Therapies for trauma

Trauma-focused therapies help you look at the trauma memory, or the beliefs and avoidance that grew from it, in a safe, guided way. The ones with the most research behind them are Cognitive Processing Therapy, Prolonged Exposure and EMDR.

Others with less research so far include Written Exposure Therapy and Cognitive Therapy for PTSD. Most of these therapies last about 3 months.

Present-Centered Therapy has some research support. It does not ask you to talk about the trauma in depth. Instead, it focuses on current problems linked to the trauma or to PTSD symptoms, like stress at work or in relationships.

Trauma-informed care is not one therapy. It is a way any service can work: understanding how trauma affects people and avoiding care that feels re-traumatizing. A good trauma therapist works this way.

Step by step

• First you learn about trauma reactions and build calming skills
• You choose a memory to work on, with the thoughts and body feelings linked to it
• You hold the memory for about 30 seconds while following the movement, then talk about what came up
• Later you strengthen a more positive belief about yourself

You usually don’t have to describe every detail out loud, and there is no homework.

EMDR often takes about 3 months of weekly 50–90-minute sessions. A single traumatic event may take 3–6 sessions; complex trauma may take 8–12 or more.

The VA lists EMDR among the trauma-focused therapies with the most research support for PTSD. Experts still debate exactly why it works, but not whether it helps. It is also used for anxiety, phobias and other trauma-linked struggles.

EMDR should be done by a licensed clinician trained specifically in it. Ask how many people they have treated with EMDR and how they prepare you before memory work starts.

• You learn about PTSD and how the therapy works
• You write about how the trauma has affected you
• You check whether the facts support your stuck thoughts, and consider fairer ones
• You may choose to write a detailed account and read it aloud
• Later sessions focus on safety, trust, control, self-esteem and closeness

CPT usually takes 12 weekly sessions. It can be one-to-one (about 60 minutes) or in a group of about 6–10 people (about 90 minutes). Some people feel better after a few sessions.

The VA lists CPT among the trauma-focused therapies with the most research support for PTSD. Talking about trauma can be uncomfortable, but this usually eases as you continue.

What happens

• Early on you learn a breathing skill to manage anxiety
• You list people, places or activities you’ve avoided, and work through them step by step
• You talk through the memory in session at your own pace
• Between sessions you listen to a recording of yourself and practise real-world steps

PE usually takes 8–15 weekly sessions of 60–90 minutes, over about 3 months. The VA lists it among the trauma therapies with the most research support. Discomfort is usually mild to moderate and fades.

In WET, you write about a specific traumatic event during sessions, with a therapist’s support. There is no homework between sessions. The VA describes it as a brief, 5-session therapy.

In a VA trial of 178 veterans, both WET and Prolonged Exposure helped. People who had WET were more likely to finish treatment, and it needed fewer sessions. The VA says it has less research than CPT, PE and EMDR so far.

Cognitive Therapy for PTSD revisits the trauma memory to change negative thoughts about what happened. The VA lists it among trauma-focused therapies with less research support than the top three.

• For ages 3 to 18
• The therapist meets with the child and the parent or caregiver, mostly side by side
• There are also joint child–parent sessions
• Usually 8 to 25 sessions

TF-CBT has been tested in 25 controlled trials and many real-world studies, with strong evidence it helps across genders, races, ethnicities and types of trauma.

NIMH notes that effective therapy for children often includes parent involvement and skills practised at home. In TF-CBT, caregivers learn the same skills so they can support them every day.

Good trauma therapy starts with learning about trauma and building calming skills. EMDR, PE and TF-CBT all begin this way before any memory work.

Facing hard memories can be uncomfortable at first. In CPT and PE, this discomfort is expected and usually eases as you continue. If you feel much worse, tell your therapist straight away.

CPT and PE include practice between sessions, like writing or small real-world steps. EMDR and Written Exposure Therapy have no homework.

Many VA trials found PTSD therapy by video works as well as in person in most cases. This can help if travel is hard or there are no trauma therapists nearby.

• Which trauma therapies are you trained in?
• How many people have you treated with this approach?
• How will we prepare before working on memories?
• How will we track whether it’s helping?
• What happens if I feel overwhelmed between sessions?

The National Center for PTSD’s PTSD Treatment Decision Aid helps you learn about proven treatments, compare the ones that might suit you, and prepare to talk them over with your care team.

Be cautious of anyone who promises a quick cure or claims to “release trauma” in one session. Ask about their license and training, and whether they use a proven treatment.

• Don’t give advice unless you are asked
• Give them space if they pull away, and let them know you’ll be there later
• Remember you can’t force change; your steady presence still matters
• Tell them you want to listen, and that it’s fine if now isn’t the time

Try not to ask for details of the trauma or the sessions. Let them share if and when they want to.

Trauma therapy can stir up feelings before things ease. A rough week doesn’t mean therapy is failing. Gently encourage them to tell their therapist how they’re doing.

It’s normal to feel helpless at times, and you don’t have to know everything. The VA encourages family members to look after their own physical and mental health and keep up their own activities and friendships.

Places to lean on

• A faith or spiritual group
• A support group
• Doctors or other health professionals
• Family, friends, coworkers and neighbours

You can ask your primary care provider for a referral, contact your insurance or EAP, or use FindTreatment.gov, SAMHSA’s locator for mental health services. Veterans can also ask their VA care team about trauma therapies.

Find A Helpline lists free, confidential helplines in many countries. In an emergency, contact your local emergency number.