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.

Colleagues, clients, and I are talking about the return of trauma symptoms in people who have achieved remission from post-traumatic stress disorder (PTSD). It’s possible that pandemic conditions have strained brain resources that kept people in remission. Beyond pandemic languishing, to describe this current push-pull of stressors, Amy Cuddy, Ph.D., and other thinkers are using the term pandemic flux syndrome. Counselors and clients, together, are working on how to return to remission from trauma symptoms during these unprecedented times.

Let’s review what we know about trauma, trauma symptoms, and how to reduce them.

(A comprehensive explanation of trauma and its treatment are beyond the scope of this post. Information from the National Institute for Mental Health and National Center for PTSD may be helpful.)

At essence, the cause of trauma symptoms is the brain being alarmed too high, for too long, for it to recover its stable functioning.

Post-traumatic alarm is caused by:

1. novel experiences of danger, threat, and shock,
2. residual physiological and psychological effects from having experienced the original trauma(s),
3. involuntary trauma symptoms,
4. lack of comfort and help with thinking, and
5. ways of thinking that perpetuate alarm.

At essence, to reduce trauma symptoms, a person has to “un-alarm” their brain for long enough for the brain to recover stable functioning.

In the list of the causes of alarm, although #1 is part of the human condition, and #2 is permanent, #3, symptoms, can dissipate if a person can help themselves with #4 and #5 as their own cognitive therapist.

Unfortunately, this process doesn’t:

• make “un-happen” what happened.
• result in instantaneous relief from an act of determination or will.
• remove feelings, including those judged as “negative.”
• disarm normal human brain functioning. Remembering – both consciously and involuntarily – and feeling activated will continue to happen.

Beginning with #4, after offering kindness and comfort to oneself, one heads directly for #5, ways of thinking.

Here are some initial questions to ask oneself:

1. Although I may not want this to be true and I may be somewhat numbed to it, what is going on in my life that logically and understandably might be alarming me? This could be one thing or a list of things. Although stressors related to the pandemic may be on my list, let me go deeper. What else might be alarming me?

2. Thinking “This shouldn’t be this way,” can alarm the brain. About what, even in the smallest way, am I thinking, “This shouldn’t be like this” or “This shouldn’t have happened”?

3. Thinking “This is too much for me,” can alarm the brain. Am I thinking, perhaps about some things at some times, “This is too much for me”? About what?

4. Thinking “I should be or do _____” or “I shouldn’t be or do ______” can alarm the brain. About what am I thinking “I should” or “I shouldn’t” about myself or my efforts? About what am I thinking “They should” or “They shouldn’t” about others and their actions?

5. Feeling upset or outraged at others can alarm the brain. Sometimes outrage at injustice is merited. Sometimes, I can rage at others or despair over myself or others as an outpouring of an inner sense of powerlessness, helplessness, and lack of control. Am I in danger and need to extricate myself? If I am not in danger, about what am I feeling a lack of power and control?

6. The brain knows “tough love” is an alarming oxymoron. Am I using “tough love” on myself? About what am I criticizing and judging myself? By what criteria am I measuring and evaluating myself and coming up short? Are these criteria realistic and helpful, aligned with my values and priorities, or are they cruel rules?

7. What facts and realities about myself, others, the human condition, and the way the world works am I avoiding? What do I need to approach, see as it is, acknowledge and/or accept, address with my cognitive skills, and, thus, help “un-alarm” my brain and ease my distress?

Of the 100 billion humans estimated to have ever lived, we can’t know what portion of them experienced trauma, or developed trauma symptoms. Over half of U.S. women and 60% of U.S. men have experienced at least one traumatic event in their lives. In my estimation, those who attempt to reverse the very brain changes that result in trauma symptoms are no less than heroic.

. . . . .

The content of this post is informed by cognitive behavior therapy (CBT), dialectical behavior therapy (DBT), cognitive processing therapy (CPT), acceptance and commitment therapy (ACT), positive psychology, and other therapeutic modalities.

Image: iStock

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.

One purpose of research is to determine what helps most people, most of the time, better than other ways, and better than nothing.

One of the most effective therapies found by research to help people regain freedom from trauma symptoms is Cognitive Processing Therapy (CPT). CPT offers a sequence of 12 sessions, the first 6 of which are considered fundamental. If trauma symptoms abate, use of the protocol can be ended at any point in the sequence.

Addressing trauma can feel like too much. At the same, time, the sequencing of the CPT sessions can feel like too little, too slowly, especially if sessions are scheduled once per week. The founders of CPT suggest twice per week sessions as optimal and posit that all 12 sessions might be held in an intensive session, perhaps two days over a weekend. The intensively scheduled sessions might feel like too much, and they would also be enough, and all at once.

Some of the indirect learning and support that in-person CPT counseling sessions offer is missing from telehealth sessions, especially during the stress of a pandemic. With clients’ input, we have discovered that a) assistance with emotion regulation, b) a sense of progress outside of assessment scores, and c) an overview of the process, all in straightforward language, are needed.

Since I define terms and provide links to the content in this post elsewhere, I have provided few links here but have included a list of related resources at the end of the post.

“Inner wisdom” is our in-house term and adaption of “Wise Mind,” a component of the “States of Mind” concept from Dialectical Behavior Therapy (DBT) invented by Marsha Linnehan, Ph.D. In sum, the guidance of one’s “inner wisdom” would result from awareness of one’s thoughts and feelings – the content of one’s mind and heart – and from accessing emotion and cognitive structures and functions in the brain.

The content below is expressed in first person. The second person “you” can be perceived as directive and unhelpful.

What do I get from therapy for trauma?

I gain freedom and power.

