Abstract: PTSD treatments occupy five systemic levels-chemical, biological, neurophysiological, phenomenal,and cognitive. Pharmacological treatments bridge the chemical and biological levels. They are oftenimprecise in effect, and drugs imply brokenness. Direct neurophysiological manipulations include Stellateganglion block, deep brain stimulation, transcranial magnetic stimulation, etc. These are new, ofteninvasive, and sparsely attested. EMDR and RTM employ imaginal manipulation of internal images.Cognitive manipulations work with conscious responses. Cognitive interventions may expose patients tocultural issues, especially when performed in a group context. These include hyper-masculinizedexpectations, military culture, shame as self-blame, etc. EMDR, cognitive, and pharmacologicalapproaches have shown equivalent efficacy. RTM modifies the imaginal structure of trauma memories,reimagining them as nonthreatening, past events. RTM may be employed without disclosure of traumacontent. We hypothesize that changes to imaginal images directly and lastingly impact neurology via thereconsolidation updating mechanism. Four published RCTs of RTM will be presented with informationabout a fifth unpublished study of trainee results. All studies found effect sizes exceeding 0.08 SMDswith high patient satisfaction.