Which Are The Best Types Of CBT For Complex PTSD?

Trauma-focused cognitive-behavioral therapy (CBT) is strongly recommended by the American Psychological Association and it includes CBT, cognitive processing therapy, cognitive therapy and prolonged exposure therapy – all of these are therapies that fall under the umbrella of cognitive-behavioral therapies that are used to address PTSD/complex PTSD.

But which of the CBT family of treatments works best?


Cloitre et al., (2010) found that exposure-based therapy for those who had experienced chronic and early life trauma was more effective than therapies that did not include exposure therapy.

Bryant et al. (2003) compared how effective the following treatments were for PTSD: 


  • Exposure therapy alone
  • Cognitive restructuring
  • Supportive counseling

His study found that 60-85% of those who received CBT therapies (i.e. exposure therapy or cognitive restructuring numbered, respectively, as 1 and 2 above) no longer met the criteria to be diagnosed with PTSD after treatment compared to just 40% of those who received supportive counseling (number 3, above).

However, a meta-analysis conducted to assess the effectiveness of prolonged exposure therapy for PTSD found that it was no more effective than other forms of CBT (e.g. cognitive processing therapy and cognitive therapy (powers et al.,2010) although they did also find that exposure therapy was effective.

Overall, whilst research suggests that any form of CBT can be effective in the treatment of PTSD and that exposure therapy has the most empirical support, there is not yet enough research evidence to determine which is the most effective. However, Smucker et al. (2003) suggest that:

  • EXPOSURE THERAPY may be most effective when the person’s PTSD is characterized mainly by fear (as fear leads to avoidance and exposure therapy helps the person overcome this avoidance).


  • COGNITIVE RESTRUCTURING may be most effective when the individual’s main PTSD symptoms are guilt and anger.

However, many sufferers of PTSD/complex PTSD will be suffering from all of the above symptoms so may need to be treated using both of the above.



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Bryant RA, Moulds ML, Guthrie RM, Dang ST, Mastrodomenico J, Nixon RD, Felmingham KL, Hopwood S, Creamer M. A randomized controlled trial of exposure

therapy and cognitive restructuring for posttraumatic stress disorder. J Consult Clin Psychol. 2008 Aug;76(4):695-703. doi: 10.1037/a0012616. PMID: 18665697.


Cloitre M, Stovall-McClough KC, Nooner K, Zorbas P, Cherry S, Jackson CL, Gan W, Petkova E. Treatment for PTSD related to childhood abuse: a randomized controlled trial. Am J Psychiatry. 2010 Aug;167(8):915-24. doi: 10.1176/appi.ajp.2010.09081247. Epub 2010 Jul 1. PMID: 20595411.


Powers MB, Halpern JM, Ferenschak MP, Gillihan SJ, Foa EB. A meta-analytic review of prolonged exposure for posttraumatic stress disorder. Clin Psychol Rev. 2010 Aug;30(6):635-41. doi: 10.1016/j.cpr.2010.04.007. Epub 2010 May 2. PMID: 20546985.


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