Cognitive Behavioral Therapy: CBT for PTSD in Veterans

June 20, 2025

Authored by: Eilaf Meenai, MD

Edited by: Emma Loker, B.S

Posttraumatic stress disorder, or PTSD, occurs after someone experiences or witnesses a deeply traumatic event. Examples include combat, physical or sexual assault, serious accidents, or natural disasters, to name a few.

Among veterans, exposure to trauma is unfortunately common. 23% of all veterans receiving care through the United States Department of Veterans Affairs (VA) are reported to have had PTSD at some point in their lives.¹

Cognitive behavioral therapy (CBT) for veterans is considered the gold standard treatment for PTSD. On this page, you’ll learn everything you need to know about CBT for PTSD in veterans.

What Is Cognitive Behavioral Therapy for PTSD?

CBT is one of the most widely studied and well-established forms of talk therapy used to treat PTSD. It is a structured, time-limited therapy that helps people identify and change unhelpful thought patterns and behaviors.

CBT was officially recommended for use in veterans with PTSD by the U.S. Department of Veterans Affairs and the Department of Defense in their joint clinical practice guidelines starting in the early 2000s.² The endorsement of CBT for PTSD in veterans came after extensive experimentation on people from different service eras, like Vietnam, the Gulf War, Iraq, and Afghanistan.

Currently, the VA fully endorses CBT, especially trauma-focused forms, as a first-line treatment for PTSD.³ It is a central part of evidence-based care in VA hospitals and clinics across the country.

Types of CBT Used in PTSD Treatment

The types of CBT used by the Department of Veterans Affairs for PTSD are trauma-specific. They help you directly confront and process the traumatic experiences that led to PTSD in the first place.

Here are the main types of CBT most commonly used to treat PTSD in veterans:³

Cognitive Processing Therapy (CPT)

CPT is a trauma-focused, manualized form of CBT that has been specifically developed to treat PTSD. It was originally created in the late 1980s by Patricia Resick for survivors of sexual assault, but it’s been rigorously adapted and tested in veteran and military populations over the years.⁴

Today, CPT is one of the most widely used and well-researched PTSD treatments in the VA system. CPT doesn’t require a detailed, repeated retelling of the trauma memory. This makes it a great fit for veterans who do not want to go straight into recounting trauma memories in graphic detail right away, but are willing to think critically about how those memories affect them. It is particularly well-suited for:

Veterans struggling with guilt, shame, or self-blame.
Those who feel emotionally numb or cut off from others.
Individuals who want to understand how trauma changed the way they see the world, but aren’t comfortable repeatedly talking about the trauma itself.⁵

In CPT sessions, you learn to identify the “stuck points” that often follow trauma. Examples include guilt, shame, or distorted thoughts about the event (“It was my fault,” “I’m not safe anywhere,” etc.).

This type of CBT for PTSD in veterans runs for 12 sessions, once a week, and can be delivered individually or in groups, with individual sessions being 50-60 minutes long. It can also be done via telehealth.

Prolonged Exposure (PE)

The main idea of PE is that avoidance keeps PTSD alive. When someone avoids trauma reminders, which could be smells, crowded places, night driving, or their own thoughts, it does feel like self-protection. But in the long term, avoidance teaches the brain that those things are dangerous when, in reality, they’re not.

PE helps veterans confront the memories and situations they’ve been avoiding, not to retraumatize them, but to retrain the brain to understand that the danger has passed.⁶ It is best suited for veterans who:

Are avoiding specific people, places, or situations because of trauma reminders.
Experience recurrent nightmares, flashbacks, or intrusive memories.
Feel that they are in “fight-or-flight” mode, even in safe environments.
Are open to telling their trauma story in detail.

Veterans go through two types of exposures in PE: In vivo exposure and imaginal exposure. “In vivo” means “in life.” In in vivo exposure, the veteran gradually faces real-world situations, places, or activities they’ve been avoiding because they remind them of the trauma.

In imaginal exposure, the veteran revisits the trauma memory in detail, out loud, during the therapy session. The purpose is to help the brain finally process what happened, instead of pushing it away or reliving it like it’s still happening right now.

Trauma-Focused CBT (TF-CBT)

TF-CBT is an integrative, skills-based therapy that combines standard cognitive-behavioral techniques with deliberate trauma-sensitive interventions. You can think of it as a three-phase model:⁷

The stabilization phase, which focuses on emotional regulation, coping skills, and psychoeducation.
Trauma narration and processing, where you recount your traumatic experiences along with what you felt, thought, feared, or believed in the moment.
Integration and reinforcement phase, where you begin to re-anchor yourself in your present life. You practice newly learned PTSD coping strategies with CBT in real-world settings and reconnect with your relationships, responsibilities, and roles that have been impacted by PTSD.

