If you’ve experienced a life-threatening or deeply violating event, you may be struggling with disruptive symptoms like unwanted memories of what happened, difficulty sleeping, anxiety that causes you to avoid valued activities, guilt or shame, difficulties with trust, or intense emotional or physical reactions to reminders of the trauma. You may feel broken or worry you’ll never get your life back.

If any of this sounds familiar, there is good news: the psychologists at Aviva Psychology Services are trained to help people like you recover from traumatic events with trauma-informed, evidence-based therapy for PTSD. These PTSD therapies are safe, proven effective by decades of scientific research, and customized for each individual client to address their unique history, symptoms, goals, and preferences. 

Is Therapy for PTSD Right for Me? 

PTSD is most commonly associated with war, and so you may be thinking, “I can’t have PTSD because I’m not a veteran.” 

However, anyone who experiences a traumatic event in which they were exposed to actual or threatened death, serious injury, or sexual violence could develop PTSD after the event. People from all walks of life, including all genders, ages, occupations, races, and religions, can experience trauma as part of everyday life. 

While the experiences of soldiers during war might be the example we see most often in movies and television, research tells us that PTSD can also occur after events like car accidents, sexual assaults, house fires, childhood or intimate partner abuse, natural disasters like floods, experiences of police brutality, or encounters with violent crime. PTSD can also occur when we learn about a loved one experiencing serious harm or death from violent or accidental circumstances, like a workplace accident or suicide. Some people develop PTSD from repeated exposure to other people’s trauma that is part of their occupation. This type of exposure to trauma is sometimes called "vicarious trauma" and is experienced by people such as firefighters, EMTs, and healthcare workers.

You may notice that the examples above are focused on life-threatening or safety-violating experiences and do not include other major, life-changing events like a romantic breakup, working in a stressful job environment, the loss of a loved one due to old age, or living with a chronic illness. All of these experiences are profoundly impactful, and they may result in mental health diagnoses that warrant treatment via therapy, medication, or both.

However, clinical science defines PTSD in very specific ways to help clinicians determine who needs very specific PTSD treatments, which can be enormously helpful to those with specific types of experiences and symptoms but can worsen symptoms for others. Therefore, specific definitions are important for safe, effective treatment. You can read more about definitions of trauma and PTSD, located here. This article will explore the evidence-based psychotherapies for PTSD available at Aviva Psychology Services to help clients know what to expect during these specialized treatments. 

What is Evidence-Based Therapy?

There are many forms of therapy in the world, but not all forms of therapy are supported by robust scientific research that identifies the therapy as safe, effective, and ethical. Many forms of therapy have some support by theory or research, but not all research is considered equal. 

For a therapy to be considered evidence-based, it needs many well-designed, large-scale research studies to support it, and those studies must use rigorous research standards, appropriate statistical analyses, and diverse populations of subjects. This type of research is required to convincingly demonstrate that the therapy consistently results in positive changes for treating a specific psychological experience. Research must also demonstrate that the therapy performs at least as well as existing therapies or that it outperforms them.

Accumulating research to support a therapy intervention takes considerable time, and therefore newly developed therapies, while exciting and often the subject of news articles and social media posts, are not considered well-supported by research until the scientific community conducts more research. Fortunately, PTSD is a highly researched disorder, and there are decades of robust, high-quality research supporting multiple forms of therapy for PTSD as safe, effective, and empowering interventions. Four of these therapies are available at Aviva Psychology Services. 

How Does Therapy Begin? 

Regardless of the specific type of PTSD treatment you and your therapist decide is the right therapy for you, the first step in any evidence-based treatment for PTSD is completing assessment. In the first sessions of trauma-focused therapy, you and your therapist will work together to develop a shared understanding of your unique history, symptoms, needs, preferences, and goals. 

This stage of therapy can be emotionally challenging as it involves talking about your past experiences of trauma. This process will be guided by your therapist to help you manage the strong, difficult emotions that come up when discussing traumatic experiences and the symptoms developed as a result of trauma. Emotions like anger, fear, disgust, guilt, and shame are normal to experience during this process, and learning to feel these natural emotions without avoiding them is a key part of healing from PTSD and trauma. 

