Work through a self-help guide for PTSD and CPTSD based on Trauma-Focused Cognitive Therapy (TF-CT).
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This self-help guide is intended for people with mild-to-moderate symptoms of post-traumatic stress disorder (PTSD) or complex post-traumatic stress disorder (CPTSD).
If you're feeling distressed, in a state of despair, suicidal or in need of emotional support you can phone NHS 24 on 111.
For an emergency ambulance phone 999.
This guide aims to help you:
This guide is based on Trauma-Focused Cognitive Therapy (TF-CT). TF-CT aims to help people who have been through trauma and adversity to make sense of what they’ve experienced, and become less distressed and affected by it.
If you think you’re experiencing post-traumatic stress disorder (PTSD) or complex post-traumatic stress disorder (CPTSD), it’s important for you to visit your GP and discuss your concerns. This guide can help with managing symptoms while you wait for an assessment by your GP or a mental health professional.
Working through this guide can take around 30 to 40 minutes. Please go through it at your own pace.
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If you’d like to print the guide at any time, you’ll find an option to save and print the whole guide, including the parts you have added, in each section.
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Traumatic events are extremely threatening or horrific events that overwhelm a person’s ability to cope. They can be events you experience yourself, or events you witness.
Witnessing a traumatic event might involve watching or hearing someone else experience it, or watching the event on TV. Some people can also be very affected when they learn that a close family member or friend experienced trauma.
It’s important to know that what’s traumatic for one person might not be traumatic for another person.
Experiencing trauma is common. Around 70% of people experience at least one traumatic event during their lifetime, and about 30% experience four or more traumatic events during their lifetime.
Adverse childhood experiences (ACEs) are sometimes considered traumatic events.
It’s normal to be distressed by trauma, and to need time and support to adjust to what you’ve experienced. This includes people who are specially trained, like firefighters and soldiers. Symptoms of PTSD or CPTSD don’t always appear immediately after a trauma.
If you have experienced traumatic events, you’ll probably have memories about those distressing events. It’s important to note that having memories about distressing experiences is not the same as having PTSD or CPTSD.
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If what you’ve experienced continues to distress you, and is interfering with your everyday life, you may be experiencing PTSD or CPTSD. There’s more information on CPTSD in the next section.
‘Re-experiencing’ means memories of trauma(s) repeatedly pop into your mind, without you choosing or wanting to think about them.
Anything you experienced at the time of the traumatic event(s) can be re-experienced, including sights, sounds, smells, tastes, physical sensations, thoughts, and feelings. The memories may seem very vivid and real, and it can feel like the events are happening right now, even though they’re in the past.
It’s common for people who’ve been through traumatic experiences to try to cope by using avoidance. You, or the people around you, might be trying to avoid or ‘push away’ thoughts, feelings, or conversations about the trauma.
You might be trying to keep your mind busy all the time so you don’t have to talk or think about the event(s). Sometimes people use alcohol, legal or illegal drugs, or self-harm as a way to avoid thinking about the trauma.
In order to be diagnosed with PTSD, your symptoms would have to go on for several weeks and have a significant impact on your life.
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In order for someone to be diagnosed with CPTSD, they have to be experiencing all of the symptoms of PTSD as well as additional symptoms. If you think you are experiencing CPTSD, read the previous section, which has information on PTSD symptoms, first.
If you aren’t experiencing PTSD symptoms, but you’re experiencing any of the symptoms below, it might help to look at the other mental health self-guides on NHS inform.
CPTSD is diagnosed based on the symptoms a person is experiencing, rather than the type of trauma they’ve experienced.
Re-experiencing symptoms (see Section 3)
Avoidance symptoms (see Section 3)
Sense of threat symptoms (see Section 3)
In order to be diagnosed with CPTSD, these symptoms (including the PTSD symptoms) would have to go on for several weeks and have a significant impact on your life.
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If you are experiencing PTSD or CPTSD, you might also experience these symptoms.
In the following sections of the guide, you can find information on managing and recovering from PTSD and CPTSD symptoms.
