CBT for PTSD
Evidence-based, trauma-focused CBT grounded in the leading psychological model of PTSD.
CBT for PTSD (trauma-focused CBT) is a structured, NICE-recommended treatment for post-traumatic stress disorder. It's grounded in the Ehlers and Clark (2000) cognitive model of PTSD, which explains PTSD as arising from how a traumatic memory is processed and interpreted, rather than simply from the traumatic event itself. Treatment works directly with the trauma memory and the beliefs attached to it, rather than only managing symptoms.
This page discusses trauma and PTSD and is for information only — it isn't a crisis or emergency service. If you're having thoughts of suicide or are in crisis, please contact:
Samaritans: free, 24/7, call 116 123
NHS 111 (select the mental health option), or your GP
Emergency services: call 999 or go to A&E if you or someone else is in immediate danger.
Is this you?
Something happened, maybe recently, maybe years ago, and part of you hasn't been able to move past it the way you expected to. You might be having unwanted memories or flashbacks, feeling constantly on edge, avoiding anything that reminds you of what happened, or noticing the event has changed how you see yourself or the world. If the past keeps intruding on your present in ways that don't seem to be settling, this page is for you.
What is post-traumatic stress disorder?
PTSD is a recognised psychological response to experiencing or witnessing a traumatic event, involving symptoms such as intrusive memories or flashbacks, avoidance of trauma-related reminders, negative changes in mood or beliefs, and a persistent sense of current threat, such as hypervigilance or an exaggerated startle response.
Does everyone who experiences trauma develop PTSD?
No. Most people experience some distress after a traumatic event, and for many this settles naturally within the first few weeks. NICE guidance actually recommends a period of "watchful waiting" for the first month after a trauma before beginning formal treatment, since natural recovery is common. PTSD is considered when symptoms persist and significantly affect daily life beyond that point.
Is CBT an effective treatment for PTSD?
Yes. Trauma-focused CBT is recommended by NICE (NG116) as a first-line treatment for PTSD, alongside EMDR (Eye Movement Desensitisation and Reprocessing), based on a strong body of clinical evidence. It's typically offered to adults who have been experiencing PTSD symptoms for more than a month.
What makes it "trauma-focused"?
Unlike more general anxiety-management approaches, trauma-focused CBT works directly with the traumatic memory itself and the meaning that's been attached to it, rather than only addressing symptoms like anxiety or sleep difficulties on their own. This is considered more effective for PTSD specifically, because the trauma memory and its associated beliefs are what tend to drive the disorder.
How CBT helps with self-esteem
CBT for self-esteem works by first identifying your personal "bottom line" belief and the rules for living that have grown up around it, so the pattern becomes visible rather than feeling like simply "the way things are." From there, therapy involves testing those beliefs against real evidence often through structured behavioural experiments and helping expand one's attention, leading to gradually building a more balanced, realistic, and kinder view of yourself.
The Ehlers and Clark model of PTSD
What is the Ehlers and Clark model, and why does it matter?
The Ehlers and Clark (2000) cognitive model of PTSD is one of the most influential and well-evidenced explanations of why PTSD develops and persists, and it directly shapes how trauma-focused CBT is delivered. Rather than treating PTSD as simply "a severe reaction to a terrible event," the model explains PTSD as arising from a combination of three interacting factors.
What are the three factors in the model?
1. The nature of the trauma memory. The model proposes that trauma memories are often poorly processed at the time: stored with strong sensory and emotional detail, but not properly placed into context (the sense that "this happened, in the past, and I survived it"). Because the memory isn't well contextualised in time, ordinary reminders (a smell, a sound, a similar situation) can trigger the memory as if the threat were happening again right now, rather than as something being recalled from the past. Which is why flashbacks and intrusions can feel so immediate and overwhelming.
2. Negative appraisals of the trauma and its aftermath. PTSD tends to involve excessively negative interpretations. Not just about the event itself, but about what it means. This might include beliefs like "I'm permanently damaged," "nowhere is safe," or "I can't trust my own judgement anymore." These appraisals create an ongoing sense of current threat, even though the traumatic event is over.
3. Unhelpful coping strategies that maintain the problem. To manage the distress, it's natural to develop strategies such as avoiding reminders, suppressing thoughts about the trauma, staying constantly alert for danger, or using safety behaviours. The model explains that while these feel protective, they actually prevent the trauma memory and the negative appraisals from being updated, which is what keeps PTSD going rather than letting it resolve naturally.
How does this model translate into actual therapy sessions?
Treatment based on this model (often called Cognitive Therapy for PTSD, or CT-PTSD) works on all three factors together: helping the trauma memory become better processed and contextualised. Often through carefully guided recall paired with updating information ("this is a memory, not a current threat"); identifying and shifting the negative appraisals that are keeping the sense of threat alive; and gradually reducing the avoidance and safety behaviours that have been maintaining the problem, so you can reclaim parts of life that PTSD has affected.
What sessions look like
How long are sessions, and how much do they cost?
trauma-focused CBT sessions are often longer than standard 1-1 sessions — commonly 90 minutes rather than 60 — to allow enough time for memory work without an abrupt stop. 90 minute sessions are charged at £100.
How many sessions will I need?
Trauma-focused CBT is typically delivered over around 8 to 12 sessions, though this can vary — for example, if you've experienced multiple traumas, more sessions may be appropriate. We'd agree an approximate structure together after assessment.
Is there anything that might mean this isn't the right starting point for me?
If you're experiencing significant dissociation, feel at risk of harm to yourself or others, or your PTSD relates to very recent (within the last month) or highly complex or repeated trauma, a more thorough assessment is needed before starting, and this may involve a different approach or a referral elsewhere. This would be discussed openly with you before treatment begins.
FAQ's
Will I have to describe the traumatic event in detail?
Trauma-focused CBT does involve working with the memory of what happened, but this is done in a structured, carefully paced way, and always with your consent and at a pace that's manageable, not by being asked to simply retell the story repeatedly without purpose.
Do I need a formal PTSD diagnosis to book a session?
Not necessarily, many people come with clinically significant PTSD symptoms without having a formal diagnosis. An initial assessment helps clarify what's going on and whether this approach is the right fit.
What if I'm not sure this is the right fit?
Book the free discovery call, a low-pressure conversation to see whether this feels right for you, with no obligation to book anything further.
Key References
Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319–345.
- National Institute for Health and Care Excellence (2018) Post-traumatic stress disorder [NG116]. Available at: www.nice.org.uk/guidance/ng116