Treatment for the effects of childhood trauma

If your childhood still affects your sleep, mood, relationships or sense of safety, treatment can help. You do not need to wait for a crisis, and you are not too old. Trauma-focused talk therapies have strong research behind them, including for adults whose trauma began in childhood.¹

This page explains the main treatments for adults, what complex PTSD is, how therapists pace care when trauma ran deep, and what therapy for children looks like. It ends with tips for finding a therapist.

Do I need a diagnosis to get help?

No. An ACE history is not a diagnosis, and you do not need one to talk with a professional. A therapist will ask about your symptoms and your life now. Then you can decide together what to work on.

Childhood adversity can lead to several different conditions, such as PTSD, depression, anxiety or substance use problems. Each has proven treatments. Good care treats the problems you have now, while taking your history into account.

Trauma-focused therapies for adults

Trauma-focused therapies help you process traumatic memories, so they lose some of their power. They also help you change painful beliefs that grew out of the trauma, such as "It was my fault" or "No one can be trusted."⁴

The badges show how strong the research is. See how we rate evidence.

Most of these therapies involve some time thinking or talking about what happened. That can feel scary. A good therapist goes at a pace you can handle and teaches you ways to calm down first. NICE says trauma-focused therapy should include learning about trauma reactions, ways to manage flashbacks and a safety plan.⁴

Do these therapies work for childhood trauma?

Yes. A review of 16 trials looked only at adults with PTSD after childhood physical or sexual abuse. Therapy helped, and the gains lasted at follow-up. Trauma-focused therapies worked better than therapies that did not focus on the trauma. One-on-one sessions worked better than group therapy alone.¹

Another review of 51 trials looked at people likely to have complex PTSD symptoms. CBT, exposure therapy and EMDR all eased PTSD symptoms more than usual care. CBT and exposure also improved negative beliefs about the self and problems in relationships. On average, people whose trauma began in childhood improved somewhat less.⁹ Somewhat less still means real improvement for many people.

For depression, the news is also encouraging. A review of 29 studies with up to about 6,800 adults with depression found that more than 6 in 10 reported childhood trauma. They started treatment more depressed, but they improved about as much as people without that history, with medicine, therapy or both. They were no more likely to drop out.⁸

What is complex PTSD?

The World Health Organization's disease list, ICD-11, includes a diagnosis called complex PTSD. A person has all the core symptoms of PTSD: reliving the trauma, avoiding reminders and feeling under threat. They also have three lasting problems:^4,5

• Trouble managing emotions, such as strong reactions that are hard to calm, or feeling numb
• A deeply negative view of oneself, such as feeling worthless, defeated or ashamed
• Trouble in relationships, such as finding it hard to feel close to others or to stay connected

Complex PTSD is more often linked with trauma that was early, repeated and caused by other people, such as long-term childhood abuse.^5,4 It can follow other kinds of trauma too.⁵ The U.S. diagnostic manual, DSM-5, does not have a separate complex PTSD diagnosis. It covers some of these problems within PTSD.⁵ In one U.S. sample of about 1,800 adults, about 4% met criteria for complex PTSD and about 3% for PTSD.⁵

You do not need the label to get help. If these problems sound familiar, tell your therapist.

Phase-based care: does stabilization have to come first?

For many years, experts have debated how to treat complex PTSD.

• The phase-based view. Some experts suggest starting with a skills phase. This means learning to manage emotions and relationships before working on trauma memories. One example is a program called STAIR (Skills Training in Affective and Interpersonal Regulation). The idea is that skills make trauma work safer and help people stay in treatment.⁶
• The direct view. Others argue that trauma-focused therapy is the best treatment for both PTSD and complex PTSD. In their view, a long skills phase can delay getting to the root of symptoms.⁶

What does the research say so far? The VA's National Center for PTSD reports that early trials have not found an advantage for the phase-based approach. People with complex PTSD often start with more severe symptoms but improve about as much with standard PTSD treatments.⁶ VA and Defense Department guidelines found too little evidence to recommend for or against STAIR as a treatment for PTSD.²

NICE takes a practical middle path. For people with complex PTSD, it advises therapists to:⁴

• Allow extra time to build trust, with longer or more sessions if needed
• Consider whether housing and other life circumstances are safe and stable enough
• Help with barriers to trauma work, such as substance use, dissociation (feeling detached or "spaced out"), strong emotions, relationship problems or a harsh view of oneself
• Plan for support after treatment ends

What this means for you: You do not have to "earn" trauma therapy by being calm first. But it is fine to ask for time to build skills and trust. A good therapist will talk with you about pacing.

Medicines

Medicines are not a cure for the effects of childhood trauma. But they can help with PTSD, depression and anxiety. VA and Defense Department guidelines recommend individual talk therapy over medicine for PTSD. When medicine is used, the guideline recommends sertraline, paroxetine or venlafaxine.²

Your doctor will choose any medicine with you based on your health and other medicines. Never stop or change a medicine on your own. Talk with your doctor or pharmacist before changing anything. See Medicines for PTSD and Antidepressant medicines.

Therapy for children and teens

If a child in your life has been through trauma, help is available. NICE recommends trauma-focused CBT for children and teens ages 7 to 17 with PTSD symptoms. It usually takes 6 to 12 sessions and involves parents or caregivers when appropriate.⁴

The best-known version, called TF-CBT, teaches children coping skills and helps them tell the story of what happened in a safe way. A safe parent or caregiver often takes part. A 2022 review of 28 trials found that TF-CBT reduced posttraumatic stress more than comparison conditions, such as usual care or a waiting list. It also eased depression, anxiety and grief.⁷

If a child is being hurt right now, call 911. The Childhelp hotline, 1-800-422-4453, offers 24-hour support and guidance by call or text.¹⁰ See Parenting with your own history.

Trauma-informed care

You may hear the term "trauma-informed care." It describes how a clinic or program treats everyone, not a specific therapy. SAMHSA describes a trauma-informed service as one that understands how common trauma is, recognizes its signs, builds that knowledge into everyday practice and works to avoid causing new harm.¹¹

SAMHSA lists six key principles:¹¹

1. Safety, both physical and emotional
2. Trustworthiness and openness about decisions
3. Peer support from people with lived experience
4. Collaboration that shares power between staff and the people they serve
5. Empowerment, voice and choice in your own care
6. Attention to culture, history and gender

In practice, this might mean a clinician explains each step, asks before touching you and lets you choose where to sit. You can ask for these things in any health care setting.

Finding a therapist

Look for a licensed therapist with specific training in a trauma-focused therapy. Useful questions to ask:

• "What training do you have in CPT, PE, EMDR or other trauma therapies?"
• "How do you pace treatment for someone with childhood trauma?"
• "How will we know if it is working?"

SAMHSA's FindTreatment.gov lists state-licensed programs for mental health and substance use. It is confidential and anonymous.¹² Veterans can ask the VA. Many therapists offer video sessions.

See How to find a therapist, Paying for therapy and our therapy finder. If you have been to therapy before and it did not help, it may be worth trying a trauma-focused approach or a different therapist.

Common questions

When to get help

Reach out for professional help if memories, nightmares, numbness, anger, low mood or drinking are getting in the way of your life. You deserve care, whether the trauma was last year or 60 years ago.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.