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Calming your mind and body will help you feel safer and more in control of your mental health. You can do this through physical activity or relaxation exercises.
It can take some time and practice to feel the benefit of relaxation exercises, so make sure to keep going with them even if you don’t notice a difference straight away. It’s important to practice these exercises at times when you’re feeling calm, as well as when you feel distressed or on edge.
Belly breathing is a simple relaxation technique:
We have a number of other breathing and relaxation exercises on NHS inform. Try doing one of these when you're feeling distressed.
You might also find it helpful to do more exercise and physical activity, to help calm your mind and body.
Learn more about keeping active
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Re-experiencing trauma can be very distressing and unsettling. It may seem as if the traumatic event(s) are happening again. ‘Grounding’ techniques can be used to make you feel calmer, safer, and more present in the here and now. They can also help you find a balance between feeling numb and being overwhelmed by emotions.
Grounding can be used when a trauma memory comes to mind during the day (as a memory) or at night (as a nightmare).
Describe to yourself all the ways that things are different right now, compared to at the time of the traumatic event(s).
You could think about:
To remind yourself that the trauma isn’t happening now, it can be helpful to behave in ways that weren’t possible during the trauma(s). For example, stand up, move around, look around, or stretch your arms and legs if you felt powerless at the time of the trauma(s).
Think of a few positive words which remind you that you’re safe in the present.
For example:
Carry something with you that feels nice to touch or smells nice, and use this when you’re feeling distressed or disorientated. The object must not remind you of the trauma, and should be small enough to carry with you.
For example, you might carry:
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Experiencing trauma can disrupt how people live their lives. It can be difficult to tell the difference between taking reasonable precautions, and behaving in ways that are unhelpful. You could discuss the things that you are doing to keep yourself safe with a trusted friend or family member, or your GP, to reflect on whether you’re behaving in your best interests.
Everybody needs a weekly routine, social connections, and things in their life that make them happy and feel meaningful. If you don’t feel you have these things, or if the effects of trauma are disrupting your enjoyment of your life, it may be helpful to start taking steps towards improving your quality of life. This will help you feel in control, and reduce the sense that your life is ‘on hold’.
It can also be easy to isolate yourself and do less when your mood is low. Unfortunately, this can make problems worse. A vicious cycle can develop where you do less because of your mood, but the less you do, the more your mood goes down.
If you’re avoiding particular things because of what you have experienced, it will probably be beneficial to try to reduce that avoidance.
Think about what you’ve been avoiding, and whether avoidance is making your life more difficult. If you can confront the things that make you feel anxious, it will help you put the trauma(s) behind you. It will also help increase your confidence that you can overcome difficulties, and help you feel safer.
There are 5 steps to this activity:
Situation | Difficulty score (0 = no distress, 10 = extreme distress) |
Driving to work | 9 |
Watching a film or TV programme that shows a car crash | 5 |
Getting into the car | 2 |
Talking about the car accident | 6 |
Although reducing avoidance might be difficult at first, if you keep going you will find it easier. The more you confront the things you’re avoiding, the more your quality of life and confidence will improve.
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Avoidance is a common way to cope after trauma. It makes sense that you would want to avoid thinking about traumatic events because those events are very distressing to think about. Avoidance reduces distressing feelings in the short term.
Here are some important questions to consider:
Is avoidance working for you in the long term?
Has avoidance helped you to permanently stop re-experiencing your painful trauma-related memories, or just escape them temporarily?
Has avoidance helped you have the life that you’d like to have, or be the person you want to be?
How has avoidance affected your relationships, health and wellbeing?
How much time, energy, and money do you spend on avoiding thinking about traumatic events?
Some avoidance and distraction from traumatic memories can be helpful. However, avoidance can interfere with recovery and healing when it becomes extreme, or when it becomes someone’s main or only method of coping.
Avoidance becomes a problem when it stops you living your life.
You probably have very understandable reasons for using avoidance to cope with your trauma memories. You may have heard advice like, “just try not to think about it” or “don’t dwell on it.” You may be afraid that if you let yourself feel strong upsetting emotions, and think about the traumatic event(s), it could be emotionally overwhelming.
