Trauma-focused CBT

What is trauma-focused CBT?

Trauma-focused CBT is a structured psychological therapy that helps people process a distressing or traumatic experience and reduce the anxiety, flashbacks and avoidance that can follow it. It builds on the principles of cognitive behavioural therapy, adapted specifically to work with traumatic memories, and is delivered online to adults across Brighton and East Sussex.

The ’trauma-focused’ part matters because ordinary CBT techniques do not always fit how traumatic memories behave. After a frightening or overwhelming event, memories can become fragmented and sensory rather than sitting in the past as a clear, ordered story. They can be triggered by sounds, smells or situations that seem unrelated on the surface. Trauma-focused CBT combines standard CBT tools, examining unhelpful beliefs and patterns of avoidance, with specific techniques for working through the memory itself, so the images, sounds or physical sensations linked to the event gradually lose some of their intensity and their grip on daily life eases.

People bring a wide range of experiences to this therapy: intrusive memories or nightmares, avoidance of places or reminders connected to the event, feeling constantly on edge or easily startled, sleep problems and low mood or shame connected to what happened. A formal diagnosis of post-traumatic stress disorder is not required before starting. Many people begin therapy simply because a specific event keeps intruding on their thinking or their sleep, months or sometimes years after it happened.

When it helps

Trauma-focused CBT is most often used after a single distressing event, such as a road traffic collision, a physical or sexual assault, a frightening medical procedure or birth experience, witnessing violence or a sudden and shocking bereavement. It is also used, often with adaptations to pacing and structure, for people whose difficulties stem from repeated or prolonged trauma rather than one clear incident.

Current NICE guidance on post-traumatic stress disorder names trauma-focused CBT and EMDR as the two recommended psychological treatments for adults with PTSD. Neither is considered superior across the board, and which one suits you can depend on your history, how you tend to process difficult material, and personal preference. A psychologist will usually talk this through with you at assessment rather than assuming one approach fits everyone.

This therapy tends to work best once some stability has returned after the event, since it involves engaging with the memory directly rather than only managing day-to-day symptoms. If you are currently in crisis, feeling unsafe, or in the immediate aftermath of a traumatic event, a psychologist may recommend stabilisation work first, or a different starting point altogether.

If you need support right now

This is not a crisis service and cannot respond quickly to an emergency. If you are struggling to keep yourself safe or are having thoughts of suicide, contact the Samaritans free, at any time of day or night, on 116 123, or go to your nearest A&E.

What to expect

Therapy usually begins with an assessment, where a psychologist asks about the event or events, your current symptoms, how they affect your work, relationships and sleep, and what you would like the therapy to help with. There is no expectation that you describe everything in detail at this stage. Early sessions typically focus on psychoeducation, understanding why the mind and body react to trauma the way they do, alongside building grounding and coping skills that give you more of a sense of control before any detailed work with the memory begins.

When you and your psychologist agree you are ready, sessions move into working directly with the trauma memory. Depending on the approach used, this might involve retelling the event in a structured, paced way, working with the specific images or moments that feel most stuck, or identifying and testing unhelpful conclusions the mind has drawn from what happened, such as self-blame or a belief that the world is now permanently unsafe. You set the pace together with your psychologist, and you are never required to share more detail than you choose to at any point.

Later sessions usually focus on consolidating what has changed and planning for situations, anniversaries or reminders that might still feel difficult. Delivered online, sessions follow a similar structure and length to in-person therapy, typically weekly to begin with, over secure video, with the same care taken over preparation and pacing.

The evidence for trauma-focused CBT

Trauma-focused CBT has one of the stronger evidence bases among psychological therapies, built on several decades of randomised controlled trials across different trauma types and age groups. The National Institute for Health and Care Excellence recommends it as a first-line treatment for adults with PTSD, alongside EMDR, in its guidance on the recognition and management of post-traumatic stress disorder. Trials consistently show meaningful reductions in intrusive memories, avoidance and hyperarousal symptoms over a course of treatment, and these improvements are generally maintained once therapy has ended rather than fading quickly.

Research on online delivery of trauma-focused therapies has grown considerably, and outcomes for CBT delivered by video call are broadly comparable to in-person delivery for many people, provided sessions take place somewhere private and free from interruption. Online delivery also removes travel time, which can matter when sessions are frequent, as they often are in the early stages of trauma work.

Trauma-focused CBT for Brighton and East Sussex

Clinical psychologists for Brighton and East Sussex work online with adults, so trauma-focused CBT is available wherever you happen to be based, from the seafront through the Lanes and North Laine into BN1 and BN2, and out to Hove, Kemptown, Preston Park, Hanover, Withdean and Portslade. Because sessions run over video, location matters less than having a private space and a stable connection at the time you have agreed.

Brighton’s population includes a steady mix of commuters, students and people who have moved down from London, drawn in part by the train links from Brighton, London Road and Preston Park stations. Online sessions fit around that pattern well: no travel across the city or up to Victoria or London Bridge is needed, and appointments can sit around shift work, term time or caring responsibilities more easily than a fixed clinic visit. We will update this site as the practice develops.