Abstract: OBJECTIVE: The 2023 Veterans Affairs/Department of Defense Clinical Practice Guideline for posttraumatic stress disorder (PTSD; Veterans Affairs/Department of Defense, 2023) identified medications and specific psychotherapies as recommended or suggested treatments. Yet, more patients with PTSD receive general counseling than these recommended treatments (Cameron et al., 2023). We aimed to understand why different PTSD treatment options were preferred. METHOD: This study examined the treatment preferences of 887 people who screened positive for PTSD, along with their reasons for the least and most preferred options (which were analyzed with content analysis). RESULTS: Evidence-based trauma-focused treatments as a whole were most often ranked first (45.4%), although examined individually, general counseling was most commonly ranked first (31.8%). Having a trauma focus was rarely listed as a reason to not want a treatment. People tended to prefer a treatment because of the content of the treatment or the way it was presumed to work, along with believing it would be a good personal fit or that they were familiar with it. Perceived effectiveness followed. The reasons for not preferring a treatment had to do with presumed aversiveness (including side effects, addiction, etc.) most often, along with a perceived lack of fit or something about the content or mechanism. CONCLUSIONS: When presenting treatment options to patients, it may be helpful to discuss what matters to patients in a treatment and to assess their reasons for preferring a treatment both before and after they have done so, giving an opportunity to correct any misperceptions.