Trauma-focused CBT

What is trauma-focused CBT?

Trauma-focused CBT is a structured talking therapy that helps adults process a distressing or traumatic experience so it stops intruding on daily life. It combines cognitive behavioural techniques with a focus on the trauma memory itself, and it is recommended by NICE as a first-line treatment for post-traumatic stress disorder (PTSD).

Sessions typically begin with psychoeducation, understanding why the mind and body react the way they do after a frightening or overwhelming event. From there, the work moves to processing the memory directly, often through guided recall or a written account, paced to what feels manageable. Alongside this, sessions address unhelpful beliefs that can take hold after trauma, such as ongoing self-blame or a sense that the world is now permanently unsafe, and build practical skills for managing triggers, sleep difficulties and flashbacks.

Trauma-focused CBT is a specific, structured approach rather than general supportive counselling. It follows a protocol built around the trauma memory itself, which is part of why it has been studied so extensively and why NICE is able to point to it with confidence.

When trauma-focused CBT helps

Trauma-focused CBT is suited to adults dealing with the aftermath of a single distressing event, such as a road traffic collision, an assault, a serious medical episode or a frightening birth experience. It also helps with trauma that has followed on from workplace incidents or sudden bereavement. Common symptoms include intrusive memories or flashbacks, nightmares, avoidance of reminders, feeling constantly on edge, and emotional numbness or detachment from everyday life.

You do not need a formal diagnosis to start this kind of work. A first conversation is about understanding what has happened and what support would help, not about labelling. Where symptoms are consistent with PTSD, trauma-focused CBT is one of the approaches with the strongest evidence behind it, though it is not the only option, and EMDR is also NICE-recommended for trauma and may suit some people better depending on the memory involved and personal preference.

Where trauma is longstanding, repeated or dates back to childhood, the picture is often more complex, and a first assessment will look at whether trauma-focused CBT is the right starting point or whether a different pace or approach fits better. This is a conversation, not a fixed rule, and it is worked out with you rather than assumed in advance.

If what you are dealing with includes thoughts of suicide or serious self-harm, please note that this is not a crisis service. The Samaritans are available free, any time, on 116 123, and in an emergency you should call 999 or go to your nearest A&E.

What to expect from sessions

An initial session focuses on your history and current symptoms, and on agreeing together what the work will cover and roughly how long it might take. NICE guidance for single-event trauma in adults typically points to around eight to twelve weekly sessions, though this varies from person to person and is reviewed as treatment progresses.

Nothing is rushed. You are not asked to describe everything in full detail from the first session, and the pace of working with the trauma memory is agreed with you rather than set in advance. Techniques might include imaginal reliving, where the memory is revisited in a controlled and supported way, written narrative work, or gradual, safe exposure to situations that have been avoided since the event. Between sessions, there may be short practical tasks to build on what has been covered, such as noticing and recording triggers or practising a grounding technique.

All sessions take place online by video call, which suits adults balancing work, caring responsibilities or a commute, and means the pace and privacy of the room you choose is in your control.

The evidence for trauma-focused CBT

NICE guidance on PTSD (NG116) identifies trauma-focused CBT as a first-line treatment for adults, alongside EMDR, based on a substantial body of clinical trial evidence built up over several decades. It is one of the most researched treatments for PTSD internationally, with a consistent finding that structured work on the trauma memory, rather than avoidance of it, is what allows symptoms to settle over time. Avoidance is a natural response to trauma, but it is also what tends to keep symptoms going, which is part of why a structured, paced approach to the memory is central to how this therapy works. As with any therapy, individual response varies, and progress is monitored throughout rather than assumed.

Trauma-focused CBT online for Bromley and south east London

We are clinical psychologists for Bromley and south east London, working online with adults, including people in Beckenham, Chislehurst, Shortlands, Bickley, Hayes and Petts Wood. Bromley South runs Southeastern and Thameslink services into Victoria and London Bridge in around twenty minutes, and a lot of people commuting from BR1 and BR2 postcodes are already used to fitting video calls around a working day, whether that is on a break near The Glades or at home after getting back from the station. Working online removes the need to travel to a session on top of that, while keeping the structure and pacing that trauma-focused work depends on. We will update this site as the practice develops.

Frequently asked questions

Do I need a diagnosis before I start? No. An assessment conversation is where we work out together whether trauma-focused CBT fits what you are experiencing.

What if sessions bring things up between appointments? This is common, and part of the first sessions is agreeing how to manage this, including what to do if you are struggling and, where relevant, involving your GP.

Is this only for one specific type of trauma? It can help with a single distressing event or with trauma linked to a particular period, such as a difficult birth. More complex or long-standing trauma sometimes needs a different pace or approach, which would be discussed at assessment.

Will I have to talk about everything in detail straight away? No. How much detail you go into, and when, is agreed with you rather than expected from the outset.