CLINICIAN'S TRAUMA UPDATE Online
Issue 20(4), AUGUST 2026
For COMPLETE summaries, see this month's CTU-Online.
Treatment
Improved symptoms may not be enough to improve patients’ lives
Indicators of clinically meaningful response, such as reliable change and clinically significant
change, are calculated based on statistical change of the symptoms being treated. Establishing
how symptom change relates to meaningful differences in patients’ lives is important to
promote recovery. A prior study of PE found that treatment response (10-point decrease on the
CAPS-IV) was related to improved quality of life (QoL) in female Veterans, but greater
improvement was needed to help patients experience good QoL endpoints. Investigators from
the National Center for PTSD attempted to replicate these findings using data from a study of
PE and CPT in both male and female Veterans. Read this CTU-Online.
Graduated exposure reduces self-reported distress during PE
PE traditionally starts imaginal exposure with the most distressing traumatic event in order to
most directly address trauma-related memories and associated symptoms. However, it is
possible that a more gradual approach to imaginal exposures may reduce patient distress
during PE and increase treatment tolerability and retention. Investigators from the Consortium
to Alleviate PTSD examined whether a more gradual imaginal exposure approach would involve
less self-reported distress. Read this CTU-Online.
Does improving emotion regulation enhance trauma-focused treatment?
Some researchers have argued that people who experience childhood abuse may need emotion
regulation skills training to benefit from trauma-focused treatment. A team led by investigators
from Leiden University in the Netherlands tested this assumption in a secondary analysis of an
RCT comparing PE to Skills Training in Affective and Interpersonal Regulation+PE among 96
adults with childhood-abuse-related PTSD. CTU-Online.
Veterans in exposure treatment become increasingly willing to share with others
Involving loved ones in PTSD care can promote treatment engagement and response. But how
willing are individuals with PTSD to discuss their trauma and symptoms with loved ones? A
team led by investigators at the National Center for PTSD examined this question using data
from an RCT that found Written Exposure Therapy was non-inferior to PE. Read this CTU-Online.
Successful residential PTSD treatment predicts military retention
Residential treatment programs are shown to be effective in reducing PTSD symptoms, but
other functional outcomes have been less studied. Investigators from the Naval Health
Research Center examined how PTSD symptom changes during residential treatment impacted
an important occupational outcome, namely military separation. Read this CTU-Online.
MST group shows limited effect on posttraumatic stress symptoms
MST can cause numerous mental and physical health problems, including PTSD. Warrior Renew
is a 12-week group treatment developed to reduce isolation, build community, and improve
relationships for individuals impacted by MST. A team led by investigators from the Seattle VA
conducted an RCT to compare an 8-week virtual version of Warrior Renew to a health-focused
class. Read this CTU-Online.
Veteran sex, trauma type may impact CPT response
Identifying who might benefit most from specific trauma-focused therapies before beginning
care is a major goal of personalized treatment, but research has largely focused on the unique
effects of predictors. A retrospective chart review by investigators at VA Salt Lake City Health
Care System examined whether Veteran sex and trauma type interact to impact response to
CPT in routine care. Read this CTU-Online.
Feasibility of at-home ketamine self-administration
Ketamine is an established treatment for medication-resistant depression and may have a role
in treating PTSD. The most widely available forms of ketamine are intranasal and intravenous,
both requiring costly clinical infrastructure and in-person visits. An industry-led group
conducted a retrospective chart review to assess the safety and efficacy of at-home
subcutaneous ketamine as a less expensive, more accessible alternative. Read this CTU-Online.
Take Note
Literature review of ibogaine research
A team led by investigators from Paris-Saclay University conducted a narrative review of
published research since 1990 on the use of ibogaine for any mental health or substance use
disorder. Opioid use disorder was the most common condition studied, with PTSD treatment
more rare. Only two RCTs were found. Read the article.
Systematic review of clinical practice guidelines
Investigators at University of Zurich in Switzerland conducted a review of 10 clinical practice
guidelines for PTSD in which they compared methodology and recommendations. Read the article.
Review of PTSD pharmacotherapy
A Cochrane Review conducted a meta-analysis of all randomized controlled trials of
pharmacotherapy for adults with PTSD. Read the article.
Commentary on scaling up access to PTSD treatment
A team led by investigators from the National Center for PTSD discussed barriers to delivery of
PTSD psychotherapies in VA and the military, along with treatment delivery considerations to
enhance access (e.g. accelerated delivery formats, task-sharing). Read the article.
Update process for the PTSD Treatment Decision Aid
A team led by investigators from the National Center for PTSD described the process of
updating the PTSD Treatment Decision Aid, a tool to assist in the shared decision-making
process. Read the article.
Commentary on DSM-5 moral problems Z-code
A team led by investigators from McLean Hospital discussed the clinical and conceptual
implications of the DSM-5 including a new Z-code for “moral problems”. Read the article.
Overview of medically induced PTSD
A team led by investigators from University of Manitoba described unique presentations of
traumas that occur in medical settings, including implications for assessment and treatment. 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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