Evidence-Based PTSD Treatments for Veterans | What Works

If you’re a veteran seeking treatment for PTSD, depression, or anxiety, it’s natural to want to know which treatments actually work. The good news is that decades of research have identified highly effective psychological treatments for these conditions.

This article explains the treatments recommended by Australian and international clinical guidelines, helping you understand your options and have informed conversations with your treatment providers.

Key Point: The 2023 VA/DoD Clinical Practice Guidelines and Australian Guidelines both recommend trauma-focused psychological therapies as the most effective treatments for PTSD in veterans.

First-Line Treatments for PTSD

Clinical practice guidelines consistently identify three trauma-focused psychotherapies as the most effective treatments for PTSD:

1. Prolonged Exposure (PE)

Prolonged Exposure is based on the principle that avoiding trauma-related memories and situations maintains PTSD symptoms. PE helps you gradually approach these avoided memories and situations in a safe, controlled way until they no longer cause intense distress.

PE typically involves:

• Imaginal exposure: Revisiting the traumatic memory by describing it aloud in detail, allowing the memory to be processed
• In vivo exposure: Gradually approaching safe situations you’ve been avoiding because they trigger distressing reminders

PE is recommended as a first-line treatment by the American Psychological Association, the VA/DoD, the Australian Guidelines, and the UK’s National Institute for Health and Care Excellence (NICE). A randomised controlled trial of 916 veterans found PE to be highly effective for reducing PTSD symptoms.

2. Cognitive Processing Therapy (CPT)

Cognitive Processing Therapy focuses on how you think about your trauma and its aftermath. It helps identify and challenge unhelpful beliefs (“stuck points”) that developed because of the trauma, such as beliefs about safety, trust, power, control, self-esteem, and intimacy.

CPT typically involves 12 sessions and may include a written account of your traumatic experience. Research has shown that CPT is particularly effective in veteran populations, with benefits maintained at long-term follow-up.

3. Eye Movement Desensitisation and Reprocessing (EMDR)

EMDR involves recalling traumatic memories while engaging in bilateral stimulation, typically guided eye movements. This process helps the brain reprocess distressing memories, reducing their emotional intensity.

The Australian National Health and Medical Research Council recommends EMDR with its highest grade of evidence. The VA/DoD also recommends EMDR, noting “strong evidence” for its effectiveness in treating PTSD. Studies show that both weekly and intensive (daily) EMDR formats can produce significant, lasting improvements in veteran populations.

How Do These Treatments Work?

While the specific techniques differ, these treatments share common elements that contribute to their effectiveness:

• Processing the trauma: All three involve engaging with the traumatic memory in some way, allowing it to be processed rather than avoided
• Changing unhelpful beliefs: Addressing thoughts and beliefs that developed from the trauma and are contributing to ongoing distress
• Reducing avoidance: Helping you re-engage with life rather than avoiding reminders of the trauma
• Structured approach: Following an evidence-based protocol typically over 8-16 sessions

Intensive and Massed Treatment Formats

Traditionally, PTSD treatments are delivered in weekly sessions over several months. However, research increasingly supports intensive treatment formats — where treatment is compressed into a shorter period, such as daily sessions over 2-3 weeks.

Studies show that intensive formats can be as effective as standard weekly treatment, with treatment gains maintained at 6-12 month follow-up. These formats may suit veterans who:

• Prefer to address their symptoms more quickly
• Have work or travel constraints that make weekly sessions difficult
• Want to focus intensively on treatment without the gaps between sessions

DVA funds Trauma Recovery Programs in hospitals across Australia that provide intensive, evidence-based treatment meeting national accreditation standards.

Treatment for Depression and Anxiety

While PTSD often co-occurs with depression and anxiety, these conditions can also occur independently. Evidence-based treatments include:

• Cognitive Behavioural Therapy (CBT): Highly effective for depression and anxiety disorders, addressing unhelpful thought patterns and behaviours
• Behavioural Activation: Particularly effective for depression, focusing on increasing engagement with rewarding activities
• Exposure Therapy: Effective for anxiety disorders including panic disorder, social anxiety, and specific phobias

The Role of Medication

Clinical guidelines recommend psychological therapy as the preferred first-line treatment for PTSD. However, medication may be beneficial when:

• You are unable or unwilling to engage in trauma-focused therapy
• Psychological treatment is unavailable
• Symptoms are severe and medication may help you engage in therapy

Newer antidepressants (SSRIs and SNRIs) have the strongest evidence for treating PTSD, depression, and anxiety disorders. For veterans with nightmares specifically, prazosin may be considered. Medication decisions should be made in consultation with a psychiatrist or GP who can discuss benefits and risks.

What About Other Treatments?

You may hear about other treatments for PTSD. Some have emerging evidence, while others lack sufficient research:

• Written Exposure Therapy (WET): A brief 5-session treatment showing promise in recent trials
• Narrative Exposure Therapy (NET): Suggested for use but with less evidence than PE, CPT, or EMDR
• Complementary approaches: Mindfulness, yoga, and physical activity may support recovery when used alongside evidence-based treatment

Note: Clinical guidelines recommend against adding or removing components from evidence-based treatments, as this can reduce their effectiveness.

Finding the Right Treatment for You

The best treatment is one you’re willing to engage with. Research shows that when given a choice, veterans tend to prefer psychological treatments over medication. Within psychological treatments, your preferences matter — all three recommended therapies (PE, CPT, EMDR) have strong evidence, so discussing options with your provider can help you find the best fit.

If you have concerns about a particular approach, talk to your treatment provider. A good therapist will explain the rationale for their approach and work with you to find a treatment you’re comfortable with.

Frequently Asked Questions

Related Resources

• Related: PTSD in Australian Veterans
• Service page: DVA Psychiatric Assessments