A Conceptual Framework and Narrative Review of Current and Emerging Posttraumatic Stress Disorder Treatments

Background: This narrative concept-generating review proposes a theoretical and heuristic framework for conceptualizing established and emerging interventions for posttraumatic stress disorder (PTSD) including three categories: top-down/conscious (e.g., cognitive processing therapy, CPT), bottom-up/non-conscious (e.g., pharmacotherapy) and hybrid/conscious and non-conscious integration (e.g., eye movement desensitization and reprocessing, EMDR). The categorization offers a preliminary novel classification of well established and emerging interventions, while highlighting gaps in current treatment approaches. Methods: Clinical guidelines and review articles from 2008 through 2026 were used to create the framework; PubMed and Google Scholar databases were searched for relevant meta-analyses, systematic reviews, narrative reviews, and randomized clinical trials. A total of 27 treatment modalities were included presenting effect size data from 43 published articles. Results: Treatments across categories present mixed results for efficacy. While guideline recommended treatments offer more robust evidence, many understudied emerging interventions exhibit preliminary efficacy. At the intersection of conscious and non-conscious approaches, hybrid modalities may present unique potential benefits. However, superiority determinations between modalities cannot be made and further empirical validation of categorization is needed. Conclusions: The proposed framework highlights the need for increased investigation of treatments that address PTSD as an interconnected whole-body disorder to potentially expand care options.