CBT for PTSD: How It Works, Examples & Effectiveness

Cognitive behavioral therapy (CBT) for PTSD helps people understand unhealthy thought processes and emotions brought on by their trauma. By understanding the underlying causes behind their reactions, CBT can lessen the negative effects of panic and make these reactions less severe.¹ CBT is a short-term weekly therapy option, with 12-20 sessions lasting about 50 minutes each.

Set S.M.A.R.T. Goals

S.M.A.R.T. goals are set by the individual with the help of their therapist, and stand for:

• Specific: The individual knows exactly what it is they want to accomplish. The goal is clearly defined.
• Measurable: The individual will know if progress is being made and when they have achieved their goal.
• Attainable: The individual has the skills and resources necessary to reach the goal.
• Realistic: The individual will devote their time and energy into accomplishing it.
• Time-specific: The therapist helps decide on an appropriate time frame for completing the goal.

Failure is more likely to occur when an individual does not set reasonable and realistic goals that are unattainable given their skill level or time frame. A qualified CBT therapist can help ensure you are setting S.M.A.R.T goals to increase the likelihood of achieving them.

Stress Inoculation Training

Stress inoculation training for PTSD can be provided independently or with other treatments. It focuses on teaching coping techniques to help lower anxiety when experiencing stress-related stimuli in PTSD. Healthier coping techniques, such as breathing sessions, progressive muscle relaxation skills, and communication skills are used to increase clients’ ability to cope during times of stress or triggers.^2,3

Meditation

When used in combination with CBT, meditation for PTSD can offer similar results as using medication, according to one study. Meditation helps lower stress levels, reduce intrusive thoughts, and improves mood.⁴

Journaling

Journaling about your trauma offers many benefits. People who repress and suppress emotions often end up with depression, anxiety disorders, or chronic illness. Journaling in a notebook or using a journaling app is a form of cathartic release that allows you to release trauma stored in the body.

Activity Scheduling

Giving yourself rewards for scheduling activities that encourage you to practice self-care can help motivate yourself to complete other tasks even when you’re feeling depressed or overwhelmed by your symptoms. Activity scheduling ensures you participate in positive experiences and gives you something to look forward to, hopefully making it easier to continue completing necessary tasks throughout each day.

Exposure Tasks

Individuals with PTSD sometimes avoid situations that increase anxiety. Gradually exposing yourself to these situations helps limit avoidance, build your confidence, and reduce anxiety. It is recommended that you face feared situations a little at a time, building up to more intense situations that you avoid most.^5,6

Examples of Cognitive Behavioral Therapy for PTSD

CBT therapy for PTSD can look different depending on an individuals’ symptoms and type of PTSD. Everyone experiences mental health differently and PTSD is no exception.

Here are a few examples of cognitive behavioral therapy for PTSD:

CBT for PTSD in a Veteran

Jamie, a 36-year-old Iraq war veteran, seeks veteran mental health services for having symptoms of PTSD for the past six and a half years. He continuously avoids thoughts, memories, or images that could be connected with the experience of his fellow unit members and himself driving over an explosive device while traveling to another base.

Jamie reports a history of difficulties attending work for a number of days out of the week, repeated nightmares of the event, higher levels of depressive moods along with some irritability, and difficulty feeling connected with his spouse and other family members.

Jamie attends 16 sessions of cognitive behavioral therapy with a focus on prolonged exposure to help him process symptoms of PTSD in veterans. During these sessions, the therapist assigns Jamie weekly homework assignments to regularly practice coping skills.

The therapist encourages Jamie to journal his anxiety levels each day to increase awareness of stress, anxiety, and other symptoms. In doing so, Jamie’s therapist hopes he will increase self-expression about how he is feeling to be able to rely both on himself and a support system. This helps Jamie to monitor and reduce the impact of his symptoms by becoming aware of his warning signs and the need to initiate his coping skills.

CBT for PTSD From Witnessing Violence

Sarah, a 22-year-old who witnessed her younger brother’s murder by gunshot, has been experiencing symptoms of PTSD for 3 years. She has recurrent nightmares of the murder, and she avoids the place where her brother died and thoughts about her brother’s death. She reports continuous increasing ruminative thought and guilt surrounding her lack of protection of her brother, as well as irritability and depression throughout the year.

Sarah’s PTSD symptoms have begun to seriously impact her work and family relationships. After being assessed for comorbid symptoms of grief and depression in addition to PTSD, Sarah would benefit from about 12 sessions of a combination of CBT and cognitive processing therapy.

Sarah begins seeing a therapist. Her therapist begins challenging her in each session to use healthier thinking patterns and to engage in coping techniques. When Sarah’s anxiety levels rise, the therapist helps her by pointing out the unhealthy thought or increased stress response and allowing her time to practice restructuring her thoughts and engaging in a breathing activity or to relax her muscles.

