If you’re exploring treatment options for PTSD, you’ve likely come across Eye Movement Desensitisation and Reprocessing (EMDR) repeatedly. This is a well-known therapy, popularised by celebrities such as Prince Harry, Sandra Bullock and Lady Gaga talking about their experiences. It might seem like it is the only way to recover from traumatic experiences…
However, there are other pathways to healing from traumatic experiences. Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) like EMDR are also considered gold-standard, evidence-based treatments recommended by major health organizations worldwide.
Why might I consider a choice in the therapy I do?
Having choice in therapy has been shown to effect dropout from therapy. For example, some research has shown when it comes to medication and behavioural therapy such as PE for PTSD if the client chose the therapy, they were more likely to complete it, compared to if they were not given a choice (Melville, 2017). The research (Holmes et al., 2019) supports the commonsense notion that people who do more therapy generally have better outcomes.
What as The Difference Between a Trama Focussed Therapy and a “Trauma Therapy”
All the trauma focused therapies are evidence based, meaning they have been undergone randomised controlled trials to understand if they are effective for PTSD. Randomised controlled trials are considered the best scientific approach to understanding the effects of therapy. Similarly, all these therapies have been developed with PTSD symptoms and change as their focus. Usually, there is also ongoing research. A therapy claiming to be a trauma therapy may not be developed with PTSD in mind, and it may not have been developed with a scientific basis like randomised controlled trials behind it. For example, Somatic Experiencing is a therapeutic method used for treating trauma. It has been used for 50 years in clinical application according to its developer Peter A. Levine (Somatic Experiencing® (SETM) | Explore Healing Methods, n.d.). However, a search of PubMed, a data base that comprises more than 40 million citations for biomedical literature only shows three randomised controlled trials for Somatic Experiencing. In contrast, a 2019 meta-analysis of CPT trials (Asmundson et al., 2019) included 11 studies with a total of 1130 participants. CPT was developed in the late 1980s.
Trauma Focussed Therapies What Do They Have in Common?
Before looking at differences, it’s worth noting what they share:
1. Trauma-focused
All three therapies directly address traumatic memories rather than avoiding them.
2. Evidence-based
Each has extensive research support showing significant reductions in PTSD symptoms.
3. Time-limited
They are typically delivered over a structured number of sessions rather than open-ended therapy.
4. Aim for recovery
The goal is not just coping, but meaningful symptom reduction—and often remission.
Knowing how something works helping you choose
Differences: How the Paths Diverge
While the destination is similar, the journey looks quite different across the three therapies.
Primary focus: CPT centres on thinking patterns and unhelpful beliefs (stuck points). PE centres on breaking the cycle of avoidance. EMDR centres on reprocessing stuck memories through bilateral stimulation.
Theoretical basis: CPT and PE are both rooted in cognitive-behavioural theory, while EMDR is guided by the Adaptive Information Processing model — a distinct theoretical framework.
Trauma narrative: PE places detailed verbal recounting of the trauma at the heart of treatment. CPT includes an optional written narrative but does not require it. Similarly, if the PTSD sufferer does not have a clear memory CPT can still be used. EMDR requires minimal verbal narration — clients hold the memory in mind but do not need to describe it in detail.
Between-session homework: CPT involves worksheets and written exercises to build upon what is done in session. PE requires listening to recordings and completing in vivo exposures. EMDR homework is minimal; the core processing happens within sessions.
Format: CPT can be delivered individually or in groups, making it the most accessible in terms of cost and format flexibility. PE and EMDR are delivered individually.
Session length: CPT individual sessions run 60 minutes; PE sessions run 90 minutes; EMDR sessions typically run 60 to 90 minutes.
