Trauma-focused psychotherapies are the treatment of choice for PTSD. Despite this, nearly one-half of PTSD patients do not respond to these treatments. This situation has not changed over several decades. This keynote will provide an overview of the current knowledge of how effective trauma-focused therapies are, and critique attempts to improve treatment response. Many of these attempts have involved pharmacological augmentations of psychotherapy, although these have been largely unsuccessful. This keynote will outline some alternative promising approaches to augmenting treatment using behavioural strategies and digital tools. It will also overview recent work on understanding predictors of treatment response for trauma-focused psychotherapies, and highlight that there are multiple factors that can influence treatment outcome. This conclusion points to the potential for more targeted and flexible approaches that address specific needs of patients rather than a ‘one size fits all’ approach.