While avoiding trauma memories makes sense, it can also stop you recovering and healing. This is because the harder you try to avoid and push away memories, thoughts or feelings, the more you will experience them. This is no one’s fault – it’s just the way the human mind works.
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To permanently become less upset and affected by traumatic experiences, and to stop traumatic experiences from popping into your mind, you’ll need to temporarily think more about those experiences.
At the moment, your trauma memories don’t have a place in your long-term memory. This is why they pop into your mind without you choosing to think about them.
If you think more about traumatic experiences now, it’ll help you to understand and ‘process’ what happened, and move forward with your life.
Processing trauma memories involves deliberately thinking about what happened. This will be upsetting in the short term. However, letting yourself think about those experiences will allow your brain to transform the memories so that they can be filed away like your other long-term memories.
As a first step, it’s worth considering whether now is the right time to try to process your traumatic experience(s).
Think about the following points:
Is the trauma in the past? For example, are you still in danger? It’s very difficult to adjust to trauma(s) if they haven’t stopped and aren’t fully in the past.
If you’re in danger, call the police. If you’re struggling to escape from a potentially dangerous situation, our Problem-solving guide can help you to identify different options.
How motivated are you to change? How much is your PTSD or CPTSD limiting your life?
What might stand in the way of you taking the time to think about your trauma memories?
What is going on in your life? Is your life relatively stable at the moment?
If you’re going through a period of high stress or change, now may not be the right time to work through trauma memories.
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Each traumatic experience is an event – a ‘story’ that has a beginning, middle and end.
To process each trauma, it is best if you go through each event separately, from beginning to end. You could try writing about the event, or telling someone you trust the story of what happened from beginning to end.
You’ll probably notice the first time you attempt this that the trauma story is distressing to think about. The memory may not have a clear order, or some details may be missing.
As you let yourself think through what happened, you may find the details become clearer, the order of events makes more sense, and the story becomes less distressing.
It’s important that you feel safe and in control of how and when you’ll think about each trauma memory. Only do what is manageable, and what you feel in control of. For example, if writing is easier than talking, you could try that first. If thinking about some parts of what happened seems like too much, try thinking about less upsetting parts first and then come back to the more distressing parts.
Here are some suggestions for talking or writing about each traumatic event:
It can help if you try to answer the following questions:
You may not fully understand what happened. You may have formed a negative view of yourself, other people, or the world based on what happened.
Perhaps you need more information in order to piece things together, or to correct any misunderstanding or confusion. For example, learning about how an event happened could help you to believe that although bad things happen sometimes, they don’t happen all the time.
The ideas described in this section are just suggestions to try. It may take several practices before they lead to positive changes.
You may find that after attempting this task, you think about trauma memories more for a few days. This isn’t a bad sign. It shows your brain wants to think through what happened in order to make sense of it.
If you have any concerns or doubts about telling your story, you may benefit from the support of a trained professional. If you feel you need help with your mental health, try speaking to your GP. Talking therapies are recommended for PTSD and CPTSD, as well as medication if your doctor recommends it.
Read more about treating CPTSD
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Experiencing trauma can affect how people view themselves, other people, and the world, and it can be easy to get into unhelpful ways of thinking.
Some examples of unhelpful thought patterns that you may have after trauma(s) are listed below. If you’re experiencing any of these, it might be useful to discuss your thoughts with trusted family or friends, or a professional.
It can be easy to believe that because something terrible happened, it will happen again.
For example:
“My partner’s late coming home; they must have been in an accident like mine.”
It can be easy to assume you know what other people are thinking, and the assumptions are usually negative.
For example:
You get really upset at work and then become concerned that other people judged you. In fact, there is little evidence to support this conclusion and your colleagues seem to be supportive and kind.
It can be easy to jump to conclusions when trying to understand what you’re experiencing.
For example:
“My anxiety means I’m in danger.”
People who think this way believe everything is to do with them, and it’s usually negative – they place blame on themselves and take responsibility for things when they don’t need to.
For example:
“That car accident was my fault, I should never have been trying to drive to work in the rain.”
