Understanding cognitive therapy for PTSD
Learn how therapy connects memories, their meanings and present reactions, and how you can choose the pace with your therapist.
Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed
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Understanding cognitive therapy for PTSD
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Why danger can feel present
Cognitive therapy for PTSD (CT-PTSD), based on Ehlers and Clark's model, explores how memories and their meanings can keep a sense of threat going. A memory may feel as if it is happening now, and reminders can bring it back even when you do not notice what set it off. What happened, or its aftermath, may also affect how you see yourself or the world. This handout supports CT-PTSD with a trained therapist and does not replace it.
What you work on together
You build a shared picture of what keeps the difficulty going. Avoiding reminders, pushing memories away, watching for danger or going over events again and again may help briefly but keep threat in focus. Therapy explores what events mean to you, links the memory with what you know now, and supports returning to activities that matter. Memory work is therapist-led, with your consent and an agreed pace. You need not recount events here.
Reminders and real danger
Noticing differences between then and now can help with reminders. It never means ignoring present danger or removing necessary protection. Fictional illustration: a loud sound brings a memory closer. Someone notices where they are now and uses a difference between then and now that they practised with their therapist. If abuse or danger is still happening, tell your therapist or GP promptly. They can help you plan how to stay safe and get protection.
If someone in your life frightens, threatens or controls you, don't practise with them. Talk to your therapist first. If you are in danger, call 999.
Free domestic abuse helplines, open day and night: in England, the National Domestic Abuse Helpline (run by Refuge) on 0808 2000 247; in Scotland, Scotland's Domestic Abuse and Forced Marriage Helpline on 0800 027 1234; in Wales, Live Fear Free on 0808 80 10 800; in Northern Ireland, the Domestic and Sexual Abuse Helpline on 0808 802 1414.
Questions and support
If reading increases distress or you feel unreal or far away, pause and contact your therapist before continuing. If help cannot wait, contact your GP or urgent-care service now.
This worksheet is for feelings you can manage. If you have urges to hurt yourself, or you feel unsafe, use your safety plan if you have one and tell your therapist. If you might act on the urges, call 999 or go to A&E. To talk to someone now, call Samaritans free on 116 123.
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When to use ‘Understanding cognitive therapy for PTSD’
‘Understanding cognitive therapy for PTSD’ is a psychoeducation handout based on cognitive behavioural therapy (CBT), most often used in CBT for trauma and PTSD.
It is designed to be read within therapy rather than as a standalone self-help tool: a therapist introduces it and discusses it with the client. You can preview the full handout above, then assign it for clients to read between sessions on any device or download it as a print-ready PDF. Where a short reflection is included, it offers space to respond to the reading.
How it works
Most people work through it in around 8 minutes. It moves through four short sections to read:
- Why danger can feel present: Cognitive therapy for PTSD (CT-PTSD), based on Ehlers and Clark's model, explores how memories and their meanings can keep a sense of…
- What you work on together: You build a shared picture of what keeps the difficulty going. Avoiding reminders, pushing memories away, watching for danger or going over…
- Reminders and real danger: Noticing differences between then and now can help with reminders. It never means ignoring present danger or removing necessary protection.…
- Questions and support: If reading increases distress or you feel unreal or far away, pause and contact your therapist before continuing. If help cannot wait,…
The handout can be read on a phone, tablet or computer, or downloaded as a print-ready PDF. If it includes a reflection, answers entered on the Formulate platform are saved automatically and shared back with the therapist for review before the next session.
The CBT approach behind it
‘Understanding cognitive therapy for PTSD’ introduces a CBT approach that involves noticing the links between situations, thoughts, feelings, physical sensations and behaviour and finding practical ways to change unhelpful patterns. The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going and practical, testable ways to change it.
Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.
Evidence & sources
This handout is grounded in established cognitive behavioural therapy theory and practice. Key sources include:
- Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy.
- Ehlers, A., Clark, D. M., Hackmann, A., McManus, F., & Fennell, M. (2005). Cognitive therapy for post-traumatic stress disorder: development and evaluation. Behaviour Research and Therapy.
- National Institute for Health and Care Excellence (2018). Post-traumatic stress disorder (NG116). NICE.
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- NHS 111 (NHS 24 in Scotland): 111 — choose the mental health option for urgent help, in England, Scotland and Wales (in Wales, press 2)
- Lifeline: 0808 808 8000 — for urgent help in Northern Ireland, free, day or night
- Samaritans: 116 123 — free, day or night, 365 days a year
- Shout: 85258 — text SHOUT, free, day or night
- SANEline: 0300 304 7000 — 4pm–10pm, every day
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