CPT vs PE for PTSD

Therapists are always looking for the best treatment for their clients. The question of how do Prolonged Exposure and Cognitive Processing Therapy compare for the treatment of posttraumatic stress disorder (PTSD) was examined by a large team lead by Paula Schnurr from the National Center for PTSD (2022).

The trial was the first to compare the treatments in Veterans and is the largest study of psychotherapy for PTSD ever conducted. The randomized clinical trial examined 916 veterans. These Veterans had a high severity of PTSD and multiple comorbidities.  Here is a breakdown of the stats.

  • Men 730 [79.7%]
  • Women 186 [20.3%]
  • Mean age 45.2
  • Age range [21-80] years
  • 455 participants randomized to PE (mean CAPS-5 score at baseline, 39.9 [95%CI, 39.1-40.7] points)
  • 461 participants randomized to CPT (mean CAPS-5 score at baseline, 40.3 [95%CI, 39.5-41.1] points)
  • Treatment dropout
    • PE (254 participants [55.8%]
    • CPT (215 participants [46.6%]
    • They defined dropout strictly, as failure to complete 100% of protocol sessions.

What did they find

The team reported that PTSD severity on the CAPS-5 improved substantially in both PE and CPT groups from before to after treatment. The mean improvement was greater in PE than CPT but the difference was not clinically significant. Results for self-reported PTSD symptoms were comparable with CAPS-5 findings.


The team concluded that although PE was statistically more effective than CPT, the difference was not clinically significant, and improvements in PTSD were meaningful in both treatment groups. They suggested that their findings highlight the importance of shared decision-making to help patients understand the evidence and select their preferred treatment


Schnurr, P. P., Chard, K. M., Ruzek, J. I., Chow, B. K., Resick, P. A., Foa, E. B., Marx, B. P., Friedman, M. J., Bovin, M. J., Caudle, K. L., Castillo, D., Curry, K. T., Hollifield, M., Huang, G. D., Chee, C. L., Astin, M. C., Dickstein, B., Renner, K., Clancy, C. P., Collie, C., … Shih, M. C. (2022). Comparison of Prolonged Exposure vs Cognitive Processing Therapy for Treatment of Posttraumatic Stress Disorder Among US Veterans: A Randomized Clinical Trial. JAMA network open5(1), e2136921.