Psychotherapy for Trauma or Stress

After exposure to terrifying or catastrophic events, most people, about 70-80%, eventually recover and resume a normal life with little or no professional intervention.  A large number of people, about 20-30%, experience prolonged psychological distress that may interfere with their abilities to work, to trust others, to maintain hope about the future, and/or to live a fulfilling life.  They may suffer from intrusive thoughts and images, nightmares, and flashbacks of traumatic events long after those events are ended.  

The relived experience of the past in thoughts and images may cause severe anxiety as if the terrifying or catastrophic events were happening again in the present.  Avoidance as a way of coping with this anxiety can worsen the imagined danger from memories of the original trauma.  When people suffer this way, they may have a Trauma-and-Stressor-Related Disorder, the most severe form of which is PTSD or Post-Traumatic Stress Disorder. 


Each person coping with very severe trauma or stress has unique characteristics and medical background, and therefore should be thoroughly assessed by a psychiatrist (physicians who specialize in mental illness).  Every individual coping with trauma or stress would benefit from connecting with a skilled psychotherapist.  Psychiatrists and allied clinicians can work collaboratively to treat very severe trauma and stress using well-established protocols usually involving both psychotherapy and medication.  The overall treatment goal is to address simultaneously biological, psychological, and social factors affecting both the person with PTSD and his or her family.

Psychotherapy for PTSD is best received from a trained and licensed clinician who follows an evidence-informed approach. One of these approaches is Exposure Therapy, which is a form of Trauma-Focused Cognitive Behavioural Therapy (TF-CBT).  Exposure Therapy changes erroneous beliefs, and emotions about the dangers of the intrusive thoughts/images/memories of the traumatic or catastrophic events.  Other approaches include non-trauma-focused CBT, Cognitive Therapy (CT), reprocessing techniques such as Eye Movement Desensitization and Reprocessing (EMDR), and Somatic Therapies.


Two meta-analyses published in 2013 and 2014 examined how well various psychotherapy approaches worked for PTSD. The first report, published in 2013 by Watts and colleagues based in the US, was a comparison of 137 treatments for PTSD from 112 separate studies.  The authors found that the most effective intervention were Cognitive Therapy and Exposure Therapy.  Interestingly, EMDR was just as effective as Exposure Therapy. Less effective than CBT-based therapies were antidepressant medications such as paroxetine, sertraline, and fluoxetine, which are selective serotonin reuptake inhibitors (SSRIs).  [Ref 1]

The second report, published in 2014 by Ehring and colleagues based in Germany, The Netherlands, and Saudi Arabia, was a comparison of various psychotherapy treatments for adult survivors of childhood abuse from 16 separate studies.  The authors found that virtually all psychotherapy methods examined–including Trauma-Focused CBT, non-trauma-focused CBT, EMDR–significantly reduced depression, anxiety, and other symptoms of PTSD.  However, Trauma-Focused CBT approaches were the most effective in creating the largest measured reductions in symptoms of PTSD. [Ref 2]


If you or a loved one is affected by trauma or stress , there is support and advocacy available.  Visit websites about trauma or stress by the Canadian Mental Health Association (CMHA), Centre for Addiction and Mental Health (CAMH), and PTSD Association of Canada for more information.  Talk to your Family Physician or qualified health care professional and use Psychotherapy Matters.


Help is available at Psychotherapy Matters

To find a psychotherapist available to work with individuals and families struggling with trauma or stress, use the link provided here, scroll down to “Help with…” and select “Trauma or stress”



  1. Watts BV, Schnurr PP, Mayo L, Young-Xu Y, Weeks WB, Friedman MJ. Meta-analysis of the efficacy of treatments for posttraumatic stress disorder. J Clin Psychiatry. 2013 Jun;74(6):e541-50. Read it here.
  2. Ehring T, Welboren R, Morina N, Wicherts JM, Freitag J, Emmelkamp PM. Meta-analysis of psychological treatments for posttraumatic stress disorder in adult survivors of childhood abuse. Clin Psychol Rev. 2014 Dec;34(8):645-57. Read it here.


Information provided here and anywhere else on is for learning purposes only and should not be used to guide treatment of clients/patients. Copyright © 2016

Vicky Nguyen
Vicky Nguyen

Vicky is a psychiatrist and recent graduate from the Northern Ontario School of Medicine (NOSM). She completed her PhD and MD training at the University of Toronto. Her research interests are directed at promoting innovative practices and policies to address sub-optimal wait times, access, equity, and quality of health care services for disadvantaged populations in Ontario. She is certified to provide IPT and CBT. She is trained to provide other types of therapy including DBT, and Psychodynamic Psychotherapy.

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