Home / Mental health / PTSD and trauma / PTSD therapy
Mental health
Trauma-focused therapies
How prolonged exposure, cognitive processing therapy, EMDR, written exposure and trauma-focused CBT treat PTSD, how well they work, and how to start.
The best-tested treatment for PTSD (post-traumatic stress disorder) is a kind of talk therapy called trauma-focused therapy. It helps you face the memory of what happened, safely and step by step, so it loses its power over your daily life.1,4
This page explains the main types: prolonged exposure, cognitive processing therapy, EMDR, written exposure therapy and trauma-focused CBT. It covers how each one works, how well they work, what U.S. guidelines say, and how to get started.
Key points
- Trauma-focused talk therapy is the first choice in the 2023 VA/DoD guideline. It is favored over medicine when both are possible.3,9
- The three most recommended are prolonged exposure (PE), cognitive processing therapy (CPT) and EMDR.3 Most take about 8 to 16 sessions, often over about 3 months.1,2
- In VA figures, about 57 in 100 people improved in a meaningful way after about 3 months of trauma-focused therapy. Without treatment, about 8 in 100 did.10
- Written exposure therapy is a shorter option, about 5 sessions with no homework.2,9
- These therapies can help at any age. Mild memory problems or heart disease do not rule them out.11
What makes a therapy "trauma-focused"?
PTSD keeps going partly because of avoidance. Staying away from memories, places and people that remind you of the trauma brings relief for a moment. Over time, though, it keeps the fear alive and blocks recovery.5
Trauma-focused therapies work on the trauma itself, and on what it has come to mean to you.1 They tend to use two tools:12
- Exposure. You slowly and safely face the trauma memory. You might talk or write about it, or visit safe places you have been avoiding. With practice, the memory becomes less upsetting.
- Cognitive restructuring. You take a fresh, realistic look at what happened. This is especially helpful if you blame yourself or feel guilt or shame for something that was not your fault.
You stay in control the whole time. A trained therapist helps you set the pace.5
How well do these therapies work?
PTSD treatment works. A VA handout based on research reviews compared what happened to people after about 3 months:10
| After about 3 months | How many had meaningful improvement |
|---|---|
| Trauma-focused talk therapy | About 57 in 100 |
| Antidepressant medicine | About 36 in 100 |
| No treatment | About 8 in 100 |
So more than half of people who get trauma-focused therapy feel clearly better. Not everyone does, and some people still have symptoms at the end. Research reviews also suggest the benefits of therapy tend to last longer than those of medicine.9
These therapies often ease depression too. In trials, CPT and PE lowered depression along with PTSD.9
What the guidelines recommend
The U.S. Department of Veterans Affairs and Department of Defense (VA/DoD) updated their PTSD guideline in 2023.3
| Level | Therapies |
|---|---|
| Recommended (strongest support) | Prolonged exposure, cognitive processing therapy, EMDR |
| Suggested (good support, a bit less) | Cognitive therapy for PTSD, written exposure therapy, present-centered therapy |
| Not enough evidence yet | Many other therapies, including group therapy on its own9 |
The guideline suggests the "suggested" options when the top three are not available or not wanted.3,9
The American Psychological Association (APA) has its own guideline, last updated in 2025. It most strongly recommends CBT, CPT and PE. It gives a weaker, conditional recommendation to cognitive therapy, EMDR and narrative exposure therapy (a short form of exposure therapy).4 The two guidelines mostly agree. The main difference is how strongly they rate EMDR.
The main therapies, one by one
Prolonged exposure (PE)
Strong evidenceYou meet one-on-one with a therapist, usually for 8 to 15 weekly sessions of 60 to 90 minutes.5 Early on, you learn a slow-breathing skill and list the people, places and activities you have been avoiding. From about the third session, you talk through the trauma in detail while your therapist checks how you are doing. Between sessions, you listen to recordings of yourself telling the story. You also practice approaching safe situations on your list, starting with easier ones.5 Learn more: Prolonged exposure therapy and Exposure therapy.
