Editing Post-traumatic stress disorder (section)

==== Cognitive behavioral therapy ====
{{Main|Trauma focused cognitive behavioral therapy}}
[[File:Depicting basic tenets of CBT.jpg|thumb|The diagram depicts how emotions, thoughts, and behaviors all influence each other. The triangle in the middle represents CBT's tenet that all humans' core beliefs can be summed up in three categories: self, others, future.]]

CBT seeks to change the way a person feels and acts by changing the patterns of thinking or behavior, or both, responsible for negative emotions. Results from a 2018 systematic review found high strength of evidence that supports CBT-exposure therapy efficacious for a reduction in PTSD and depression symptoms, as well as the loss of PTSD diagnosis.<ref name="Forman-Hoffman_2018"/> CBT has been proven to be an effective [[Treatments for PTSD|treatment for PTSD]] and is currently considered the standard of care for PTSD by the [[United States Department of Defense]].<ref>{{cite web |title=Treatment of PTSD – PTSD: National Center for PTSD |url=http://www.ptsd.va.gov/public/treatment/therapy-med/treatment-ptsd.asp |publisher=U.S. [[Department of Veterans Affairs]] |date=May 26, 2016 |url-status=live |archive-url=https://web.archive.org/web/20161201110743/http://www.ptsd.va.gov/public/treatment/therapy-med/treatment-ptsd.asp |archive-date=December 1, 2016}}</ref><ref>{{cite news |title=PTSD Treatment Options |url=http://dcoe.mil/PsychologicalHealth/About_PTSD/Treatment_Options.aspx |newspaper=Defense Centers of Excellence |date=November 23, 2016 |url-status=live |archive-url=https://web.archive.org/web/20161130035254/http://dcoe.mil/PsychologicalHealth/About_PTSD/Treatment_Options.aspx |archive-date=November 30, 2016}}</ref>

In CBT, individuals learn to identify thoughts that make them feel afraid or upset and replace them with less distressing thoughts. The goal is to understand how certain thoughts about events cause PTSD-related stress.<ref>{{Cite web |url=http://www.apa.org/ptsd-guideline/treatments/cognitive-behavioral-therapy.aspx |title=Cognitive Behavioral Therapy (CBT) for Treatment of PTSD |publisher=[[American Psychiatric Association]] |archive-url=https://web.archive.org/web/20180109063624/http://www.apa.org/ptsd-guideline/treatments/cognitive-behavioral-therapy.aspx |archive-date=2018-01-09 |access-date=2018-01-08}}</ref><ref>{{Cite web |url=https://www.ptsd.va.gov/public/treatment/therapy-med/treatment-ptsd.asp |title=Treatment of PTSD – PTSD |publisher=[[National Center for PTSD]] |access-date=2018-01-08}}</ref> A study assessing an online version of CBT for people with mild-to-moderate PTSD found that the online approach was as effective as, and cheaper than, the same therapy given face-to-face.<ref>{{Cite journal |date=27 January 2023 |title=Online CBT for post-traumatic stress disorder is as effective as face-to-face therapy |url=https://evidence.nihr.ac.uk/alert/online-cbt-for-ptsd-is-as-effective-as-face-to-face-therapy/ |journal=NIHR Evidence|doi=10.3310/nihrevidence_56507 |s2cid=257844874 |url-access=subscription }}</ref><ref>{{cite journal | vauthors = Bisson JI, Ariti C, Cullen K, Kitchiner N, Lewis C, Roberts NP, Simon N, Smallman K, Addison K, Bell V, Brookes-Howell L, Cosgrove S, Ehlers A, Fitzsimmons D, Foscarini-Craggs P, Harris SR, Kelson M, Lovell K, McKenna M, McNamara R, Nollett C, Pickles T, Williams-Thomas R | title = Guided, internet based, cognitive behavioural therapy for post-traumatic stress disorder: pragmatic, multicentre, randomised controlled non-inferiority trial (RAPID) | journal = BMJ | volume = 377 | pages = e069405 | date = June 2022 | pmid = 35710124 | pmc = 9202033 | doi = 10.1136/bmj-2021-069405 }}</ref> A 2021 Cochrane review assessed the provision of CBT in an Internet-based format found similar beneficial effects for [[Internet-based treatments for trauma survivors|Internet-based therapy]] as in face-to-face. However, the quality of the evidence was low due to the small number of trials reviewed.<ref>{{cite journal | vauthors = Simon N, Robertson L, Lewis C, Roberts NP, Bethell A, Dawson S, Bisson JI | title = Internet-based cognitive and behavioural therapies for post-traumatic stress disorder (PTSD) in adults | journal = The Cochrane Database of Systematic Reviews | volume = 2021 | issue = 5 | pages = CD011710 | date = May 2021 | pmid = 34015141 | pmc = 8136365 | doi = 10.1002/14651858.CD011710.pub3 }}</ref>

