PTSD

What is PTSD?

Post-traumatic stress disorder (PTSD) develops when the normal process of recovering from a traumatic experience becomes stuck. After a trauma, it is common to experience distressing memories, heightened alertness and difficulty sleeping. For most people, these reactions gradually settle over the weeks that follow. In PTSD, the brain has not been able to process the traumatic memory properly, so it continues to intrude into the present as though the danger is still real.

Trauma can take many forms. It may involve a single event such as an accident, assault or natural disaster, or it may involve prolonged or repeated experiences such as abuse, domestic violence, combat or working in high-risk environments. Complex PTSD can develop following sustained or repeated trauma, particularly in childhood, and often involves additional difficulties with emotional regulation, self-identity and relationships.

PTSD is not a sign of weakness. It is a normal psychological response to abnormal events. The brain’s threat detection system has become stuck in a protective mode, continuing to sound the alarm long after the danger has passed. The good news is that trauma-focused therapies can help the brain process the memory properly, reducing the intensity of symptoms and helping you reclaim a sense of safety and control.

Symptoms of PTSD

PTSD symptoms typically fall into four clusters:

• Re-experiencing: intrusive memories, flashbacks, nightmares, intense distress when reminded of the event, physical reactions such as sweating or a racing heart when triggered. Flashbacks can feel as though you are reliving the event in the present moment, with the same sensory detail and emotional intensity as the original experience.
• Avoidance: steering clear of people, places, activities or conversations that remind you of the trauma, emotional numbing, feeling detached from others. Avoidance can become increasingly restrictive over time, limiting your ability to engage fully with life.
• Hyperarousal: being constantly on edge, difficulty sleeping, irritability or anger outbursts, difficulty concentrating, an exaggerated startle response, hypervigilance. Your nervous system remains in a heightened state of alert, as though scanning for danger even in safe environments.
• Negative changes in thoughts and mood: persistent negative beliefs about yourself or the world, distorted feelings of blame or guilt, loss of interest in activities, difficulty experiencing positive emotions, feeling cut off from others, a sense that the future is foreshortened

These symptoms can develop soon after the traumatic event or may not appear until months or even years later. They can fluctuate in intensity, often worsening during periods of stress or when something triggers a reminder of the trauma.

Types of PTSD

Trauma responses vary depending on the nature of the experience:

• PTSD: develops following a single traumatic event or a discrete period of trauma, characterised by the four symptom clusters above
• Complex PTSD: develops following prolonged or repeated trauma, particularly in childhood or situations where escape was not possible, and includes additional difficulties with emotional regulation, negative self-concept and relationship problems. People with complex PTSD often experience a deep sense of shame, a feeling of being permanently damaged, and significant difficulties with trust and closeness.
• Delayed-onset PTSD: symptoms that emerge months or even years after the traumatic event, sometimes triggered by a life change, additional stressor, or a period when the defences that kept the trauma at bay begin to weaken

It is also common for PTSD to co-exist with other difficulties, including depression, anxiety, panic and substance use difficulties. When this happens, your psychologist will develop a treatment plan that addresses the trauma alongside any co-occurring difficulties.

How therapy can help

PTSD is a well-understood condition with strong evidence for effective treatment. Our clinical psychologists may use:

• EMDR (eye movement desensitisation and reprocessing): a specialist trauma therapy that helps the brain reprocess traumatic memories so they no longer trigger the same intense distress. EMDR is recommended by NICE guidelines for PTSD and works by stimulating the brain’s natural information processing system through bilateral stimulation, typically eye movements, while you focus on the traumatic memory.
• Trauma-focused CBT: a structured approach that helps you process the traumatic memory, challenge unhelpful beliefs about the trauma, such as excessive self-blame, and gradually reduce avoidance behaviours that are keeping the PTSD going
• Compassion-focused therapy (CFT): addresses the shame, self-blame and self-criticism that frequently accompany trauma, helping you develop a more compassionate relationship with yourself and your experiences
• Schema therapy: particularly relevant for complex PTSD, working with the deeper patterns and beliefs that develop following prolonged or childhood trauma, including difficulties with trust, emotional regulation and self-identity
• Stabilisation and grounding techniques: skills to help you manage flashbacks, dissociation and emotional overwhelm, often an essential first step before deeper trauma processing

The choice of approach depends on the nature of your trauma, whether it was a single event or prolonged, how recently it occurred, and what other difficulties are present. Your psychologist will discuss the options with you and explain why a particular approach is recommended.

Our approach

At The Online Psychologists, we understand that trauma is deeply personal and that seeking help requires courage. We take a careful, phased approach to trauma therapy, ensuring that you feel safe, supported and in control throughout the process.

