Side-by-side comparison
Pick a clinical presentation and see how the major orientations conceptualise and treat it. Useful for revising why and where one approach differs from another — the same patient through different lenses.
Greyed-out orientations don't have notes for this presentation yet.
Cognitive Behavioural Therapy (CBT)
Formulation
Maladaptive processing of the traumatic memory: stored in an overly generalised, fragmented way. Avoidance of reminders prevents emotional processing and integration. Common cognitions: threat ('I'm still in danger') and self-blame ('I should have done more'); safety behaviours (hypervigilance, avoidance) maintain them.
Typical intervention
Trauma-focused CBT: psychoeducation, imaginal exposure (repeated narrative recounting) to promote habituation and reprocessing, cognitive work on trauma-related thoughts, and in-vivo exposure to safe reminders.
Acceptance and Commitment Therapy (ACT)
Formulation
Avoidance of trauma-related memories and sensations, fusion with trauma narratives ('the world is dangerous; I am broken'), and loss of present-moment contact (flashbacks, hypervigilance).
Typical intervention
Grounding in present (when am I safe right now?), accepting trauma-related sensations and emotions without escape, accessing self-as-context (the observing part that experienced but was not destroyed), and gradual values-aligned action to rebuild a life beyond trauma-avoidance.
Dialectical Behaviour Therapy (DBT)
Formulation
DBT addresses trauma-related dysregulation through distress tolerance (surviving flashbacks and hyperarousal), emotion regulation (processing grief, anger, shame), and mindfulness. DBT alone is not sufficient for PTSD's core pathology.
Typical intervention
DBT stabilises behavioural dysregulation and builds the capacity to tolerate trauma-related affect. First-line evidence-based PTSD treatments (Prolonged Exposure, Cognitive Processing Therapy) then proceed. DBT is typically the adjunct when severe self-harm or suicidality co-occurs.
Psychodynamic Psychotherapy
Formulation
Trauma shatters the ego's organizing assumptions and overwhelms the capacity to symbolize: the event is not remembered but relived, repeated in dreams, enactments, and relationships (repetition compulsion) in an unconscious attempt at mastery. Meaning — 'why me', guilt, betrayal by protectors — carries as much weight as fear.
Typical intervention
A reliable frame and relationship first; help the patient build a narrative where there were only fragments; interpret re-enactments (including in the transference) as the trauma speaking; work through survivor guilt and the mourning of who they were before.
Emotion-Focused Therapy (Greenberg)
Formulation
Trauma leaves primary maladaptive fear and shame wired to cues that no longer signal danger, plus interrupted action tendencies — the fight that couldn't happen, the scream that was swallowed. Unfinished business with perpetrators or non-protecting others keeps the emotion recycling.
Typical intervention
Within a safety-first alliance: re-evoke the emotion at a workable distance, complete the interrupted responses (empowered anger, grief), use empty-chair work to confront the perpetrator or the one who failed to protect, and transform shame with self-compassion and protest — memory reconsolidates with the new response inside it.
Compassion-Focused & Mindful Self-Compassion (Gilbert; Neff & Germer)
Formulation
Alongside fear, the engine is often shame and self-blame ('I should have fought back', 'it was my fault') — the threat system turned inward. Survivors frequently fear kindness itself: care was absent or dangerous when it mattered, so compassion triggers backdraft.
Typical intervention
Build soothing capacity before trauma material: rhythm breathing, safe-place and compassionate-other imagery; titrate backdraft explicitly; bring the compassionate self to the traumatized part ('what does she need to hear?'); self-forgiveness work for the impossible choices survival required.
Mindfulness-Based Cognitive Therapy (MBCT)
Formulation
Not a first-line trauma treatment, but its lens is useful post-stabilization: intrusions gain power from the struggle against them, and rumination about the trauma ('why did I…') functions like depressive rumination — doing-mode grinding on what cannot be solved by thought.
Typical intervention
Adjunctively and with trauma-sensitive adaptations (choice, eyes open, short practices, grounding anchors other than breath if needed): train present-moment anchoring so intrusions are recognized as memory-events happening NOW-here rather than reality; reduce the secondary war with symptoms while trauma-focused therapy does the exposure work.
Person-Centered Therapy (Rogers)
Formulation
Trauma — especially interpersonal trauma — teaches that people are dangerous and that one's own experience cannot be trusted or told. The self fragments around what cannot be admitted into awareness; disclosure risk feels like annihilation.
Typical intervention
The conditions themselves are the treatment ground: a genuinely safe, non-directive relationship where the survivor controls pace and depth, is believed, and is prized while telling it. For many survivors this is the first relationship that does not repeat the trauma's power structure — the precondition for any deeper processing.