PTSD and trauma

PTSD, post-traumatic stress disorder, can develop after a frightening, dangerous or overwhelming event and leaves the nervous system reacting as though the danger is still present. It often brings flashbacks, nightmares, hypervigilance and avoidance of anything connected to what happened. Specialist psychological therapy, using NICE-recommended approaches, can help the alarm system settle.

What PTSD and trauma are and how they show up

PTSD can develop after a single traumatic event, such as an accident, assault or medical emergency, or after repeated or prolonged experiences, sometimes called complex trauma, which can shape relationships and sense of self more broadly. Symptoms typically fall into a few groups: re-experiencing, through flashbacks, nightmares or intrusive memories; avoidance of people, places or reminders connected to the event; hyperarousal, including a heightened startle response, irritability and difficulty sleeping; and negative changes in mood or beliefs, such as persistent guilt, shame or a sense that the world is no longer safe.

Not everyone who goes through a traumatic event develops PTSD, and there is no fixed timeline for when symptoms might appear, some people notice difficulties within days, others months or years later. Trauma can also show up alongside depression, anxiety or substance use, since coping with intrusive symptoms over time takes a toll on other areas of life.

Trauma related to childbirth, medical procedures or ongoing situations such as an abusive relationship can present differently again, sometimes with less obvious flashbacks and more of a persistent sense of dread, numbness or difficulty trusting others. It is also common for people to feel a strong urge to avoid thinking about what happened altogether, which can make it harder to recognise trauma as the underlying cause of unrelated-seeming problems, such as irritability at work or difficulty in close relationships.

When to seek help

If flashbacks, nightmares, avoidance or a constant sense of being on edge have followed a difficult or frightening event and are not settling with time, it is worth speaking to a specialist. This applies whether the event happened recently or years ago. If you are having thoughts of harming yourself, please see the crisis support information below before anything else.

How a clinical psychologist assesses and treats PTSD

Assessment involves understanding what happened, how your symptoms present, and how they are affecting your day-to-day life, always at a pace that respects what you are ready to talk about. NICE recommends trauma-focused CBT and EMDR (eye movement desensitisation and reprocessing) as first-line treatments for PTSD, and both have a strong evidence base. Trauma-focused CBT works by helping you process the traumatic memory in a structured way while addressing unhelpful beliefs that have developed since, such as excessive self-blame or a sense of ongoing danger. EMDR uses bilateral stimulation, usually guided eye movements, while recalling aspects of the memory, which appears to support the brain’s own reprocessing of it.

Treatment usually starts with stabilisation, building coping strategies for managing symptoms day to day, before moving into direct work on the traumatic memory itself. This sequencing matters: processing work is more effective, and safer, once you have some grounding techniques and a trusting relationship with your psychologist in place.

Where trauma is more complex, arising from repeated experiences rather than a single event, treatment often takes longer and places more emphasis on emotional regulation and relational patterns before moving into memory-focused work. A psychologist will adapt the pace and structure of therapy to fit this, rather than applying a single-incident model to a presentation that does not fit it. Throughout treatment, your psychologist will regularly review how you are coping and adjust the plan collaboratively.

What online sessions look like

Sessions run over secure video call, usually fifty minutes for CBT and slightly longer for EMDR sessions where needed. You will need a private, quiet space where you feel able to work through difficult material without interruption. Your psychologist will check in with you regularly about how the online format feels, and will slow down or adjust the pace if a session brings up more than expected.

Choosing between EMDR and trauma-focused CBT

Both approaches have similar success rates for PTSD, so the choice often comes down to what suits you as an individual. Some people prefer trauma-focused CBT because it involves more explicit discussion and structured written work around the memory and the beliefs attached to it. Others find EMDR easier to tolerate because it requires less verbal description of what happened in detail. Your psychologist will talk through both options with you during assessment and make a recommendation based on your specific presentation, though the final decision is always made together.

PTSD, trauma and life in Islington and north London

Islington’s N1 postcodes take in Upper Street, Angel, Highbury, Canonbury and Barnsbury, with the Victoria and Northern lines running through the area. Trauma symptoms, hypervigilance on a crowded platform, avoidance of certain routes, disrupted sleep before a demanding day, can sit uneasily alongside the pace of life in this part of north London. Online sessions mean you can access specialist trauma therapy without needing to travel to and from a clinic, which some people with PTSD find easier given how avoidance and anxiety around travel can be part of the presentation itself.

Getting started

Sessions are online, so there is nothing to wait for before starting. Our get started page is the quickest way in, and we will match you with a psychologist experienced in trauma-focused work.

What to expect from your first sessions

The first one or two sessions focus on gathering a clear history and understanding your current symptoms, without asking you to relive the traumatic event in detail. Your psychologist will also spend time on grounding and stabilisation techniques you can use between sessions if symptoms feel overwhelming. Only once this foundation is in place does the work move towards the memory itself, and even then it happens in a structured, paced way rather than all at once.

If you need support right now

If you are in crisis or thinking about harming yourself, please don’t wait for an appointment. Call 999 in an emergency, contact NHS 111 and select option 2 for a mental health crisis, or call the Samaritans on 116 123, free, at any time, day or night.