Your therapist will also help you explore your recovery goals. This process can be challenging because PTSD can make it difficult to imagine a different future for yourself. Your therapist will help you identify the changes you want to make, your priorities and preferences in treatment, and will help you decide which specific PTSD therapy is the best fit for you. 

Psychologists at Aviva Psychology Services are trained in four unique evidence-based psychotherapies for PTSD. Each treatment has a unique approach to treating PTSD, different durations of treatment, and different pros and cons. Your therapist will guide you through the process of shared decision-making, in which your lived experiences and your therapist’s expertise will help you make the decision about which PTSD treatment to pursue. 

At Aviva Psychology Services, there are four available trauma-focused, evidenced-based therapies: Cognitive Processing (CPT), Prolonged Exposure (PE), Written Exposure Therapy (WET), and Skills Training in Affective and Interpersonal Regulation (STAIR). This article describes what to expect in each, as each one has a unique approach to treatment.

However, all PTSD treatments have one thing in common: they will be customized to you as a unique individual to help you reduce PTSD symptoms by reducing avoidance. Avoidance is something survivors of trauma do mentally (by avoiding thoughts, memories, or emotions related to the trauma) and in their behavior (by avoiding people, places, or things that remind us of the trauma). Avoidance is a natural, often life-saving instinct during the danger of a traumatic experience. However, research tells us that persistent avoidance after the danger of trauma has passed is a primary cause of PTSD. Therefore, a central goal of all forms of PTSD treatment is to break avoidance habits so that you can reduce symptoms and regain your sense of freedom and safety.

What to Expect in CPT

Cognitive Processing Therapy (CPT) is considered strongly supported by research evidence and a gold standard treatment for PTSD. It is a type of cognitive behavioral therapy, which means it helps people understand the relationship between their thoughts and their actions. By understanding this relationship, people are empowered to make changes to live more consistently with their goals and values. 

“Cognitive processing” essentially means “thinking about your thinking.” CPT teaches people to think about how their thinking was changed by the experience of trauma. We are designed to learn from our experiences and often update our beliefs in ways that are true and helpful. However, after trauma, people also sometimes change their beliefs in ways that are inaccurate and unhelpful and make it harder to live safe, healthy, rewarding lives.

For example, a survivor of a car accident may be helped by bystanders and learn, “Many people want to help and protect others when they can.” This is a helpful, accurate belief. However, a survivor of a car accident may also conclude, “I can never travel safely by car ever again.” This belief is based on a real experience, and it’s true that no car travel is ever guaranteed to be 100% safe. However, we also know that most car rides end safely and that being able to travel by car is often important for daily life activities. 

In CPT, untrue and unhelpful beliefs are seen as problematic because they cause emotional pain and lead to avoidance behaviors with steep personal cost, such as loss of autonomy, relationships, and opportunities. These beliefs are addressed in three stages. First, CPT helps clients build awareness of their thinking by “catching” their trauma-related thoughts. Second, CPT helps clients learn to thoughtfully evaluate their beliefs, gently checking to see if they are true and if they are helpful. In the third stage, CPT helps clients come up with new beliefs that are more true and are more helpful. Because the research shows that certain areas of life are most impacted by trauma, CPT specifically devotes time to exploring beliefs related to the topics of safety, trust, power/control, esteem, and intimacy. 

It is important to note that the goal of CPT is not to simply “believe the opposite” – this is often just another untrue and unhelpful belief! For example, a survivor of assault may believe “all men are dangerous and will hurt me.” It’s understandable that the survivor came to believe this, and at the same time, this thought is also neither fully true nor fully helpful. However, CPT would not want the survivor to change their belief to “all men are safe and will never hurt me.” This is also untrue and unhelpful! CPT would instead help the client select and build confidence in a new belief of their choosing. For example, the survivor might to practice a new belief like, “While all men have the capacity to be dangerous to me, I have the capacity to evaluate risk, set boundaries, and seek help when needed.” This belief is more true and more helpful, as it is balanced rather than extreme and is empowering rather than terrifying or naive.

