Imagine surviving a traumatic event such as a car crash, an earthquake, or an explosion.
That in itself would be distressing.
Now imagine reliving that experience repeatedly, as if trapped in a waking nightmare every day. For many people worldwide, this is the reality of post-traumatic stress disorder (PTSD).
Some individuals who experience severe trauma go on to develop PTSD (van der Kolk, 2000), and they require informed, compassionate support and appropriate treatment.
This article explains PTSD and trauma, summarizes common treatment options, and offers practical guidance and resources to help practitioners and caregivers support clients living with trauma and PTSD.
This Article Contains:
- PTSD and Trauma: A Psychological Explanation
- 6 Possible PTSD Treatment Options and Paths
- How to Help Clients With PTSD and Trauma
- Using CBT to Heal Trauma: A Guide
- 2 Helpful Worksheets for Adults & Youth
- A Look at Trauma Psychoeducation: 2 Worksheets
- A Note on Group Therapy for Clients With PTSD
- Resources From PositivePsychology.com
- A Take-Home Message
- References
PTSD and Trauma: A Psychological Explanation
To place PTSD in context, it helps to look briefly at its history and how trauma affects people.
1. Brief historical background
Early descriptions of trauma-related reactions date back at least to World War I, when clinicians called many wartime presentations “shell shock” (Myers, 1915). During World War II, similar reactions were often labeled “combat fatigue” and linked to prolonged deployment (Marlowe, 2001).
2. Types of trauma
Psychological trauma can be caused by a single catastrophic event or by repeated and prolonged stressors (Neria, Nandi, & Galea, 2008). Examples include motor vehicle accidents, assaults, abduction, torture, sexual violence, witnessing death or serious injury, war, and natural disasters (Kessler et al., 2014).
Traumatic experiences are common: by adolescence many people have encountered at least one traumatic event (Copeland, Keeler, Angold, & Costello, 2007). Responses to trauma vary widely between individuals (Bonanno, 2004).
3. Relationship between PTSD and trauma
PTSD is closely linked to traumatic experiences; symptoms reflect how the nervous system and mind process overwhelming events (van der Kolk, 2000). While PTSD can affect anyone regardless of age, gender, or background, prevalence varies across populations (Beals et al., 2013; Creamer, Burgess, & McFarlane, 2001).
PTSD manifests with a complex mix of somatic, cognitive, emotional, and behavioral symptoms that arise from unresolved trauma (van der Kolk, McFarlane, & Weisaeth, 1996).
4. Etiology of PTSD
Multiple individual and social risk factors influence whether someone develops PTSD after trauma. These include age at the time of trauma, gender, educational level, socioeconomic status, prior traumatic experiences or adverse childhood events, marital and social support status, and the initial intensity of reaction to the event (Kroll, 2003; Stein, Walker, & Hazen, 1997; Sareen, 2014).
Genetic and biological research also suggests that certain genes and receptor proteins may affect susceptibility to PTSD (Zhao et al., 2017; Miller, Wolf, Logue, & Baldwin, 2013).
5. Criteria symptoms for PTSD
Core PTSD symptoms include intrusive memories, nightmares, and flashbacks; active avoidance of trauma reminders; heightened arousal and hypervigilance; and disturbed sleep (American Psychiatric Association, 2013). These symptoms can significantly impair social, occupational, and interpersonal functioning (Bryant et al., 2011).
A PTSD diagnosis requires symptoms to persist for more than one month and to cause clinically significant distress or interference in daily life (American Psychiatric Association, 2013).
6 Possible PTSD Treatment Options and Paths
Several evidence-based pathways exist for treating PTSD. Treatment choice depends on symptom profile, patient preference, accessibility, and clinical judgement (Schwartzkopff et al., 2021).
1. Cognitive-Behavioral Therapy (CBT)
Cognitive-Behavioral Therapy (CBT) is one of the most widely recommended treatments for PTSD (Monson & Shnaider, 2014). Trauma-focused CBT targets the memories, thoughts, and emotions tied to the traumatic event and can be delivered individually or in groups (Warman et al., 2005).
In trauma-focused CBT the client gradually and safely engages with the traumatic memory to identify unhelpful beliefs and replace them with more balanced, realistic thoughts. Guided exposure reduces avoidance and builds adaptive coping (Malkinson, 2010; Hawley, Rector, & Laposa, 2016).
