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Cognitive behaviour therapy for posttraumatic stress disorder
Abstract
Following considerable empirical scrutiny, cognitive behaviour therapy (CBT) has proven to be a safe and effective treatment for posttraumatic stress disorder (PTSD). This article overviews the general principles of treatment and describes the components that comprise CBT for PTSD. We then move on to review the efficacy of CBT for the treatment of PTSD caused by various traumas, including assault, road traffic accident (RTA), combat, and terrorism. Recent advances in early intervention and in the treatment of disorders that are comorbid with PTSD are reviewed. Finally, future directions are discussed. In particular, it is proposed that randomised controlled trials (RCT) of CBT for PTSD must be conducted with enhanced methodological rigour and public health relevance.
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“Breathing interventions—including controlled breathing, slow-breathing techniques (from yoga and other Eastern disciplines), coherence breathing, brahmari breathing (“bee breath,” also from yoga), and breathing at ones resonant frequency—utilize a decrease in respiratory rate, prolonged expiration (pranayama), breathing against airway resistance, or vibration of the airway to reduce physiological”
From Fear and the Defense Cascade (2015) · cites this paper as [146]
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“These interventions—which potentially include repeated exposure to traumatic memories and cognitive-restructuring techniques that aim to teach more realistic appraisals of the trauma—are thought to be a form of extinction learning in which conditioned fear responses are inhibited by new learning of safe associations, a process that involves top-down inhibition of the amygdala by the PFC and hippo”
From Fear and the Defense Cascade (2015) · cites this paper as [188]
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“These interventions—which potentially include repeated exposure to traumatic memories and cognitive-restructuring techniques that aim to teach more realistic appraisals of the trauma—are thought to be a form of extinction learning in which conditioned fear responses are inhibited by new learning of safe associations,…”
BackgroundA critical review of psychological treatments of posttraumatic stress disorder in refugees
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“Across a broad range of acute and chronic populations, CBT has been shown to perform better than other psychological or psychopharmacological interventions (Foa & Meadows, 1997 ; Harvey et al. 2003).”
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Self-citationCognitive behavioral therapy for the treatment of post-traumatic stress disorder: A review
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Self-citationTen years after the genocide: Trauma confrontation and posttraumatic stress in Rwandan adolescents
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“A large number of studies of trauma victims who live in industrialized countries have demonstrated that cognitivebehavioral therapy (reviewed in Harvey, Bryant, & Tarrier, 2003 ) and stress management techniques (Foa et al., 1999; Foa, Rothbaum, Riggs, & Murdock, 1991) are effective methods of treating PTSD.”
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Vernberg, E. M., Steinberg, A. M., Jacobs, A. K., Brymer, M. J., Watson, P. J., Osofsky, J. D., Layne, C. M., Pynoos, R. S., & Ruzek, J. I. (2008) · Professional Psychology: Research and Practice · doi:10.1037/a0012663 · Cited by 185
“These interventions seek to prevent the possible negative outcomes of overwhelming anxiety or dissociation, which has been shown to interfere with sleep, eating, hydration, decision making, and performance of life tasks and to lead to panic attacks, dissociation, posttraumatic stress disorder (PTSD), depression, anxie…”
BackgroundCarr, C., d’Ardenne, P., Sloboda, A., Scott, C., Wang, D., & Priebe, S. (2012) · Psychology and Psychotherapy: Theory, Research and Practice · doi:10.1111/j.2044-8341.2011.02026.x · Cited by 183
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“We then discussed the efficacy of each treatment for particular trauma groups using and expanding on the categories provided by Harvey et al.[8] Studies that recruited mixed trauma type patients were not included in this secondary analysis.”
MethodResultInfluentialAlexander, D. A., & Klein, S. J. (2009) · Prehospital and Disaster Medicine · doi:10.1017/s1049023x00006610 · Cited by 148
Treatment of Acute Stress Disorder: A Randomized Controlled Trial
Bryant, R. A., Mastrodomenico, J., Felmingham, K. L., Hopwood, S., Kenny, L., Kandris, E., Cahill, C., & Creamer, M. (2008) · Archives of General Psychiatry · doi:10.1001/archpsyc.65.6.659 · Cited by 145
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Mendes, D. D., Mello, M. F., Ventura, P. R., Passarela, C. D. M., & Mari, J. D. J. (2008) · The International Journal of Psychiatry in Medicine · doi:10.2190/pm.38.3.b · Cited by 138
“Conversely, exposure therapy is based on recalling traumatic memories (imagery exposure) and actual (in-vivo) exposure to stimuli associated with the trauma to enable the organization of these memories and, consequently, the reduction of anxiety and PTSD symptoms [4, 55].”
