Prolonged exposure therapy for posttraumatic stress disorder: A systematic review and meta-analysis of randomized controlled trials.

In 30 seconds

This systematic review and meta-analysis assessed prolonged exposure (PE) therapy for posttraumatic stress disorder across randomized controlled trials. Of 52 identified trials, 43 studies (54 comparisons; N = 4964) contributed to quantitative synthesis. PE reduced PTSD severity more than inactive controls (Hedges’ g = 0.74, 95% CI [0.51, 0.98]) and had a small advantage over active treatments (g = 0.24 [0.12, 0.36]). The active-treatment advantage was concentrated in comparisons with non-trauma-focused therapies; PE showed no meaningful superiority over other trauma-focused protocols, including Cognitive Processing Therapy and EMDR.

Key findings

• Compared with inactive controls, PE had a medium-to-large effect on PTSD severity (Hedges’ g = 0.74, 95% CI [0.51, 0.98]; k = 20).
• PE had a small advantage over active treatments (g = 0.24 [0.12, 0.36]; k = 34), largely reflecting comparisons with non-trauma-focused therapies (g = 0.40).
• PE showed no meaningful superiority over other trauma-focused protocols, including Cognitive Processing Therapy and EMDR (g = 0.04).
• Trauma type, military versus civilian population, and session number did not significantly moderate outcomes.

Why it matters

The findings place PE among effective PTSD treatments while clarifying that its advantage depends on the comparator: it outperformed inactive controls and, modestly, active treatments overall, but not other trauma-focused approaches. This distinction can help clinicians interpret comparative evidence without assuming that one established trauma-focused protocol is generally superior to another.

What to keep in mind

GRADE certainty was moderate for both primary comparisons and was downgraded for inconsistency. The exploratory comparison of complex-presentation and unselected samples was imprecise and cannot establish equivalence.