What is the recommended first-line psychotherapy intervention for individuals seeking treatment for mental health conditions such as depression, anxiety disorders, and post-traumatic stress disorder (PTSD)?

From the Guidelines

Prolonged exposure, cognitive processing therapy, or eye movement desensitization and reprocessing psychotherapy are recommended as the first-line psychotherapy interventions for individuals seeking treatment for mental health conditions such as depression, anxiety disorders, and post-traumatic stress disorder (PTSD). These therapies have been shown to be effective in reducing symptoms and improving quality of life for individuals with these conditions 1. The recommendation is based on the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline, which evaluated the evidence using the GRADE method and made recommendations based on the quality and strength of evidence.

Key Points

• Prolonged exposure therapy involves helping patients gradually become comfortable with situations, places, or memories that they have been avoiding due to trauma-related distress.
• Cognitive processing therapy focuses on identifying and challenging negative thought patterns and behaviors that contribute to the development and maintenance of PTSD symptoms.
• Eye movement desensitization and reprocessing psychotherapy involves using eye movements or other forms of stimulation to process and integrate traumatic memories into the patient's narrative, reducing their distressing effects.

Implementation

For implementation, patients work collaboratively with a trained therapist to set specific goals, complete homework assignments between sessions, and gradually confront feared situations through exposure techniques when appropriate. These therapies are particularly effective because they address both cognitive distortions (unhelpful thinking patterns) and behavioral responses that maintain mental health conditions. The structured, skills-based approach provides patients with practical tools they can continue to use after therapy ends, promoting long-term recovery and relapse prevention. Research consistently shows that these therapies produce significant symptom reduction across these conditions, often comparable to medication but with more durable effects after treatment concludes 1.

Comparison with Other Therapies

While other therapies, such as cognitive behavioral therapy (CBT), may also be effective for these conditions, the recommendation for prolonged exposure, cognitive processing therapy, or eye movement desensitization and reprocessing psychotherapy is based on the most recent and highest-quality evidence available 1. Other studies, such as those published in Neuropsychopharmacology, may provide additional guidance on the treatment of social anxiety disorder, but the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline provides the most comprehensive and up-to-date recommendations for the treatment of PTSD and other mental health conditions 1.

From the Research

Recommended First-Line Psychotherapy Interventions

The recommended first-line psychotherapy interventions for individuals seeking treatment for mental health conditions such as depression, anxiety disorders, and post-traumatic stress disorder (PTSD) include:

• Trauma-focused psychotherapies, such as prolonged exposure (PE) and cognitive processing therapy (CPT) 2, 3
• Cognitive-behavioral therapy (CBT), which is a first-line, empirically supported intervention for anxiety disorders 4, 5
• Eye movement desensitization and reprocessing (EMDR) 3

Characteristics of Effective Psychotherapy Interventions

Effective psychotherapy interventions for mental health conditions such as depression, anxiety disorders, and PTSD typically have the following characteristics:

• They are evidence-based and empirically supported 2, 3, 4, 5
• They are tailored to the individual's specific needs and circumstances 2, 3
• They involve a combination of cognitive and behavioral techniques, such as exposure and cognitive therapy 4, 5
• They can be delivered in a variety of formats, including individual and group therapy, and online or in-person 6

Benefits of Psychotherapy Interventions

The benefits of psychotherapy interventions for mental health conditions such as depression, anxiety disorders, and PTSD include:

• Reduced symptoms and improved functioning 2, 3, 4, 5
• Improved quality of life and overall well-being 2, 3, 6
• Increased self-esteem and self-efficacy 4, 6
• Reduced risk of relapse and improved long-term outcomes 2, 3, 6