, E.J. (2015). Evidence-Based Cognitive-Behavioral Treatments for PTSD in Adults. In: Martin, C., Preedy, V., Patel, V. (eds) Comprehensive Guide to Post-Traumatic Stress Disorder. Springer, Cham. https://doi.org/10.1007/978-3-319-08613-2_17-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-08613-2_17-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Online ISBN: 978-3-319-08613-2

  • eBook Packages: Springer Reference Behavioral Science and PsychologyReference Module Humanities and Social SciencesReference Module Business, Economics and Social Sciences

Publish with us

Policies and ethics

Chapter history

  1. Latest

    Evidence-Based Cognitive Behavioral Treatments for PTSD in Adults
    Published:
    04 June 2015

    DOI: https://doi.org/10.1007/978-3-319-08613-2_17-2

  2. Original

    Evidence-Based Cognitive-Behavioral Treatments for PTSD in Adults
    Published:
    18 March 2015

    DOI: https://doi.org/10.1007/978-3-319-08613-2_17-1

Search

Navigation