Sarah’s therapist also assigns her weekly homework of journaling her anxiety and symptom levels; she is encouraged to keep practicing thought restructuring and coping mechanisms outside of sessions and to log them as well. As Sarah and her therapist work on these tasks together, Sarah begins to communicate more about her emotions and become more aware of how blaming herself impacts her thoughts.

CBT for PTSD Caused by Abuse

Bill, a 40-year-old who was physically abused by his parents until he was 18, reports a history of PTSD symptoms beginning in his early 20’s. He experienced a heightened startle reflex to any sudden movement, avoidance of talking about the abuse he experienced, constant tenseness in his body, and significant anger with people in his life.

At around 17 years old, Bill began drinking alcohol to cope with the abuse he was experiencing at home. This led to alcohol charges for a minor for which he was placed in juvenile detention. He now drinks daily, generally at least twelve 16-oz cans of beer in a day, and has been arrested for disorderly conduct. He works infrequently but in the last three months has been unsuccessfully attempting to cut back on drinking and find regular work.

Bill agrees to complete an assessment with a local therapist who is trained in trauma and substance use treatment. The therapist diagnoses Bill with PTSD and an alcohol use disorder and informs Bill that they would like to try applying acceptance and commitment therapy (ACT) in their sessions. Bill’s therapist helps him by encouraging him to accept feelings or thoughts that come up during sessions. The therapist hopes Bill will begin to develop skills to do this at home, becoming accepting of himself in and out of session.

Bill and his therapist practice mindful meditation and muscle relaxation in each session, especially if Bill’s therapist notices that he’s tense, talking about drinking cravings, or having difficulty calming his anger and anxiety in session. Over time, the therapist helps Bill to become more comfortable talking about the events of his past and his feelings.

Bill begins to regularly engage in coping techniques independently in and out of session; he has begun to engage in more healthy self-expression instead of letting his anger explode onto others, and reduced his drinking as his avoidance symptoms have decreased through the use of coping techniques.

How Does CBT for PTSD Compare With Other Therapies?

You may have a stereotypical idea of what therapy is like that involves laying on the couch and talking about your childhood. In this form of psychoanalytic or psychodynamic therapy, the therapist examines your past to gain a better understanding of your unconscious psychological patterns.  CBT for PTSD is different from other forms of therapy because it’s a short-term approach that emphasizes the present over the past, and includes practical exercises to reinforce what you learn during sessions.

Types of CBT Used to Treat PTSD

While standard cognitive behavioral therapy is a common therapy style for treating PTSD, there are subtypes of CBT that may work better for some people.

The following therapy options are also common treatments for PTSD:

Trauma-focused CBT

Children between the ages of 3 and 18 who have experienced trauma benefit from trauma-focused cognitive behavioral therapy (TF-CBT). TF-CBT is specifically designed to address childhood trauma and involves collaboration and support from the child’s parents, caregivers, or family members as part of the treatment.

Like other forms of CBT, it is a short-term, structured therapy, with sessions lasting about 60 minutes and participants attending 8-25 sessions. Sessions are divided equally between child and parent or caregiver.

Exposure Therapy

Those experiencing PTSD may engage frequently in avoidance of people, places, sounds, and other things that remind them of their previous trauma. Exposure therapy introduces individuals to increasing levels of the stress-related stimulus. They will begin to learn how to cope with these until their anxiety levels lower and, ideally, become non-existent when confronted with the stimuli. Research indicates that  exposure therapy can be effective in reducing PTSD symptoms, especially in lowering panic and anxiety symptoms and increasing the individual’s ability to cope with stress-inducing situations.

Cognitive Processing Therapy

Cognitive processing therapy (CPT) is a form of CBT specifically for people with PTSD. The primary difference is CPT was created specifically for treating PTSD.Individuals are encouraged to consider how the event happened and how it changed their thoughts. They are challenged to consider the factual basis of these thoughts or if they have formed negative or maladaptive thoughts as a result.^7,8,9

Eye Movement Desensitization & Reprocessing (EMDR)

Eye movement desensitization and reprocessing (EMDR) is a newer treatment in the CBT world that focuses on talking about the traumatic event or memories, processing this information, and giving attention to a back and forth movement with the eyes. EMDR and CBT have some things in common but EMDR for PTSD uses a form of movement like directing eye movements from one side to the other to stimulate the brain to reassess and process trauma. The purpose is to match the way you mentally process memories unconsciously to help reduce the amount of stress and anxiety related to the memories.^1,10,9,11

Acceptance & Commitment Therapy (ACT)

Acceptance and commitment therapy is a newer model of CBT. It focuses on acknowledging and accepting one’s thoughts and emotions surrounding the stress-related stimuli and memories of the traumas instead of necessarily controlling or challenging one’s thoughts.

