Letter To the American Psychological Association Regarding 

The Use and Risks of Prolonged Exposure, 

Eye Movement Desensitization and Reprocessing, and Cognitive Processing Therapy 

By Louise Gaston, PhD 


*This is an article from the Spring 2023 issue of Combat Stress

To Whom It May Concern, 

You will find hereby some of my articles published in Combat Stress, a magazine for Veterans and clinicians (see attachments).  

For over 30 years, I have had many concerns about the use of trauma-focused therapies (PE, EMDR, and CPT) for treating PTSD, especially for veterans. Their dropout rates are very high, even in RCTs, and adverse effects are numerous and severe (see Pitman et al. (1991) cited below). However, their adverse effects have not really been studied for the last 30 years. Indeed, highly enthusiastic about trauma-focused therapies, RCT researchers have neglected to inquire about adverse effects of PE, EMDR and CPT, a fact which was even stated in the appendices of the 2017 APA guidelines for treating PTSD and which contradicted the main recommendations of the committee.  

In my expert opinion, as a clinician and a researcher specialized in PTSD, the popular recommendation to use, in a sine qua non fashion, trauma-focused therapies for treating PTSD is unethical.   

Finally, I wish to reiterate that, in evaluative research, there is a clear and major distinction between efficacy (derived from RCT settings) and effectiveness (derived from real-life settings), a scientific reality which is almost never acknowledged. 

Honestly, I am very skeptical about a true intention on the part of the APA to truly consider how much PTSD sufferers are damaged by trauma-focused therapies (especially veterans), because their use has been highly recommended by the APA, the VA, etc. Nonetheless, I am willing to give this APA committee a chance and thus submit the attached body of research, clinical realities, and reflections. 


Dr. Louise Gaston, PhD 


In the summer of 2022, an insurance manager called me. He wished to discuss the effects of therapies such as PE (prolonged exposure) for treating PTSD. As he explained, the problematic situation was that his insurance company paid for whole PE packages (10 or 12 sessions) while almost all patients left after 1 or 2 sessions. After reading my articles in Combat Stress, he wanted to discuss the dropout rates and adverse effects associated with TFTs, including PE. After 10 minutes, this insurance manager realized some of the reasons behind such a very high drop rate and made an immediate decision, namely, to stop reimbursing the costs of PE packages. 


Dr. Louise Gaston, psychologist, has founded in 1990 a clinic specialized in Post-Traumatic Stress Disorder, TRAUMATYS, in Canada, where she developed an integrative model for treating PTSD, which is flexible and open-ended. In addition, she elaborated a comprehensive 2-year training program in PTSD and trained more than 200 experienced clinicians in evaluating and treating PTSD. Thousands of individuals presenting with PTSD and comorbidity have been treated with this integrative model for PTSD. According to an independent and retrospective study, the associated PTSD remission rate is 96%: 48% complete and 48% partial. Dr. Gaston is the author of several book chapters and more than 40 scientific/clinical articles.  

Since 1980, Dr. Gaston has been practicing psychotherapy. She has been trained and supervised over 15 years. She knows all major models of psychotherapy (dynamic, humanistic, cognitive, and behavioral) and has been trained over 5 years in treating personality disorders.  

As a clinical researcher, Dr. Gaston collaborated with many colleagues in diverse settings. She has carried out two clinical trials. Her main research topic was the alliance in psychotherapy and its interaction with techniques as they contribute to better outcomes. In collaboration with Dr. Marmar, MD, she has developed the California Psychotherapy Alliance Scale, CALPAS, a measure of the alliance in psychotherapy which is worldly used. 

In 1988, Dr. Gaston completed a 2-year postdoctoral fellowship in PTSD and psychotherapy research, at the Langley Porter Psychiatric Institute, University of California, San Francisco, under the supervision of Dr. Horowitz, M.D., author of Stress Response Syndrome, and Dr. Marmar, MD, both ex-presidents of the International Society for PsychotherapyResearch and the International Society for Traumatic Stress Studies. Afterwards, she was assistant professor in the Department of psychiatry at McGill University in Canada from 1988 to 1994. Dr. Gaston elaborated scales on the MMPI-2 to assess PTSD in civilians. 

For many years, Dr. Gaston has provided courses of continuing education across the USA: Integrating Treatments for PTSD, Trauma and Personality Disorders, Memories of Abuse and the Abuse of Memory, and Ethics Working for You. Nowadays she writes, trains, and supervises on PTSD. 


Combat Stress Magazine

Combat Stress magazine is written with our military Service Members, Veterans, first responders, and their families in mind. We want all of our members and guests to find contentment in their lives by learning about stress management and finding what works best for each of them. Stress is unavoidable and comes in many shapes and sizes. It can even be considered a part of who we are. Being in a state of peaceful happiness may seem like a lofty goal but harnessing your stress in a positive way makes it obtainable. Serving in the military or being a police officer, firefighter or paramedic brings unique challenges and some extraordinarily bad days. The American Institute of Stress is dedicated to helping you, our Heroes and their families, cope with and heal your mind and body from the stress associated with your careers and sacrifices.

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