Best type of therapy for complex ptsd
Trauma can affect all areas of your life — but healing is possible. Therapies optimized for trauma can be especially helpful.
Traumatic experiences can leave a deep imprint on the body and mind. The impact may show up immediately or years later, affecting your mood, relationships, and even your sense of self. But there are effective treatments to help you heal from trauma.
Around 70% of adults in the United States have experienced at least one trauma in their lives. Not everyone will have lasting effects, but 6% of U.S. adults develop post-traumatic stress disorder (PTSD).
Trauma can change your brain and nervous system, leading to dysregulation and symptoms such as depression and anxiety. As such, trauma therapies focus on soothing the nervous system, integrating traumatic memories, and supporting both mind and body healing.
There’s no one-size-fits-all when it comes to trauma treatment — the “best” type is the one that works for you. Finding the right therapy can take some time, but support is available along the way.
How can therapy help with trauma?
Trauma can come after a one-off event, such as an accident or assault, or from repeated events, like an abusive relationship or childhood neglect. Complex trauma — the kind that arises from repeated events — often stems from childhood experiences that affect your adult life.
Therapy can help you integrate traumatic event(s) and understand them — which helps you begin the healing process. Your memories of the trauma will stay, but they’ll start to have less power over you and your emotions.
“Therapy is helpful in normalizing an individual’s responses to the trauma they experienced,” explains Lisa Curtis, a licensed clinical social worker in New York. “[It] can provide them with new skills to manage their feelings and responses while also providing a context and education around the event itself.”
There are many evidence-based practices (EBPs) for trauma and PTSD, which are interventions that have proven robust in working with targeted populations, though not all recommended therapies are EBPs.
Types of therapy for PTSD and trauma include:
Cognitive processing therapy
Cognitive processing therapy (CPT) was developed by Patricia Resick, PhD, ABPP, as a treatment for PTSD. It aims to help people who feel “stuck” by their thoughts about the trauma.
In CPT, your therapist will help you learn to challenge and change unhelpful beliefs about the trauma that are keeping you “stuck.” The aim is to help you understand and think differently about the event(s), thereby relieving the negative effects.
A 2018 review concluded that, based on existing evidence, CPT is “an effective PTSD treatment with lasting benefits across a range of outcomes.”
According to the American Psychological Association (APA), this therapy is strongly recommended for PTSD.
Prolonged exposure therapy
Prolonged exposure (PE) is a behavioral treatment for PTSD that, as the name suggests, involves confronting the source of your fear to reduce anxiety around it.
Avoidance is a prominent symptom of post-traumatic stress. PE therapy aims to help you overcome avoidance that developed after your trauma.
During therapy, you’ll learn to control your breathing, talk about your trauma, and gently confront your fear in the real world. For example, someone who lived through sexual assault might go back to the location where it occurred to help them realize that the trauma is no longer happening and that they are now safe.
“The more we avoid the feelings, thoughts, sensations, memories, and images that are connected to our trauma, the worse the symptoms of trauma become,” explains Avigail Lev, PsyD, a licensed clinical behavioral therapist, author, and director of the Bay Area CBT Center in California.
“So the most important part of treating trauma is exposing individuals to the feelings, thoughts, sensations, memories, places, and images connected to their trauma [because] this aids in the process of desensitization.”
According to the APA, PE therapy is strongly recommended for PTSD.
Trauma-focused CBT (TF-CBT) therapy is a cognitive behavioral treatment mainly used for kids and teens with trauma.
TF-CBT’s goal is to help children recognize false beliefs (such as who to blame for abuse), correct unhealthy behavior patterns, and develop new ways to cope, such as self-soothing and expressing their emotions. Parents or caregivers are also involved in this approach.
A 2014 review concluded that TF-CBT could effectively reduce symptoms of PTSD in some children, and the APA strongly recommends forms of CBT for treating PTSD.
Eye Movement Desensitization and Reprocessing (EMDR) is a trauma therapy developed by psychologist Dr. Francine Shapiro in 1987. The therapy is unusual in that it doesn’t involve much talking — it aims to help you process and release traumatic memories through eye movements.
In an EMDR session, your therapist will ask you to hold a specific aspect of a traumatic event in mind while you focus on their hand moving back and forth (or, sometimes, rhythmic tapping).
The aim is to help your brain “reprocess” the memory — which wasn’t fully processed at the time due to overwhelming stress — by engaging both sides of your brain (known as bilateral stimulation).
This reprocessing aims to release the memories, ultimately relieving nightmares, flashbacks, and triggers.
For some people, EMDR may yield results faster than other forms of therapy, such as talk therapy.
A 2014 study by Shapiro found that 80% to 90% of people saw results within the first 3 sessions, while a 2017 review found it to be just as effective as cognitive behavioral therapy (CBT).
Note that EMDR appears to work best for single-event trauma, and it may not be as effective for complex trauma or complex PTSD.
According to the APA, EMDR therapy is a conditionally recommended treatment for PTSD.
Traumatic memories are held in the body as well as the mind. Somatic therapy focuses on how your emotions can physically impact the body. These emotions can resurface suddenly if you encounter a trigger or something that reminds you of a trauma.
Somatic therapy aims to “release” pent-up trauma to relieve mental health symptoms and chronic pain, using methods such as developing body awareness and grounding in your body.