Exposure therapy is a type of cognitive behavioral therapy<ref>{{cite web |vauthors=Grohol JM |date=2016-05-17 |title=What Is Exposure Therapy? |work=Psych Central.com |url=http://psychcentral.com/lib/2009/what-is-exposure-therapy/ |access-date=2010-07-14 |publisher=Psychcentral.com |url-status=live |archive-url=https://web.archive.org/web/20100811161615/http://psychcentral.com/lib/2009/what-is-exposure-therapy/ |archive-date=2010-08-11}}</ref> that involves assisting trauma survivors to re-experience distressing trauma-related memories and reminders in order to facilitate habituation and successful emotional processing of the trauma memory. Most exposure therapy programs include both imaginal confrontation with the [[traumatic memories]] and real-life exposure to trauma reminders; this type of CBT has shown benefit in the [[Treatments for PTSD|treatment of PTSD]].<ref name="McLean 2022">{{cite journal |last1=McLean |first1=Carmen P. |last2=Levy |first2=Hannah C. |last3=Miller |first3=Madeleine L. |last4=Tolin |first4=David F. |title=Exposure therapy for PTSD: A meta-analysis |journal=Clinical Psychology Review |date=February 2022 |volume=91 |pages=102115 |doi=10.1016/j.cpr.2021.102115|pmid=34954460 |s2cid=245394152 }}</ref><ref name="Shalev 2017" />

Some organizations{{which|date=December 2011}} have endorsed the need for exposure.<ref name="pmid15617511">{{cite journal |vauthors=Ursano RJ, Bell C, Eth S, Friedman M, Norwood A, Pfefferbaum B, Pynoos JD, Zatzick DF, Benedek DM, McIntyre JS, Charles SC, Altshuler K, Cook I, Cross CD, Mellman L, Moench LA, Norquist G, Twemlow SW, Woods S, Yager J |title=Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder |journal=The American Journal of Psychiatry |volume=161 |issue=11 Suppl |pages=3–31 |date=November 2004 |pmid=15617511}}</ref><ref>{{cite book |title=Committee on Treatment of Posttraumatic Stress Disorder, Institute of Medicine: Treatment of Posttraumatic Stress Disorder: An Assessment of the Evidence |place=Washington, D.C. |publisher=National Academies Press |year=2008 |isbn=978-0-309-10926-0}}{{page needed|date=January 2014}}</ref> The U.S. Department of Veterans Affairs has been actively training mental health treatment staff in [[prolonged exposure therapy]]<ref>{{cite web |title=Prolonged Exposure Therapy |date=2009-09-29 |publisher=U.S. Department of Veteran Affairs |url=http://www.ptsd.va.gov/public/pages/prolonged-exposure-therapy.asp |access-date=2010-07-14 |archive-url=https://web.archive.org/web/20091114064548/http://www.ptsd.va.gov/public/pages/prolonged-exposure-therapy.asp |archive-date=2009-11-14 |department=PTSD: National Center for PTSD}}</ref> and [[cognitive processing therapy]]<ref>{{cite journal |vauthors=Karlin BE, Ruzek JI, Chard KM, Eftekhari A, Monson CM, Hembree EA, Resick PA, Foa EB |title=Dissemination of evidence-based psychological treatments for posttraumatic stress disorder in the Veterans Health Administration |journal=[[Journal of Traumatic Stress]] |volume=23 |issue=6 |pages=663–73 |date=December 2010 |pmid=21171126 |doi=10.1002/jts.20588}}</ref> in an effort to better treat U.S. veterans with PTSD.

Recent research on contextually based [[behavior therapy#Third generation|third-generation behavior therapies]] suggests that they may produce results comparable to some of the better validated therapies.<ref>{{cite journal |vauthors=Mulick PS, Landes S, Kanter JW |year=2005 |title=Contextual Behavior Therapies in the Treatment of PTSD: A Review |journal=International Journal of Behavioral Consultation and Therapy |volume=1 |issue=3 |pages=223–228 |doi=10.1037/h0100747 |url=http://www.uwm.edu/~jkanter/pdf/publication/IJBCT-1-3.pdf |archive-url=https://wayback.archive-it.org/all/20120916131249/http://www.uwm.edu/~jkanter/pdf/publication/IJBCT-1-3.pdf |archive-date=16 September 2012 |citeseerx=10.1.1.625.4407}}</ref> Many of these therapy methods have a significant element of exposure<ref name="Hassija 2007">{{cite journal |vauthors=Hassija CM, Gray MJ |year=2007 |title=Behavioral Interventions for Trauma and Posttraumatic Stress Disorder |journal=International Journal of Behavioral Consultation and Therapy |volume=3 |issue=2 |pages=166–175 |doi=10.1037/h0100797 |url=http://eric.ed.gov/ERICWebPortal/contentdelivery/servlet/ERICServlet?accno=EJ801196|url-access=subscription }}</ref> and have demonstrated success in treating the primary problems of PTSD and co-occurring depressive symptoms.<ref>{{cite journal |vauthors=Mulick PS, Naugle AE |year=2009 |title=Behavioral Activation in the Treatment of Comorbid Posttraumatic Stress Disorder and Major Depressive Disorder |journal=International Journal of Behavioral Consultation and Therapy |volume=5 |issue=2 |pages=330–339 |doi=10.1037/h0100892 |url=http://www.thefreelibrary.com/Behavioral+activation+in+the+treatment+of+comorbid+posttraumatic...-a0221920130}}</ref>