Cognitive Behavioral Therapy for Post-Traumatic Stress Disorder

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counseling session for PTSD
Learn about cognitive behavioral therapy for post-traumatic stess disorder (PTSD CBT). Getty/E+/clearstockconcepts

Cognitive Behavioral Therapy for PTSD

Cognitive behavioral therapy (CBT) is one for of psychotherapy that have been found to be effective for people coping with post-traumatic stress disorder (PTSD) as well as other psychological problems. So what exactly is CBT, how effective can it be with or without other treatments, and what can you expect?

The Basis of CBT

CBT treatments are based on the idea that psychological problems arise because of the way we interpret or evaluate our situations, thoughts, feelings, and behaviors.

How Psychological Problems Develop

Describing the philosophy behind CBT is easiest with using an example.

Let's say a spider bit you when you were a kid, and since then you've considered all spiders dangerous. By viewing all spiders this way, you probably feel anxious and afraid whenever you see one, no matter how big or small it is.

Because of your fear, you're careful to avoid spiders. Of course, you might be able to lead a very happy life by avoiding all spider contact. However, you can't always avoid what you fear.

For example, let's say you're invited to a picnic by some friends you like a lot and haven't seen for some time. You're excited to see them until you discover the picnic is being held in a wooded area where there may be—spiders! You're so worried that a spider may bite you, you decide not to go, and end up feeling sad.

As you can see from this example, fear and avoidance can easily keep you from living a fulfilling and positive life.

How Psychological Problems Progress

Sometimes even the thought of something you fear may cause anxiety. Using the spider example again, let's say that you fear spiders and you hear a story about someone who was bitten by a spider while sleeping. You may start to worry about the risk of going to sleep at night and being bitten while you're defenseless in bed.

If you worry enough, you may not get the sleep you need. At this point it becomes "the fear of the fear" in a way that becomes disabling.

Worries like these can be exhausting, and unfortunately, we can't avoid our thoughts. Yet people keep on trying. Maybe you've tried to distract yourself from upsetting thoughts by, say, reading a book or magazine. This can work pretty well if your thoughts aren't deeply distressing.

But if you have PTSD, chances are you know that something so simple can't protect against traumatic thoughts or memories, such as those that occur in PTSD. Some people with PTSD may turn to more extreme and even unhealthy strategies, such as drinking or abusing drugs. These distractions may briefly help people forget, but the upsetting thoughts always come back, usually with even greater intensity. In addition, substance abuse can cause a host of other health and psychological problems.

How Can PTSD CBT Help?

The goals of PTSD CBT include:

    What Happens in PTSD CBT?

    A cognitive behavioral therapist may use a number of CBT techniques to help people with PTSD, including:

    • Self-monitoring
    • Cognitive restructuring
    • Behavioral experiments

    Let's take a look at each of these separately.


    The therapist may first have you track (self-monitoring) and possibly write down the thoughts you have in response to certain situations, especially those that cause you anxiety or other upsetting feelings. This technique is designed to help you become more aware of how you evaluate your experiences and their consequences, such as anxiety.

    Cognitive Restructuring

    After you've developed your evaluations, the therapist may help you gather evidence for and against them and consider how true they actually are.

    Through this cognitive restructuring technique, you may come to realize that:

    • Your evaluations and the ways you interpret situations are not entirely accurate. 
    • Although your thoughts may often feel true, they may not be based in fact.

    Using the spider example, you may come to realize that it is actually quite rare for spiders to bite and, in fact, many spiders are not dangerous. This realization should lower your anxiety about spiders. It may also make you less likely to avoid enjoyable situations where spiders might be present, such as the picnic with your friends.

    Behavioral Experiments

    You may take part in behavioral experiments that involve having you "test out" your new ways of looking at the world. To do this, you go into situations where you contact things you once feared, such as spiders. When you don't have any bad consequences, such as being bitten, you can see for yourself that your former thoughts were not as accurate as you believed.

    Who Can Benefit From CBT?

    CBT has been successful in treating a range of psychological problems besides PTSD, such as anxiety disorders, depression, eating disorders, and alcohol and drug abuse problems. But CBT may not be right for some people. Reasons for this include:

    • Highly Structured Sessions. CBT sessions are usually highly structured with specific goals for each session which is structured to meet them. You may like this amount of structure while someone who wants to do more self-exploration in therapy doesn't, or vice versa.
    • Time Limitations. Many CBT sessions may last only a certain number of weeks, after which you're expected to have gained enough skills to continue on your own. This works well if you have a single issue to work through. However, this short-term focus may not meet your needs if you're looking for longer-term support.

    Bottom Line on Cognitive Behavioral Therapy for PTSD

    As you can see, it's important to explore and learn as much as you can about the different types of CBT treatments available. That's the best way to find the one that meets your needs. You may also be interested in learning more about PTSD CBT techniques such as cognitive processing therapy, and seeking safety.


    Barlow, D.H. (2014). Clinical handbook of psychological disorders. 5th Edition. New York, NY: Guilford Press.

    Sin, J., Spain, D., Furuta, M., Murrells, T., and I. Norman. Psychological Interventions for Post-Traumatic Stress Disorder (PTSD) in People with Severe Mental Illness. Cochrane Database of Systematic Reviews. 2017. 1:CD011464.