Cognitive processing therapy (CPT)
Strong evidenceCPT usually takes 12 sessions, either one-on-one for 60 minutes or in a group for 90 minutes.6 It looks at upsetting beliefs that grew out of the trauma. Examples are "It was my fault" or "The world is never safe." You learn to check the facts for and against each belief, and decide whether another view fits better. Homework includes worksheets and short writing tasks. Writing a full account of the trauma is optional. Later sessions look at safety, trust, control, self-esteem and closeness with others.6 Learn more: Cognitive processing therapy.
EMDR
Strong evidenceEMDR stands for eye movement desensitization and reprocessing. You hold the trauma memory in mind for short periods, about 30 seconds at a time. Meanwhile, you follow a back-and-forth movement or sound, such as the therapist's moving finger, a light or a tone. Then you talk about what came up. Later, you focus on a more helpful belief about yourself.7 Sessions are usually weekly for about 3 months, and there is no homework.7 Studies are mixed on whether the eye movements themselves add anything beyond the memory work.9 Learn more: EMDR.
Written exposure therapy (WET)
Moderate evidenceWET is short: about 5 sessions. In each one, you write about the trauma, then talk briefly with your therapist. There is no homework.2,9 In a 2023 trial with 178 veterans, people did about as well with WET as with prolonged exposure.8 WET took fewer and shorter sessions. Far fewer people quit WET early: about 1 in 8, compared with about 1 in 3 for PE.8
Trauma-focused CBT
Strong evidenceFor adults, "trauma-focused CBT" is a broad name for cognitive behavioral therapies that work on the trauma. PE and CPT are both types.4 Another is cognitive therapy for PTSD, where you revisit the memory to make sense of it and challenge harsh thoughts about it.2 For children and teens ages 3 to 18, a specific program called TF-CBT is widely used. The therapist works with the child and the parent or caregiver, apart and together. It has been tested in 25 randomized trials, and many children improve in 8 to 25 sessions.13
Present-centered therapy (PCT)
Moderate evidencePCT does not ask you to go over the trauma. Instead, you work on current problems linked to PTSD, such as stress at home or work.2 Fewer people drop out of PCT than out of the trauma-focused therapies.9 It can be a good start for people who are not ready to face the memory.
Comparing the options
| Therapy | Usual length | Homework? | Retell the trauma in detail? |
|---|---|---|---|
| Prolonged exposure | 8–15 sessions | Yes | Yes, out loud |
| Cognitive processing therapy | About 12 sessions | Yes | Optional, in writing |
| EMDR | About 3 months, weekly | No | Briefly bring it to mind |
| Written exposure therapy | About 5 sessions | No | Yes, in writing |
| Present-centered therapy | About 3 months | Varies | No |
Sources for this table: 2,5,6,7,9
Will therapy make me feel worse?
Many people worry about this. Facing the memory can bring mild to moderate discomfort. It is usually brief, and it tends to ease as treatment goes on.5,6 Most people who finish EMDR say the benefits were worth the discomfort.7
Some people stop therapy early. If you feel like quitting, tell your therapist. They can slow the pace, add coping skills, or help you consider a different therapy.
Do I need to fix other problems first?
Not usually. The 2023 guideline suggests that drinking or drug problems, or other mental health conditions, should not by themselves keep someone from trauma-focused therapy.3 Your therapist may treat them at the same time. If alcohol is part of the picture, see Coping with trauma symptoms.
Therapy in later life
Older adults with PTSD can benefit from these therapies. Fewer studies include people over 65, and very few include people over 75. But in the studies that exist, trauma-focused therapy was well tolerated and eased symptoms.11 Nothing in the research says older adults should be steered away from first-choice therapy.11
Some points for older adults and families:11
- Memory problems. Mild or moderate cognitive impairment (thinking and memory problems) is not a reason to rule out therapy. A therapist may do a short memory check and adjust the approach.
- Heart health. There is no evidence that the stress of exposure is unsafe for the heart. If you have heart disease, your therapist can work with your doctor first.
- Hearing and vision. Ask for large-print handouts and a quiet room. Bring your hearing aids or magnifier.
- Family. A caregiver can join some sessions if you want, but the focus stays on you.
- Getting there. Video sessions can help if driving or mobility is hard.