BackgroundBaños, R. M., Guillen, V., Quero, S., García-Palacios, A., Alcaniz, M., & Botella, C. (2011) · International Journal of Human-Computer Studies · doi:10.1016/j.ijhcs.2011.06.002 · Cited by 137
The acceptability and preference for the psychological treatment of PTSD
Tarrier, N., Liversidge, T., & Gregg, L. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2005.11.012 · Cited by 134
Self-citationKlein, B., Mitchell, J., Abbott, J.-A., Shandley, K. A., Austin, D., Gilson, K., Kiropoulos, L. A., Cannard, G., & Redman, T. (2010) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2010.04.005 · Cited by 136
“…assault, as ell as general victims of crime (Harvey, Bryant, & Tarrier, 2003). ace-to-face CBT for PTSD typically involves 1–1.5 h of treatment er week over 9–12 weeks, covering psycho-education, anxiety anagement, cognitive and exposure therapy, and relapse preention (Harvey et al., 2003).”
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“It involves teaching individuals to identify and evaluate dysfunctional thoughts about their victimization, elicit rational alternative thoughts, and evaluate their beliefs about themselves, the offense, and the world (Harvey et al. 2003; Marks et al. 1998).”
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“The literature on PTSD also suggests that the diagnosis is associated with other psychological problems [37].”
BackgroundBorderline Personality or Complex Posttraumatic Stress Disorder? An Update on the Controversy
Lewis, K. L., & Grenyer, B. F. S. (2009) · Harvard Review of Psychiatry · doi:10.3109/10673220903271848 · Cited by 128
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“Techniques found to be safe and effective for the treatment of PTSD were used including: psychoeducation, anxiety management (deep breathing and progressive muscle relaxation), cognitive restructuring, imaginal exposure, graded in vivo exposure, and relapse prevention.(26) Specific treatment protocols were adapted fro…”
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“The principal intervention is trauma focused CBT (TF-CBT), facilitating the processing of traumatic memory, the restructuring of negative appraisals of the memory, and the cognitive and behavioural management of PTSD symptoms (Ehlers and Clark, 2000; Grey, Young and Holmes, 2002; Harvey, Bryant and Tarrier, 2003 ).”
Prevention of trauma and stressor-related disorders: A review
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“These interventions are adapted from CBT approaches, which are known to be effective treatments for chronic PTSD (Harvey et al, 2003) and include psychoeducation, exposure, cognitive restructuring, and anxiety management (Bryant, 2007).”
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“A manual for treating PTSD was developed which included validated components commonly used in CBT for PTSD, including psychoeducation, anxiety coping skill training, exposure, and cognitive restructuring (Bisson et al., 2007; Harvey et al., 2003).”
MethodSomatic Experiencing Treatment with Social Service Workers Following Hurricanes Katrina and Rita
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“Early mental health treatment has been found to shorten the period of suffering (Harvey et al., 2003).”
BackgroundPharmacotherapy for post traumatic stress disorder (PTSD)
Williams, T., Phillips, N. J., Stein, D. J., & Ipser, J. (2026) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002795.pub4 · Cited by 97
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“Considerable evidence shows that cognitive behaviour therapy (CBT) is a safe and effective treatment for PTSD (e.g. Devilly & Spence, 1999; Harvey, Bryant, & Tarrier, 2003; McDonagh et al., 2005), and it has been found to be efficacious across a wide range of trauma groups (Harvey et al., 2003).”
BackgroundPharmacotherapy for post traumatic stress disorder (PTSD)
Williams, T., Phillips, N. J., Stein, D. J., & Ipser, J. C. (2022) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002795.pub3 · Cited by 96
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“The debriefing and counselling methods explored are quite diverse in nature; they vary from group [55,59] to individual therapy; between single [56,61], and multiple sessions [55,57–60]; and regarding the content of each intervention.”
BackgroundInfluentialAversive stimuli exacerbate defensive motor behaviour in motor conversion disorder
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Self-citationExtent of trauma exposure and PTSD symptom severity as predictors of anxiety-buffer functioning
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“However, the precise mechanisms responsible for the effectiveness of CBT are not entirely clear (Harvey et al., 2003).”
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Self-citationEarly intervention for post‐traumatic stress disorder
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“Clinical trials have established the effectiveness of cognitivebehavioral therapy for anxiety disorders such as posttraumatic stress ( Harvey et al. 2003 ).”
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“Successful treatment of patients with traumatic memories has often involved the use of strategies that bring the memory into awareness in the absence of the negative emotional reaction (Harvey, Bryant, & Tarrier, 2003).”
BackgroundTreatment of chronic PTSD by cognitive therapy and exposure: 5-year follow-up
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“Though such techniques have been effective for anxiety sufferers, current imagery-based treatments show room for improvement (Bradley, Greene, Russ, Dutra, & Westen, 2005; Foa & Meadows, 1997; Harvey, 2003).”
