Cbt and ptsd

Cognitive Behavioral Therapy (CBT) for Treatment of PTSD

Cognitive behavioral therapy focuses on the relationship among thoughts, feelings, and behaviors; targets current problems and symptoms; and focuses on changing patterns of behaviors, thoughts and feelings that lead to difficulties in functioning.

Introduction to CBT

Cognitive behavioral therapy focuses on the relationship among thoughts, feelings, and behaviors, and notes how changes in any one domain can improve functioning in the other domains. For example, altering a person’s unhelpful thinking can lead to healthier behaviors and improved emotion regulation. CBT targets current problems and symptoms and is typically delivered over 12-16 sessions in either individual or group format.

This treatment is strongly recommended for the treatment of PTSD.

How CBT Can Help with PTSD

Several theories specific to trauma explain how CBT can be helpful in reducing the symptoms of PTSD.

For example, emotional processing theory (Rauch & Foa, 2006) suggests that those who have experienced a traumatic event can develop associations among objectively safe reminders of the event (e.g., news stories, situations, people), meaning (e.g., the world is dangerous) and responses (e.g., fear, numbing of feelings). Changing these associations that lead to unhealthy functioning is the core of emotional processing. 

Social cognitive theory (Benight & Bandura, 2004) suggests that those who try to incorporate the experience of trauma into existing beliefs about oneself, others, and the world often wind up with unhelpful understandings of their experience and perceptions of control of self or the environment (i.e., coping self-efficacy). For instance, if someone believes that bad things happen to bad people, being raped confirms that one is bad, not that one was unjustly violated.

Understanding these theories helps the therapist more effectively use cognitive behavioral treatment strategies.

Using CBT to Treat PTSD

Therapists use a variety of techniques to aid patients in reducing symptoms and improving functioning. Therapists employing CBT may encourage patients to re-evaluate their thinking patterns and assumptions in order to identify unhelpful patterns (often termed “distortions”) in thoughts, such as overgeneralizing bad outcomes, negative thinking that diminishes positive thinking, and always expecting catastrophic outcomes, to more balanced and effective thinking patterns. These are intended to help the person reconceptualize their understanding of traumatic experiences, as well as their understanding of themselves and their ability to cope. 

Exposure to the trauma narrative, as well as reminders of the trauma or emotions associated with the trauma, are often used to help the patient reduce avoidance and maladaptive associations with the trauma. Note, this exposure is done in a controlled way, and planned collaboratively by the provider and patient so the patient chooses what they do. The goal is to return a sense of control, self-confidence, and predictability to the patient, and reduce escape and avoidance behaviors.

Education about how trauma can affect the person is quite common as is instruction in various methods to facilitate relaxation. Managing stress and planning for potential crises can also be important components of CBT treatment. The provider, with the patient, has some latitude in selecting which elements of cognitive behavioral therapy are likely to be most effective with any particular individual. 

Case Example

Jill, a 32-year-old Afghanistan War veteran

Jill had been experiencing PTSD symptoms for more than five years. She consistently avoided thoughts and images related to witnessing her fellow service members being hit by an improvised explosive device (IED). This case example explains how Jill's therapist used a cognitive worksheet as a starting point for engaging in Socratic dialogue.

For Patients & Families

What is Cognitive Behavioral Therapy?

CBT has been demonstrated to be effective for a range of problems including depression, anxiety disorders, and posttraumatic stress disorder. In many studies, CBT has been demonstrated to be as effective as, or more effective than, other forms of psychological therapy or psychiatric medications.

References & Resources

Journal Article

Benight, C. C., & Bandura, A. (2004). Social cognitive theory of posttraumatic recovery: The role of perceived self-efficacy. Behaviour Research and Therapy, 42(10), 1129–1148.


Monson, C. M. & Shnaider, P. (2014). Treating PTSD with cognitive-behavioral therapies: Interventions that work. Washington, DC: American Psychological Association.


Ehlers, A. (2013). Trauma-focused cognitive behavior therapy for posttraumatic stress disorder and acute stress disorder. In Simos, G., & Hofmann, S. G. (eds). CBT for anxiety disorders: A practitioner book  (pp. 161-190). New York, NY: Wiley.

Journal Article

Rauch, S., & Foa, E. (2006). Emotional processing theory (EPT) and exposure therapy for PTSD. Journal of Contemporary Psychotherapy, 36(2), 61-65. doi: 10.1007/s10879-006-9008-y


Grey, N. (Ed.) (2009). A casebook of cognitive therapy for traumatic stress reactions. Hove, UK: Routledge.

Updated July 31, 2017

Date created: March 2017

Cognitive behavioral therapy for the treatment of post-traumatic stress disorder: a review

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Borderline Personality Disorder Symptom Test

Borderline Personality Disorder includes many different symptoms that in one way or another indicate the presence of this mental disorder. However, the severity of the disease and its symptoms can vary greatly.

