Patients who had taken part in a randomized clinical trial of the treatment of chronic PTSD by either cognitive therapy or imaginal exposure were reassessed after 5 years. At 5-year follow-up a clear superiority of cognitive therapy over imaginal exposure emerged, although there had been no difference between the two treatment groups up to 12 months posttreatment. The cognitive therapy group showed significant differences on the primary outcome measures: total PTSD symptoms on the CAPS and percentage of PTSD cases. At 5 years no patients who received cognitive therapy were diagnosed with full PTSD compared to 29% of those who received imaginal exposure. All secondary outcomes showed lower scores for cognitive therapy, of which 3 were significant. Those who were not assessed at 5 years scored significantly higher on assessment measures, especially avoidance, at posttreatment.