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Choreographing time: toward therapy-aligned entactogens for complex PTSD

Neuropsychopharmacology volume 51, pages 811–812 (2026)Cite this article

Subjects

“Sometimes I suddenly feel like it’s happening again… and I can’t sleep in my apartment,” a patient confided during an outpatient visit. Trials of sertraline and escitalopram had yielded only modest relief, and prazosin had done little for her nightmares. As she remained on a months-long waitlist for trauma-focused therapy, she grew increasingly despondent, describing the feeling of being stuck without effective options. Such encounters underscore how limited pharmacotherapy remains for post-traumatic stress disorder (PTSD). Despite decades of research, pharmacologic progress has been slow and often misaligned with the psychological processes that drive recovery. A meta-analysis of 52 randomized trials found a pooled medication response rate of just 39%, with nearly one-third of patients discontinuing treatment [1].

Emerging reviews highlight growing interest in integrating pharmacologic and psychological approaches for PTSD and complex PTSD (cPTSD), though the evidence remains limited and methodologically inconsistent [2]. The ICD-11’s recognition of cPTSD underscores that chronic or developmental trauma produces distinct clinical needs. Many patients benefit from a stabilization phase emphasizing safety, affect regulation, and alliance building before exposure work. Bridging these gaps requires aligning drug effects with the functional aims of psychotherapy—particularly in cPTSD, where affective instability, identity disturbance, and relational mistrust frequently derail trauma-focused work. Darby and colleagues outline this phase-based model in detail [3], and pretreatment stabilization in a Veterans Affairs cohort increased completion of trauma-focused therapy without delaying its onset [4].

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  1. Fellow Physician, Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA

    Apurva Parikh

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Correspondence to Apurva Parikh.

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Parikh, A. Choreographing time: toward therapy-aligned entactogens for complex PTSD. Neuropsychopharmacol. 51, 811–812 (2026). https://doi.org/10.1038/s41386-025-02314-w

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