Following initial assessment and shared decision-making about treatment, CPT typically involves 12 weekly sessions. CPT uses a structured therapeutic approach in which there is a planned topic for each of the 12 sessions, though the way the topic is discussed is customized to each individual client. CPT requires daily completion of worksheets to help clients learn and become confident in practical skills for examining beliefs and behaviors and building new ones that are more helpful for daily life. These worksheets typically require about 15 minutes per day for the duration of treatment. 

What to Expect in PE

Prolonged Exposure (PE) is considered strongly supported by research evidence and a gold standard treatment for PTSD. It is a form of cognitive behavioral therapy, which means it focuses on helping clients understand the relationship between their thoughts and their actions. As a PTSD treatment, PE is especially focused on thoughts and behaviors related to avoidance. 

Research about PTSD tells us that avoiding trauma-related memories and trauma-related reminders, which are highly uncomfortable but not actually dangerous, is a primary cause of persistent symptoms of PTSD and can even cause symptoms to worsen over time. PE teaches survivors to gradually approach trauma-related memories, feelings, and situations so that difficult emotions subside over time. PE can be summarized as a supportive, structured process of facing fears to slowly reclaim freedom and confidence. 

One way this is done is via imaginal exposure, a process in which a survivor of trauma recounts the events of the trauma out loud and in detail for a large portion of the session, often describing the trauma multiple times per session. This process allows the client to experience and process natural but uncomfortable emotions—like sadness, anger, fear, or disgust—with the support and guidance of their therapist. This exercise does not erase or change the memory. Instead, it decreases the frequency and intensity of the memory by helping clients learn that remembering is not reliving, that discomfort is not danger, and that the trauma is in the past. With repetition, the client's mind begins to "let go" of the traumatic memory so that it does not resurface so often or so intensely.

PE also uses a strategy called in vivo exposure. In this process, survivors of trauma work with their therapist to develop a list of things they’ve been avoiding since the trauma. This list consists of things that are generally safe but that are avoided because they are trauma reminders. For example, a survivor of a car accident may avoid all vehicles and travel in vehicles. The client and therapist work together to rank the list of avoided experiences by difficulty and, starting at the easy end of the list, the client is taught strategies for gradually and safely facing their fears. For example, the survivor who fears vehicles may first practice sitting in their parked car, then driving around the block with a friend in the car, and then gradually progress to driving longer distances alone. This process allows clients to reclaim a sense of freedom and autonomy after the trauma.

Following initial assessment and shared decision-making about treatment, PE typically involves 8-14 weekly sessions, with the duration customized to the individual. PE uses a structured therapeutic approach in which there is a pre-planned agenda for each session, though the details vary by each unique client and unique trauma. PE requires daily exposure exercise homework in the form of listening to session recordings (for imaginal exposure) and practicing facing trauma-reminders (for in vivo exposure). PE homework assignments typically require about 90 minutes per day for the duration of treatment. 

What to Expect in WET

A newer PTSD treatment with moderate and growing research support is called Written Exposure Therapy (WET). It is a form of cognitive behavioral therapy, which means it focuses on helping clients understand the relationship between their thoughts and their actions. As the name implies, WET uses writing as a primary strategy. 

In WET, the therapist provides the client with assignments that involve writing about what happened during the trauma, what emotions and thoughts were present during the trauma, and how the trauma has impacted the client’s life. These writing exercises are emotionally challenging but safe to complete, and they are carefully designed by the researchers who developed the treatment to help clients emotionally process their experience of trauma. 

These assignments are completed by the client during the therapy appointments for approximately 30 minutes of the appointment. This means WET is an unusual therapy: you and your therapist won’t communicate at all for about half the session! Following the writing exercise, the therapist provides emotional support and guidance in processing both the trauma memory and the writing exercise. It is important to note that because sessions are devoted to completing the writing exercises and then discussing the experience of writing, WET typically does not include discussion of the client’s daily life or other experiences.

This intense and specific focus allows WET to be effective in only 5 weekly sessions. Because the writing is done during the sessions, WET does not require any completion of homework assignments between appointments. Together, the very short duration and complete lack of homework make WET an excellent option for clients who have limited time to devote to trauma-focused therapy.

