Manualized trauma-focused therapy is the first-line treatment for posttraumatic stress disorder (PTSD). VA/DoD Clinical Practice Guidelines – Management of Posttraumatic Stress Disorder and Acute Stress Disorder 2023 recommend Prolonged Exposure Therapy (PE), Cognitive Processing Therapy (CPT), and Eye Movement Desensitization and Reprocessing (EMDR) as the most effective treatments for PTSD. In addition, Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (known as COPE) integrates PE for PTSD with relapse prevention for substance use disorder (SUD) and may be particularly useful when working with individuals with co-occurring PTSD and opioid use disorder (OUD). Although EMDR has been identified as an effective treatment for PTSD, we do not have expertise in providing this treatment. Accordingly, this toolkit focuses on PE, CPT, and COPE. Providers who are interested in EMDR resources and training can visit the EMDR International Association.
A manualized therapy is one in which the provider uses a manual to assist in care delivery, ensuring that all important related topics are addressed. Use of a manual to guide and structure therapy with a patient is associated with improved attendance, adherence, and symptom reduction compared to therapy that does not use a manualized approach. This approach does not limit the therapist or reduce their expertise. Rather, manualized treatment provides a scaffold that addresses core issues related to trauma and PTSD in a systematic way and provides evidence-based work for the patient to complete outside of therapy sessions.