Navigating the landscape of trauma treatments: the need for personalized care
Authors: Thanos Karatzias
Journal: World Psychiatry (2025)

Post-traumatic stress disorder (PTSD) significantly impairs an individual's daily functioning and quality of life. Although both pharmacological and psychological treatments are effective for this disorder, the latter are commonly used as a first line of support. Fortunately, various psychological treatments have been developed over the years and have been proven effective in managing and alleviating the symptoms of PTSD. Following the excellent overview by Brewin et al1, we comment here on the primary psychological treatments for PTSD, some challenges in their implementation, and important future research directions in this area. Traditional trauma treatments have laid the foundations for contemporary therapeutic interventions. Among the most widely recognized is trauma-focused cognitive-behavioral therapy (TF-CBT), which combines cognitive restructuring techniques with exposure therapy to address maladaptive thought patterns and desensitize individuals to traumatic memories. Its structured format, typically delivered over a series of sessions, has garnered empirical support for its efficacy in treating PTSD. Eye movement desensitization and reprocessing (EMDR) is another established treatment modality for trauma treatment, which integrates bilateral stimulation, such as eye movements or taps, with guided imagery to facilitate the processing and resolution of traumatic memories. Despite ongoing debate regarding its underlying mechanisms, numerous studies have demonstrated its effectiveness in reducing trauma-related symptoms and improving overall well-being. While such exposure treatments for PTSD are effective for many patients, they are not universally so. This is the case especially for certain groups, such as those with history of childhood trauma2, who tend to suffer from more complex forms of traumatization3, highlighting the need for ongoing research and innovation. Emerging psychological therapies, such as virtual reality exposure therapy (VRET), and pharmacological adjuncts offer promising avenues. VRET leverages immersive technology to create controlled, realistic simulations of traumatic environments. This can enhance the exposure experience providing a safe yet vivid context for trauma processing. Initial research indicates that VRET may be as effective as traditional exposure therapy4. Pharmacological adjuncts to psychological therapies are also under investigation. For example, the use of 3,4-methylenedioxymethamphetamine (MDMA) has shown promise in enhancing the therapeutic process, potentially by reducing fear responses and facilitating emotional engagement with traumatic memories5. The introduction of complex PTSD as a new condition in the ICD-11 has provided an opportunity to identify effective interventions for those who have developed complex presentations as a result of traumatic stressors. Complex PTSD has a greater number of symptoms than PTSD, typically resulting from multiple, interpersonal, chronic and/or childhood stressors6. Therefore, a personalized approach to care and treatment might be especially appropriate. It can be argued that complex PTSD requires a greater number of different kinds of interventions or a longer course of treatment compared to PTSD. Modular therapies with a cognitive behavioral orientation2 that target the symptom clusters of the condition individually and sequentially in a person-centred manner, using skills development and memory processing – such as enhanced skills in affective and interpersonal regulation (ESTAIR) – have been proposed as an alternative to TF-CBT or EMDR approaches for the treatment of complex PTSD7. Preliminary findings suggest that modular interventions can be effective8. However, it is possible that the same treatments used for PTSD are also effective for complex PTSD, with equally good outcomes. Considering that most randomized controlled trials to date have excluded people with more complex trauma presentations, further research on this matter is required. Despite the breadth of trauma treatments available, several challenges persist within the field. Access to specialized care remains a significant barrier for many individuals, particularly those from marginalized communities or remote areas. Additionally, cultural considerations and systemic inequalities may influence the suitability and acceptability of certain treatment modalities, underscoring the need for culturally competent care and equitable access to resources9. Furthermore, considering the scarce resources for treatment delivery in many parts of the world, there is a need to adapt existing interventions into more cost-efficient forms that can be delivered/facilitated by therapists without highly specialist training. Overall, current evidence does not match clinical needs. As discussed by Brewin et al1, "although several treatments have been shown to be effective for people with PTSD, exactly how effective they are, who is likely to benefit from them, and who can deliver them are all up for debate". The heterogeneity of trauma presentations necessitates a nuanced understanding of each individual's unique needs and preferences. Treatment planning should prioritize collaborative and client-centred approaches, empowering survivors to actively participate in their treatment journey. Additionally, further research is essential to elucidate the mechanisms of action underlying the various interventions and optimize treatment for different groups of patients. Continued innovation and personalized approaches are essential to address these challenges, ensuring that all individuals with PTSD and complex PTSD have the opportunity to heal and reclaim their lives. It is essential to identify which treatments work for whom. Currently, in clinical practice, we offer the same interventions to all clients, while we should aim to match every trauma survivor with the right treatment for his/her needs. A personalized approach to trauma care and treatment will result in improved treatment efficacy, higher patient as well as clinician satisfaction, and reduced dropout rates and treatment disengagement. Clients and therapists should discuss right from the beginning of the therapeutic process the different treatment approaches, and collaboratively agree on which one or ones to use. Although the modular treatment paradigm is in line with this personalized treatment agenda, further research using innovative designs in identifying what works for whom is essential. Specific research is also required on the effectiveness of treatments for complex PTSD. For example, a key question identified by Brewin et al1 is whether interventions for this condition should focus primarily on disturbances of memory, as per PTSD theories, or on disturbances of identity, as per complex PTSD theories. Moreover, although there is substantial evidence for the treatment of PTSD in adults, this is less the case for children and young people. In addition, considering that traumatic life events that are considered intentional (e.g., domestic violence) are more toxic and are associated with poorer outcomes, it is worthwhile to explore whether different treatments work differently in groups who have been exposed to different traumatic events. As research progresses, integrating new modalities and refining existing ones will be crucial in the ongoing effort to provide comprehensive, effective and personalized care for those affected by trauma. The ethos of offering personalized trauma care and treatment should be a substantial component of the training of future clinicians.