Can EMDR treat Complex Trauma?
Adapted Blog from our Podcast
This is a blog adapted from our Podcast Episode: Single Event versus Chronic Trauma. You can take a listen to our Podcast Episode at Simply Mental on Spotify. Use the button above to navigate there.
Recognizing the Layers of CPTSD
Complex Post-Traumatic Stress Disorder (CPTSD) is more than just an extended version of PTSD. While both conditions share core symptoms—re-experiencing trauma, avoidance, and hypervigilance—CPTSD adds layers of complexity, making it distinct in its presentation and treatment. The additional criteria for CPTSD, as outlined in the ICD-11, include emotional dysregulation, interpersonal difficulties, and a negative self-concept. These factors make healing a more intricate and personalized process.
The Challenge of Identifying CPTSD
Despite its clinical definition, CPTSD is rarely diagnosed formally. Many individuals meet the criteria but are only given a PTSD diagnosis due to the limitations of medical assessments. Physicians and other professionals often lack the time to explore the deeper, chronic patterns associated with CPTSD. This results in individuals navigating a condition that profoundly impacts their emotional and relational lives without a formal label to validate their experience.
The Role of Emotional Dysregulation
Emotional dysregulation in CPTSD manifests as difficulty managing strong emotions. Individuals may experience intense mood swings, prolonged emotional distress, or an inability to self-soothe. Unlike those with single-event PTSD, whose emotional responses are often tied to a specific incident, individuals with CPTSD struggle with regulating emotions across various aspects of life. This challenge often stems from prolonged exposure to instability, making it difficult to establish emotional balance.
Interpersonal Difficulties: A Symptom, Not the Root
CPTSD often creates struggles in relationships, not because individuals lack the desire for connection but because their early experiences shaped how they relate to others. They may unconsciously adjust to others’ behaviors, making them appear highly adaptable at first. However, as relationships progress, these patterns shift, leading to confusion and conflict. Interpersonal challenges are not just isolated struggles—they are symptoms of deeper emotional wounds.
Negative Self-Concept and the Internal Locus of Control
One of the most profound impacts of CPTSD is the development of a negative self-concept. Individuals may believe they are unworthy, incapable, or fundamentally flawed. This perception often extends to a low internal locus of control—the belief that external forces dictate their lives rather than their own actions. As a result, therapy can feel futile to them. They may enter therapy expecting the therapist to "fix" them, and when progress isn’t immediate, they might blame the therapist rather than seeing their own capacity for change.
The Importance of Addressing Self-Perception in Therapy
A negative self-concept, paired with a low internal locus of control, makes treatment particularly challenging. If someone believes they are incapable of change, they may struggle to engage in therapy. Recognizing this barrier is crucial for clinicians. Therapy must help clients shift from a passive role—where they feel powerless over their healing—to an active role where they recognize their agency. Addressing this early can prevent therapeutic disengagement.
Differences in PTSD and CPTSD Treatment
Understanding the distinction between PTSD and CPTSD informs the therapeutic approach. PTSD, especially from a single traumatic event, often responds well to structured treatment protocols like EMDR. Many individuals with single-event PTSD make significant progress in just a few sessions because they already possess a foundation of self-concept and emotional regulation.
CPTSD, on the other hand, requires a broader and more nuanced approach. Individuals with chronic trauma lack the same adaptive information and support systems that those with single-event PTSD may have. Their healing process is longer and involves addressing multiple interconnected issues rather than resolving a single traumatic memory.
A Useful Analogy: Flash Burns vs. Sunburns
One way to understand the difference between PTSD and CPTSD is through the analogy of burns. PTSD can be likened to a flash burn—a sudden, painful injury that draws immediate attention and concern. Support systems rally around the individual, and healing, though painful, is relatively direct.
CPTSD, however, is more like a severe sunburn. The damage accumulates over time, often unnoticed until it becomes unbearable. There is no single, obvious moment of injury—just years of exposure to harmful conditions. This distinction is crucial in understanding why CPTSD requires a different therapeutic approach.
Tailoring Treatment for CPTSD
Unlike PTSD treatment, which may focus on reprocessing a specific traumatic event, CPTSD treatment involves a multi-phase process that integrates several core areas of healing:
Safety Planning – Many individuals with CPTSD have a history of self-injury or other self-destructive behaviors. Establishing safety is the first step in treatment.
Challenging Thoughts and Emotions – Helping clients recognize that their thoughts aren’t always true and that emotions, while valid, may not always reflect reality.
Exploring Self-Perception – Identifying deeply ingrained beliefs about oneself and challenging negative narratives.
Identifying Trusted Feedback Sources – Learning to differentiate between valuable, supportive feedback and external criticism that should not carry weight.
Emotional Regulation Techniques – Developing strategies to calm the nervous system and manage emotional responses.
Boundary Setting – Teaching interpersonal effectiveness, helping individuals set boundaries around time, energy, and relationships.
Addressing Trauma through EMDR – For many, this stage involves processing multiple traumatic experiences rather than just one.
Integrating Healing into Daily Life – Ensuring that the insights gained in therapy translate into everyday resilience and self-awareness.
The Flexibility of Therapy for CPTSD
While CPTSD is complex, therapy does not have to be an overwhelming, all-or-nothing process. Clients can choose to focus on specific, immediate challenges rather than unpacking their entire history. For example, someone with childhood trauma might seek therapy to address recent medical trauma with their child. While past experiences may influence their distress, they can still find meaningful relief without diving into every past wound.
Therapy can be tailored to an individual’s needs. While deep trauma work is often necessary for long-term healing, individuals should know they have control over their therapeutic journey.
Final Thoughts: Hope for Those with CPTSD
CPTSD is a deeply challenging condition, but it is not insurmountable. With the right therapeutic approach, individuals can untangle the effects of chronic trauma and build a sense of self that is resilient, empowered, and self-compassionate. While the healing process takes time, it is absolutely possible to move from a place of survival to one of thriving.