2. Eye Movement Desensitization and Reprocessing (EMDR)
EMDR was developed specifically to treat trauma and has shown clinical effectiveness in adults and children (Shapiro, 2007; Chen et al., 2018). The model proposes that unprocessed traumatic memories retain the emotions, beliefs, and sensations from the event; EMDR facilitates adaptive processing and reduces the intensity and vividness of those memories using bilateral stimulation (Shapiro, 1995; 2014).
3. Narrative Exposure Therapy (NET)
Narrative Exposure Therapy helps clients construct a coherent life narrative that integrates traumatic experiences rather than allowing trauma to dominate a person’s story (Elbert & Schauer, 2002; Schauer et al., 2011). NET is used individually and in groups, especially in contexts shaped by political or social conflict, and aims to reorganize fragmented memories through structured exposure and testimony-building (Schnyder et al., 2015).
4. Prolonged Exposure Therapy
Prolonged Exposure teaches clients to approach avoided trauma-related memories, feelings, and situations in a controlled way so that they learn these cues are not dangerous. Both imaginal and in vivo exposures are applied at a pace that the client can tolerate (Foa & Rothbaum, 1998; Eftekhari, Stines, & Zoellner, 2006).
5. Medications
No single medication uniquely treats PTSD, but certain antidepressants—especially selective serotonin reuptake inhibitors (SSRIs) and some serotonin-norepinephrine reuptake inhibitors (SNRIs)—can reduce core symptoms of anxiety and depression that often accompany PTSD (Marken & Munro, 2000; Davidson et al., 2006).
6. Psychedelic-assisted therapy
Psychedelic-assisted psychotherapy, including MDMA-assisted treatment, is an emerging and controversial area that has shown promise in controlled trials for treatment-resistant PTSD (Doblin, 2002; Mitchell et al., 2021). Such approaches should only be delivered in regulated clinical settings by trained professionals (Pilecki et al., 2021).
Reviewer’s comment
Yoga therapy and Internal Family Systems (IFS) are additional approaches sometimes used in trauma care. Bessel van der Kolk discusses body-based and somatic therapies in The Body Keeps the Score, highlighting how nonverbal therapies can complement cognitive approaches.
Download 3 Free Positive CBT Exercises (PDF)
These science-based exercises offer practical tools clients and practitioners can use to support recovery and build resilience through CBT techniques.
How to Help Clients With PTSD and Trauma
Clients with trauma-related problems benefit from targeted, compassionate care. The following practical guidelines can help clinicians and caregivers support recovery.
1. Reassure clients they are not to blame
Survivor guilt and self-blame are common after trauma (Bub & Lommen, 2017; Murray, Pethania, & Medin, 2021). Clinicians should clearly and repeatedly reassure clients that the traumatic event was not their fault and normalize their reactions to extreme stress.
2. Do not avoid discussing trauma out of fear of re-traumatizing
Avoidance is central to PTSD (Lancaster et al., 2016). Although discussing traumatic memories can be painful, carefully guided and controlled exploration—within a safe therapeutic framework—helps clients process memories rather than reinforcing avoidance.
3. Use creative and nonverbal therapies
Art, movement, and writing therapies can provide alternative ways to process overwhelming experiences without forcing verbal disclosure (Schouten et al., 2014). Creative approaches may be especially helpful when talking about the trauma feels too intense.
4. Measure symptom progress
Use standardized tools to monitor symptoms over time. The Impact of Event Scale–Revised (Weiss, 2007) provides subscales for intrusion, avoidance, and hyperarousal and can help track change at baseline, mid-treatment, and end of therapy.
Using CBT to Heal Trauma: A Guide
Trauma-focused CBT can be delivered in different ways, but many programs follow similar stages. Below is a concise overview of common steps used in trauma-focused CBT.
1. Assessment of symptoms
Begin with a detailed clinical assessment to document the traumatic event(s), identify triggers, and map current symptoms. This assessment informs an individualized treatment plan.
2. Provide a clear treatment rationale
Explain how PTSD symptoms develop, how therapy will address them, and offer simple analogies so clients understand the rationale for exposure, cognitive work, and skill-building.
3. Reduce thought suppression
Encourage clients to let distressing thoughts surface rather than repeatedly trying to push them away. Reducing suppression helps break cycles of avoidance and allows therapeutic processing to proceed.
4. Psychoeducation
Teach clients about PTSD, how the brain and body respond to trauma, and why traumatic memories may remain unprocessed. Psychoeducation can normalize reactions and increase engagement (Bremner, 2006).
