The term trauma therapy is used frequently, but it can mean many different things. There are several evidence-based treatments for trauma-related symptoms, and they do not all look the same. Some focus on approaching memories or situations that have been avoided. Others focus more heavily on beliefs that developed after a traumatic experience. Treatment may also look different depending on a person’s age, symptoms, goals, and other mental health needs.
Understanding these differences can make it easier to know what to look for when seeking treatment for yourself or your child.
Trauma-informed care and trauma-focused therapy are not the same thing
A helpful place to start is distinguishing between trauma-informed care and trauma-focused treatment.
A trauma-informed approach recognizes that past experiences can affect how someone experiences relationships, emotions, environments, and treatment itself. The Substance Abuse and Mental Health Services Administration (SAMHSA) identifies principles such as safety, trust, collaboration, and empowerment as central to trauma-informed care. These principles can—and ideally should—shape many types of mental health care.
Trauma-focused therapy goes a step further. Rather than simply taking a person’s trauma history into account, trauma-focused treatments directly address trauma-related symptoms and the thoughts, emotions, memories, beliefs, or patterns of avoidance that may be maintaining them.
Importantly, experiencing a traumatic event does not automatically mean that someone will develop Posttraumatic Stress Disorder (PTSD) or need trauma-focused therapy. People respond to trauma differently, and many factors can influence recovery.
For people who do develop significant trauma-related symptoms or PTSD, however, there are effective treatments available.
What happens in trauma-focused therapy?
There is no single exercise or technique that defines trauma-focused treatment. Broadly, these therapies help people process traumatic experiences and change patterns that may be keeping trauma-related symptoms going.
One common target is avoidance. After something frightening or overwhelming happens, avoiding reminders of the experience can make sense in the short term. Someone might avoid particular places, conversations, memories, emotions, people, or activities because approaching them brings up distress.
The problem is that persistent avoidance can also prevent someone from learning that reminders can be tolerated, that the traumatic event is no longer happening, or that some of the conclusions they drew from the experience may no longer fit their current circumstances. Exposure-based trauma treatments therefore help people gradually and intentionally approach safe trauma-related memories, emotions, and situations rather than continuing to organize their lives around avoiding them.
Other treatments place greater emphasis on trauma-related beliefs. A traumatic experience can affect the way someone thinks about themselves, other people, safety, trust, responsibility, or the world more broadly. Trauma-focused treatment may help someone examine these beliefs and develop a more accurate and flexible understanding of what happened and what it means now.
Although discussing or approaching trauma can be part of treatment, effective trauma therapy is more than simply retelling a difficult experience. The specific strategies used depend on the treatment model and the needs of the individual.
Different evidence-based approaches to trauma treatment
Several therapies have research supporting their use for trauma-related symptoms. The right approach depends in part on the person’s age, presenting concerns, treatment history, preferences, and other clinical needs. Below, we highlight several evidence-based approaches to trauma treatment that our clinicians use at Boston Child Study Center (BCSC).
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) was developed specifically for children and adolescents (ages 3-18) who have experienced trauma. It also includes involvement from parents or caregivers.
TF-CBT is a structured treatment that incorporates skills for managing emotions and trauma reminders, gradually processing traumatic experiences, addressing unhelpful trauma-related thoughts and beliefs, and strengthening communication between children and caregivers. Research supporting TF-CBT includes numerous randomized controlled trials, and the model has been studied across different types of traumatic experiences and populations.
Prolonged Exposure (PE)
Prolonged Exposure (PE) is an evidence-based treatment for PTSD that focuses on reducing avoidance.
In treatment, people gradually approach safe situations they have been avoiding because of trauma-related fear and repeatedly revisit the traumatic memory in a structured therapeutic setting. The goal is not to force someone to forget what happened or convince them that the experience was not painful. Instead, repeated practice can help the person learn that trauma memories and reminders can be experienced without needing to escape or avoid them.
Cognitive Processing Therapy (CPT)
Cognitive Processing Therapy (CPT) focuses particularly on beliefs that may have developed or changed following trauma.
For example, people may develop beliefs involving self-blame, safety, trust, control, or responsibility. CPT helps individuals identify and examine these patterns and develop perspectives that are more balanced and consistent with the available evidence.
Like PE, CPT has a substantial research base and is recommended in major PTSD treatment guidelines.
DBT Prolonged Exposure (DBT-PE)
For some individuals, PTSD occurs alongside significant difficulties with emotion regulation, self-harm, suicidal behaviors, or other concerns that are already being treated through Dialectical Behavior Therapy (DBT).
The DBT Prolonged Exposure protocol (DBT-PE) was developed to integrate PTSD treatment into comprehensive DBT for individuals with PTSD and complex, high-risk presentations. The protocol incorporates principles of Prolonged Exposure while continuing to use DBT to address behavioral stability and other treatment targets.
Clinical trials have provided support for the use of DBT-PE in populations with PTSD alongside suicidal and self-injurious behaviors.
Dialectical Behavior Therapy for PTSD (DBT-PTSD)
Dialectical Behavior Therapy for PTSD (DBT-PTSD) is a trauma-focused treatment designed for individuals with complex PTSD presentations, particularly those who have experienced childhood abuse and have significant difficulties with emotion regulation.
DBT-PTSD combines elements of Dialectical Behavior Therapy (DBT) with trauma-focused cognitive and exposure-based interventions. Treatment focuses on helping individuals manage intense emotions, address trauma-related beliefs such as shame and self-blame, and process traumatic memories while reducing avoidance and other behaviors that interfere with recovery.
Research, including randomized controlled trials, has demonstrated promising outcomes for DBT-PTSD, particularly among adults with PTSD related to childhood abuse and co-occurring difficulties with emotion regulation. Unlike DBT-PE, which was developed as a protocol integrated into comprehensive DBT, DBT-PTSD is a distinct treatment model that incorporates DBT principles alongside trauma-focused interventions.
So, which trauma therapy is best?
There is not one trauma treatment that is automatically the right choice for every person.
Research evidence is only one part of evidence-based practice. The American Psychological Association defines evidence-based psychological practice as the integration of the best available research with clinical expertise while considering the individual’s characteristics, culture, and preferences.
That means choosing a treatment should involve more than asking, “Which therapy has research behind it?” It can also mean considering:
- What symptoms are causing the most difficulty?
- Is PTSD actually the primary treatment target?
- What other concerns need to be addressed?
- Has the treatment been studied for someone of this age and clinical presentation?
- What approaches is the person willing to engage in?
- Does the clinician have appropriate training in the treatment being offered?
Trauma treatment should be individualized, collaborative, and based on a thoughtful understanding of what is keeping a person’s difficulties going.
Trauma is treatable
Traumatic experiences can have lasting effects, but those effects do not have to remain unchanged.
Evidence-based trauma treatments give people opportunities to approach what they have been avoiding, develop new ways of responding to trauma-related thoughts and emotions, and reconnect with parts of life that trauma may have disrupted.
At Boston Child Study Center, clinicians provide evidence-based assessment and treatment for children, adolescents, young adults, adults, and families experiencing trauma-related concerns. Treatment recommendations are individualized based on each person’s needs, goals, and clinical presentation.
To learn more about our trauma therapy services, please reach out to our intake team.