TF-CBT has 12 to 25 sessions, depending on a veteran’s needs and pace. The sessions are 50-60 minutes each and are delivered individually in person or via telehealth, sometimes as part of a stepwise treatment plan (e.g., using TF-CBT to prepare for PE later).

How CBT Helps Veterans With PTSD

PTSD rewires the way the brain reacts to danger and stores memory. After trauma, especially in war or military settings, the brain learns one thing above all else. And that is “survival at all costs.” This hypervigilance, however, interferes with sleep, strains relationships, makes it hard to hold a job, and can leave you feeling either numb or constantly on edge.

CBT for PTSD in veterans helps them identify and challenge the distorted thoughts that trauma leaves behind. Many veterans walk around carrying deeply ingrained, often self-punishing beliefs that formed during or after the trauma.

Cognitive therapy for veterans breaks down their negative thoughts and tests their truth. The therapist doesn’t argue with them or offer blind optimism. They only help veterans replace trauma-fueled beliefs with balanced, more compassionate thoughts.

Many veterans with PTSD also feel emotionally shut down, or worse, overwhelmed by feelings they can’t name or manage. CBT helps build emotional literacy, which is the ability to understand what you’re feeling, where it’s coming from, and how to manage it. It does so by helping you:⁸

Learn grounding techniques for dissociation or flashbacks.
Practice distress tolerance skills when panic hits.
Identify emotional triggers that you didn’t know were connected to trauma.
Build routines for rest and nutrition, which both impact emotional stability.

Benefits of CBT for PTSD in Veterans

When you’ve been through trauma that changed your brain, your body, and your sense of safety, it is natural to wonder what CBT outcomes actually look like. What changes? What improves?

Here are some CBT benefits for PTSD in veterans as reported in clinical studies:

1. A Significant Drop in PTSD Symptoms

Research consistently shows that veterans who complete trauma-focused CBT experience a substantial PTSD symptom reduction.

Clinically meaningful improvement refers to fewer nightmares, less re-experiencing (like flashbacks), reduced avoidance, and a decrease in hypervigilance or exaggerated startle responses.⁹

2. Improvement in Depression and Anxiety

PTSD rarely exists in isolation. Many veterans also struggle with depression, anxiety, panic attacks, suicidal thoughts, or a near-constant feeling of dread. Veterans who go through CBT frequently report feeling more hopeful and more emotionally stable by the end of treatment.¹⁰

3. Better Sleep

CBT also leads to long-term improvements in sleep without the need for medication.¹⁰ As veterans work through trauma memories and reduce hyperarousal, their nervous system calms down. They’re no longer waking up in fight-or-flight mode, and over time, they start sleeping through the night.

4. Long-Term Impact

Unlike medications that only tend to work as long as you take them, the strategies learned in CBT stick with you for life. Long-term studies show that CBT’s benefits continue months and even years after therapy ends because the brain has been reconditioned.⁸

What to Expect in CBT Sessions for Veterans

Before therapy begins, there’s a comprehensive intake session, which is also your first meeting with your therapist. In this session, you’ll be asked about:

What brought you in.
Your trauma history, to the extent you’re comfortable sharing at that point.
Sleep, mood, substance use, and current stressors.
Past treatment, if any, and what did or didn’t work.

In therapist-led CBT for PTSD, you may also be asked to complete standardized PTSD symptom measures like the PCL-5 or CAPS-5 to track your progress in the future.⁵

Your first “real” CBT session won’t be straight about trauma. It’ll be heavy on education about PTSD and what CBT is, plus an explanation of how many sessions you’ll have and how long they’ll be.

You and the therapist will collaboratively set goals, identify what you want out of therapy, and agree on a treatment plan.

Next, each weekly session will follow a clear structure with a quick check-in, and a discussion of weekly assignments (which could be thought logs, in-vivo exposure tasks, or practicing coping skills).

It’ll be followed by the main therapeutic work, which varies by the type of CBT. These sessions can get intense. But the therapist is trained to watch your distress level and adjust as needed.

You’ll end each session by reviewing what you covered and planning the next steps.

VA CBT Services for PTSD

The VA runs nearly 200 specialized programs for PTSD treatment with CBT across the country.¹¹ They are trauma-informed CBT services delivered by professionals who work with veterans every day.

VA CBT services for PTSD include:

One-on-one mental health assessments. A trained clinician will meet with you to assess your PTSD. They may use interviews, screening tools, or diagnostic testing to confirm what you’re dealing with and determine the best course of care.
Cognitive behavioral therapy. If you’re diagnosed with PTSD, the VA offers one-on-one psychotherapy using different CBT types. CPT is one of the VA’s frontline treatments because it’s shown to work in thousands of veterans’ lived experiences.
Group therapy for specific needs. CBT principles are also used in targeted group sessions for managing anger, handling stress, or providing combat support. There are also trauma-focused groups for veterans who served in the same combat zones or experienced similar types of trauma.
Family therapy. PTSD doesn’t just affect the person who carries it. It also impacts families and relationships. The VA offers one-on-one family therapy sessions, which include psychoeducation and CBT-informed communication tools to help families heal together.

