CBT for PTSD

Looking for information on cognitive behavioral therapy (CBT) for PTSD? In this article, we explore CBT for PTSD in depth, looking at the benefits, example treatment plans, sample exercises, and research on the effectiveness of CBT therapy for PTSD. We will also explore the limitations of this therapeutic modality.

What is CBT?

Cognitive behavioral therapy (CBT) is an effective modality for the treatment of post-traumatic stress disorder (PTSD).

Cognitive behavioral therapy explores the relationship between a person’s thoughts, feelings, and behaviors—also called the CBT triangle. The premise of CBT is that changes in one area of these domains will have a correlative impact on other areas of functioning.

For example, suppose a person has a core belief that they are unloveable. In that case, they may experience automatic negative thoughts that it is pointless to try to pursue a romantic relationship, and then avoid ways to meet potential partners.

CBT can help target these cognitions, either individually as they arise in sessions or as part of a formal CBT program—which may be delivered in a group format, over 12 to 16 sessions.

There are several types of cognitive behavioral therapy:

Culturally-informed CBT

This is a type of cognitive behavioral therapy adapted to include the client’s cultural beliefs, accepted strengths, and support, while validating experiences of oppression.

CBT with medication

The use of SSRIs (selective serotonin reuptake inhibitors) in conjunction with CBT is a dual approach to treatment.

Trauma-focused CBT

This type of cognitive behavioral therapy is used as a conjoint parent-child treatment. It involves cognitive-behavioral principles and exposure techniques to treat PTSD, depression, and behavioral problems.

Veterans treatment

The Veterans Administration (VA) uses cognitive processing therapy (CPT) and prolonged exposure (PE) to treat PTSD.

• Cognitive processing therapy (CPT): Provided individually or in a group, CPT involves working with a therapist to examine the person’s thoughts about their trauma and assess their accuracy together.
• Prolonged exposure (PE): Delivered individually, PE works through repeated exposure to thoughts, feelings, and situations the client may have avoided due to traumatic experiences. Through PE, clients learn they don’t need to avoid these reminders.

Benefits of CBT therapy for PTSD

According to the Veterans Association, cognitive behavioral therapy is one of the most effective treatments for PTSD.

And, when combined with certain medications, such as SSRIs and SNRIs, the effects of CBT can be even more impactful. .

CBT for PTSD has several benefits, such as:

• Can decrease PTSD symptoms
• Reduce symptoms of anxiety and depression
• Improve sleep
• Help with cognitive restructuring by encouraging clients to evaluate core beliefs and unhelpful thoughts and beliefs about themselves, others, and the world (such as thought distortions like catastrophizing), with the goal of developing more adaptive thoughts and behaviors

CBT PTSD effectiveness

A study reviewing the scope of CBT treatment demonstrated that CBT is an effective treatment for many types of PTSD, including:

• War trauma: Self-managed CBT showed reductions in PTSD, depression, and anxiety scores.
• Sexual assault: Brief CBT reduced the severity of PTSD symptoms, sustained at three months post-intervention.
• Children and adolescents: Trauma-focused CBT improved PTSD and anxiety symptoms in children and adolescents.
• Comorbid PTSD: Studies show that CBT treatment of PTSD and substance use disorder reduced substance use and psychiatric symptoms. In cases of PTSD and severe mental illness, significant improvements were shown and were maintained at three and six month follow ups.
• Refugees: Culturally adapted CBT helped to reduce PTSD severity in refugees.

The study authors also found that CBT has preventive potential following various traumatic incidents, before meeting the diagnostic criteria for PTSD.

There is a body of evidence in support of CBT therapy for PTSD that shows, at least in some instances, that it’s more effective than other interventions.

One study found CBT for PTSD had better remission rates than other therapies, like EMDR. A further study highlighted several meta-analyses that compared the effectiveness of CBT and found 11 trials stating EMDR was only slightly more effective in reducing symptoms of PTSD.

