Two well-established first-line cognitive-behavioral psychotherapies for posttraumatic stress disorder (PTSD), prolonged exposure therapy (PE) and cognitive processing therapy (CPT), are used in the US Department of Veterans Affairs (VA) and US Department of Defense (DoD) based chiefly on good outcomes in randomized clinical trials (RCTs) with civilians. PE and CPT are manualized (ie, protocolized in a session-by-session manner) trauma-focused therapies that are based on processing the emotional and cognitive aspects of the traumatic event. Consequently, these treatments are emotionally demanding for patients because PTSD is characterized by a strong motivation to avoid talking about the trauma and rekindling negative emotions associated with it. The prominence of PE and CPT in treating individuals with military-related PTSD has been increasingly challenged in recent years because RCTs of veterans and military personnel have yielded mixed results, with patients often not obtaining clinically meaningful symptom improvement. These findings have led to questions about the extent to which these therapies should be prioritized and how military-related PTSD is best conceptualized, namely as a disorder that can be reliably managed by brief (approximately 12 session) monotherapies or as a highly complex and multiform condition requiring more individualized and comprehensive intervention.

美国退伍军人事务部（VA）和美国国防部使用了两种行之有效的创伤后应激障碍（PTSD）一线认知行为心理疗法，即长时间暴露疗法（PE）和认知加工疗法（CPT）。 （DoD）主要基于对平民的随机临床试验（RCT）的良好结果。PE和CPT是基于创伤事件的情感和认知方面的手动化（即，以会话方式进行协议）的针对创伤的疗法。因此，这些疗法对患者的情感要求很高，因为PTSD具有避免谈论创伤并重新点燃与之相关的负面情绪的强烈动机。近年来，在退伍军人和军人的随机对照试验中，PE和CPT在治疗与军事相关的PTSD个体中的地位日益受到挑战，因为患者的RCT取得了不同的结果，患者通常无法获得具有临床意义的症状改善。这些发现引起了人们对以下问题的质疑：应该优先考虑这些疗法的程度以及如何最好地概念化与军事相关的PTSD，即可以通过短暂（约12个疗程）单一疗法可靠治疗的疾病，还是高度复杂和多种形式的疗法需要更多个体化和全面干预的情况。