PTSD Treatment: Evidence-Based Psychotherapies and Medications

First-Line Psychotherapies (Trauma-Focused)

Modality	Core Mechanism	Format
Prolonged Exposure (PE)	Imaginal + in vivo exposure → habituation, emotional processing	8–15 sessions, 90 min
Cognitive Processing Therapy (CPT)	Challenging stuck points (self-blame, safety, trust, power, esteem, intimacy)	12 sessions, 60–90 min
Eye Movement Desensitization and Reprocessing (EMDR)	Bilateral stimulation during memory recall → adaptive information processing	8–12 sessions, 90 min
Written Exposure Therapy (WET)	Structured writing about trauma → extinction, reorganization	5 sessions, 30 min

First-Line Medications

• SSRIs: Sertraline (FDA), paroxetine (FDA), fluoxetine (off-label).
• SNRIs: Venlafaxine XR (strong evidence).

Adjunctive Medications

• Prazosin (nightmares, sleep) – mixed recent trial data; still widely used.
• Atypical antipsychotics (quetiapine, risperidone) – for severe hyperarousal, dissociation, comorbid psychosis.
• Mood stabilizers – limited evidence; for comorbid bipolar.

Treatment Selection

• Patient preference, comorbidity, access, clinician expertise.
• Combined psychotherapy + medication > either alone for many.
• Insufficient response → switch modality, augment, or intensive programs (IOP, residential).

Guidelines: VA/DoD, APA, ISTSS, NICE all endorse trauma-focused therapy as primary.