CBT for PTSD on repeat

My client has returned, and their PTSD is worse, will repeating therapy help?

Jeremiah Schumm and colleagues (2017) examined this question in their comparison of veterans who repeated a course of manualized, cognitive-behavioural therapy for posttraumatic stress disorder compared with veterans who do not repeat.

They examined three types of Cognitive Behavioural Therapies for PTSD. They were Cognitive Processing Therapy (CPT), Prolonged Exposure therapy (PE) and Cognitive-Behavioral Conjoint Therapy for PTSD (CBCT).  The last therapy in the preceding list is a behavioural therapy for PTSD that is also a relationship therapy.

They found that those who repeated treatment had significant improvements in PTSD symptoms during both the first and second course of CBT for PTSD.  They also reported that the degree of improvement did not differ between these two courses of therapy.


Jeremiah Schumm and colleagues highlighted that relapse appeared to be a motivational factor. Rather than further treatment gains or other reasons for repeating. They noted that there was a significant increase in the severity of self-rated PTSD symptoms for repeaters between the first and second episode of treatment.


As is often the case there are limitations to research and more research is needed. The researcher outlined a range of limitations within their study.

  1. The study was uncontrolled, so it is not possible to draw causal inferences.
  2. They did not obtain data from veterans about their reasons for repeating a course of treatment.
  3. Due to the therapies being delivered as part of routine clinical care, fidelity measures were not collected. Thus deviation from the treatment protocols or CAPS administration could have impacted the findings.
  4. There was no data on veterans’ symptoms following treatment. Hence, we don’t know if repeaters’ and non-repeaters’ symptoms differ after their participation in CBT for PTSD.
  5. They did not know if treatment repeaters received treatment from providers outside of the study.


Despite the limitation of this research it appears to support that a second course of CBT for PTSD is a viable option for some who experience a relapse in PTSD symptoms or who otherwise fail to respond to an initial course of therapy. At the very least the study did not report any adverse effects.


Foa, E. B.,Hembree, E. A.,&Rothbaum, B.O. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences. New York, NY: Oxford University Press.

Monson, C. M.,& Fredman, S. J. (2012). Cognitive-behavioral conjoint therapy for PTSD: Harnessing the healing power of relationships. New York, NY: The Guilford Press.

Resick, P. A., Monson, P. A.,& Chard, K. M. (2017). Cognitive processing therapy for PTSD: version comprehensive manual. New York, NY: Guilford Press.

Schumm, J. A., Pukay-Martin, N. D., & Gore, W. L. (2017). A Comparison of Veterans Who Repeat Versus Who Do Not Repeat a Course of Manualized, Cognitive-Behavioral Therapy for Posttraumatic Stress Disorder. Behavior therapy, 48(6), 870–882. https://doi.org/10.1016/j.beth.2017.06.004