Trauma Therapy

What is trauma therapy?

Trauma therapy refers to psychotherapies designed to help people recover from the effects of traumatic experiences. They are the recommended first-line treatments for PTSD and can also help people with other trauma-related difficulties.

Evidence-based approaches

• Cognitive processing therapy (CPT): helps you examine and change unhelpful beliefs related to the trauma, such as self-blame.
• Prolonged exposure (PE): gradually approaching trauma memories and avoided situations in a safe, structured way.
• Trauma-focused CBT: combines cognitive and behavioral techniques, and is widely used with children and adolescents.
• Eye movement desensitization and reprocessing (EMDR): recalls traumatic memories while engaging in guided bilateral stimulation, such as eye movements.

What to expect

Most trauma-focused therapies run for about 8 to 16 sessions. Early sessions focus on education and building coping skills. It is common to feel some distress during treatment, and your therapist will help you manage it.

How trauma affects people

Traumatic experiences can leave lasting effects on the body and mind. Some people develop PTSD, with intrusive memories, avoidance, changes in mood and thinking, and heightened alertness. Others experience depression, anxiety, sleep problems, difficulty trusting others, shame or substance use. Trauma that is repeated or begins in childhood can affect identity and relationships. None of this means a person is weak: these are understandable responses of a nervous system that has been through something frightening, and they can improve with the right support.

The stages of trauma recovery

Many therapists describe recovery in three broad phases, though they overlap and aren’t strictly linear:

1. Safety and stabilization: building safety in your life, learning to manage distress, grounding, sleep and relationships, and understanding trauma reactions.
2. Processing: working through trauma memories and the beliefs attached to them, using a specific method such as those below.
3. Reconnection: rebuilding relationships, meaning and plans for the future.

People who’ve experienced prolonged or complex trauma often spend longer on the first phase, while a single-event trauma may allow a quicker move to processing. A therapist should work out the right pace with you.

Approaches in more detail

• Cognitive processing therapy (CPT) is typically delivered in about 12 weekly sessions. It focuses on “stuck points,” such as beliefs that the trauma was your fault or that the world is entirely unsafe, and teaches you to examine and update them.
• Prolonged exposure (PE) involves gradually approaching trauma memories and avoided places, with repeated retelling of the memory and practice outside sessions, so that distress lessens. See exposure therapy.
• Trauma-focused CBT (TF-CBT) is widely used with children, adolescents and caregivers, combining psychoeducation, coping skills, a trauma narrative and parenting support.
• EMDR has you recall aspects of the trauma while following guided bilateral stimulation, and has good evidence for PTSD, although how it works is still debated.
• Narrative exposure therapy helps people with multiple traumas build a coherent life story, and has been used in refugee and conflict settings.
• Skills-based and phase-oriented approaches such as skills training in affective and interpersonal regulation help with complex trauma; some people also benefit from DBT skills.

Safety, pacing and choice

Good trauma therapy puts safety and choice first. You don’t have to tell the whole story at once, and you should understand what each step involves before you begin. A skilled therapist watches how you respond, slows down if you feel overwhelmed and teaches ways to ground yourself. It’s normal for symptoms to feel stronger for a time as memories are processed, and for relief to follow. If it feels too intense or you feel unsafe, tell your therapist. Trauma therapy isn’t appropriate for everyone at every moment; if you’re in crisis, using substances heavily or unsafe at home, stabilization may need to come first.

Medication and other support

Some people benefit from medication, such as certain antidepressants, for PTSD symptoms or co-occurring depression and anxiety; see antidepressants. Help for sleep and nightmares may be part of care; see sleep and mental health. Peer groups, trusted relationships, exercise, mindfulness and creative activities can add support, but they aren’t a substitute for therapy when symptoms are significant.

When to seek help

Consider seeking help if distressing memories, nightmares, avoidance or feeling constantly on edge continue beyond a few weeks, or affect your work and relationships. If you have thoughts of suicide, or are in danger, call a crisis line or emergency services; see Get Help Now.

Finding a trauma therapist

Ask potential therapists about their specific training in trauma-focused approaches and how they ensure safety during treatment. See our guide on how to find the right therapist.

Online platforms such as BetterHelp and Sesame list therapists who work with trauma and PTSD; check that they have specific training in approaches such as trauma-focused CBT, CPT or EMDR.

Questions people often ask

Do I have to describe everything that happened? Some therapies involve revisiting the memory, but you control the pace, and others focus mainly on beliefs and coping. Is it safe to start if I’m still in a difficult situation? Safety and stability usually come first, and a therapist will help you decide when processing is right. What if I’m not sure my experience counts as trauma? If an experience is affecting your life, you deserve support, whatever its size.