If something troubling happens today, I am able to kindly – and without judgment – help myself with it.

When a troubling feeling or thought occurs, I can say, “Well, of course you would be feeling that feeling or thinking that thought, given what happened.” In doing so, I perform a profound act of compassion for myself.

What is the process by which one engages in therapy for trauma?

At essence, my intention is to be able to help myself with whatever is happening, whether it be an interior state or an external circumstance.

What is meant by “help myself”?

Help would begin with, kindly and respectfully, becoming aware of my feelings and thoughts and, thus, become able to access my inner wisdom wherein my knowledge, life experience, and skills reside.

Then I would use any or all of these meticulously acquired skills, in potentially most useful order:

1. Adjust the volume on my inner intensity through self-soothing and attention-shifting so I can regulate the emotion centers of my brain and thus free my prefrontal cortex to think things through.
2. When I become aware I am replaying the trauma in my mind or dwelling on intrusive thoughts, I very gently shift my attention, often to something that engages my senses and/or accesses my inner knowing. I’m aware that rethinking is like using flashcards to train myself to memorize what alarms and distresses me.
3. If I am thinking some form of, “Who am I, who I am not, and what did I do or not do to cause this?”, remind myself that reality is complex and dynamic and very little can be definitively identified as causal.
4. Remind myself that the “just-world hypothesis,”* however unsupportable, is based on my very human longing for things to make sense.
5. Remind myself that it’s usually my humanity that wishes things were different AND that to increase my chances of effectively helping myself with a current reality, I’ll need to use a reality-based approach.
6. Ask myself, “Do I have any self-care deficits going on? What can I do to buttress my ability to engage in the awareness process? Do I need food, water, to move a bit? What can I do to help myself feel more steady and strong?”
7. Identify feelings and differentiate between natural, primary feelings, and thought-generated, secondary feelings.
8. Ask, “What thoughts am I thinking that might be causing my feelings?”
9. Among my thoughts, identify and differentiate between facts, beliefs, and hypotheses. (“Hypotheses” are posited to be reality-based vs. belief-based statements generated by one’s inner wisdom that may be truthful, if not verifiably factual.)
10. Identify problematic patterns of thinking, particularly the “just-world hypothesis.”*
11. Ask useful questions about my thinking (from an individualized set of questions derived from CPT’s Challenging Questions Worksheet).
12. Among these questions, ask, “Is there any feeling here that I’m trying not to feel? What is it? Is there any reality here that I’m trying to not think about? What is it? Am I doing something to try to not feel or think? What realities do I need to approach rather than try to protect myself from?”
13. Accept that humans are not given predictive powers. One’s own actions might have made things better…and they might have made things worse. There is no way to know.
14. Ask, “Am I thinking in ‘if-thens’? Am I thinking, ‘If only I __________ or if only they __________’?” If so, I recognize I’m thinking I can know the complexity of reality and predict which factors would change which outcomes. I realize I’m just trying to think my way out of feeling sad. I give myself a hug for wishing things could be different.
15. Then I do activate my prefrontal cortex. It helps me regulate emotions now. I’m also working it like a muscle to increase its power to help me in the future.
16. Assess probabilities. Start by asking, “What are the odds? 50-50?”
17. Ask, “What opposites are both true?”
18. Do a cost-benefit analysis with rank ordering.
19. Acknowledge family-of-origin issues (FOOI) that may be playing a role in my thinking process, give them a nod but little time, and shift my attention to my hard-won, individually identified values and priorities.
20. Ask myself, “Let’s say I’m given 100 years on this planet. How would I want to spend them? How about the next 100 minutes? Is this to what I want to give my time? Might I have given this due time?”
21. Ask myself, “Given these cards I’ve been dealt, how do I want to play them?”
22. Devise strategies based on my values, priorities, and skills-informed, inner wisdom’s guidance.
23. Ask, “I’ve consulted my inner wisdom. Is there anyone I might consult who is likely to honor the nuances of withholding judgment, fostering my independence, all the while offering commentary?!”
24. Make a judgment call and execute the strategies.
25. Accept outcomes as the best I could do at the time given the data and resources I had.
26. Return to the opposites-are-both true dialectic of consolidating gains to foster stability AND opening myself to possible instability as I gain new insights and grow.
27. Continue to monitor beliefs that oppress from without and from within. Become aware of familial, cultural, and societal beliefs that may be so deeply held that they are nearly invisible. Differentiate between those in which I willingly participate to organize society and those that limit me. Jettison the unhelpful beliefs that I can and shift my attention to my values, priorities, and inner knowing.

*”The just-world belief holds that good things happen to good people, that bad things happen to bad people, and that the world should be a fair and just place. This belief emanates from the desire to find an orderly, cause-effect association between an individual’s behavior and the consequences of that behavior…this is a hard-wired, evolutionary need of humans to predict and control events in order to survive.” (CPT manual, page 65)  Further, the just-world hypothesis holds that hard work will be rewarded, bad deeds will be punished, “things happen for a reason,” “what goes around comes around,” and that self, others, and the world should be controllable, orderly, and predictable. In contrast, reality is complex and dynamic. Some occurrences are unforeseeable and have no discernible origin, causality, meaning, or explanation. Ultimately, it is compassion for humans and their aching hearts that is merited.

• Here is a list of providers of CPT.
• Here is our overview of online CPT.
• Here is our CPT session outline.
• Here is our in-house CPT guide and glossary which includes a comprehensive definition of the “just-world hypothesis.”
• Here is our main CPT page which includes links to self-guided training.
• A description of the CPT Enrichment Group for people interested in, engaged in, or having completed CPT is here.
• Here is the description of the CPT group.

Last updated 5/21/21

The views expressed are my 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.