An Update on Psychotherapy for the Treatment of PTSD.
Barbara Olasov Rothbaum, Laura E Watkins
American Journal of Psychiatry May 1, 2025 DOI: 10.1176/appi.ajp.20250110 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Topics | PTSD |
| Keywords | PTSD Treatment Trauma therapy Mental health interventions Evidence-based psychotherapy Behavioral medicine |
| Citations | 13 |
| Key findings | Trauma-focused psychotherapies, not medications or medication-psychotherapy combinations, are the only first-line treatments recommended in PTSD treatment guidelines. |
Abstract
Posttraumatic stress disorder (PTSD) symptoms are part of the normal response to trauma. Most trauma survivors will recover over time without intervention, but a significant minority will develop chronic PTSD, which is unlikely to remit without intervention. Currently, only two medications, sertraline and paroxetine, are approved by the U.S. Food and Drug Administration to treat PTSD, and the combination of brexpiprazole and sertraline and MDMA-assisted therapy have FDA applications pending. These medications, and the combination of pharmacotherapy and psychotherapy, are not recommended as first-line treatments in any published PTSD treatment guidelines. The only interventions recommended as first-line treatments are trauma-focused psychotherapies; the U.S. Department of Veterans Affairs/Department of Defense PTSD treatment guideline recommends prolonged exposure (PE), cognitive processing therapy (CPT), and eye movement desensitization and reprocessing, and the American Psychological Association PTSD treatment guideline recommends PE, CPT, cognitive therapy, and trauma-focused cognitive-behavioral therapy. Although published clinical trials of psychedelic-assisted psychotherapy have not incorporated evidence-based PTSD psychotherapies, they have achieved greater response rates than other trials of combination treatment, and there is some enthusiasm about combining psychedelic medications with evidence-based psychotherapies. The state-of-the-art PTSD psychotherapies are briefly reviewed here, including their effects on clinical and neurobiological measures.
Comparable studies
Other narrative reviews on PTSD, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Psychedelic Psychiatry's Brave New World. | 2020 | Review | |
| Reviewing the Potential of Psychedelics for the Treatment of PTSD | 2020 | Review | |
| Novel psychopharmacological therapies for psychiatric disorders: psilocybin and MDMA. | 2016 | Review | |
| MDMA-assisted psychotherapy for PTSD: Are memory reconsolidation and fear extinction underlying mechanisms? | 2018 | Review | |
| Clinical applications of hallucinogens: A review. | 2016 | Review |
Citations in the library
Cited by 4
- Neurochemical, Neurocircuitry, and Psychopathological Mechanisms of PTSD: Emerging Pharmacotherapies and Clinical Perspectives. ACS Chemical Neuroscience June 10, 2025
- 3,4-Methylenedioxymethamphetamine (MDMA) does not induce robust psychomotor activation and 50-kHz ultrasonic vocalisations in tryptophan hydroxylase 2 (Tph2)-deficient rats lacking serotonin in the central nervous system. British Journal of Pharmacology November 23, 2025
- Priorities for public health preparedness for psychedelics: education, workforce readiness, and strategic information needs in a rapidly changing landscape Frontiers in Public Health August 6, 2026
- MDMA as an early post-trauma intervention in a translational animal model of PTSD. Progress in Neuro-Psychopharmacology and Biological Psychiatry July 24, 2026
Cites 7
- MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nature Medicine June 1, 2021
- MDMA-assisted therapy for moderate to severe PTSD: a randomized, placebo-controlled phase 3 trial. Nature Medicine October 1, 2023
- Psychedelics reopen the social reward learning critical period Nature June 14, 2023
- Inhibition of serotonin transporters disrupts the enhancement of fear memory extinction by 3,4-methylenedioxymethamphetamine (MDMA) Psychopharmacology July 24, 2017
- A randomized controlled trial of 3,4-methylenedioxymethamphetamine (MDMA) and fear extinction retention in healthy adults Journal of Psychopharmacology February 15, 2022
and 2 more in the library