Trauma-focused CBT and EMDR — structured clinical viva

You are the psychiatry registrar. A 41-year-old veteran with combat-related PTSD has partial benefit from sertraline 150 mg daily. He avoids driving, has flashbacks of an IED, and blames himself for a colleague's death. He asks for 'the best therapy' and whether EMDR is 'just eye-wiggling'. Discuss first-line trauma-focused options, mechanisms (Ehlers–Clark, PE, CPT stuck points, EMDR phases), readiness, evidence syntheses, complex presentations and phase-based care debates, medication interface, and how you would structure a course with monitoring.