Trauma therapy works for most people. If it did not work for you, here is what comes next.

Between one in four and nearly one in two people finish the best available trauma therapy and still have PTSD. That is an enormous group, and being in it says something about the treatment rather than about you. Here is what the numbers say and what to try next, in order of how much evidence is behind each option.

If you have had therapy for trauma and you still feel it, you are not unusual, you did not fail at it, and you are not out of options. This is what the numbers actually say, and what to do next.

What the standard treatment is

The treatment with the strongest evidence is called trauma-focused therapy. The "trauma-focused" part is doing real work in that phrase, and it is not the same as general counselling.

In plain terms, it means going back to the memory on purpose, in a structured way, with someone trained to hold it, and staying with it rather than steering around it. The usual versions have unhelpful names, so here they are in ordinary words:

Prolonged exposure. You tell the memory out loud, repeatedly, and you stay in it until your body stops treating it as a live emergency.

Cognitive processing therapy. You work on the conclusions you drew at the time, usually about blame, safety and your own worth.

Cognitive therapy for PTSD. Similar, with more attention to the triggers in daily life that set it off.

Narrative exposure therapy. You build the whole life story in order, placing the trauma inside it rather than letting it sit outside time.

EMDR. You hold the memory while following a moving finger or another left-right cue.

How well it works

A 2025 review in JAMA Psychiatry pooled 34 randomised trials covering 3,208 people and asked one plain question: afterwards, did the person still have PTSD?

The proportion who no longer did:

EMDR, 86%

Cognitive therapy for PTSD, 76%

Cognitive behavioural therapy, 61%

Cognitive processing therapy, 57%

Prolonged exposure, 56%

Present-centred therapy, which is supportive but not trauma-focused, 28%

Waiting list, 13%

Read the bottom two lines first. Thirteen percent of people lost the diagnosis while on a waiting list, because some people do recover on their own. Everything above that is the treatment doing something, and the trauma-focused approaches are doing roughly four to six times as much as time alone.

One caution on EMDR's 86%, because it is the highest number here and the most quoted. None of those EMDR trials were run in the United States or included military or veteran participants, so it is not a like-for-like comparison with the others. It is a strong result, not a league table win.

The part that matters if you are reading this

Now turn those numbers over.

If 56% of people lost the diagnosis, 44% of them did not. Depending on the treatment, somewhere between one in four and nearly one in two people finished a course of the best available therapy and still had PTSD.

That is not a small group of unlucky outliers. It is enormous. If you are in it, you are in the ordinary range of what happens, and the conclusion to draw is about the treatment, not about you.

Two more things from the same review and the literature around it. If you are a veteran or serving military, the odds were lower before you started: cognitive processing therapy cleared the diagnosis in 44% of military samples against 69% of civilian ones, and prolonged exposure in 50% against 66%. Nobody fully knows why. And across trials, around one person in five does not finish, which is its own problem rather than a verdict on the method.

Before you decide it failed

Two questions worth answering honestly, because they change what to do next.

Did you actually have trauma-focused therapy? A great deal of what gets offered is supportive counselling: regular, kind, useful for many things, and not this. Look at that list again. Present-centred therapy, the supportive kind, cleared the diagnosis in 28%. Better than nothing, and roughly half the trauma-focused figures. If nobody ever asked you to go back into the memory deliberately, you have not yet tried the treatment that the numbers above describe.

Did you finish it? These courses run about 8 to 12 sessions. Stopping at three is not the same as it not working, and trauma-focused work usually feels worse before it feels better, which is exactly when people stop.

What to try next, in order of how much evidence is behind it

1. A different trauma-focused protocol. These are not interchangeable brands of the same thing. Prolonged exposure and cognitive processing therapy ask genuinely different things of you. Not responding to one is weak evidence about the next, so trying another is a new bet rather than the same bet repeated.

2. EMDR. This is the correction worth making to how it is usually described. EMDR is not an add-on to CBT. It is a first-line treatment in its own right, recommended as such by the UK's National Institute for Health and Care Excellence, and it posted the best numbers in that review. If you have done CBT and it was not enough, EMDR is not a supplement to try alongside, it is a different treatment to try instead.

3. Medication, alongside rather than instead. This is a conversation with a prescriber, not something to start, stop or change based on an article.

4. Body-based work, added on. Here the evidence is thinner and the honest picture is mixed. Yoga has the most behind it: a review of 20 trials and 954 people found it improved people's own reports of their symptoms, and did not improve the ratings made by clinicians. Those are both real findings and nobody has a clean explanation for the gap.

5. TRE and the other somatic methods. Tension and trauma releasing exercises, somatic experiencing and their relatives are widely recommended and barely tested. For TRE specifically there is no systematic review in PTSD at all. The PTSD evidence is one small study in refugees and a published case report, and the best-designed trial of it was in a different condition entirely and found nothing.

That is not a reason to refuse something that helps you. If a body-based practice makes you calmer, gets you sleeping, or is the thing that keeps you turning up to the therapy that does have evidence, it is earning its place. The mistake is swapping it in for the treatment with the numbers, on the grounds that the treatment with the numbers did not work the first time.

What about MDMA

This is the question people in this situation actually ask, so here is the state of it rather than the headline.

The trials looked strong. The second phase 3 trial gave 104 people with moderate to severe PTSD either MDMA plus therapy or a placebo plus the identical therapy, which is a hard comparison to win, and the MDMA group improved substantially more. The effect size was 0.7, which in this field is large.

Then it was rejected. In June 2024 the FDA's advisory committee voted 9 to 2 that the trials had not shown it works, and 10 to 1 that the benefits did not outweigh the risks. The FDA turned the application down that August.

The reason is worth understanding, because it is not "the drug does nothing". The problem was blinding. On a substance like MDMA, nearly everyone knows which group they are in, and in these trials the people scoring the outcomes often knew too. One committee member said it felt strange to vote no when the effect looked so strong, and that there were simply too many problems. The honest summary is that the trials could not prove what they appeared to show.

As of now it is not approved and not available on prescription in the United States. An application was reportedly refiled in 2026, without a new trial, and that has not been confirmed by the company.

The practical point: this is exactly the stage at which people go looking for it informally. That means an unknown substance, no cardiac or psychiatric screening, and none of the structure that the trials were actually testing. Mura is educational only and does not supply, prescribe or recommend any substance. The longer version is here.

What to say when you ask

The words matter, because the wrong ones get you a waiting list for general counselling.

"I am looking for trauma-focused therapy for PTSD."

"Which protocol do you use?" A good answer names one: prolonged exposure, cognitive processing therapy, cognitive therapy for PTSD, narrative exposure, EMDR.

"I have already tried X and finished it. What would you suggest that is different?"

If you are offered something supportive and open-ended, it is fair to ask directly whether it is trauma-focused, and what else is available if it is not.

The one thing to take from this

Not responding to a treatment is information about that treatment, in that form, at that time. It is not information about whether you can get better.

The strongest evidence in this entire field says that most people do, with the right protocol, finished properly. If the first attempt did not do it, the honest next step is a different one, not a smaller one.

If you are in crisis right now, this is not the page you need. Please contact your local emergency services or a crisis line.

This article is for general information and is not a substitute for professional care. If you are in crisis or thinking about harming yourself, please contact your local emergency services or a crisis line. See crisis lines.