If I were only allowed two, plain-language sentences to explain what trauma symptoms are and how to reduce them, these would be the sentences I would offer.

1. Trauma symptoms result from the brain being overworked from being alarmed at too high of a level for too long.
2. Reduction in trauma symptoms requires “un-alarming” the brain to a low enough level, for a long enough time, for it to restore to stable functioning.

I’m anticipating that people who have found this post may have already consulted sources like the National Institute for Mental Health or the National Center for PTSD. They may hypothesize that the troubling feelings, thoughts, or actions they are having might be considered symptoms of trauma-related disorders.

[One can only view official diagnostic criteria through purchase of access to the Diagnostic and Statistical Manual of Mental Disorders (DSM–5).]

One of the leading cognitive theory-based counseling protocols for trauma disorders is cognitive processing therapy (CPT). This self-help guide is founded in CPT, with additions as noted below.

Becoming one’s own therapy provider

For various reasons, including privacy and safety concerns, or lack of access and resources, people with distressing symptoms may have come to the conclusion that they need to figure out how to become their own trauma therapists.

Auspiciously, the top, evidence-based counseling protocols for reducing trauma symptoms are based in cognitive theory. A premise of cognitive theory is that individuals learn and practice skills with a mentor, then take over as their own mentors, coaches, and cognitive therapists. One of the most heroic examples of this exchange is by the women of the Congo, many of whom could neither read nor write, who worked together using CPT in 2013.

Validating the idea that trauma therapy can be effectively self-administered, according to a CPT training I attended, a self-help CPT manual is in development.

About this guide

For people in need right now, during a period of intense, global distress, whose only access to counseling for trauma may be a mobile phone, I have attempted to, in plain language, using straight text:

1. Synthesize and distill the findings of research on what reduces trauma symptoms for most people, most of the time, most efficiently, better than other ways, and better than doing nothing.
2. Add pandemic-urgent elements to cognitive processing therapy (CPT) from other other cognitive theory-based protocols, including cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT). These additions have been found to be helpful to clients doing trauma therapy while undergoing the stressors of lockdown and the threat of severe illness or death during the COVID-19 pandemic.
3. Add the hard-won insights we gained from attempting to address trauma symptoms while isolated at home, from the distance of online-only counseling sessions.
4. Add case study data, practice wisdom, and personal wisdom from clients’ and my own experiences with engaging in therapy for trauma.

Caveats

Writing plainly and simply about recovery from trauma is difficult. This guide may not be presented as systematically and thoroughly as some might need. Self-help may be insufficient. At this time, research data is insufficient to back self-help as an evidence-based treatment for trauma symptoms. For urgent or persistent trauma symptoms, contact a health care professional.

About this post

I consider this post 1) a summary of what might be helpful, and 2) a table of contents linking to previous and forthcoming, non-sequential, trauma-related posts and pages on this site. I have attempted to be as brief and concise as possible and to use as few clinical terms as possible. I will continue to update it.

Again, if at all possible, consult a qualified, licensed counselor for individualized guidance and support.

To get started

First, consider taking one or more of these online assessments to establish a baseline for your symptoms. Then continue to take them as you begin to serve as your own cognitive therapist. These scores can create tangible data by which you can track your progress and show areas of strength and challenge. Taking any assessment comes with the caveat that expert interpretation should be done by an expert.

CPT uses these assessments:

• PHQ-9. Free, online version, registration not required. Free .pdf version. Here’s how to score it.
• PCL-5. More on scoring is here.
• The PHQ-9 and PCL-5 are both available in Cognitive Processing Therapy for PTSD: A Comprehensive Manual, Resick et al., 2017.

Other assessments in the public domain that might prove of interest:

• PC-PTSD-5. Assessment and explanation here.
• ACE Score. Assessment and explanation here.
• If you have interest in other online assessments, these from the American Psychiatric Association are in the public domain. The Society of Clinical Psychology maintains a list of assessments in the public domain. Again, consult an expert for expert evaluation.

Next, familiarize yourself with stressor-related and trauma disorders and what treats them. Consider one, some, or all of these.

• National Institute for Mental Health
• National Center for PTSD
• “A Biological Model of PTSD and CPT,” pages 10-13, Cognitive Processing Therapy for PTSD: A Comprehensive Manual, Resick et al., 2017
• “Describing Cognitive Theory,” pages 89-93, Cognitive Processing Therapy for PTSD: A Comprehensive Manual

Then, read Becoming One’s Own Cognitive Therapist.

Consider taking online training in CPT to learn CPT first-hand and to possibly pass the protocol onto others in need. Several trainings are listed on our main CPT page and are free or low-cost.

Now that we know the central role alarm plays in both developing and reducing trauma symptoms, let’s go about un-alarming our brains.

Self-administering CPT

Option 1: Comprehensive. Uses the CPT therapists’ manual.

CPT is structured to consist of 12 sessions. The first 7 sessions are considered fundamental and the last 5 offer deeper insights. Some people experience noteworthy symptom reduction in a few sessions – termed “early responders” – and complete the protocol in fewer than 12 sessions.

Although Cognitive Processing Therapy for PTSD: A Comprehensive Manual (hereafter referred to as “CPT manual”) is intended for therapists, portions are highly readable and can be used to self-administer the protocol. Sections noted below can be found by turning pages in the print version or scrolling through the electronic version.

1. Read “A Biological Model of PTSD and CPT,” pages 10-13.
2. Read “Describing Cognitive Theory,” pages 89-93.
3. Follow the directions in this CPT session outline.

