Cognitive therapy

Cognitive therapy is very much like the positive or constructive thinking described above. Cognitive therapy helps you understand how your thoughts affect your feelings. In PTSD people have a tendency to overestimate the likelihood of trauma occurring again and feel fear. For example if the trauma followed a car accident the person may think “I will crash” or “Other drivers are careless and will hit me.” Likewise, if the trauma following being assaulted then they may think, “Other people want to hurt me” “All men are dangerous.” This is why people become anxious in situations that remind them of the traumatic situation. Other people feel shame through having shame related thoughts e.g. “I am weak because I should be able to cope with the accident.” Whilst other people feel guilty, e.g. “I should have died not .......” “It was my fault” even when there is no or little evidence that the person was to blame. There are four steps to reducing this negative thinking and feeling better:

  • become more aware of distressing thoughts
  • pay attention to the connections between your thoughts, feelings and behaviours
  • challenge (talk back to) your negative thoughts
  • Substitute positive and more realistic thoughts for negative and unrealistic ones.

Exposure Therapy

Exposure therapy is based on the principle that we get used to things that are just annoying and not truly dangerous. This is called habituation, and it occurs naturally in over 95% of people.

Exposure therapy is the opposite of how people typically respond to anxiety which is avoidance. Because while avoidance may provide temporary relief, it just doesn't last. Facing triggers for anxiety is the key to reducing the frequency and severity of PTSD symptoms.

Exposure may be done in real life or in imagination. It is believed by some that real life exposure is more effective than imaginal exposure. While anxiety or other discomfort may get worse in the first few minutes of real life exposure, it is important to continue exposure until the discomfort and anxiety has diminished. Escaping discomfort only reinforces avoidance as a coping tactic, and produces all the limitations associated with avoidance-like avoiding safe places or situations that might be fun, beneficial or essential for a career and a full family life. It also increases the likelihood that the anxiety might spread, first to similar triggers and eventually to triggers that have little or nothing to do with the original anxiety. Examples of exposure are resuming driving after being in an accident or returning to a now-safe site where an assault once occurred.

Exposure in imagination involves the person recounting traumatic memories until they lose they no longer cause excessive distress. This can be done by saying them aloud repeatedly, writing, reading and rewriting a biography of the events or recording them on a tape and playing them over and over until they are no longer distressing.

Stress Inoculation and Coping

Stress Inoculation involves learning several skills that will help you cope better with PTSD symptoms. People usually try all a range of coping techniques to determine what helps most. When PTSD symptoms strike, coping techniques are used to reduce the intensity of symptoms and the distress they create. But it is not enough to understand the principles behind these techniques; they must be practiced repeatedly until they can be employed easily and automatically-almost without thinking about them. Some people use anxiety coping techniques to help control anxiety while they do exposure therapy. For example some techniques of stress inoculation are:

  • Breathing Excercises
  • Progressive Muscular Relaxation
  • Assertiveness training
  • Rational self-talk
  • Rational self-talk
  • Graded tasks/exposure


Whilst you may be having difficulties with coping at the moment. Your therapist will help you to choose which of the above or which combination of approaches is most likely to help you. It is also important to remember that most people do improve with psychological therapy.