The Three Therapies Explained
Cognitive Processing Therapy (CPT)
Developed by Dr Patricia Resick in (Resick et al., 2024), CPT is a structured, treatment grounded in cognitive-behavioural principles. It focuses on how you think about your trauma rather than on the trauma narrative itself (Hence you can do it if there are memory difficulties). CPT operates on the understanding that PTSD symptoms often stem from “stuck points” — deeply held but unhelpful beliefs that arose from the trauma, such as “It was my fault,” “The world is completely dangerous,” or “I can never trust anyone again.” By identifying and examining these beliefs, the person experiencing PTSD becomes unstuck and moves towards recovery
Sessions involve psychoeducation about PTSD, a written impact statement, and structured worksheets that help clients examine thinking and beliefs about traumatic experiences. In addition to this five core life domains: safety, trust, power and control, esteem, and intimacy are examined as these are often disturbed by trauma. A trauma narrative (a written account of the event) may optionally be incorporated; research shows both versions are equally effective.
How long does it take to recover?
CPT is structed around 12 sessions, some people need less some people need more, this is discussed with a therapist during the process. CPT can be completed intensively – in as little as two weeks (Baez 2026), twice weekly (6 weeks) or once per week (3 months).
Prolonged Exposure (PE)
Developed by Dr Edna Foa (Foa et al., 2019) at the University of Pennsylvania, PE is rooted in emotional processing theory and associative learning. The central insight is that PTSD is maintained largely through avoidance. When survivors avoid trauma-related thoughts, feelings, places, and people, the brain never gets the chance to learn that these reminders are not actually dangerous. PE systematically dismantles avoidance by guiding clients to approach what they have been avoiding, in a controlled and supportive environment.
PE has two core exposure components. In vivo exposure involves gradually confronting real-world situations — a park, a type of person, a news story — that have been avoided because of their association with the trauma. Imaginal exposure involves revisiting the traumatic memory in detail during sessions, recounting it aloud, and listening back to recordings at home. Through repeated, safe re-engagement with the memory and reminders, the fear response habituates and the memory loses its power to hijack everyday life.
How long does it take to recover?
Typically, 8 to 15 sessions across approximately 3 months. A non-inferiority trial has demonstrated that PE completed intensively over 2 weeks was equally effective as a 3-month episode of treatment (Dell et al., 2023).
Eye Movement Desensitisation and Reprocessing (EMDR)
EMDR was developed by psychologist Francine Shapiro in the late 1980s (Shapiro & Solomon, 2010) when she noticed that lateral eye movements seemed to reduce the emotional charge of disturbing thoughts. It follows a structured eight-phase protocol guided by the Adaptive Information Processing (AIP) model, which holds that PTSD symptoms arise from traumatic memories that were never fully processed and remain “frozen” in the nervous system in their original, distressing form. EMDR aims to reactivate the brain’s natural information-processing capacity to integrate these stuck memories.
The hallmark of EMDR is bilateral stimulation — typically guided eye movements following the therapist’s moving hand or a light bar, though auditory tones or tactile taps may also be used. While holding a traumatic memory in mind, the client follows the bilateral stimulation in short sets. Some researchers theorise this process mimics what occurs during REM sleep, when the brain consolidates and integrates experiences. The emotional intensity of the memory diminishes across sets until it can be held without significant distress (Shapiro & Solomon, 2010).
How long does it take to recover?
Typically, 6 to 12 sessions. There are several intensive protocols (Butler, 2024) where the protocol is completed in 60 min per day for two weeks, or three x 90 min sessions for four consecutive days followed by 90 min booster sessions every four weeks, or two x 90 min sessions, over four consecutive days for two weeks.
Cognitive Processing Therapy (CPT) at the Centre for Clinical Psychology
All our therapists at the Centre for Clinical Psychology are trained in CPT. We choose to focus on our delivery of CPT as a therapy of choice that not only improves PTSD and CPTSD symptoms, but also improves:
Depression (Resick, et al. 2002, 2012)
Guilt (Resick et al. 2002, Nishith, Nixon & Resick, 2005)
Physical health complaints (Galovski et al. 2009)
Hopelessness (Gallagher & Resick, 2012)
Social and work functioning (Wachen et al., 2014)
Experience of joy in life (Kehle-Forbes et al. 2025)
Suicidal ideation (Johnson et al., 2021)
If you are suffering after a traumatic experience or think you may be experiencing PTSD or complex PTSD our psychologists at Centre for Clinical Psychology can help you. Please contact the team at (03) 9077 0122 or register online.
