Psychotherapy for Trauma & PTSD
Trauma is related to disturbing experiences of an extreme type – a terrorist incident, an air-line crash, assault, rape or other sexual abuse, a natural disaster. Milder examples include a (non-injurious) car accident, getting trapped in a lift, or a personal accident. Exposure to such incidents produces trauma: an upsetting memory linked to the event, which may be accompanied by shock, anxiety and emotional distress.
Where a client is overwhelmed by the traumatic memory itself, I lead with EMDR (Eye-Movement Desensitisation and Reprocessing) – the technique with the strongest evidence base for neutralising a specific charged memory. Alongside it, I draw on ACT, CBT and the approach set out in my new book, FLOAT: Exiting the Anxiety-Stress Loop, to work with the anxiety loop that often builds up around the memory — hypervigilance, avoidance, and catastrophic interpretations of what the flashbacks mean. Below are the ways trauma and PTSD commonly show up, what’s actually driving each one, and how this combined approach works.
Symptoms of PTSD include:
- Flashbacks, in which the traumatic incident is vividly replayed in the mind
- Anxiety
- Hyper-vigilance for danger
- Impaired concentration
- Nightmares
- Insomnia
- Irritability
- Hopeless thinking patterns
- Detachment / emotional numbness
- Avoidance of activities and places associated with the trauma
- In some cases, suicidal thoughts
Most people exposed to trauma do not develop PTSD. Overall rates sit around 5–10%, though this rises substantially – to 15–33% – for the most severe or repeated forms of trauma, such as repeated abuse, assault, sexual violence, or combat. In most cases, symptoms appearing and worsening after six weeks is what distinguishes PTSD from a normal, fading stress reaction. Note: this page does not apply to domestic abuse, where the danger is ongoing rather than in the past – that situation requires safeguarding measures, not the approach described here.
Why does my brain keep replaying the memory in flashbacks and nightmares?
Trauma can impair how the brain files a memory away. Normally the hippocampus places a memory in context — when it happened, that it’s over – but when the amygdala (the brain’s threat-detection centre) is overstimulated during a traumatic event, the hippocampus can be suppressed, so the memory never gets properly filed as “in the past.” That’s why a flashback can feel like it’s happening right now rather than being remembered: the brain genuinely hasn’t finished processing it as a completed event. This is precisely the kind of unprocessed memory EMDR is designed to address directly.
Will I definitely develop PTSD after something traumatic happens to me?
No – most people don’t. Only around 5–10% of people who experience a traumatic event go on to develop PTSD, though the risk is considerably higher after the most severe or repeated forms of trauma. Feeling supported by family, friends or others afterwards measurably reduces the risk. For most people, the shock and distress fade within four to six weeks without becoming a lasting disorder; it’s only when symptoms persist and worsen beyond that window that it’s classed as PTSD.
Why am I so on edge or hypervigilant all the time now?
Hypervigilance isn’t a personal flaw – it’s your nervous system doing exactly what it learned to do to keep you safe. In the context the trauma occurred in, staying alert and ready to react was genuinely adaptive. The problem is that this state doesn’t switch itself off once the danger has passed; the brain keeps applying a survival-mode setting to situations that no longer warrant it. The good news is that hypervigilance shows meaningful improvement for many people within three to six months, particularly with treatment.
Why do I keep avoiding places or things that remind me of what happened?
Avoidance brings short-term relief – steering clear of a trigger stops the racing heart and distressing thoughts it produces. But research consistently finds avoidance is the strongest predictor of ongoing PTSD symptoms, because each successful avoidance teaches the brain that the danger will occur again because it had to be escaped, reinforcing the very fear it was meant to relieve. Breaking that cycle, gradually and safely, is a core part of recovery rather than something to push through alone.
How does EMDR actually work?
EMDR pairs brief recall of the traumatic memory with a form of bilateral stimulation – most often guided eye movements, tracking the therapist’s hand moving side to side. The leading explanation is the Adaptive Information Processing model: the theory that your brain has a built-in system for processing distressing experiences into ordinary memory, which trauma can overwhelm and stall. The bilateral stimulation appears to help the brain complete that stalled processing, similar to mechanisms thought to occur during REM sleep. After several repetitions, the intense emotional charge attached to the memory typically reduces – the memory remains, but it’s remembered rather than relived.
Will my PTSD symptoms get better over time, or do I need treatment?
It depends on how long it’s been. Most spontaneous improvement happens within the first two to six months after a traumatic event; if symptoms haven’t started easing by then, they’re unlikely to resolve fully on their own, and waiting often lets the pattern become more entrenched rather than fading. The distinction clinicians draw is between acute PTSD (developing shortly after the event, often resolving within three months) and chronic PTSD (persisting beyond three months, sometimes for years, without treatment). The encouraging part: treatment remains effective even when PTSD has been present for years or decades – it’s never too late to address it.
What’s the actual way out of trauma symptoms?
For the memory itself, EMDR does the most direct work – it’s not something you can think or reason your way through, which is why a specific reprocessing technique matters here more than on some other pages. Alongside it, the Float approach addresses the anxiety loop that tends to build up around the memory:
Awareness: stepping back from a flashback or intrusive thought into the space in which it appears, rather than being pulled fully inside it — noticing “a memory has surfaced” rather than being swept back into reliving it.
Acceptance: allowing hypervigilance, nightmares and intrusive memories to be what they are — a nervous system still running an old survival setting – rather than treating each recurrence as fresh evidence of danger or breakdown.
Witnessing: noticing the pattern itself – which situations, sounds or anniversaries tend to trigger it, and how avoidance quietly reinforces the fear rather than relieving it.
Dissolving: as the memory is processed (through EMDR) and the surrounding avoidance loop is no longer fed, both the intensity of flashbacks and the constant sense of threat typically fade – not because the event is forgotten, but because it’s finally been filed as something that happened, rather than something still happening.
CBT is often used alongside this to address catastrophic thoughts directly – the beliefs that each flashback or nightmare is evidence of breakdown, rather than a normal (if distressing) part of an unprocessed memory settling. ACT supports the same shift, building willingness to experience difficult memories and sensations without the compulsive avoidance that keeps the pattern going. Resilience coaching can also help rebuild coping mechanisms during recovery: reaching out for support, keeping to a routine, calming techniques, staying engaged with purposeful activity, and reflecting on what’s been learned.
New from Dr John Eaton: FLOAT: Exiting the Anxiety-Stress Loop
My latest book lays out this model in full, drawing on neuroscience, philosophy, and thirty-six years of clinical work. Out 13 August 2026. Pre-order the Kindle edition on Amazon at the introductory price of 99p.
For a short video on the EMDR technique,
If you’re struggling right now
If you’re having thoughts of suicide or feel unable to keep yourself safe, please reach out for immediate support: contact the Samaritans free, 24 hours a day, on 116 123, or your GP, or NHS 111. If you are currently in an unsafe situation, such as ongoing domestic abuse, please contact the National Domestic Abuse Helpline free on 0808 2000 247, or the police if you are in immediate danger. You don’t have to be in crisis to reach out – if you’d like to talk about starting therapy, please get in touch below.
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