Types of Trauma Therapy and What the Research Says

Therapists use many names for trauma work, and the names say little about how well each has been tested. This article reports what two U.S. guidelines and the main studies say about each type.

Three cautions. A trial result describes the people in that trial and does not predict what will happen for you. Some of the studies were done with veterans. And the 2023 guideline from the Departments of Veterans Affairs and Defense (VA/DoD) says its recommendations "are not intended to define a standard of care and should not be construed as one." Not everyone needs treatment at all, as do I need trauma therapy? explains.

Which therapies do U.S. guidelines recommend most strongly?

Specific trauma-focused psychotherapies. The VA/DoD guideline describes these as therapies that use "cognitive, emotional, or behavioral techniques to facilitate processing a traumatic experience and in which the trauma focus is a central component of the therapeutic process."

The VA/DoD guideline gives its highest rating, "Strong for," to three: "We recommend the individual, manualized trauma-focused psychotherapies for the treatment of PTSD: Cognitive Processing Therapy, Eye Movement Desensitization and Reprocessing, or Prolonged Exposure." Manualized means the therapist follows a written protocol.

The VA's public pages describe each one. Prolonged exposure (PE) is a therapy "in which you will gradually approach trauma-related memories, feelings, and situations that you have been avoiding since your trauma." In cognitive processing therapy (CPT), "you will learn ways to evaluate and change the upsetting thoughts about your trauma." In eye movement desensitization and reprocessing (EMDR), "you will pay attention to a back-and-forth movement or sound while you call to mind the upsetting memory and any thoughts or physical feelings that come with it."

The American Psychological Association's 2025 guideline gives its "Strong For" rating to CPT, PE and trauma-focused cognitive behavioral therapy (CBT). It explains that trauma-focused CBT is a broad grouping of therapies, not one specific therapy, with elements such as psychoeducation, cognitive restructuring, in vivo exposure, imaginal exposure, or trauma-focused coping.

So CPT and PE sit at the top of both lists. What each treatment asks of you is described in do you have to talk about what happened in trauma therapy?, and session numbers are in how long does trauma therapy take?

Where do the two guidelines differ?

On three treatments.

• EMDR. It has a strong recommendation from VA/DoD. The American Psychological Association rates it "Conditional For," its second tier, alongside cognitive therapy and narrative exposure therapy.
• Present-centered therapy. VA/DoD rates it "Weak for," with the wording "We suggest." The American Psychological Association lists it under insufficient evidence to recommend for or against.
• Written exposure therapy. VA/DoD suggests it. The American Psychological Association lists it under insufficient evidence when compared with no treatment or usual care. In a separate comparison with CPT and PE it found "no difference in effect" and made no recommendation for or against, noting that the large trials were "conducted by the treatment developer."

The full VA/DoD sentence reads: "We suggest the following individual, manualized psychotherapies for the treatment of PTSD: Ehlers' Cognitive Therapy for PTSD, Present-Centered Therapy, or Written Exposure Therapy." In both guidelines, insufficient evidence means too little good research. It is not a finding that a treatment fails, and it is not an endorsement.

How often do people drop out or feel worse?

The research is not fully consistent. A 2020 meta-analysis of randomized trials of psychological therapies for PTSD put the pooled dropout rate at 16%, and found that therapies with a trauma focus were significantly associated with greater dropout. A 2013 meta-analysis of 42 studies found an average of 18%, varying significantly across studies. In that analysis, group format and a greater number of sessions predicted dropout and trauma focus did not, although trauma-focused treatments resulted in higher dropout compared with present-centered therapy. The two analyses disagree on whether a trauma focus by itself raises dropout.

Dropout can be far higher than those averages. In a 2022 trial of 916 veterans with military-related PTSD at 17 VA medical centers, dropout was 55.8% in PE and 46.6% in CPT. Both groups improved. PE was statistically more effective than CPT, but the authors judged the difference not clinically significant.

Written exposure therapy, a five-session treatment, has the clearest lower-dropout findings. In a 2018 noninferiority trial of 126 veteran and nonveteran adults, it was noninferior to CPT in reducing PTSD symptoms, and 6.4% dropped out against 39.7% in CPT. In a 2023 trial of 178 veterans, it was noninferior to PE, and 12.5% dropped out against 35.6%. Both trials were led by the treatment's developer at VA medical facilities.

On feeling worse: a 2016 study looked at 192 women in two randomized trials of PE, CPT and CPT without the written account. A minority had a rise in PTSD symptoms during treatment: 28.6% in CPT, 20.0% in PE and 14.7% in CPT without the account, with no significant differences between treatments. Those women still showed clinically significant improvement by the end, and the rise was not related to leaving treatment. The limits: these were women in research trials, a rise was defined by one self-report threshold, and those who had one ended with higher symptom scores and were more likely to still have a PTSD diagnosis, both of which the study calls small effects.

If you ever have thoughts of suicide, in treatment or out of it, call or text 988, or call 911 in an emergency.

What do guidelines and trials say about psychodynamic therapy?

That there is too little research to judge. VA/DoD lists psychodynamic therapy under insufficient evidence to recommend for or against, and notes that its source reviews found "no studies of psychodynamic psychotherapy." The American Psychological Association's 2025 panel, citing "the interest in and use of psychodynamic therapies," examined existing reviews and ran extra searches. It "found that there was still insufficient literature that met the criteria to be able to make a recommendation regarding psychodynamic approaches," and its research agenda calls for clinical trials. The studies that exist are few.

