Project Summary

This research project is in progress. PCORI will post the research findings on this page within 90 days after the results are final.

PCORI has identified Post-Traumatic Stress Disorder (PTSD) as an important research topic. Patients, caregivers, clinicians, and others want to learn: Which treatments for adults with PTSD are most effective, and for whom? To help answer this question, PCORI launched an initiative in 2019 on Treatment of Post-Traumatic Stress Disorder (PTSD) in Adults. The initiative funded this research project and others.

What is the research about?

Posttraumatic stress disorder, or PTSD, is a mental health problem in which people relive trauma over and over. People with PTSD may have bad dreams or scary thoughts. Many people with PTSD also have substance use disorder, or SUD. SUD involves long-term use of alcohol or other drugs. Two types of treatments that can help people with PTSD are trauma-focused psychotherapy, or TFT, and non-trauma-focused psychotherapy, or NTFT. Doctors don’t know how well treatments that help patients with PTSD work for patients with both PTSD and SUD.

In this study, the research team is comparing how well TFT and NTFT work to reduce PTSD symptoms in patients with PTSD and SUD. The team is also looking to see which treatment patients are more likely to complete.

Who can this research help?

Results may help patients with PTSD and SUD and their doctors when considering ways to treat PTSD.

What is the research team doing?

The research team is recruiting 420 patients with PTSD and SUD from 14 Veterans Affairs medical centers. The team is assigning patients by chance to receive either TFT or NTFT. All patients receive weekly treatment with a therapist for three months. Patients also receive SUD treatment as part of their usual care.

In the TFT group, patients receive one of two treatments. In the first treatment, patients receive 90-minute sessions that help them face their fear by thinking about their own past trauma. In the second treatment, patients receive 60-minute sessions that help them change upsetting thoughts about trauma. Patients receive the treatment their therapist usually provides.

In the NTFT group, patients receive 60-minute sessions that focus on helping them to better understand and solve problems in their current life.

Doctors are asking patients about their PTSD symptoms before, right after, and three and six months after treatment. The research team is comparing how well TFT and NTFT improve patients’

  • PTSD symptoms
  • Treatment completion
  • Drug or alcohol use
  • Ability to perform activities of daily living
  • Anger
  • Sleep
  • Quality of life
  • Depression
  • Treatment satisfaction

The research team wants to know if these outcomes vary among different groups of patients. These groups include patients who use different types of drugs or those who have different treatment preferences.

Patients with lived experience with PTSD and SUD and doctors who treat patients with PTSD and SUD are helping to plan and conduct this study. Healthcare system administrators and researchers who are experts in PTSD and SUD are advising on the study.

Research methods at a glance

Design Element Description
Design Randomized controlled trial
Population 420 adults with both PTSD and SUD seeking SUD treatment at 1 of 14 Veterans Affairs clinical sites

TFT: Prolonged exposure therapy or cognitive processing therapy

NTFT: Present-centered therapy


Primary: PTSD symptom severity; PTSD treatment noncompletion

Secondary: substance use; PTSD-related psychosocial functioning; PTSD diagnosis and remission; problems caused by substance use; anger; sleep disturbances; quality of life; depression; treatment satisfaction

Timeframe 6-month follow-up for primary outcomes

Project Information

Shannon M. Kehle-Forbes, PhD
Center for Veterans Research and Education
Comparative Effectiveness of Trauma-Focused and Non-Trauma-Focused Treatment Strategies for PTSD among Those with Co-Occurring SUD (COMPASS)

Key Dates

November 2019
June 2025

Study Registration Information


Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: March 14, 2024