In reality, there are many things that have to happen for a traumatic event to take place – you can’t be totally responsible for what happened. With this example, most people drive in the rain and have no difficulties – staying at home every time it rains is not possible, and it isn’t a reasonable thing to expect of yourself.
It can be easy to think in extremes when you’re distressed; there are no shades of grey.
For example:
“I wasn’t able to drive to the shops today – I’ll never be able to drive again.”
It can be easy to set high standards for yourself or other people, and make harsh judgments if those high standards aren’t met.
For example:
“I must get over this by the end of the month.”
When people think like this, they’re being critical of themselves, which can make an already difficult situation even more difficult. If you find yourself thinking this way, it can be helpful to try to be kind to yourself.
Do you ever have thoughts like this? Make a list of the ones you have most often, and use the activity in the next section to reflect on them.
It’s important to remember that anyone can experience thoughts like this, and that patterns of unhelpful thinking can be changed so they don’t bother you as much, or at all.
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If you’re regularly getting into unhelpful ways of thinking, it can be helpful to start stepping back from your thoughts and challenging them. Use this section to give you some ideas.
Example:
“I feel afraid walking down this path. I’m going to be attacked again.”
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You could use the table below to challenge your own unhelpful thoughts.
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Working on your PTSD or CPTSD is difficult. Only you know how challenging this has been for you, and only you can do the tasks necessary to overcome PTSD or CPTSD. This process will be easier if you’re kind to yourself. This isn’t the same as being self-indulgent, ‘letting yourself off the hook’, or ‘spoiling’ yourself. It isn’t lazy to need a break, and it isn’t useful to be unkind to yourself or ignore your own mental or physical needs.
It’s important to take time out for self-care – doing so will make you more likely to succeed in overcoming your difficulties. Self-care means focusing on yourself and your own happiness, and doing things that make you feel good. It could mean doing something enjoyable, spending time with family and friends, having fun, or setting aside time to relax. For example, you could go for a walk, take a hot bath, or watch your favourite film.
Use the list below to write down one thing every day for a week that you can do to make yourself feel good, and reward yourself for working to overcome your PTSD or CPTSD.
Download a list you can print or fill out on your device
The text you add to the list will only be saved to your device.
Please note: if you use an iPhone, the only way to edit the list is by using a PDF app on your device.
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This self-help guide is intended for people with mild-to-moderate symptoms of post-traumatic stress disorder (PTSD) or complex post-traumatic stress disorder (CPTSD).
If you're feeling distressed, in a state of despair, suicidal or in need of emotional support you can phone NHS 24 on 111.
For an emergency ambulance phone 999.
Keep using the techniques you found helpful from this guide – they should continue to benefit you. If there are some things that you didn’t find helpful to begin with, stick with them for a few weeks – Trauma-Focused Cognitive Therapy (TF-CT) can take a little time to work.
If you’re feeling distressed, in a state of despair, suicidal or in need of emotional support you can phone NHS 24 on 111. For an emergency ambulance phone 999.
If you feel you need more help with your mental health, try speaking to your GP, or search for mental health and wellbeing services in your area.
For information and advice when you’re feeling down, you can phone Breathing Space on 0800 83 85 87.
The Breathing Space phoneline is available:
If you found this guide helpful and would like to do more work like this, Living Life offers a range of structured psychological interventions and therapies to improve mental health and wellbeing. This service is appointment-based and specifically for low mood, or mild/moderate depression or anxiety. Living Life are open Monday to Friday, from 1pm to 9pm, and you can phone them on 0800 328 9655 for an assessment appointment.
To learn more about coping with PTSD and CPTSD, visit some other parts of NHS inform:
Read more about PTSD and CPTSD
Learn what to do when you have a panic attack
Work through our panic self-help guide
You can also visit some other websites for information:
Watch a video on Adverse Childhood Experiences (ACEs)
Read about discrimination related to PTSD on the See Me Scotland website
Learn about what’s available for veterans with PTSD:
Visit the Veterans First Point website
Visit the Combat Stress website
Visit the Legion Scotland website
Last updated:
27 May 2021