• 1989. A trial of 112 people with serious disorders resulting from traumatic events tested trauma desensitization, hypnotherapy and psychodynamic therapy against a waiting list. Treated participants were significantly lower in trauma-related symptoms than the waiting-list group. The abstract reports the three treatments together and gives no effect sizes, so it does not show how psychodynamic therapy did by itself. The trial also predates modern diagnostic methods.
• 2016. A study of Israeli veterans compared CBT (148 patients) with psychodynamic therapy (95). Patients were assigned according to the nature of their complaint and symptoms, not at random. After treatment, 35% of the CBT patients and 45% of the psychodynamic patients had remitted, with no difference between the groups. At follow-up the rates were 33% and 36%. The authors recommended further randomized controlled trials to determine efficacy.
• 2018. A systematic review concluded that the evidence gave examples supporting psychodynamic therapy as an effective treatment for PTSD, but confirmed CBT as more effective for this disorder. It reported comparable dropout rates for the two approaches.

Put plainly: the trials are few and small, and psychodynamic therapy has not been shown to equal the trauma-focused therapies for PTSD symptoms. Guidelines neither recommend it nor advise against it. It overstates the evidence to say it has been shown to work for PTSD, and it overstates it equally to say it does not.

What about body-based and newer approaches?

The research is thin, and the guidelines say so. VA/DoD lists yoga, somatic experiencing and neurofeedback under insufficient evidence to recommend for or against. Of yoga it says: "The single study with the critical outcome, low evidence quality, and variability in practices precludes a recommendation." The American Psychological Association also places neurofeedback under insufficient evidence.

Mindfulness is another point of difference. VA/DoD gives one program a weak recommendation: "We suggest Mindfulness-Based Stress Reduction for the treatment of PTSD." The American Psychological Association rates the same program insufficient evidence, and VA/DoD places other mindfulness trainings there too.

Internal family systems is not rated by VA/DoD. The American Psychological Association names it, along with psychodynamic treatments, among understudied interventions "commonly used in the field or of high public interest but not represented in RCTs and systematic reviews," and calls for clinical trials of both. An RCT is a randomized controlled trial. MDMA-assisted therapy is covered in medication, therapy or both for PTSD?

What does Dr. Rabin offer, and what should you ask?

Dr. Rabin's trauma therapy is psychodynamic, attachment-based, trauma-informed and mindfulness-based, guided by safety, pacing and the therapeutic relationship. The work moves at the client's pace and builds trust and stability before approaching painful material. The client decides what is discussed and when. She trained at The Trauma Center.

As this article has shown, the approach her trauma page describes is not among the therapies U.S. guidelines recommend most strongly for PTSD, and it has been studied much less. That is a statement about what has been tested, not a prediction for any one person.

This guide makes no claim either way about whether she offers CPT, PE, EMDR or any other named protocol. Ask on a free consultation of about 15 minutes, requested through the contact page, whether she offers the treatment you are interested in or would refer you. How to choose a trauma therapist has more questions to bring.

Keep reading

• How to Choose a Trauma Therapist
• Trauma-Informed vs. Trauma-Focused Therapy: What the Labels Mean
• What to Expect in Trauma Therapy
• All trauma guides

Sources

• U.S. Department of Veterans Affairs and Department of Defense, VA/DoD Clinical Practice Guideline for Management of Posttraumatic Stress Disorder and Acute Stress Disorder (June 2023)
• American Psychological Association, Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults (2025)
• VA National Center for PTSD, Prolonged Exposure (PE) for PTSD (last updated September 25, 2026)
• VA National Center for PTSD, Cognitive Processing Therapy (CPT) for PTSD (last updated September 25, 2026)
• VA National Center for PTSD, Eye Movement Desensitization and Reprocessing (EMDR) for PTSD (last updated September 25, 2026)
• Lewis C, Roberts NP, Gibson S et al., Dropout from psychological therapies for post-traumatic stress disorder (PTSD) in adults: systematic review and meta-analysis. Eur J Psychotraumatol (2020)
• Imel ZE, Laska K, Jakupcak M et al., Meta-analysis of dropout in treatments for posttraumatic stress disorder. J Consult Clin Psychol (2013)
• Schnurr PP, Chard KM, Ruzek JI et al., Comparison of Prolonged Exposure vs Cognitive Processing Therapy for Treatment of Posttraumatic Stress Disorder Among US Veterans: A Randomized Clinical Trial. JAMA Netw Open (2022)
• Sloan DM, Marx BP, Lee DJ et al., A Brief Exposure-Based Treatment vs Cognitive Processing Therapy for Posttraumatic Stress Disorder: A Randomized Noninferiority Clinical Trial. JAMA Psychiatry (2018)
• Sloan DM, Marx BP, Acierno R et al., Written Exposure Therapy vs Prolonged Exposure Therapy in the Treatment of Posttraumatic Stress Disorder: A Randomized Clinical Trial. JAMA Psychiatry (2023)
• Larsen SE, Wiltsey Stirman S, Smith BN et al., Symptom exacerbations in trauma-focused treatments: Associations with treatment outcome and non-completion. Behav Res Ther (2016)
• Brom D, Kleber RJ, Defares PB, Brief psychotherapy for posttraumatic stress disorders. J Consult Clin Psychol (1989)
• Levi O, Bar-Haim Y, Kreiss Y et al., Cognitive-Behavioural Therapy and Psychodynamic Psychotherapy in the Treatment of Combat-Related Post-Traumatic Stress Disorder: A Comparative Effectiveness Study. Clin Psychol Psychother (2016)
• Paintain E, Cassidy S, First-line therapy for post-traumatic stress disorder: A systematic review of cognitive behavioural therapy and psychodynamic approaches. Couns Psychother Res (2018)

Last reviewed October 2026. This guide is general information, not medical advice or a diagnosis. If you are in crisis or thinking about harming yourself, call or text 988, or call 911 in an emergency.