Comparing CBT With Other PTSD and Mental Health Therapies

CBT is the first-line treatment recommendation for PTSD in veterans, with decades of research behind it.³ Compare that to antidepressant medications, like SSRIs, which are prescribed as a first-step medication when depression or anxiety are present alongside PTSD.

Antidepressants don’t process trauma; they only manage physical symptoms. That’s why they’re paired with therapy, rather than used as a stand-alone treatment. For veterans dealing with nightmares and sleep disruptions due to PTSD, prazosin or trazodone may also be prescribed.

Prazosin works by blocking adrenaline in the brain, which reduces the frequency and intensity of trauma-related nightmares. But it doesn’t touch the emotional or cognitive symptoms of PTSD. Similarly, trazodone is used to help veterans fall and stay asleep, but it does not resolve trauma itself.

Medications also need to be taken indefinitely to maintain symptom relief, and stopping them suddenly may worsen symptoms. In contrast, CBT is time-limited to a certain number of sessions. It has been shown to have long-lasting benefits, even after treatment ends.

Get CBT for PTSD at Mission Connection

At Mission Connection, we understand that living with PTSD as a veteran means surviving each day while carrying what no one else sees. That’s why we offer CBT for PTSD in veterans as part of a comprehensive outpatient mental health program tailored to fit your life.

Our licensed clinicians deliver evidence-based military PTSD and CBT treatment, both in-person and via telehealth, at times that work for your schedule.

Our programs include daily group sessions, weekly one-on-one CBT sessions for veterans, psychiatric support, and medication management, all without putting life on pause.

Call us today or get in touch online to get started.

References

U.S. Department of Veterans Affairs. (2023). How common is PTSD in veterans? Va.gov; U.S. Department of Veteran Affairs. https://www.ptsd.va.gov/understand/common/common_veterans.asp
U.S. Department of Veterans Affairs. (2023) Management of Posttraumatic Stress Disorder and Acute Stress Disorder. https://www.healthquality.va.gov/guidelines/mh/ptsd/
Department of V. A. Administration. (2015, January). Effective Treatments for PTSD: Consider Cognitive Behavioral Therapy (CBT) as First Line Treatment. Veterans Affairs. https://www.pbm.va.gov/PBM/AcademicDetailingService/Documents/Academic_Detailing_Educational_Material_Catalog/66_PTSD_NCPTSD_Provider_Effective_Treatment_for_PTSD.pdf
Resick, P. A., & Schnicke, M. K. (1992). Cognitive processing therapy for sexual assault victims. Journal of Consulting and Clinical Psychology, 60(5), 748–756. https://doi.org/10.1037//0022-006x.60.5.748
Resick, P., Monson, C., & Chard, K. (2008). Cognitive Processing Therapy Veteran/Military Version: THERAPIST’S MANUAL. Department of Veterans Affairs. https://www.apa.org/ptsd-guideline/treatments/cognitive-processing-therapist.pdf
U.S. Department of Veterans Affairs. (2014). Prolonged Exposure for PTSD – PTSD: National Center for PTSD. Va.gov. https://www.ptsd.va.gov/understand_tx/prolonged_exposure.asp
Crane, K., Kristy, P., & Watters, M. (n.d.). COGNITIVE BEHAVIORAL THERAPY STRATEGIES. https://www.mirecc.va.gov/visn5/EBT/CBT-D/Cognitive_Behavioral_Therapy_Strategies.pdf
Sloan, D. M., Unger, W., & Gayle Beck, J. (2016). Cognitive-behavioral group treatment for veterans diagnosed with PTSD: Design of a hybrid efficacy-effectiveness clinical trial. Contemporary Clinical Trials, 47(47), 123–130. https://doi.org/10.1016/j.cct.2015.12.016
Beck, J. G., Coffey, S. F., Foy, D. W., Keane, T. M., & Blanchard, E. B. (2009). Group Cognitive Behavior Therapy for Chronic Posttraumatic Stress Disorder: An Initial Randomized Pilot Study. Behavior Therapy, 40(1), 82–92. https://doi.org/10.1016/j.beth.2008.01.003
Committee on the Assessment of Ongoing Efforts in the Treatment of Posttraumatic Stress Disorder, Board on the Health of Select Populations, & Institute of Medicine. (2014). Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Final Assessment. National Academies Press (US).
U.S. Department of Veterans Affairs. (2019, June 14). PTSD treatment | Veterans Affairs. https://www.va.gov/health-care/health-needs-conditions/mental-health/ptsd/