Examples of a CBT for PTSD treatment plan

An example CBT-focused treatment plan for PTSD might look like:

• Assessment: In addition to the biopsychosocial assessment, therapists may want to incorporate a measure like the DSM’s PTSD diagnostic tool, known as the PCL-5.
• Treatment planning: Sample SMART (specific, measureable, achievable, realistic, timely) goals might include:
  • Reduce PTSD symptoms by 30%, as measured by the PCL-5, within eight weeks by participating in weekly CBT sessions, focusing on cognitive restructuring and exposure therapy techniques. The client’s baseline score at intake was [insert baseline measure].
  • Decrease avoidance behavior by 40% in six weeks by engaging in weekly in vivo exposure tasks and tracking progress through a daily activity log. On intake, the client was avoiding the trauma/trigger [insert baseline measure] percent of the time.
  • Practice relaxation techniques nightly and monitor sleep patterns through a sleep diary to improve sleep quality by 50% within 4 weeks.

CBT exercises for PTSD

Your CBT therapy for PTSD treatment plan may incorporate CBT for PTSD worksheets, such as:

• Thought records worksheets: Identify automatic thoughts and triggers.
• Thought distortions worksheet: Helps clients identify maladaptive thoughts to challenge and reframe them into more helpful thoughts and behaviors.
• Core beliefs worksheets: Identify negative core beliefs to influence the client’s thoughts and behaviors.
• Behavioral activation worksheets: Identify enjoyable activities the client can schedule throughout the day/week and a journal to note how the activity helped.
• Exposure hierarchy worksheets: Identify triggers, develop fear rating systems, create an exposure plan, and track progress.
• Coping skills worksheets: Prompt and record specific coping strategies.
• Mindfulness meditation or relaxation skills: This might be a script or an app the client can download and use when triggered. Teaching and practicing meditation exercises like deep breathing and progressive muscle relaxation can be very effective for clients experiencing PTSD.

Limitations of CBT for PTSD

Potential drawbacks of CBT for PTSD  include:

• Initial difficulty talking about trauma
• Requires active participation, which may be hard following a traumatic event
• May cause emotional distress during exposure
• May not address complex PTSD
• Requires regular adherence
• May not be suitable for individuals with certain comorbid conditions
• Clients with comorbid substance use disorder may be at a greater risk of relapse
• Not all CBT is culturally supportive

Sources

• American Psychological Association. PTSD Guideline, Treatments: Cognitive behavioral Therapy.
• de Arellano, M. A., Lyman, D. R., Jobe-Shields, L., George, P., Dougherty, R. H., Daniels, A. S., Ghose, S. S., Huang, L., & Delphin-Rittmon, M. E. (2014). Trauma-focused cognitive-behavioral therapy for children and adolescents: assessing the evidence.
• Huey, S. J., Jr, Park, A. L., Galán, C. A., & Wang, C. X. (2023). Culturally Responsive Cognitive Behavioral Therapy for Ethnically Diverse Populations.
• Kar N. (2011). Cognitive behavioral therapy for the treatment of post-traumatic stress disorder: a review.
• Khan, A. M., Dar, S., Ahmed, R., Bachu, R., Adnan, M., & Kotapati, V. P. (2018). Cognitive Behavioral Therapy versus Eye Movement Desensitization and Reprocessing in Patients with Post-traumatic Stress Disorder: Systematic Review and Meta-analysis of Randomized Clinical Trials.
• Murray, H., Grey, N., Warnock-Parkes, E., Kerr, A., Wild, J., Clark, D. M., & Ehlers, A. (2022). Ten misconceptions about trauma-focused CBT for PTSD.
• National Center for PTSD. (2015). Effective treatments for PTSD: Consider Cognitive Behavioral Therapy (CBT) as a first line treatment. 

How SimplePractice streamlines running your practice

SimplePractice is HIPAA-compliant practice management software with everything you need to run your practice built into the platform—from booking and scheduling to insurance and client billing.

If you’ve been considering switching to an EHR system, SimplePractice empowers you to run a fully paperless practice—so you get more time for the things that matter most to you.

Try SimplePractice free for 30 days. No credit card required.