5. Teach relaxation and grounding skills
Introduce breathing exercises, progressive muscle relaxation, guided imagery, and other grounding techniques that reduce hyperarousal and improve tolerance for exposure work.
6. Cognitive restructuring and safe memory processing
Under safe conditions, guide clients to revisit the traumatic memory in detail, identify unhelpful beliefs, and develop more realistic appraisals. This processing reduces distress and builds adaptive coping.
7. Identify and manage triggers
Help clients recognize stimuli that trigger intrusive memories or intense reactions, and teach strategies to reduce reactivity and distinguish current cues from past danger.
8. Imagery rescripting
Use guided imagery to help clients reinterpret or change the meaning of distressing images, which can reduce the emotional charge of traumatic memories (Arntz, 2012).
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The Positive Psychology Toolkit© includes hundreds of evidence-based exercises, activities, and assessments practitioners can use to support resilience and recovery.
2 Helpful Worksheets for Adults & Youth
Worksheets can clarify how trauma affects a client and provide practical tools for therapy.
1. Understanding PTSD triggers
A triggers worksheet helps clients identify three common triggers, notice physiological and emotional changes, and practice coping strategies. This can be used with adolescents and adults, in individual or group settings.
2. Simple CBT worksheet
A basic CBT appraisal worksheet explains the model of automatic thoughts and shows how thoughts, feelings, and behaviors interact. It helps clients reflect on reactions to specific situations and develop alternative appraisals.
A Look at Trauma Psychoeducation: 2 Worksheets
Psychoeducational handouts make complex neurobiological and physiological concepts accessible to clients recovering from trauma.
1. The autonomic nervous system
Explaining the autonomic nervous system helps clients understand involuntary reactions such as hyperarousal, avoidance, and intrusive memories (McCorry, 2007). A simple worksheet can illustrate fight–flight–freeze responses and practical grounding strategies.
2. The traumatized brain
Handouts that describe how trauma affects memory and processing clarify why intrusive memories occur and why exposure and cognitive work can help integrate traumatic material (Brewin, Dalgleish, & Joseph, 1996).
A Note on Group Therapy for Clients With PTSD
Deciding between individual and group therapy depends on clinical needs, patient preference, and available resources. Research offers mixed findings on group versus individual formats (Sloan, Unger, & Beck, 2016).
1. Validation
Group members often find it validating to see others with similar sleep, appetite, concentration, or emotional difficulties.
2. Helping others
Contributing support to peers can boost self-esteem and foster a sense of agency in recovery.
3. Social support
Groups provide social connection and collective coping strategies that reduce isolation.
4. Limited individual attention
Group therapy divides clinician time among participants; some clients may need focused individual sessions to address specific needs.
5. Confidentiality and trust
Clients with PTSD may feel mistrustful or reluctant to share in a group; careful screening and strong ground rules are essential to protect confidentiality and safety (Freeman et al., 2013).
17 Science-Based Ways To Apply Positive CBT
A curated collection of CBT and cognitive therapy exercises can expand the tools available to clinicians working with trauma, resilience, and emotional regulation.
Resources From PositivePsychology.com
Several practical resources can support clinicians and clients recovering from trauma.
17 validated Positive CBT tools for practitioners
This set of evidence-based tools covers strength spotting, optimism, coping, emotional avoidance, and growth mindset. When used alongside trauma-focused interventions, these tools can help clients reframe setbacks and foster post-traumatic growth.
Growing Stronger From Trauma
A strengths-focused worksheet helps clients identify personal resources and positive changes after trauma—key steps in moving forward.
Breath Awareness
Simple breathing and relaxation exercises are effective for managing hyperarousal and grounding clients during stress.
A Take-Home Message
Nearly everyone experiences trauma at some point (Copeland et al., 2007); for some, those experiences lead to persistent PTSD symptoms. We no longer view these reactions solely as “shell shock” or “combat trauma” (Myers, 1915; Marlowe, 2001). PTSD is a recognized clinical disorder that can be disabling, but effective treatments and multiple therapeutic paths are now available (American Psychiatric Association, 2013).
Understanding trauma, choosing appropriate interventions, and using supportive psychoeducation and worksheets can help clients process their experiences and regain control. With the right combination of therapy, coping skills, and social support, many people recover and rebuild meaningful lives.
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