This randomized clinical outcome study examined the efficacy of two different trauma treatments for chronic posttraumatic stress disorder (PTSD) related to female adult survivors of childhood sexual abuse in an outpatient setting. Twelve adult females (mean age 35 years), who had been victims of severe childhood sexual abuse perpetrated by a male family, were randomly assigned to one of two treatment groups: (1) imagery escripting, which combines visual reliving and rescripting of the traumatic imagery or (2) prolonged exposure plus stress inoculation training. At pre-treatment, all patients met DSM criteria for chronic PTSD. Each treatment consisted of an extensive pre-treatment evaluation session plus eight therapy sessions (1.5 to 2.0 hours each) with regular between-session homework. At post-treatment and 6-months follow-up, none of the patients in either treatment group met criteria for PTSD. In addition, all patients in both treatment groups showed significant reductions in PTSD-related symptoms, although the overall reduction of PTSD symptoms for patients in the imagery rescripting treatment group were noticeably greater than those in the prolonged exposure – stress inoculation group.