This test incorporates the results of previous studies to ensure the validity and reliability of results for borderline personality disorder symptoms.

Do you have symptoms of borderline disorder? For each following statement, indicate how much you agree with it.

The Borderline Personality Disorder Test (IDR-BPDST) is owned by IDRlabs. It builds on the work of Dr. M. Zanarini and her colleagues who created the Mental Disorder Symptom Inventory (MSI-BPD). This test is not affiliated with any particular researcher or organization in the field of psychopathology.

The Borderline Personality Disorder test is based on material that has been published in the following sources: Zanarini, Mary & Vujanovic, A & Parachini, Elizabeth & Villatte, Jennifer & Frankenburg, Frances & Hennen, John. (2003). A screening measure for BPD: The McLean screening instrument for Borderline Personality Disorder (MSI-BPD). Journal of personality disorders. 17.568-73. 10.1521/pedi.17.6.568.25355. Keng SL, Lee Y, Drabu S, Hong RY, Chee CYI, Ho CSH, Ho RCM. Construct Validity of the McLean Screening Instrument for Borderline Personality Disorder in Two Singaporean Samples. J Pers Discord. 2019Aug; 33(4): 450-469. Epub 2018 Jun 27 PMID: 29949444. Kröger C, Huget F, Roepke S. Diagnostische Effizienz des McLean Screening Instrument für Borderline-Persönlichkeitsstörung in einer Stichprobe, die eine stationäre, störungsspezifische Behandlung in Anspruch nehmen möchte [Diagnostic Instrument for Leagnostic accuracy of borderline personality disorder in an inpatient sample who seek a disorder-specific treatment]. Psychother Psychosom Med Psychol. Nov 2011; 61(11):481-6. German. Epub 2011 Nov 11 PMID: 22081467.

The work of Dr. Zanarini and her colleagues looks at the main symptoms that are characteristic of borderline personality disorder. This paper also describes certain diagnostic criteria that have been used in the studies. This test provides information for educational purposes only. IDRlabs and this test are in no way affiliated with the above researchers, organizations or institutions.

The borderline personality disorder symptom test relies on known research on the condition and other psychiatric disorders. However, all free online tests like this one are only introductory materials that will not be able to determine your inherent qualities with absolute accuracy and reliability. Therefore, our test provides information for educational purposes only. Detailed information about your mental state can only be provided by a certified specialist.

As the authors of this free online borderline personality disorder symptom ratio test, we have made every effort to ensure that this test is reliable and valid through numerous tests and statistical data controls. However, free online tests like this provide information "as is" and should not be construed as providing professional or certified advice of any kind. For more information about our online tests, please see our Terms of Service.

Post-traumatic stress disorder

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PTSD can be a debilitating condition, but professional advice can help.

November 11, we remember the Canadian soldiers who fought in battle and gave their lives. But many soldiers who have returned from the war face a new battle: post-traumatic stress disorder (PTSD). While the media tends to focus on combat veterans, many other Canadians are also struggling with unresolved trauma and PTSD.
How common is it?
According to a 2008 study, the lifetime prevalence of PTSD in Canadians is 9.2 percent. Just over 76 percent of respondents reported that being exposed to trauma is severe enough to trigger PTSD. About one in 10 Canadians will experience this debilitating condition at some point in their lives.
What is this?
Simply put, PTSD is how your body and brain respond to stress or trauma. To receive a diagnosis of PTSD, patients must meet a list of criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and these symptoms must last longer than a month.
David Rabbi, MA (Counseling Psychology) and Registered Clinical Advisor, included trauma work in his practice about five years ago.
“Trauma affects people at a very deep level, not only physical symptoms but also psychological symptoms: impact on self-awareness and self-esteem. When a trauma work is successful, it has a big impact on people's lives,” says the rabbi.
Various events can lead to trauma or PTSD, including

sexual and physical abuse in childhood
rape, assault or other violent crime
serious traffic accidents, including multiple traffic accidents
aggravated grief due to the death of a loved one
witness to a traumatic crime or death
survivors of natural disasters
war trauma as a soldier or civilian living in a war zone

“Trauma symptoms and life events from 40 or 50 years ago that still affect some people and they didn't know about it,” says the rabbi. “For example, clients who have suffered childhood abuse do not fully appreciate the impact these events have on their lives. "
Some of the symptoms people with PTSD struggle with are:

low mood, often accompanied by depression and anxiety
negative thinking
repetitive thoughts about the event
avoidance of stimuli associated with the event
forms of dissociation

