8 Psychotherapy8.2 Cognitive behavioural therapies
8.2.4 Trauma-focused therapy and complex PTSD
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Written by Resident Doctor Committee · Published
New in the 2027 syllabus
The College added this topic for exams from January 2027.
What you are treating
Post-traumatic stress disorder (PTSD) has three core features after trauma: re-experiencing, avoidance and a persisting sense of threat. Together these impair daily life.
Complex PTSD adds lasting problems with emotional regulation, a negative self-concept and relationships. Treatment tackles these alongside the PTSD symptoms.
Trauma-focused CBT
Trauma-focused cognitive behavioural therapy (CBT) works directly on trauma memories, appraisals (the meanings the person gives the trauma) and avoidance. It follows a validated treatment model.
Eye movement desensitisation and reprocessing
Eye movement desensitisation and reprocessing (EMDR) is a structured treatment given in phases. The person recalls selected traumatic material during bilateral stimulation, meaning stimulation that alternates between left and right. Eye movements are the usual method, with taps or tones as alternatives when appropriate.
Preparation: agree a shared explanation of the problem, set up ways of managing distress and plan support between sessions.
Processing: work on the distressing memory, its meanings and the bodily responses linked to it, followed by closure and review.
NICE guidance recommends offering EMDR to adults who present more than three months after non-combat trauma. It can be considered between one and three months if the person prefers it.
Adapting treatment for complexity
Task | What it addresses |
|---|---|
Stabilisation and preparation | Current safety, coping, engagement and anything getting in the way of treatment |
Trauma processing | Memories, meanings, avoidance and persistent threat |
Recovery and reconnection | Relationships, roles, valued activity and future coping |
The stages are not rigid. Tasks may overlap and come back again. Not every patient needs the same long stabilisation period before trauma-focused work.
Complex needs may mean more time to build trust and to address dissociation, emotional dysregulation, substance use or insecure living circumstances.
Coexisting substance misuse is not, on its own, a reason to exclude someone from PTSD treatment.
When there is risk to the patient or to others, safety planning runs alongside treatment.
Monitoring
Review PTSD symptoms, functioning, progress towards the person's goals, and whether treatment is increasing unsafe behaviour or causing sustained deterioration.
Therapists need training in the chosen trauma treatment and supervision. They should be able to adapt the pace without dropping the treatment's active components.
Psychological debriefing that requires early, detailed recounting of the trauma is not recommended, either to prevent PTSD or to treat it.