Older adults are less likely to be offered therapy after a PTSD diagnosis. Yet once they start, they are less likely to drop out than younger people.11 It is never too late to ask. Read more in PTSD in older adults and veterans.
Video, groups and apps
Video therapy. The 2023 guideline supports secure video sessions when the therapy has been tested that way, or when in-person care is not possible.3 Most of these therapies can be done from home.
Group therapy. CPT can be done in a group.6 But there is not enough evidence that group therapy alone works as well, and one study found individual CPT worked better than group CPT.9 Groups can still add support.
Apps. The VA offers free PE Coach and CPT Coach apps to use alongside therapy. They do not share your information with the VA.5,6 They help you practice. They do not replace a therapist.
How to get started
- Get assessed. A primary care doctor or mental health professional can check for PTSD. See Getting assessed for PTSD.
- Compare your options. The VA's free online PTSD Treatment Decision Aid lets you compare therapies and print your questions.1
- Find a trained therapist. Ask, "Are you trained in PE, CPT, EMDR or written exposure therapy?" Veterans can ask at any VA medical center. Almost all offer PE.5 Others can search SAMHSA's findtreatment.gov.12 See How to find a therapist.
- Check the cost. See Paying for therapy for insurance, Medicare and low-cost options.
- Go to every session you can. These therapies build week by week. Tell your therapist if anything gets in the way.
Do I have to tell my therapist every detail?
Can I have therapy and take medicine at the same time?
Yes. Some people use both. Antidepressants such as sertraline, paroxetine and venlafaxine have the most evidence for PTSD.1 See Medicines for PTSD. Talk with your doctor or pharmacist before changing any medicine.
What if I still have symptoms after therapy?
Is this only for veterans?
When to get help
Reach out to a doctor or therapist if trauma memories, nightmares, fear or avoidance last more than a month or get in the way of your life. Our PTSD overview and private check-in can help you take the first step.
If you are thinking about suicide or are in crisis, call or text 988 to reach the 988 Suicide and Crisis Lifeline. If someone is in immediate danger, call 911.12
Veterans and their families and friends can reach the Veterans Crisis Line by dialing 988 and pressing 1, or by texting 838255. You do not need to be enrolled in VA care.14
Sources
- U.S. Department of Veterans Affairs, National Center for PTSD. PTSD treatment basics. VA, 2026. ptsd.va.gov
- U.S. Department of Veterans Affairs, National Center for PTSD. Talk therapy for PTSD. VA, 2026. ptsd.va.gov
- Psychological Health Center of Excellence. Psychotherapy for treatment of posttraumatic stress disorder (summary of the 2023 VA/DoD clinical practice guideline, version 4.0). Defense Health Agency, 2023. health.mil
- American Psychological Association. Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults: treatments. APA, updated 2025. apa.org
- U.S. Department of Veterans Affairs, National Center for PTSD. Prolonged exposure for PTSD. VA, 2026. ptsd.va.gov
- U.S. Department of Veterans Affairs, National Center for PTSD. Cognitive processing therapy for PTSD. VA, 2026. ptsd.va.gov
- U.S. Department of Veterans Affairs, National Center for PTSD. Eye movement desensitization and reprocessing (EMDR) for PTSD. VA, 2026. ptsd.va.gov
- Sloan DM, et al. Written exposure therapy vs prolonged exposure therapy in the treatment of posttraumatic stress disorder: a randomized clinical trial. JAMA Psychiatry, 2023. PMC
- U.S. Department of Veterans Affairs, National Center for PTSD. Overview of psychotherapy for PTSD. VA, 2026. ptsd.va.gov
- U.S. Department of Veterans Affairs, National Center for PTSD. PTSD treatment works (handout). VA. ptsd.va.gov
- U.S. Department of Veterans Affairs, National Center for PTSD. Older adults and PTSD: assessment and treatment. VA, 2026. ptsd.va.gov
- National Institute of Mental Health. Post-traumatic stress disorder. NIMH, 2023. NIMH
- National Child Traumatic Stress Network. Trauma-focused cognitive behavioral therapy (TF-CBT). NCTSN, updated 2026. nctsn.org
- Veterans Crisis Line. Get help now. U.S. Department of Veterans Affairs. veteranscrisisline.net
Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.