CLINICIAN'S TRAUMA UPDATE Online
Issue 20(3), JUNE 2026
For COMPLETE summaries, see this month's CTU-Online.
Treatment
Predicting dropout from PE and CPT
Dropout from evidence-based PTSD psychotherapy is difficult to characterize, and the patient characteristics that predict quitting treatment before achieving clinically meaningful response are poorly understood. Researchers at the National Center for PTSD analyzed data from a previously published RCT comparing PE to CPT in 916 Veterans with PTSD to better understand rates and predictors of dropout. Read this CTU-Online.
Comparing Reconsolidation of Traumatic Memories with PE
Reconsolidation of Traumatic Memories (RTM) is a psychotherapy that focuses on briefly recalling a trauma memory, reducing distress in the moment, and emotionally distancing from the trauma memory. A prior study had found RTM to be superior to trauma-focused CBT for improving self-report PTSD symptoms, but the study was based on completer analysis only. A team led by investigators from Uniformed Services University conducted an RCT, in which they hypothesized that RTM would lead to greater or faster symptom reduction than PE. Read this CTU-Online.
Imaging-guided TMS decreases amygdala threat reactivity and improves PTSD
A team of Emory investigators recently reported the results of a randomized controlled trial of imaging-guided targeting of transcranial magnetic stimulation (TMS) for PTSD. TMS is an established treatment for major depression, and several studies have shown benefits for TMS in PTSD. Because the optimal brain target for TMS for PTSD is unclear, using brain imaging to guide targeting may be of value. CTU-Online.
Treatment planning for Veterans with co-occurring PTSD and substance use disorders
Patients are more likely to complete treatment when they receive a treatment they prefer and that they believe will work well. Trauma-focused treatment (TFT) is recommended over non-trauma-focused treatment (NTFT) for treating PTSD. However, patients with co-morbid substance use disorders (SUD) may be concerned that TFT will be destabilizing and cause them to relapse. A team led by investigators at the National Center for PTSD explored preferences for and expectations of TFT and NTFT among Veterans with PTSD/SUD. Read this CTU-Online.
Veterans’ experiences of addressing race-based traumas in PTSD therapies
Despite the general effectiveness of trauma-focused psychotherapies, Black Veterans may experience less symptom relief on average relative to White Veterans. Causes are likely multifaceted, but a potential reason could include limited focus on race-based trauma during these treatments. To explore this possibility, San Francisco VA Healthcare System investigators interviewed Veterans about their experiences of discussing race-based trauma in CPT or PE for PTSD. Read this CTU-Online.
Trauma re-experiencing can occur with esketamine but may not interfere with clinical effects
Ketamine can be effective in medication-resistant major depressive disorder, though its efficacy and safety in patients with comorbid PTSD are not established. European investigators representing 11 clinics analyzed retrospective data from patients with depression and comorbid PTSD receiving intranasal ketamine.Read this CTU-Online.
Further evidence that moral injury does not impact benefit of PTSD psychotherapies
There is debate about whether PTSD psychotherapy is as effective for individuals who have experienced moral injury compared with those who have not. This is the question addressed by investigators from the Cincinnati VA Medical Center, who explored whether treatment outcomes in a VA outpatient PTSD clinic differed based on moral injury exposure. Read this CTU-Online.
When do symptoms change in treatment for PTSD and alcohol use disorder?
Veterans with co-occurring PTSD and alcohol use disorder (AUD) are at risk for especially poor outcomes. A recent study examined whether PE could be augmented by topiramate, an anticonvulsant medication that is recommended for treating AUD, for treating comorbid PTSD/AUD. Investigators found that PE + topiramate outperformed PE + placebo for improving PTSD, but not AUD. A team led by investigators at VA San Diego conducted a secondary analysis of this trial to examine the timing of change in alcohol cravings and symptoms of PTSD and depression. Read this CTU-Online.
Take Note
State of the science of PTSD epidemiology
A team led by investigators at Boston University reviewed the “state of the science” of the epidemiology of PTSD, including prevalence of, risk factors for, and consequences of a diagnosis of PTSD. Read the article.
Meta-analysis of culturally adapted CBT for PTSD
A team led by researchers at University of North Texas conducted a meta-analysis of 19 studies of culturally-adapted PTSD treatments compared to either waitlist or alternative control treatments (including relaxation and treatment as usual). Read the article.
“Primer” review on PTSD
An international team of investigators wrote a review paper on the symptoms, prevalence, comorbidities, and treatments for PTSD. Read the article.
Meta-analysis of suicide prevention interventions for Veterans and service members
Researchers from Griffith University and the University of Queensland in Australia used the US VA’s Suicide Prevention Trials Database to conduct a systematic review and meta-analysis of 24
studies for reducing suicidal ideation Read the article.
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The Clinician's Trauma Update, CTU-Online, is an electronic newsletter produced by the National Center for PTSD, Department of Veterans Affairs. CTU-Online provides summaries of clinically relevant publications in the trauma field with links to published abstracts or full text articles when available. Please send any feedback to sadie.larsen@va.gov
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