Different Types of Trauma-Focused Therapy for PTSD
Finding an experienced PTSD therapist is crucial for anyone struggling with the effects of trauma. Post-Traumatic Stress Disorder (PTSD) can affect every aspect of life, from relationships and work, to self-esteem and a sense of safety in the world. Trauma-focused therapies are designed to address the roots of PTSD directly, helping people process painful experiences and reduce symptoms like flashbacks, nightmares, and hypervigilance. While there is no one-size-fits-all approach, several evidence-based therapies have been shown to make a real difference. Below, we explore five key modalities that have strong research support and are widely used in clinical practice.
Trauma-Focused Cognitive Behavioural Therapy (TF-CBT)
TF-CBT was originally developed for children and adolescents, though it has also been adapted for adults. This structured, short-term therapy integrates cognitive behavioural principles with trauma-sensitive techniques. The process often involves both the child and their caregiver, recognising the importance of family support in recovery.
Core components of TF-CBT include:
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Psychoeducation about trauma and its effects.
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Skill-building, such as relaxation techniques and identifying emotions.
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Gradual exposure, often through creating a trauma narrative.
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Cognitive coping, which challenges unhelpful thoughts.
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Caregiver involvement, helping parents support and reinforce progress.
Research consistently shows TF-CBT reduces PTSD symptoms, anxiety, and depression in young people. It also helps families rebuild trust and communication after traumatic experiences. For adults, adapted versions focus more on cognitive restructuring and self-regulation, while still using gradual exposure to trauma memories.
Cognitive Processing Therapy (CPT)
CPT is a widely used therapy for adults with PTSD. It is based on the idea that trauma can create “stuck points”, rigid, often self-blaming thoughts about what happened. For example, survivors may believe “It was my fault” or “I can’t trust anyone again.”
In CPT, clients learn to identify and challenge these beliefs through structured exercises, often using worksheets and journaling. Therapists help clients examine the evidence for and against their beliefs, leading to more balanced and flexible ways of thinking.
CPT typically lasts 12 sessions and has been shown to be highly effective with veterans, survivors of assault, and people who have experienced multiple traumas. It is particularly useful for those whose symptoms are dominated by guilt, shame, or negative self-beliefs.
Narrative Exposure Therapy (NET)
NET was developed for people who have lived through multiple or prolonged traumas, such as refugees, survivors of war, or those with histories of childhood abuse. It helps individuals construct a coherent life narrative by placing traumatic memories into the broader context of their entire life story.
A hallmark of NET is the “lifeline,” a visual timeline where flowers represent positive events and stones mark traumatic experiences. Clients then tell their story in detail, moving chronologically through their lifeline. This helps integrate fragmented memories, reducing the intensity of flashbacks and avoidance.
NET is especially valued for its cross-cultural adaptability. It has been used effectively in humanitarian settings, where traditional long-term therapies are not feasible. For those who feel overwhelmed by multiple traumas, NET provides structure and a sense of continuity.
Written Exposure Therapy (WET)
WET is a brief, highly structured therapy that requires only five sessions. Each session focuses on writing about the traumatic experience for around 30 minutes, with the therapist providing guidance but not extensive discussion.
The process involves:
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Writing about the traumatic memory in detail, focusing on thoughts and feelings.
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Handing the writing to the therapist, who reads it between sessions.
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Receiving new instructions to deepen the focus in the next writing session.
Research shows WET is as effective as longer therapies like CPT, with significantly lower dropout rates. It is especially helpful for people who want a direct, time-efficient method without extensive talking. However, it may not be the best fit for those with complex trauma or multiple traumatic events.
Trauma-Informed Guilt Reduction Therapy (TrIGR)
While many PTSD therapies address fear-based symptoms, TrIGR specifically targets guilt and shame, which are often overlooked yet deeply distressing consequences of trauma. This therapy is particularly relevant for survivors who feel responsible for what happened, such as veterans, first responders, or survivors of accidents and assaults.
TrIGR involves three stages:
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Understanding guilt and shame after trauma, and how these emotions shape daily life.
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Examining beliefs, looking at what options were realistically available at the time and how judgments may have become distorted.
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Reconnecting with values, identifying what matters most and planning ways to live in alignment with those values.
By addressing moral injury directly, TrIGR helps clients move beyond self-blame and restore a sense of integrity and self-respect.
Choosing the Right Therapy
While each of these therapies has strong evidence, the best approach depends on the individual’s history, needs, and readiness. Some people benefit most from structured, short-term interventions like WET, while others require the narrative depth of NET or the cognitive focus of CPT. For children and adolescents, TF-CBT remains the gold standard. TrIGR is an important option when guilt and shame are central to a person’s distress.
Working with a trained, experienced therapist is key. Each modality offers unique strengths, but what matters most is finding a safe, collaborative therapeutic relationship that supports recovery.
Conclusion
PTSD can make life feel fragmented, unsafe, and overwhelming, but trauma-focused therapies provide a pathway to healing. Whether through cognitive restructuring, narrative integration, writing exposure, or addressing guilt and shame, these approaches give people the tools to face trauma directly and reclaim their lives. If you or someone you love is struggling with trauma, reaching out for support can be the first step toward relief and renewal.
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