Everyone has unpleasant memories which bother them from time to time. For many people, the scourge of unpleasant memories affects their well-being and quality of life. Reliving bad experiences along with their emotional pain is probably one of the worst things about being human.

Long or intense periods of abuse, or other negative situations, have been known to create a general feeling of unease and distress that can last for many years. Often, there are specific situations, people, places, or things that can trigger negative memories and/or feelings related to them. The traumatic events may even be forgotten while their psychological effects remain.

Trauma is not only about violence. Most of it results from verbal abuse. Neither is trauma only about diagnosed post-traumatic stress disorder (PTSD). Trauma is a matter of degrees of severity, not labels given by authority figures.

Trauma is often most severe following a major disturbing event like experiencing or witnessing a severe assault. However, sometimes our minds will become fixated on seemingly minor things. It could be a hurtful text or a time someone yelled at you. If you involuntarily relive the negative event along with negative emotions, you are experiencing trauma. The emotions you feel could be the same ones you experienced during the event, or they could be emotions about the event.

Trauma comprises a large part of the burden of human mental suffering. It often results in a more negative view of the world in general. After a trauma, you may have more negative thoughts in general and have a more negative take on the things that you see. You may lose interest in people or things which you used to enjoy. Moreover, trauma tends to cause hypersensitivity and hyperarousal — you can become very angry over minor things and you never seem to really feel at peace.

Overcoming trauma isn’t easy. A trauma may last a few days or a lifetime. Everything related to trauma is unpredictable. The same event will cause trauma for one person but not for another. The trauma may go away on its own or after some form of treatment. Recovery may be gradual or relatively sudden with or without professional intervention.

If you’ve grappled with disturbing memories for years, you might not have much hope for a full recovery. However, there are many forms of treatment for emotional trauma that you may not have tried. An open mind is essential. Some of the treatments with the largest evidence base may seem strange or counterintuitive but they have worked for many people and they might work for you.

Treatments for anxiety also apply to trauma because they involve disrupting negative thinking and establishing a calm and secure mental state. The Mental Guide for Anxiety should therefore be your first stop for dealing with trauma and unpleasant memories. This article covers cognitive, lifestyle, and medical approaches for managing traumatic memories of any severity or duration.

Trauma can affect every area of life. The worse your trauma, the more intentional you may need to be in living your life. Your choices regarding relationships, work, and leisure time have the potential to raise or lower your symptoms. Regardless of whether or not you opt for a formal type of treatment, lifestyle choices can have a big impact on the course of your recovery.

A trigger is a stimulus that consistently reminds us about a traumatic memory. It can come in the form of words, people, places, objects, dates, events, or situations. Anything that reminds us (even subconsciously) of a negative event from the past can stimulate us to remember the event and become inundated with related feelings and thoughts. Fear, anger, grief, hurt feelings, frustration, self-hate — can come rushing into us when triggered.

How to manage triggers is a hot topic in psychology. The mainstream view currently is that progressive exposure to triggers is best for mental health and avoidance of triggers is considered a problem that needs to be fixed. That is an irresponsible position intended to shame people into seeking unnecessary psychotherapy. A rational approach to the controversial exposure topic requires more nuance.

The first step in managing triggers is to identify them. There is no one that doesn’t have bad memories and things that remind them of those memories. Everything is a matter of degree. Developing an awareness of how various stimuli affect your mental state is important for managing trauma (and mental health generally).

Minor triggers are easier to tolerate but also less ‘costly’ to avoid. Let’s say you had a really bad experience at a restaurant chain and going to any location of that chain reminds you a little of the event. It will give you a ping of negativity when you visit the chain which will likely gradually fade with time. On the other hand, avoiding the restaurant brand altogether could be practical and easy. With minor traumas and their triggers, the stakes are relatively low.

More intense triggers have higher stakes — negative neural pathways are stimulated and strong emotions arise. By default, that is something that you would (and should) avoid. If you were assaulted at a restaurant chain only a few months ago and have a strong emotional reaction whenever you go to that chain, avoiding it would seem like a sensible thing to do. I don’t care what the mind wizards say. If the costs of avoiding powerful triggers are low, there is no reason why you should feel pressured to expose yourself to them.

Routines can help restore a sense of security.

There are reasons why you would want to expose yourself to triggers, however. If your trigger is something that you cannot practically avoid (i.e. being at your workplace), you will be forced to pay a large cost if you try to do so (i.e. becoming unemployed). Moreover, exposure can be constructive if considerable time has passed since the traumatic event, the triggers are starting to lose their potency, and you now prioritize eliminating triggers over totally avoiding negative responses. Only you can decide whether and to what degree you should expose yourself to potential triggers.

The importance of interpersonal interactions is magnified in people with significant trauma. They have the most to gain from positive interactions and the most to lose from unhealthy interactions. Friendships (or any type of relationship) in which you feel emotionally supported are critical to this group. People with trauma have a high need for people in their lives that they ‘can talk to about anything.’ It is also harder for these individuals to be alone or deal with difficult people. Thus, light levels of positive socialization (e.g. lunchroom banter, playing sports) also take on increased importance.

