Do I need to prepare my client for trauma treatment?

Dedert and colleagues examined this question with 575 veterans seeking treatment for PTSD  in a VA outpatient clinic. They examined the association of preparatory group treatment with engagement in and treatment response to subsequent trauma-focused psychotherapies, cognitive processing therapy (CPT) and prolonged exposure therapy (PE). Nearly four hundred  (391) veterans participated in preparatory treatments. Twenty four percent (94) of these veterans engaged in  subsequent trauma-focused therapy, either CPT or PE.

Clients initiating CPT or PE without having first attended preparatory PTSD treatment had similar rates of  completion and better treatment response, as measured by decreases on the PCL-5  for PTSD and the PHQ9 measure of depressive symptoms .

Overall, veterans reported greater symptom reduction when engaging in trauma-focused therapy directly, without having previously attended a preparatory group. However, the study has some limitations, for example, it  did not use random assignment to preparatory versus trauma focused treatment. Therefore, it is likely that a selection effect occurred, whereby certain veterans were more likely to select preparatory treatment than others.

Similar findings regarding the need for preparation have been reported in relation to complex PTSD, where a stabilisation phase has included preparation for  a focus directly on the review and reappraisal of trauma memories.

 In 2015 Bicanic and colleagues reported on their examination of the need for a stabilisation phase for complex PTSD and they concluded;

“there is certainly no compelling evidence to support the assumption that well-organised and carefully administered evidence-based treatment has to be preceded by a stabilisation phase”

Similarly in 2016 the ISTSS guidelines were re-examined by 21 experts in the trauma field (Jonhg et,al, 2016) and it was concluded, the evidence did not support the recommendation for a stabilization phase prior to providing trauma-focused treatment in persons with cPTSD, or related severe or complicated presentations of PTSD.


It appears that a preparation phase before a trauma focussed therapy is not supported by the research when the participant chooses to embark on a trauma focussed therapy. The experts in the field also agree that preparation for trauma focussed therapy is not supported.


Dedert, E. A., LoSavio, S. T., Wells, S. Y., Steel, A. L., Reinhardt, K., Deming, C. A., Ruffin, R. A., Berlin, K. L., Kimbrel, N. A., Wilson, S. M., Boeding, S. E., & Clancy, C. P. (2020). Clinical effectiveness study of a treatment to prepare for trauma-focused evidence-based psychotherapies at a veterans affairs specialty posttraumatic stress disorder clinic. Psychological Services. Advance online publication.

Bicanic I, de Jongh A, Ten Broeke E. Stabilisation in trauma treatment: necessity or myth?. Tijdschr Psychiatr. 2015; 57(5):332-9.

Jongh, A. , Resick, P. A., Zoellner, L. A., Minnen, A. , Lee, C. W., Monson, C. M., Foa, E. B., Wheeler, K. , Broeke, E. t., Feeny, N. , Rauch, S. A., Chard, K. M., Mueser, K. T., Sloan, D. M., Gaag, M. , Rothbaum, B. O., Neuner, F. , Roos, C. , Hehenkamp, L. M., Rosner, R. and Bicanic, I. A. (2016), CRITICAL ANALYSIS OF THE CURRENT TREATMENT GUIDELINES FOR COMPLEX PTSD IN ADULTS. Depress Anxiety, 33: 359-369. doi:10.1002/da.22469