Table 1.

Proposed treatment components and psychological change mechanisms of effective CBT treatments for PTSD

Treatment	Therapy techniques	Patient events	Psychological mechanisms
Prolonged exposure [8]	Therapist teaches breathing retraining Therapist helps the patient develop an exposure hierarchy and assigns in vivo exercises for homework Therapist encourages the patient to engage in imaginal exposure in session Therapist promotes engagement with the trauma memory during imaginal exposure using encouragement and prompting questions Therapist helps patient process reactions to imaginal exposure	Patient practices breathing retraining and experiences relaxation Patient approaches feared situations, places, and people for homework and experiences a reduction in distress over repeated trials Patient repeatedly recounts the trauma memory aloud with a description of his/her thoughts and feelings at the time and experiences a reduction in distress over repeated trials Patient listens to tape of imaginal exposure daily for homework and experiences a reduction in distress over repeated trials Patient experiences activation of the trauma memory during in vivo and imaginal exposures Patient is confronted with disconfirming information during in vivo exposures, imaginal exposures, and processing of imaginal exposures	Emotional processing: pathological elements of the fear structure and associated erroneous perceptions are modified
Cognitive therapy for PTSD [13, 15]	Therapist helps patient identify appraisals by recalling the trauma Therapist uses Socratic dialogue to gather updating information Therapist uses behavioral experiments to gather updating information and test maladaptive behavioral/cognitive strategies Therapist helps patient recall the trauma while reminding themselves of updating information Therapist helps patient identify triggers Therapist helps patient explore how current triggers differ from past trauma	Patient reinstates pleasant activities/social contacts for homework and recognizes their life is not permanently damaged by trauma Patient recalls the trauma and recognizes idiosyncratic appraisals Patient engages in Socratic dialogue/behavioral experiments and gathers updating information Patient completes behavioral experiments in which they do not use maladaptive cognitive/behavioral strategies and recognizes how these strategies lead to further problems Patient develops a narrative account of the trauma using imaginal reliving, writing, and revisiting the site Patient practices pairing narrative account with updating information Patient identifies trauma triggers Patient experiences/induces triggers and focuses on how the present is different from the past	Patient reduces use of maladaptive cognitive/behavioral strategies Patient’s appraisals of trauma and trauma sequelae become more accurate/adaptive The trauma memory is elaborated and integrated into autobiographical memory
Cognitive processing therapy [10]	Therapist helps patient identify stuck points in their thinking Therapist teaches patient how thoughts affect feelings Therapist encourages the patient to write about the meaning of the trauma and asks patient to read in session Therapist uses Socratic dialogue to challenge stuck points in session Therapist teaches patient to challenge stuck points, identify maladaptive thinking patterns, and generate alternative thoughts	Patient writes about why they think the trauma happened and how the trauma has affected their thinking in critical domains Patient identifies stuck points in session and between sessions and is able to recognize maladaptive beliefs Patient completes ABC sheets and understands the connection between thoughts and feelings Patient talks with the therapist about stuck points in session and acknowledges evidence against their beliefs Patient challenges stuck points for homework by asking themselves a series of questions and recognizes thinking errors Patient practices labeling stuck points with patterns of problematic thinking and understands common patterns in their thinking Patient practices generating alternative beliefs and experiences a reduction in the extent stuck points are endorsed	Patient’s daily cognitions about the trauma, themselves, others, and the world become more balanced, accurate, and adaptive as characterized by a greater number of accommodated beliefs and a reduced number of assimilated and over-accommodated beliefs

These treatment components and change mechanisms reflect those proposed by the treatment developers, not those established by empirical research. The components and mechanisms listed are not exhaustive; they are meant to highlight the components and mechanisms thought to be most central to each treatment