Victoria A. Torres, Elizabeth Coe, Jalisa Jackson, Kiara Leonard, Jessica Rostockyi, Kira Swensen, Eric C. Meyer, Suzy B. Gulliver, & Stephanie Jones
Post-traumatic stress disorder (PTSD) affects millions of veterans and their family members leading to functional impairments such as time lost from work and interruptions in daily life. Often, symptoms of PTSD are accompanied by other challenges such as symptoms of depression and elevated alcohol and substance use. Several well-researched trauma-focused treatments such as Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) are available. However, providers are not always trained in these specialty therapies, and many patients drop out of these treatments. Transdiagnostic treatments such as Acceptance and Commitment Therapy (ACT) and the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) are well-known types of cognitive behavioral therapy (CBT) that were created to target the underlying emotion dysregulation seen in several different disorders including depression, anxiety, post-traumatic stress and substance use disorders. These transdiagnostic options may be useful alternatives for PTSD treatment, however, clear guidelines have not been established to guide providers and patients in selecting available therapies.
An emerging line of research highlights the importance of tailoring treatment selection based on specific pre-treatment needs and circumstances of those suffering from PTSD (Torres et al., 2025). In a sample of 90 veterans and their family members receiving telehealth from supervised graduate student therapists and their licensed supervisors, we found the following patterns:
Transdiagnostic Treatments for PTSD and Co-Occurring Symptoms
Veterans and their family members who screened positive on surveys for PTSD and co-occurring conditions like depression and substance use disorder showed more improvement with a transdiagnostic treatment like ACT or UP.
Trauma-focused Treatments for PTSD Alone
Veterans and their family members who screened positive on a survey for PTSD but did not screen positive for co-occurring conditions like depression and substance use disorder showed more improvement with a trauma-focused treatment like CPT or PE.
Why these findings matter
Simply put, treatment plans that fail to account for complex presentations fall short. Individuals who experience PTSD should feel empowered to discuss their treatment options with their mental health providers so that they can find the treatment that works best for them. Mental health providers should account for symptom complexity and talk openly with patients about their treatment options. By aligning treatment options with specific needs of individuals, mental health providers can offer more effective care, resulting in better outcomes.
Moving forward
This finding opens the door for more personalized, assessment-guided treatment plans. Findings also highlight opportunities for individuals suffering from PTSD symptoms who may have opted out of trauma-focused treatment but have not considered other treatment options. Open communication between patients and providers is an important step in choosing the treatment that works best. Studies with larger samples and randomization are needed to confirm patterns. This work could be extended by comparing outcomes from other treatments and by assessing functional outcomes such as posttraumatic growth and quality of life.
Discussion Questions
- What is your typical treatment decision-making process like when working with patients? What do you wish patients with PTSD knew about their treatment options?
- Building on these study results, what additional treatment modalities, circumstances, or outcomes would you be interested in evaluating to improve the treatment selection process?
About the Authors
Victoria A. Torres, Ph.D., is a licensed Clinical Psychologist and Research Investigator at the Warriors Research Institute (WRI) of Baylor Scott & White Health (BSWH). Her research focuses on optimizing healthcare delivery, particularly for those encountering significant barriers to treatment access.
Elizabeth Coe, Psy.D., is a licensed Clinical Psychologist and Assistant Investigator at the WRI at BSWH and an Adjunct Clinical Supervisor at Baylor University. Her interests include training/supervision, cultural considerations, and trauma-informed treatment across the lifespan.
Jalisa Jackson, BA, is a Clinical Research Assistant at the WRI at BSWH. Her research interests are centered around improving access to and quality of evidence-based treatment to underserved, culturally diverse populations with a strengths-focused approach.
Kiara Leonard, MSCP, is a fourth-year PsyD student at Baylor University. Her research and clinical interests focus on evidence-based interventions for trauma-related disorders and commonly co-occurring conditions, particularly in Veteran populations.
Jessica Rostockyj, MS, is a Clinical Research Supervisor at the WRI at BSWH. She has a background in Research Administration and Health Promotion Management. She is passionate about improving the quality of care for veterans and first responders, particularly through implementing clinical service-delivery, research, and quality improvement projects.
Kira Swensen, MPH is a Program Manager for the WRI at BSWH. Her professional background includes work as an Advanced-EMT, volunteer firefighter, graduate teaching assistant and education advocate. Her public health experience includes community-based opioid overdose prevention and harm reduction services, child nutrition, dementia caregiver health and wellness, first responder and military mental health, policy development and advocacy, research, and mental health service management.
Eric C. Meyer, Ph.D., is a Professor and Chair of the Department of Counseling and Behavioral Health at the University of Pittsburgh. The goal of his research is to improve long-term functioning and quality of life in people living with complex combinations of trauma-related behavioral health challenges including posttraumatic stress disorder, depression, anxiety, substance use disorders, chronic pain, and traumatic brain injury.
Suzy B. Gulliver, Ph.D., is the Director of the Warriors Research Institute of Baylor Scott & White Research Institute and Professor with Tenure at Baylor College of Medicine. Her research focuses on the assessment and treatment of people with high trauma load as a function of their chosen career, with the long-term goal of improving accessibility to high quality care. She is honored to serve as a Behavioral Health Consultant to the International Association of Fire Fighters, and as Co-Chair for the Governmental Affairs and Advocacy Committee of the Research Society on Alcohol.
Stephanie Jones, Ph.D., is an Assistant Professor of Epidemiology in Baylor University’s Department of Public. Her research interests focus on understanding risk factors, treatment, and health outcomes for substance use disorders and related comorbidities. She is also a veteran of the U.S. Marine Corps and is passionate about serving the military and veteran community.
Reference Article
Torres VA, Coe E, Jackson J, Leonard K, Rostockyj J, Swensen K, Meyer E, Gulliver SB, Jones S. Data-informed selection of evidence-based treatments for posttraumatic stress disorder and co-occurring symptoms. J Trauma Stress. 2025 Feb 17. doi: 10.1002/jts.23133. Epub ahead of print. PMID: 39960142.