While it does involve CBT techniques, ACT reduces the power that the trauma event has on the individual. ACT is an offshoot of mindfulness-based and CBT-based specific treatments that continues to be developed. Mindfulness techniques help to provide coping skills to reduce anxiety related to PTSD.^1,3,79

Narrative Therapy

Narrative therapy can be helpful in allowing someone to tell the story of their trauma and the context around it. In turn, it can help by allowing the individual to take ownership and re-write their own story in such a way that they can heal, increase feelings of self-esteem, and increase post-trauma growth and understanding.¹²

There are also several alternative and complementary therapies that can help someone process difficult flashbacks and emotions, like brainspotting and EFT tapping.

Is CBT for PTSD Effective?

Cognitive behavioral therapy for PTSD research continues to grow and it is one of the most widely-researched psychotherapy treatments. CBT for PTSD is effective in short- and long-term approaches for a variety of populations, ranging from PTSD in young children to older adults.^2,14

Here are several studies highlighting the effectiveness of CBT for PTSD:

• Studies show CBT is as effective as several other therapy types, and research indicates that it has been culturally validated across a variety of populations.¹⁴
• Compared to a placebo, CBT was reported to be moderately helpful in treating anxiety-related disorders. The researchers did note that drop out rates were higher in PTSD samples, especially in the exposure therapy group, which infers a need for more specialized types of CBT for PTSD.¹³
• Research shows CBT can be an appropriate, safe, and helpful intervention in the presentation of acute and chronic PTSD for people of any age.¹⁴
• Research noted a significant improvement and significant reduction in symptoms of PTSD, in addition to feelings of depression and anxiety.¹⁵
• Clinical trial results ranging from 1980 to 2005 show CBT was equal to exposure therapy and cognitive processing therapy in reducing PTSD symptoms and maintaining healthy behaviors.¹⁶

What to Expect During CBT Treatment for PTSD

“Starting cognitive-behavioral therapy for PTSD involves foundational sessions where you and your therapist work to understand your experiences. It’s a time to share your story and assess its effects on your thoughts, feelings, and behaviors. This understanding is critical for identifying where CBT will be most effective, including recognizing cognitive distortions specific to you, laying the groundwork for targeted therapy.” – Raul Haro, LMFT, RN, Pathways Recovery Center

“The next phase in cognitive behavioral therapy (CBT) for PTSD includes developing a personalized action plan with your therapist, who acts as a guide. This plan aims to differentiate specific challenges and employs CBT methods to mitigate their impact. Strategies may involve gradually reducing fear responses through exposure therapy, enhancing emotional regulation skills, or altering perceptions of traumatic events. The approach outlines recovery steps, remaining flexible to adapt to progress yet structured enough to ensure no essential steps are missed.” – Heather Wilson LCSW, LCADC, CCTP, Epiphany Wellness

How to Find a CBT Therapist for PTSD

Choosing a therapist can be challenging, but an online directory can be a good place to start, or you can ask your primary care provider for a referral. There are several online therapy options that take insurance. However, Online-Therapy.com is an excellent choice for those without insurance. You can also work with an online psychiatry service for medication management.

5 At-Home CBT Exercises for PTSD

While it’s always best to find a licensed CBT therapist if you’re experiencing PTSD symptoms, the therapist may recommend some at-home exercises to keep your symptoms under control.

Here are five CBT exercises you can use at home to reduce symptoms of PTSD:¹⁷

1. Try Practicing Cognitive Restructuring on Your Own

It can be helpful to challenge or reframe your thinking (called cognitive restructuring) in the moment on a regular basis. It can be difficult, but it’s important to challenge negative thoughts as they come up. You can also start to notice when these thoughts come up to learn what may be triggering your PTSD symptoms.

2. Practice the ABC Technique

The ABC Model allows you to explore more about how or where a negative or maladaptive belief began.

Here are the first three steps:

• Identify the (A) activating event: The trigger that would lead to a significant emotional response or maladaptive thinking
• Identify the (B) belief: The negative thought that you experienced during this trigger or event
• Identify the (C) consequences: The negative emotions or actions that happened as a result of A & B

This gives you the chance to challenge your interpretation of the trigger or belief that influenced the consequences. By engaging in this practice in a journal, you can actively track the cognitive restructuring in a more structured manner, giving you the opportunity to challenge a belief or emotional response that may have started following a traumatic event.

3. Journaling

As a follow up, keeping a journal of your thoughts, feelings, and behaviors each day may be helpful. Through journaling about trauma and monitoring your thoughts and  beliefs, you may begin to learn more about yourself, about the ABC’s that may be a trigger for your PTSD symptoms. You may also identify ways that have helped manage your symptoms in the past.

4. Meditation & Progressive Body Relaxation

PTSD symptoms may cause you to struggle with constant tenseness in your body that you feel like you can’t release. By engaging in guided meditations for PTSD, guided breathing, grounding exercises, or guided progressive relaxation, you should be able to relax your body and maybe even your anxiety levels, especially if you’ve recently experienced a trigger.

5. CBT Apps for PTSD

You can strengthen your CBT skills at home using CBT apps like Sanvello, Happify or Wysa.

CBT for PTSD Infographics