A 2017 study found that somatic experiencing — talking through past traumas while exploring the body’s physical responses and sensations — was an effective treatment for PTSD.
In psychodynamic therapy, your therapist will help you understand how your past has affected your current emotions, behaviors, and relationship patterns.
The aim is to help you understand the unconscious motives that drive your behavior.
Your therapist may help you understand how early childhood experiences, family dynamics, and current relationships — which may be shaped by trauma — affect your current coping methods and beliefs about the world.
According to a 2008 review, psychodynamic approaches in trauma therapy can lead to:
- improved self-esteem
- using more helpful coping methods, and fewer unhelpful coping methods
- improved relationships
- better social functioning
The authors note that psychodynamic approaches may be especially helpful in treating complex PTSD.
Other therapeutic techniques for trauma
While the therapy techniques above have received the most research attention, trauma therapists may also draw on other therapeutic methods.
Additional therapies and techniques that can help you heal from trauma include:
Accelerated resolution therapy
The Substance Abuse and Mental Health Services Administration (SAMHSA) recognized accelerated resolution therapy (ART) as an evidence-based treatment for trauma-related disorders in 2015.
The technique aims to help you find relief from trauma faster than other treatments for PTSD by helping you “reprogram” how your brain stores your traumatic memories in one to three sessions. ART builds on other techniques, such as EMDR.
Hypnotherapy is a popular alternative for people who have struggled with other therapy types, like EMDR or CPT.
In hypnotherapy, a therapist places you into a trance-like stance, where you’re awake and aware but relaxed and able to shut out distractions. Then, they work to reduce the emotion attached to the event.
“It can help release the emotional grip of trauma as it brings the subconscious fears, thoughts, and experiences to a conscious level,” explains Maria Micha, psychotherapist and clinical mental health counselor.
“Humans can’t access their subconscious mind and alter the terror that is ‘tattooed’ on that level. Techniques such as hypnotherapy can help release and replace the traumatic experience with functional thinking and mental patterns,” she adds.
A 2013 review suggests that hypnotherapy could help reduce PTSD symptoms.
Narrative therapy is a newer treatment approach in which your therapist will help you “re-author” your story to give your experiences meaning and shape how you see yourself and the world you live in.
This technique could help with various mental health issues. It can help you challenge beliefs you hold about yourself following trauma, such as feeling “broken” or powerless to change your circumstances.
For example, says Micha, “I ask my clients to rewrite their narrative of the traumatic event until the trauma has no emotional hold on them.”
According to the APA, narrative therapy is a conditionally recommended treatment for PTSD.
Internal family systems therapy
Internal family systems (IFS) is a type of talk therapy developed by therapist and academic Richard Schwartz, PhD.
The theory holds that your personality comprises different “parts,” each with its characteristics. All parts are held by the “Self,” or your core consciousness. So, like a family has different members, your personality has different parts, too, and all of them want what’s best for the self.
Your therapist will help you get to know your different parts during sessions. Some parts may be more affected by trauma than others. The aim is to understand why some parts are hurting and learn how to help them with compassion rather than ignore or exile them.
Art and music therapy
Art therapy can help boost mental health and support healing from trauma. It can take many forms, including dance, drama, music, writing, and creative art.
“I find art therapy very helpful in trauma therapy as the subconscious mind will often reveal the fearful patterns effortlessly,” explains Micha. “Clients are often surprised with the drawings they produce, as art will reveal suppressed subconscious emotions and fears.”
Music therapy, meanwhile, can focus on helping people ground themselves by writing songs or compositions to create affirmations and regulate their thoughts or emotions.
“Musical improvisation can help clients nonverbally explore traumatic experiences as the speech center of the brain can shut down during a traumatic flashback,” explains Kyle Fleming, a board certified music therapist and founder of a mental health practice in Illinois devoted to this type of therapy.
Inner child work
Also known as inner child healing, inner child work is a therapy that may help you heal from childhood trauma. For example, Micha usually uses it toward the end of trauma therapy with a client.
It involves “getting in touch” with your inner child to feel how you felt at various ages and working to heal your inner child’s wounds by creating the safe, secure inner and outer environments you needed as a child.
“It can help people overcome any feelings of guilt or shame they may be holding onto from childhood,” explains Jessica Pedersen, a licensed and certified clinical hypnotherapist.
Trauma systems therapy
Like trauma-focused CBT, trauma systems therapy (TST) is designed for children, adolescents, and teens.
This therapy emphasizes the person’s emotions and actions. It also considers the role that a threatening social environment or system of care can play in keeping a young person in a dysregulated state.
Most therapists will use various techniques to treat patients’ traumas rather than only one modality. And the methods they use often depend on what works for you.
“A great deal of [therapy intervention] success depends on the belief system of the clients and how ready they are for such interventions,” explains Curtis. “If a client is resistant or apprehensive about an approach, it could do more harm than good to insist on a particular technique.”
It’s also important to remember that a big part of therapy is your relationship with your therapist. In the end, it’s essential that you feel safe with your therapist.
“Ask questions about the therapists’ experience, approach, and training,” Fleming recommends, “and if something feels ‘off,’ feel free to find a new therapist. It does you no good to stick with the first therapist you meet if you feel uncomfortable with them or their approach.”
There’s always another therapist who’s willing to try other techniques that feel more comfortable for you. If you need help finding one, you can check out Psych Central’s Find a Therapist resource page.