Evidence-based trauma-focused CBT for post-traumatic stress disorder and difficulties following traumatic experiences

After a traumatic experience, it can sometimes feel as though the danger has never completely ended.

You might experience unwanted memories, nightmares or flashbacks, feel constantly alert to possible danger, or avoid people, places and situations that remind you of what happened.

Even when you know logically that the event is over, your mind and body can continue responding as though you still need to protect yourself.

Trauma-focused CBT can help you understand what is keeping that sense of threat going and begin experiencing the trauma as something that happened in the past.

Does this sound familiar?

You might:

• experience intrusive memories, images or nightmares

• feel as though the event is happening again

• avoid thinking or talking about what happened

• avoid people, places or situations that remind you of the trauma

• constantly scan your surroundings for possible danger

• feel particularly jumpy or easily startled

• struggle with guilt, shame, anger or self-blame

• feel unsafe even when you know you are not currently in danger

• find it difficult to trust other people

• feel detached or disconnected from others

• notice that your life has become increasingly organised around avoiding reminders or staying safe

PTSD can look different for different people.

You do not need to experience every symptom or have a formal diagnosis before seeking help.

Understanding what keeps PTSD going

Following trauma, your mind is trying to make sense of something extremely threatening.

Sometimes trauma memories remain vivid, fragmented or easily triggered.

A sound, smell, place, physical sensation or situation can suddenly bring back a powerful sense of what happened.

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The memory feels like a threat happening now, rather than something that happened then.

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You might experience fear, shame, anger or other strong emotions.

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You avoid the reminder, push the memory away, scan for danger or do something else to make yourself feel safer.

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The immediate distress eventually reduces.

But you may never get the opportunity to discover that the reminder itself is not dangerous, or that you can cope without continually protecting yourself.

At the same time, conclusions you have drawn from the trauma can continue to shape how you see yourself, other people and the world.

CBT helps us work with these processes so that the trauma no longer has the same power over your life.

How can CBT help with PTSD?

Trauma-focused CBT isn't simply about talking through what happened.

We'll start by developing an individual understanding of your difficulties, including:

• what happened and how it has affected you

• how your trauma memories are experienced now

• what tends to trigger them

• what the experience has come to mean to you

• situations or memories you've started avoiding

• things you do to protect yourself or stay safe

• how PTSD is affecting your everyday life

We can then use this understanding to decide what needs to change.

Working with trauma memories

Traumatic memories can sometimes feel very different from ordinary memories.

Rather than feeling like something that happened in the past, they can arrive suddenly and bring back the emotions and sense of danger associated with the original experience.

An important part of treatment can involve carefully working with these memories and helping your brain place the experience in its proper context.

The aim isn't to make you relive the trauma unnecessarily.

It's to help the memory become something you can remember without feeling as though you are back there again.

Changing meanings and reducing avoidance

Trauma can also change what you believe about yourself, other people and the world.

You might think:

“I should have stopped it.”

“I'm permanently damaged.”

“I can't trust anyone.”

“Nowhere is safe.”

We'll explore the meanings that are particularly important for you and test whether they still fit with what you know now.

Treatment can also involve gradually reducing avoidance and unnecessary safety behaviours so that you can begin discovering what is safe and reclaiming areas of life that PTSD has restricted.

What working together looks like

Treatment is based on your individual formulation rather than using a generic approach to trauma.

Together, we may work on:

Understanding your PTSD
Identifying the memories, meanings and behaviours keeping the sense of threat going.

Processing trauma memories
Helping memories become better understood in their context and feel more firmly located in the past.

Updating difficult meanings
Working with beliefs about yourself, responsibility, other people or danger that developed following the trauma.

Reducing avoidance and safety behaviours
Gradually approaching things PTSD has taught you to avoid or protect yourself from.

Reclaiming your life
Returning to activities, relationships and experiences that have been pushed aside since the trauma.

Most of the useful learning happens both inside and outside therapy, so we'll usually agree things to practise or explore between sessions.