"On the other hand, the symptoms of overexcitation, wakefulness, and the fear response are activated," says the rabbi. “Sometimes there is aggression associated with PTSD. There's a very wide range of symptoms that are similar to many other conditions, so it's not obvious that a person is suffering from trauma or PTSD. "
Relationships with spouses, families, colleagues and friends are negatively affected when a person suffers from post-traumatic stress disorder.
A counselor can use a variety of techniques to help people from all walks of life cope with—and in many cases overcome—PTSD.
Cognitive Behavioral Therapy (CBT)
CBT focuses on people's thoughts and actions. How we think about a situation affects how we feel about it and how we act. Our feelings may not be realistic, and the actions we take in a given situation, such as avoidance, may not be healthy. Through CBT, the counselor helps patients learn new, healthy ways to replace useless thoughts, feelings, and behaviors so they can move forward in their lives.
A 2011 review of CBT found that it was effective in treating acute (sudden) and chronic (long-term) PTSD in adults and children. CBT has been found to be useful for treating PTSD resulting from sexual assault, natural disasters, war, trauma, and traffic accidents. Patient rates can be as high as 50 percent, according to some studies, but overall CBT has proven to be just as effective as other psychological therapies for treating PTSD.
Eye Movement Desensitization and Reprocessing (EMDR)
This therapy is the cornerstone of the Rabbi's work with trauma. In 1987, American psychologist Francine Shapiro discovered that certain eye movements appeared to reduce the power of anxious thoughts. It started with the help of the DPDH to treat the wounded.
In the words of the rabbi, “trauma is an event that was so overwhelming in the first place that it is not fully processed by the [brain] so that when there is a reminder of it—some kind of external or internal cue—the brain and body react so like it's happening again. "
The light bar is used in DFG. The client sits in front of him, recalls the event, and allows his eyes to follow the lights as they move back and forth into the light bar.
“While the researchers are not sure why it works, it seems to mimic the rapid eye movement, deep rejuvenating sleep that humans have, which allows them to process the events of the day,” says the rabbi. “Events pop up and disappear from the neural network associated with her. ”
The consultant asks the client “what are you doing?”, and then the client reports. Results vary from client to client. EMDR is not hypnosis, but re-experiencing an event.
“I like to think that the essence of the person is present during the session, watching the event and experiencing the event in such a way that part of the brain was not present at the time of the trauma,” says the rabbi. EMCG helps the client free and integrate events that have been locked in the brain.
Cbt and DPDH are approved by the World Health Organization as a treatment for PTSD.
Group therapy
Group therapy (a type of psychotherapy involving one or more therapists working with several people at the same time) can also be effective for people who have experienced various types of trauma, such as sexual abuse.
Introduction to Therapy
The rabbi uses this method to allow the client to rethink traumatic experiences such as sexual abuse, process it and "do" the things they wish they would have done at the time.
A history of trauma such as childhood abuse, neglect, or sexual abuse makes it more difficult for adults to recover from PTSD. But it's never too late to process and heal the effects of a painful traumatic event with professional counseling to help.
Mind-Body Therapy
Research into these alternative therapies and found them to be useful for treating PTSD.
A 2013 study found that veterans who practiced yoga twice a week for six weeks had improved sleep quality and a significant improvement in symptoms of overarousal.
Mindfulness-based stretching and deep breathing
A group of nurses who participated in 60-minute sessions twice a week for eight weeks, normalized cortisol levels and reduced symptoms of PTSD.
Loving-kindness meditation was taught by a group of veterans during a 12-week study in 2013. Three months later, reductions were seen in symptoms of depression and PTSD.
PTSD: Fighting on the Home Front
Timothy Black, PhD, Associate Professor of Counseling Psychology at the University of Victoria. He is also the co-founder and national clinical director for Veterans' Transition Network. This organization helps Canadian wrestling veterans successfully reintegrate into civilian life. With the help of caregivers and other veterans, many are discovering new formations or careers, and dealing with the demons of PTSD.
Number affected
Despite the extensive amount of research on PTSD, it is difficult to estimate how many veterans return with this condition.
“We heard anywhere from 10 percent to 50 percent of combat veterans. But it's really hard to find good numbers. Even the best stats we have in Canada still have a whole range,” says Black.
Black says the transition from active combat to civilian life creates a sort of culture shock. A soldier can leave the anti-Taliban service, and for a week I will walk the streets of my hometown.
Adjusting life
One of the most difficult things in adapting to life is to return home, leaving war-torn places where, for example, girls have acid thrown in their faces because they want to get an education, and return home to hear Canadians complain about petty Problems. “They're really angry and frustrated with the way people in Canada live because we're one of the best countries in the world and that really worries them. They fight it,” Black explains.
“Alcohol and drugs are also a huge problem for dealing with their symptoms and family relationships. The research I did at the University of Victoria found one of the biggest things they struggle with making friends,” says Black.
Black quit his private practice to focus on working in groups with veterans because it was so successful.
“We hear over and over that it's the band aspect of what we do that makes a big difference. Having a military person in the group [is effective] because they are trained to feel most comfortable and safe in the group.

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