What to Expect in STAIR

Another trauma-focused treatment available at Aviva Psychology Services is called Skills Training in Affective and Interpersonal Regulation (STAIR), which has moderate research support. STAIR is a cognitive behavioral therapy that was developed with the concept of complex PTSD (CPTSD) in mind, and you can read more about CPTSD in the article linked here. What is most important to know is that research has consistently demonstrated that CPTSD is most effectively treated by the same therapies developed for treating PTSD, including the treatments discussed in this article. 

STAIR was developed to address the CPTSD symptoms of difficulty with managing emotions and difficulty in relationships. After trauma, some people experience their emotions as intense and overwhelming while others experience emotional numbing and a lack of positive emotions. Some people also find that trauma impacts their relationships, resulting in challenges with boundaries, assertive communication, making requests, and maintaining healthy relationship patterns. 

In the first half of treatment, STAIR teaches clients about how to build emotional awareness, healthy coping strategies, and greater capacity so that they are able to endure difficult emotions when doing so is part of healthy behavior. For example, STAIR teaches clients how to increase capacity to feel emotions like anxiety so that they can do things like interview for jobs, navigate the uncertainty of dating relationships, and handle the emotional rollercoaster of raising children.

In the second half of STAIR, treatment focuses on teaching skills for building and maintaining relationships that are stable and safe for the client and for those in relationships with the client. STAIR explores topics like how to develop, set, maintain, and respect boundaries. Other topics include how to say no, how to make requests, and how to develop assertive communication skills that are neither too passive nor too aggressive. Clients are also taught how to develop awareness of their current beliefs about relationships, which can be distorted by past experiences of trauma. These distorted beliefs can negatively impact current relationships, interfere with daily life, and make it hard to "move forward" from past experiences of trauma. When unhelpful beliefs are identified, clients are taught how they can teach themselves alternative perspectives that are more useful for their daily lives.

Following initial assessment and shared decision-making about treatment, STAIR typically involves 8-10 skills-focused, weekly sessions. Like the other forms of cognitive behavioral therapy described in this article, STAIR uses a structured therapeutic approach in which there is a pre-planned agenda for each session, though the details vary by each unique client and unique trauma. STAIR is a very practical, action-focused treatment with a goal of teaching clients to learn and consistently use skills for managing emotions and relationships. As such, STAIR requires clients to engage in daily homework of practicing the skills taught in therapy. Some homework assignments involve worksheets, but most involve practical use of skills, such as daily use of self-care and communication skills. STAIR homework assignments typically require 15-30 minutes per day for the duration of treatment. 

How Do I Get Started with PTSD Therapy?

If you think a PTSD therapy could be the right fit for you, the first step is getting connected to a provider who has training to assess your symptoms, determine the most accurate mental health diagnoses, and help you build an individualized treatment plan.

Psychologists at Aviva Psychology Services have training in this process and are trained to provide the PTSD therapies described in this article. You can get connected with a psychologist at Aviva by filling out the Request an Appointment form.

Selected References and Additional Reading:

1. Association for Behavioral and Cognitive Therapies. (2023). What is Evidence Based Practice?   Get Help. ABCT - Association for Behavioral and Cognitive Therapies. https://www.abct.org/get-help/what-is-evidence-based-practice/
   
   
2. American Psychological Association. (2025). Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults. https://www.apa.org/ptsd-guideline 
   
   
3. American Psychological Association. (2017, July 31). Prolonged exposure (PE). https://www.apa.org/ptsd-guideline/treatments/prolonged-exposure
   
   
4. American Psychological Association. (2017). Cognitive processing therapy (CPT). https://www.apa.org/ptsd-guideline/treatments/cognitive-processing-therapy
   
   
5. Norman, S., Hamblen, J., & Schnurr, P. (2023). Overview of Psychotherapy for PTSD - PTSD: National Center for PTSD. https://www.ptsd.va.gov/professional/treat/txessentials/overview_therapy.asp
   
   
6. What Is Cognitive Behavioral Therapy? Association for Behavioral and Cognitive Therapies. https://www.abct.org/get-help/what-is-cognitive-behavioral-therapy/
   
   
7. Written Exposure Therapy for PTSD - PTSD: National Center for PTSD. https://www.ptsd.va.gov/understand_tx/written_exposure_therapy.asp