BackgroundPerceptual and conceptual processing as predictors of treatment outcome in PTSD
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Estradiol modulation of the renin–angiotensin system and the regulation of fear extinction
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“Constructing a trauma narrative was reported to be instrumental for recovery, which lends weight to findings in other studies that exposure treatment is an essential component of TF-CBT [40-42].”
ResultMeltzer, E. C., Averbuch, T., Samet, J. H., Saitz, R., Jabbar, K., Lloyd-Travaglini, C., & Liebschutz, J. M. (2012) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-011-9263-x · Cited by 53
“5) was fewer than the number of visits typically necessary for CBT in studies of PTSD (9–12 sessions).(28) Ultimately, there is a significant benefit to focused PTSD treatment, as incomplete treatment leads to suboptimal outcomes.”
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“Recent research has addressed the utility of addressing cognitions associated with intrusive thoughts through the use of cognitive therapy [18,36,37].”
Treating Iraq and Afghanistan War Veterans With PTSD Who Are at High Risk for Suicide
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Childhood Abuse and Pain in Adulthood
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“Multiple studies link PTSD to chronic pain, and, perhaps most important in treatment settings, PTSD can be effectively treated by cognitive behavior therapy.(32) However, the clinical utility of routinely assessing childhood abuse histories in patients without signs or symptoms of PTSD seems inadvisable, as implicatio…”
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Test of a single-item posttraumatic stress disorder screener in a military primary care setting
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“Effective treatments exist [11–15] and some evidence suggests that early identification and intervention improves outcomes [16].”
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“PTSD or depression, after a traumatic stressful event [9], and may be offered.”
BackgroundExamining the Effectiveness of Restorative Justice in Reducing Victims’ Post-Traumatic Stress
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“promote acceptance of it as a mental event rather than as a reality (Harvey et al., 2003).”
BackgroundWar Narratives: Veteran Stories, PTSD Effects, and Therapeutic Fly-Fishing
Mowatt, R. A., & Bennett, J. L. (2011) · University of New Hampshire Scholars Repository (University of New Hampshire at Manchester) · Cited by 37
Pergher, G. K., Grassi‐Oliveira, R., de Ávila, L. M., & Stein, L. M. (2006) · Revista de Psiquiatria do Rio Grande do Sul · doi:10.1590/s0101-81082006000100008 · Cited by 40
Abramowitz, E. G., & Lichtenberg, P. (2010) · International Journal of Clinical and Experimental Hypnosis · doi:10.1080/00207141003760926 · Cited by 37
“HOC incorporates elements of CBT, which is the most thoroughly studied and evidence-based psychotherapeutic intervention for PTSD (Harvey et al., 2003).”
BackgroundNot Lost in Translation: Protocols for Interpreting Trauma-Focused CBT
d'Ardenne, P., Farmer, E., Ruaro, L., & Priebe, S. (2007) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465807003591 · Cited by 33
Makinson, R. A., & Young, J. S. (2012) · Journal of Counseling & Development · doi:10.1111/j.1556-6676.2012.00017.x · Cited by 35
How does immediate recall of a stressful event affect psychological response to it?
Gittins, C. B., Paterson, H. M., & Sharpe, L. (2014) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2014.07.006 · Cited by 32
What happens after a difficult birth? Postnatal debriefing services
Ayers, S., Claypool, J., & Eagle, A. (2006) · British Journal of Midwifery · doi:10.12968/bjom.2006.14.3.20577 · Cited by 32
“Although there is no published research looking at treatment efficacy for postnatal PTSD, research into PTSD in other groups suggests variable success rates of cognitive behaviour therapy with between 40% and 90% of people recovering (Harvey et al., 2003).”
BackgroundCognitive-behavioral Therapy of Patients with Ptsd: Literature Review
Shubina, I. (2015) · Procedia - Social and Behavioral Sciences · doi:10.1016/j.sbspro.2014.12.624 · Cited by 31
Regehr, C., & Sussman, T. (2004) · Brief Treatment and Crisis Intervention · doi:10.1093/brief-treatment/mhh025 · Cited by 31
“Follette, Ruzek, and Abueg (1998), Harvey, Bryant, and Tarrier (2003), and Rothbaum and Foa (1996) provide extensive overviews of the effectiveness of cognitive-behavioral approaches for posttraumatic stress disorder.”
