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PTSD: Exposure versus Cognitive Therapy

A woman Veteran talks with a therapist

VA’s study comparing the two leading forms of PTSD therapy will include men and women who are experiencing PTSD due to any military-related event.

by Tom Cramer, VA Staff Writer
Thursday, October 24, 2013

The Department of Veterans Affairs is preparing to launch a 17-site, $10 million study that will examine the two leading forms of treatment for posttraumatic stress disorder: Prolonged Exposure Therapy (PE) and Cognitive Processing Therapy (CPT).

“Our primary goal is to compare the treatments,” said Dr. Paula Schnurr, the study’s lead investigator. “But we’ll also examine which treatments are best for different types of patients; for example, women versus men.”

Schnurr is deputy executive director of VA’s National Center for PTSD and a research professor of psychiatry at the Geisel School of Medicine at Dartmouth.

“Patient-centeredness is fundamental to the delivery of care in VA,” she said, “and information about the comparative effectiveness of different treatments is a key element of making care ‘patient-centered.’ We want to make sure that Veterans have information that can help them find the care that is best for them.”

 Our primary goal is to compare the treatments…examine which treatments are best for different types of patients… 
— Dr. Paula Schnurr, the study’s lead investigator

In Cognitive Processing Therapy patients learn how to identify, challenge and ultimately neutralize unhelpful thoughts. In Prolonged Exposure Therapy, the patient is allowed to re-experience the traumatic event in a safe and supportive environment and, eventually, engage in activities they’ve been avoiding because of the trauma.

The two therapies are based on differing theories about how PTSD develops.

Schnurr said study participants will include male and female Veterans who are experiencing PTSD due to any military event. Half the study population will be randomly selected to receive Cognitive Processing Therapy, while the other half will receive Prolonged Exposure Therapy. Both therapies will be administered in 12 weekly sessions.

The study’s results will be determined by conducting regular follow-up visits with the participants. These visits will occur at both the middle and the conclusion of the study and then three to six months later.

Portrait of a woman

Dr. Paula Schnurr, Lead Investigator

“PTSD is an anxiety disorder that people sometimes develop after witnessing or experiencing a dangerous or life-threatening event,” said Dr. Kate Chard, another member of the research team. “The trauma can be caused by any number of things: exposure to combat, a car accident here at home, physical abuse, a sexual assault…”

Chard is a psychologist in the Cincinnati VA Medical Center’s PTSD Division. She’s also an associate professor of clinical psychiatry in the University of Cincinnati’s Department of Psychiatry and Behavioral Neuroscience.

“People with PTSD,” she said, “often continue to feel anxious or frightened even though the danger is no longer present.”

Another investigator on the study, Dr. Josef Ruzek, is director of dissemination and training at VA’s National Center for PTSD and a faculty member at Palo Alto University. He said PTSD symptoms tend to fall into three primary categories.

“People with PTSD may have flashbacks or intrusive memories about the traumatic event,” he explained. “Or they may have a tendency to avoid places or situations that remind them of the event. A third symptom is difficulty concentrating, or getting startled too easily.”

Enrollment in the study is scheduled to begin in March 2014.

For more information on PTSD, visit the VA National Center for PTSD Website at