All of our psychologists are HCPC-registered clinical psychologists with specialist training in trauma and PTSD. When you contact us, we take the time to understand the nature of your difficulties before matching you with a psychologist who has the right expertise for your particular presentation. This personalised matching is especially important in trauma work, where the therapeutic relationship and the therapist’s specialist knowledge both play a crucial role in outcomes.

Our therapy is delivered online via secure video sessions. For many people with PTSD, being able to access therapy from a safe, familiar environment is a significant advantage. It removes the need to travel to an unfamiliar clinic, which can itself be a source of anxiety, and gives you more control over your surroundings during sessions.

We draw on evidence-based approaches including EMDR, trauma-focused CBT, CFT and schema therapy. For complex PTSD, we typically take a phased approach, beginning with stabilisation and emotional regulation before moving into trauma processing. This ensures that you have the skills and resources to manage the difficult emotions that can arise during the reprocessing phase.

What does PTSD therapy involve?

Trauma therapy is a structured process, but it is always adapted to your individual needs and readiness. Here is what you can typically expect.

Assessment. Your psychologist will begin by gathering a thorough understanding of your experiences, your symptoms and how they are affecting your life. This is done sensitively and at your pace. You will not be asked to describe the trauma in detail during the assessment. The aim is to understand the pattern of your difficulties, assess your current coping strategies, and develop a shared formulation that guides the treatment plan.

Stabilisation and preparation. Before any direct trauma processing begins, your psychologist will ensure that you have the emotional resources and coping skills to manage the work ahead. This phase might involve learning grounding techniques to manage flashbacks or dissociation, developing strategies for emotional regulation, and building a sense of safety in the therapeutic relationship. For some people, this phase is brief. For those with complex PTSD or limited current coping resources, it may take longer, and that is entirely appropriate.

Trauma processing. The core phase of therapy involves processing the traumatic memory so that it no longer dominates your present-day experience. In EMDR, this involves focusing on the traumatic memory while engaging in bilateral stimulation, allowing the brain to reprocess the memory and integrate it in a less distressing way. In trauma-focused CBT, this may involve creating a detailed narrative of the trauma, working through the memory to update the meaning you have attached to it, and gradually confronting avoided situations.

Between-session work. Your psychologist may suggest tasks between sessions, such as practising grounding or self-soothing techniques, keeping a brief symptom diary, or gradually re-engaging with activities you have been avoiding. Between-session work is always discussed collaboratively and adapted to where you are in the process. It is designed to support and extend what happens in sessions, not to overwhelm you.

Integration and ending. As your PTSD symptoms reduce, the focus shifts to integrating what you have learned, rebuilding areas of life that the trauma has affected, and developing a plan for managing any future challenges. Therapy for trauma is not about forgetting what happened. It is about ensuring that the past no longer controls your present.

Frequently asked questions

How long does PTSD therapy take? For single-event trauma, EMDR or trauma-focused CBT often produces significant improvement within 8 to 16 sessions. Complex PTSD, where the trauma was prolonged or occurred in childhood, typically requires a longer course of therapy, sometimes 20 to 40 sessions or more, to allow for adequate stabilisation and processing. Your psychologist will discuss expected timescales with you during the assessment.

Can EMDR work online? Yes. EMDR has been successfully adapted for online delivery and research supports its effectiveness in this format. Your psychologist will guide you through the bilateral stimulation process via video, often using on-screen visual cues or self-administered tapping. Many clients find online EMDR just as effective as in-person sessions.

What if I cannot remember the trauma clearly? This is common and does not prevent effective treatment. Traumatic memories are often fragmented, non-linear or partially blocked. EMDR and trauma-focused CBT can work with whatever memories are available, including sensory fragments, emotional memories and bodily sensations. You do not need a complete, chronological account of what happened for therapy to be effective.

Will therapy make me feel worse before I feel better? It is possible that engaging with traumatic memories may temporarily increase distress, and your psychologist will be honest with you about this. However, the stabilisation phase of therapy is specifically designed to ensure you have the resources to manage this. Your psychologist will work at your pace and will never push you to engage with material you are not ready for. The temporary discomfort of processing is part of the path to lasting recovery.

When to seek help

If you are experiencing intrusive memories, nightmares, avoidance or persistent hyperarousal following a traumatic experience, professional support can help. There is no minimum threshold of severity, and no type of trauma is too minor to warrant help. If what happened is still affecting you, that is reason enough to seek support. Early intervention is beneficial, but PTSD also responds well to treatment even years or decades after the original event. It is never too late to get help.