BackgroundInterventions to Reduce Distress in Adult Victims of Sexual Violence and Rape: A Systematic Review
Regehr, C., Alaggia, R., Dennis, J. A., Pitts, A., & Saini, M. (2013) · Campbell Systematic Reviews · doi:10.4073/csr.2013.3 · Cited by 57
Sex hormones predict the sensory strength and vividness of mental imagery
Wassell, J., Rogers, S., Felmingam, K. L., Bryant, R. A., & Pearson, J. (2015) · Biological Psychology · doi:10.1016/j.biopsycho.2015.02.003 · Cited by 29
“Although cognitive behavioral therapy that utilizes imagery as been recognized as the treatment of choice for many psyhopathologies, including a range of anxiety disorders, current reatments only alleviate PTSD in approximately 60–70% of peole (Foa & Meadows, 1997; Harvey et al., 2003).”
BackgroundSelf-citationCollective memory: A perspective from (experimental) clinical psychology
Wessel, I., & Moulds, M. L. (2008) · Memory · doi:10.1080/09658210701811813 · Cited by 29
Hyman, I. A., Cohen, I., & Mahon, M. (2003) · The California School Psychologist · doi:10.1007/bf03340897 · Cited by 28
Morland, L. A., Greene, C. J., Grubbs, K. M., Kloezeman, K. C., Mackintosh, M., Rosen, C. S., & Frueh, B. C. (2011) · Journal of Clinical Psychology · doi:10.1002/jclp.20779 · Cited by 28
Hegde, P., Jayakrishnan, H. R., Chattarji, S., Kutty, B. M., & Laxmi, T. R. (2011) · Brain Research · doi:10.1016/j.brainres.2011.01.055 · Cited by 27
Developing and Implementing Randomized Effectiveness Trials in General Medical Settings.
Zatzick, D., Simon, G. E., & Wagner, A. W. (2006) · Clinical Psychology Science and Practice · doi:10.1111/j.1468-2850.2006.00006.x · Cited by 28
Cognitive Behavior Therapy for Schizophrenia and Psychosis: Current Status and Future Directions
Tarrier, N. (2010) · Clinical Schizophrenia & Related Psychoses · doi:10.3371/csrp.4.3.4 · Cited by 28
Self-citationSaur, R., Hansen, M. B., Jansen, A., & Heir, T. (2016) · Disability and Rehabilitation · doi:10.3109/09638288.2016.1161836 · Cited by 25
“The need to go back and repeat the course of events corresponds well with cognitive theory, in which re-experiencing events assists with correcting distorted beliefs about the course of events and helps to desensitize the conditioned fear response.[21] Opposed to an active and offensive coping style some participants…”
BackgroundIn the Aftermath of Trauma: Normative Reactions and Early Interventions
Bryant, R. A. (2004) · Wiley eBooks · doi:10.1002/9780470713570.ch10 · Cited by 25
Self-citationKeen, S. M., & Roberts, N. (2016) · Health Systems · doi:10.1057/hs.2016.2 · Cited by 24
“Considerable evidence shows that cognitive behavioral therapy is a safe and effective treatment for PTSD (Harvey et al , 2003).”
BackgroundTowards a description of the elements of art therapy practice for trauma: a systematic review
Bowen-Salter, H., Whitehorn, A., Pritchard, R., Kernot, J., Baker, A., Posselt, M., Price, E., Jordan-Hall, J., & Boshoff, K. (2022) · International Journal of Art Therapy · doi:10.1080/17454832.2021.1957959 · Cited by 24
“…will receive a PTSD diagnosis in their lifetime (Benjet et al., 2016; Kessler et al., 2017) but nearly 30 per cent of individuals who undergo a first-line, mainstream trauma-based treatment for PTSD do not experience any benefit (Bisson et al., 2007; Harvey et al., 2003; Schouten et al., 2015).”
BackgroundMental Health Treatments In The Wake Of Disaster
Bryant, R. A., & Litz, B. T. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511730030.019 · Cited by 23
Self-citation
Metadata
- Authors
- Harvey, A. G., Bryant, R. A., & Tarrier, N.
- Affiliations
- University of Oxford (GB)
- UNSW Sydney (AU)
- University of Manchester (GB)
- Corresponding author
- Harvey, Allison G.
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2003-05
- Volume
- 23
- Issue
- 3
- Pages
- 501-522
- ISSN
- 0272-7358 (ISSN-L)
- OpenAlex
- W1998199554
- Cited by
- 203
- References
- 95
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 1 · 2023: 1 · 2022: 4 · 2021: 9 · 2020: 3 · 2019: 5 · 2018: 4 · 2017: 10 · 2016: 6 · 2015: 11 · 2014: 7 · 2013: 9 · 2012: 8
- FWCI
- 1.96
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Psychology Review (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- cognitive behavioral therapy, post-traumatic stress disorder, trauma treatment, assault, traffic accidents, combat-related PTSD, terrorism, early intervention, comorbidities, treatment efficacy, randomized controlled trials
- MeSH terms
- Humans, Stress Disorders, Post-Traumatic, Cognitive Behavioral Therapy
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