Trauma Therapy for PTSD: Why One Size Rarely Fits All

For many years, I have worked as a trauma therapist supporting people living with post-traumatic stress disorder (PTSD) and complex PTSD. My work has involved helping clients understand the impact of traumatic experiences, reduce distressing symptoms, and gradually reconnect with a sense of safety, agency, and meaning in their lives.

Trauma affects people in deeply individual ways. While there are well-established, evidence-based psychological treatments for PTSD, both research and clinical experience show that no single approach works equally well for everyone.

CBT and Talk Therapy for PTSD: Benefits and Limitations

Cognitive Behavioural Therapy (CBT), including trauma-focused CBT, is one of the most widely researched treatments for PTSD and is recommended in national and international clinical guidelines, including those published by Phoenix Australia and NICE.

Broadly speaking, CBT aims to help individuals understand the relationship between thoughts, emotions, and behaviours, reduce avoidance, and process traumatic memories in a structured and time-limited way. For many people, this can lead to meaningful reductions in PTSD symptoms and improvements in daily functioning.

However, outcomes in real-world clinical settings are often more nuanced than research trials suggest.

Some clients report that repeatedly revisiting traumatic memories through verbal processing can feel overwhelming or destabilising, particularly when trauma has been chronic, relational, or occurred early in life. Others find that despite having a clear cognitive understanding of their trauma, their body continues to respond as though the danger is still present.

These experiences do not mean that CBT or talk therapy are ineffective. Rather, they highlight the complexity of trauma and the limitations of relying on any single therapeutic model in isolation.

Trauma Is Held in the Nervous System, Not Only in Memory

Research over recent decades has increasingly recognised that trauma is not only stored as conscious memory, but is also reflected in the body and nervous system.

People living with PTSD or complex trauma may experience:

• Chronic hypervigilance or muscle tension

• Emotional shutdown or numbing

• Panic or sudden physiological reactions

• Sleep disturbance, digestive issues, or persistent pain

• A sense of being “on edge” without a clear trigger

These responses are often automatic and occur outside of conscious awareness. For some people, insight and understanding alone are not sufficient to create lasting change.

Integrating Top-Down and Bottom-Up Trauma Therapy Approaches

In my clinical work, I have found that many clients respond best to a combination of top-down and bottom-up approaches to trauma treatment.

• Top-down approaches focus on cognition, emotional awareness, meaning-making, and narrative understanding.

• Bottom-up approaches focus on the body, sensory experience, and nervous system regulation.

When integrated carefully, these approaches can complement one another — supporting both psychological understanding and physiological regulation, rather than prioritising one at the expense of the other.

This integration does not replace evidence-based care. Instead, it reflects a growing understanding within trauma research and practice that recovery often involves working across multiple levels of experience.

Evidence-Based Practice and the Limits of Research

Evidence-based practice is a cornerstone of ethical psychological care. It helps protect clients, guides clinicians, and ensures that treatment is grounded in research rather than opinion alone.

At the same time, not all effective trauma therapies are equally easy to research. Approaches that involve relational, somatic, or experiential elements can be more difficult to standardise, manualise, or measure using traditional research designs.

This does not mean these approaches lack value. Rather, it reflects the challenge of studying complex human processes within rigid research frameworks.

Modern definitions of evidence-based practice emphasise the integration of research evidence, clinical expertise, and client preferences. In practice, this means adapting therapy thoughtfully, collaboratively, and within clear professional and ethical boundaries.

Trauma Therapy as a Collaborative and Individualised Process

Trauma recovery is rarely linear. What feels supportive at one stage may feel overwhelming or unhelpful at another. Effective trauma therapy often involves careful pacing, choice, and respect for the client’s nervous system and lived experience.

A trauma-informed approach recognises that safety, agency, and trust are not assumptions — they are outcomes that develop over time.

While no psychological therapy can offer guarantees, many people do experience meaningful relief, increased stability, and a stronger sense of self through carefully tailored and evidence-informed support.

Considering Trauma Therapy

If you are considering trauma therapy, it can be helpful to seek a practitioner who works collaboratively, explains their approach clearly, and is willing to adapt treatment to your needs over time.

References

• Phoenix Australia – Centre for Posttraumatic Mental Health. (2020). Australian Guidelines for the Treatment of Acute Stress Disorder and Posttraumatic Stress Disorder.

• National Institute for Health and Care Excellence (NICE). (2018). Post-traumatic stress disorder (NG116).

• American Psychiatric Association. (2017). Clinical Practice Guideline for the Treatment of PTSD.

• American Psychological Association. (2006). Evidence-Based Practice in Psychology.

• Herman, J. L. (2015). Trauma and Recovery.

• van der Kolk, B. (2014). The Body Keeps the Score.

Disclaimer:
This article is intended as general information only and does not replace individual psychological assessment or treatment. Psychological therapy should always be tailored to the individual.