Refererences
Asmundson GJG, Thorisdottir AS, Roden-Foreman JW, Baird SO, Witcraft SM, Stein AT, Smits JAJ, Powers MB. A meta-analytic review of cognitive processing therapy for adults with posttraumatic stress disorder. Cogn Behav Ther. 2019 Jan;48(1):1-14. doi: 10.1080/16506073.2018.1522371. Epub 2018 Oct 18. PMID: 30332919.
Baez, L., Huberty, J., Yourell, J., Jewell, C., Lin, E., Kaysen, D., Cutts, L., Noori, S., Rosenthal, I., & Chard, K. (2026). Effectiveness of massed cognitive processing therapy for posttraumatic stress disorder: A retrospective analysis. Journal of Traumatic Stress, 1–12. https://doi.org/10.1002/jts.70045
Butler, S.-J., & Ramsey-Wade, C. (2024). How do clients experience intensive EMDR for post-traumatic stress? An interpretative phenomenological analysis. European Journal of Trauma & Dissociation, 8(4), 100479. https://doi.org/10.1016/j.ejtd.2024.100479
Dell L, Sbisa AM, Forbes A, O’Donnell M, Bryant R, Hodson S, Morton D, Battersby M, Tuerk PW, Elliott P, Wallace D, Forbes D. Massed v. standard prolonged exposure therapy for PTSD in military personnel and veterans: 12-month follow-up of a non-inferiority randomised controlled trial. Psychol Med. 2023 Nov;53(15):7070-7077. doi: 10.1017/S0033291723000405. Epub 2023 Mar 13. PMID: 36911997; PMCID: PMC10719628.
Gallagher, M. W., & Resick, P. A. (2012). Mechanisms of Change in Cognitive Processing Therapy and Prolonged Exposure Therapy for PTSD: Preliminary Evidence for the Differential Effects of Hopelessness and Habituation. Cognitive Therapy and Research, 36(6), 10.1007/s10608-011-9423–9426. https://doi.org/10.1007/s10608-011-9423-6
Galovski, T. E., Monson, C., Bruce, S. E., & Resick, P. A. (2009). Does cognitive–behavioral therapy for PTSD improve perceived health and sleep impairment? Journal of Traumatic Stress, 22(3), 197–204. https://doi.org/10.1002/jts.20418
Foa, E., Hembree, E. A., Rothbaum, B. O., & Rauch, S. (2019). Prolonged Exposure Therapy for PTSD: Emotional Processing of Traumatic Experiences—Therapist Guide. Oxford University Press. https://doi.org/10.1093/med-psych/9780190926939.001.0001
Holmes, S. C., Johnson, C. M., Suvak, M. K., Sijercic, I., Monson, C. M., & Wiltsey Stirman, S. (2019). Examining patterns of dose response for clients who do and do not complete cognitive processing therapy. Journal of Anxiety Disorders, 68, Article 102120. https://doi.org/10.1016/j.janxdis.2019.102120
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Kehle-Forbes, S. M., Baier, A. L., Ackland, P. E., Spoont, M., Polusny, M. A., Schnurr, P. P., Galovski, T., & Meis, L. (2025). “It made me feel more alive”: A qualitative analysis of quality of life improvements following completion of trauma-focused therapy for posttraumatic stress disorder. Journal of Traumatic Stress, 38(1), 158–164. https://doi.org/10.1002/jts.23091
Melville, N. (2017) Patient Preference Key to PTSD Treatment Adherence. (n.d.). Medscape. Retrieved May 6, 2026, from https://www.medscape.com/viewarticle/878509
Nishith, P., Nixon, R. D. V., & Resick, P. A. (2005). Resolution of trauma-related guilt following treatment of PTSD in female rape victims: A result of cognitive processing therapy targeting comorbid depression? Journal of Affective Disorders, 86(2–3), 259–265. https://doi.org/10.1016/j.jad.2005.02.013
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