Cognitive behavioral therapy (CBT) is a structured form of psychotherapy that includes both behavioral modification strategies and cognitive therapies. There are many different types of CBT, all of which are intended to help patients learn new responses to life situations. Most if not all patients with PTSD should have CBT as part of their treatment regimen. In this chapter, the methods for the best-evidenced cognitive and behavioral therapies for patients with PTSD are explained.

Exposure therapy can target reexperiencing symptoms (by reducing fear associated with thinking about the trauma) and avoidance behaviors (by reducing fear associated with confronting trauma-related stimuli that are not actually dangerous), as well as reduce general hyperarousal. In addition, by increasing the patient's perceived control over fear, this can facilitate processing of the traumatic memory (help patients “make sense” of it).

There are six main steps of cognitive restructuring: (1) identify a distressing event/thought; (2) identify and rate (0–100) emotions related to the event/thought; (3) identify automatic thoughts associated with the emotions, rate the degree to which one believes them, and select one to challenge; (4) identify evidence in support of and against the thought; (5) generate a response to the thought using the evidence for/against (even though <evidence for>, in fact <evidence against>) and rate the degree of belief in the response; (6) rerate emotion related to the event/thought.