Beginning with Chapter 5, which introduces Session 1, and subsequent chapters:

1. Read the goals for each session.
2. Read the sections in quotations. These are sample scripts for therapists which conveniently and succinctly summarize the central concepts of the session.
3. Read the dialogues between CLIENT and THERAPIST which provide examples of the crucial concepts highlighted in that session.
4. Study the handouts, usually collected at the end of each chapter.
5. Complete the “Practice Assignment after Session ___ of CPT,” to practice specific cognitive skills.
6. Retake assessments to track progress.

Consider using these posts to orient yourself to counseling for trauma, or to review concepts you have covered.

• Is Online Cognitive Processing Therapy for Trauma a Fit for Me?
  First attempt to summarize the mechanisms of counseling for trauma.
• How Does One Recover from Trauma Using CPT?
  Co-written synthesis by clients and counselor.
• Addressing the Return of Trauma Symptoms
  Written for people who achieved remission from post-traumatic stress disorder but have experienced a return of symptoms, possibly related to skills fatigue from on-going stressors of the COVID-19 pandemic.
• To use cognitive skills to address relationship concerns, A Formula for Relational Effectiveness may be of assistance.

Option 2: Streamlined. 

1. 1. Study the CPT session outline.
   2. Complete the components requested in the CPT session outline.
   3. Read and reread posts in the bulleted list above. They are densely written, each word chosen to convey as much information as possible without straying into simplicity or error. Do the exercises to which they link.
   4. Use this Expanded ABC Worksheet.
   5. Retake assessments to track progress.
   6. If you find this method inadequate, consider using the comprehensive option.

Option 3: Fast track.

Trauma symptoms are caused by the brain being too alarmed for too long to function stably. People with trauma symptoms frequently describe feeling as if their “brains are on fire.” This makes sense. Although an over-simplification, when people have trauma disorders, the emotion centers of the brain overwhelm the cognitive centers.

We don’t have mechanical ways of restoring cognitive centers. Medications for trauma symptoms are of limited assistance. To restore their brains to stable functioning and, thus, reduce trauma symptoms, people have to use cognitive skills – their own hearts and minds as tools – to ease the brain’s emotion centers and activate cognitive centers.

Since cognitive theory posits that thoughts cause feelings, logically, then, thoughts that cause alarm are the subject of interest. Surprisingly, beliefs about the way people should be, others should be, and the way the world should work unconsciously cause alarm. When people or situations aren’t as they’re believed they should be, this is experienced as a discordant, existential threat.

Since the brain evolved to handle reality as it is, approaching, acknowledging, and accepting reality and the human condition as they are – complex and dynamic, however, painful and sorrowful they might be – begins to restore the brain to stability.

Here’s a summary of the inner dialogue of a person using cognitive skills to ease emotion centers and activate cognitive centers. Most terms used are in the glossary and in other posts on this site.

“I am aware of an intense inner state. Let me take back my consciousness. What am I feeling? Which are my primary feelings and which are my secondary feelings? Let me feel my natural, human, primary feelings. My brain is designed to handle them. They will come and they will go. Now, what are my secondary feelings, caused by thoughts? What thoughts am I thinking to cause these feelings? Of those thoughts, which are beliefs? Which are facts? Let me follow the facts. Based on the facts, and my own values and priorities, what would be the most realistic and helpful thing to say or do next – or not say or not do?”

Use that inner dialogue over and over again. Retake assessments. Consult yourself as your own cognitive therapist. If your self-help efforts are not producing desired results, it would be realistic and helpful to consult experts who may be of assistance.

Finally

I share openly that I developed trauma symptoms after experiences of school and community violence in 2007. I worked with two psychologists using cognitive theory-based protocols, achieved remission from trauma symptoms, and became a rostered provider of cognitive processing therapy in 2019. In 2021, I experienced re-emergence of some of those symptoms, including involuntary ones. I consulted a psychologist, reviewed my training, wrote about the re-emergence of trauma symptoms here, and wrote this, the index page of a guide to help people reduce trauma symptoms.

As Marsha Linehan, Ph.D., puts it in her DBT Skills Training Manual, “People may not have caused all their own problems, but they have to solve them anyway.” I am sorry for you and for me that we have experienced these hardships. AND. We can help ourselves continue on, living as richly and consciously as we can in the time we have.

Given the intense distress that trauma symptoms can cause, in order to reduce people’s suffering, urgency is merited. I’ve imagined myself inside a train at the window. A distressed person on the platform, at the last minute, calls out to me, “I have trauma symptoms! How can I help myself?!” I’m able to answer with only a few sentences as the train pulls away. What would I say?

“You are not what happened to you! And symptoms aren’t your fault! They’re a brain thing! You’ve got to un-alarm your brain! Thoughts cause feelings! Look at the content of your thoughts. Be humane and merciful. Do not judge. Do NOT impose rules. Follow facts! Be kind!”

CPT resources

• Database of rostered providers of CPT. (Disclaimer: I am listed in the database as a rostered provider of CPT.)
• Providers of therapy for trauma may also be found in Psychology Today’s for-pay database. (Disclaimer: I pay to have my private practice listed in Psychology Today’s database.)
• CPT founders’ site.
• Overview of online CPT (also linked to above)
• This site’s main CPT page. Includes links to self-guided training.
• CPT session outline.
• In-house CPT guide and glossary which includes a comprehensive definition of the “just-world hypothesis.”
• Posts on this site categorized under CPT.
• Posts on this site categorized under Trauma.

Specific posts on this site that may be of interest (also linked to above)

• An earlier version of this post: How Does One Recover from Trauma Using CPT?
• Becoming One’s Own Cognitive Therapist
• Addressing the Return of Trauma Symptoms
• To use cognitive skills to address relationship concerns, A Formulation for Relational Effectiveness may be of assistance.

Views expressed are the author’s own. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.