PTSD & Acute Trauma
Trauma- and Stressor-Related Disorders (DSM-5-TR)
Intrusions, avoidance, negative cognitions/mood, and hyperarousal following exposure to a traumatic event. Includes PTSD and acute stress disorder. Best-studied area of psychotherapy — multiple treatments have strong evidence.
Prevalence: ~6% lifetime; higher in combat veterans, assault survivors
Clinical Picture
PTSD treatment has more high-quality evidence behind it than almost any other condition in psychotherapy research. The three treatments with the strongest evidence — CPT, Prolonged Exposure, and EMDR — work through different mechanisms but converge on the same principle: the traumatic memory must be accessed and processed rather than avoided. Where they diverge is in how processing happens. PE uses repeated narrative exposure. CPT works through written accounts and cognitive restructuring of 'stuck points.' EMDR uses bilateral stimulation during trauma reprocessing. The clinical question isn't which is 'best' in the abstract but which fits this client's presentation, tolerance for distress, and cognitive style.
Treatment Considerations
For single-incident adult trauma with clear PTSD symptoms, any of the guideline-recommended treatments is a reasonable starting point. The choice often depends on practical factors: PE requires homework (daily listening to session recordings); CPT requires written work; EMDR requires less between-session work but demands the client's capacity to tolerate dual attention. For clients with significant dissociation, avoidance, or complex trauma histories, a stabilization phase may be necessary before trauma processing begins. The somatic and attachment-focused approaches listed in the emerging evidence tier may be more appropriate as primary treatments for developmental or complex trauma.
53 Therapeutic Approaches
Sorted by evidence tier: guideline-recommended first, then RCT-supported, then emerging/limited evidence.
Related Clinical Vignettes
Sources & References
Prevalence data from NIMH, WHO, and DSM-5-TR field trial publications. Evidence tiers reflect guideline status (APA, NICE, VA/DoD, WHO) and meta-analytic findings as of early 2025. Individual modality citations are listed on each modality page. Full bibliography available on the Sources page.