Unfortunately, it is common for people grappling with demons to isolate themselves. It is not uncommon for them to even stop associating with long-time friends. Sometimes, the reason offered for this is that they can’t relate to others as they could in the past. Other times, they feel they need to ‘work out their issues’ alone before being ‘ready to go out again.’ Regardless of the reason, if you have trauma, intentionally isolating yourself for a long period will probably impede recovery.

Ideally, you can find people that you can talk to about the trauma itself. If not, or if you don’t want to discuss your trauma, social support is still equally important. Trauma often begets a general insecure, threatened feeling towards the world. People feel unsafe, like everyone is a potential threat. Such a worldview, though it may seem justified, makes it impossible to ever feel at ease. Your guard is always up for the next traumatic event. Having kind, empathic people around — ones that make you feel psychologically safe — is one of the best weapons you have against living in this undesirable high-tension state.

‘Staying busy’ or following a routine can help deal with trauma. Too much time on your hands is frequently an invitation for your bad memories to pay you an impromptu visit. By maintaining some sort of structure in your day, you can minimize idle time and keep your mind engaged in the here and now.

There are many more advantages to having a routine. A routine can make it easier to incorporate positive mental health habits into your day, such as exercise or breathing practices. By following a routine, your healthy habits do not depend upon your willpower in the moment.

Routines can be empowering. Traumatized individuals often suffer from a feeling of powerlessness and hopelessness. If you stick to a routine, however, your sense of agency, self-efficacy, and self-esteem will likely improve relative to a less disciplined lifestyle. Maintaining routines provides a continual sense of accomplishment in addition to the increased progress on each lifestyle habit itself.

Many people who have taken up a creative pursuit for the first time following a traumatic experience have reported a significant improvement in their mental health.

Routines can help restore a sense of security. By reliably providing (generally) positive, predictable experiences, hyper-vigilance for threats should diminish as peace of mind grows. For instance, if you hold fear surrounding busy places, a routine of going to the food court over lunch break may provide the limited exposure you need to progressively overcome that fear.

The general sense of insecurity common among people with trauma can also improve for non-exposure-related situations. For example, a pleasant home-based routine, like applying makeup, could provide a sense of security by virtue of its predictable, non-threatening, and fun nature.

Suffering and creativity appear related at a deep level in human beings. Perhaps it is about energy. Emotional pain is a type of energy and energy can always be redirected. An abundance of anecdotal evidence from trauma sufferers suggests that creative outlets can aid in recovery. Writing, drawing, singing, playing a musical instrument, dancing, acting, photography, martial arts, crafts, decorating, dressing — there are many ways to express ourselves artistically.

The creative expression may or may not be directly related to the trauma. It can be happy, sad, or ambiguous. There is no one correct way to channel your energy for therapeutic purposes. You can express your anger with some creative writing in the morning and play an uplifting piece on your guitar in the evening. It all depends on what you feel like. Isn’t that what creativity is, after all — a series of highly personal choices… an expression of autonomy?

A number of theories have sought to explain why creative expression is therapeutic in people with trauma. It is a way to immerse yourself fully in an activity, leaving little room for a wandering mind. It can be a way of regaining a sense of independence or self-efficacy that may have been lost. For the more physical types of expression like dancing or acting, somatic theories of trauma theorize that bodily movement unlocks areas in the body in which traumatic feelings have been stored.¹

Neuroplasticity, or reprocessing theory, posits that artistic endeavors help with trauma by accessing parts of the brain associated with the traumatic memory and facilitating a more complete processing (not unlike in EMDR) or more constructive neural connections.² Neuropsychologists also speculate that since creativity and emotions are both located in the right hemisphere of the brain, they are closely intertwined.³

Finally, expressive theories dictate that creative outlets facilitate a robust expression of repressed emotions — particularly important for people who have difficulty expressing their thoughts and feelings verbally.⁴

The evidence base for creative therapy for trauma is presently small. A systematic review of 6 trials of art therapy from 2014 reported that half of the included studies found a significant drop in trauma symptoms.⁵

Artistic outlets are not only for people with pre-existing artistic talent, inclination, or experience. Many people who have taken up a creative pursuit for the first time following a traumatic experience have reported a significant improvement in their mental health. If no type of art or creative hobby holds particular interest for you, many ideas can be found on the Internet.

Many studies have documented the mental health benefits of regular exercise.⁶ A limited number of studies have investigated the effects of exercise on PTSD, with mixed results. Some studies show that exercise lowers PTSD symptoms while others have not found a significant effect.⁷ However, the studies have noted that larger volumes of exercise have been associated with greater improvement in symptoms.⁸
The inconsistency in PTSD exercise studies should not be taken as proof that exercise does not help people with trauma. Given the small number of studies, small sample sizes, wide variation of results, and other quality issues to date, there is potential for greater empirical support with more research in the future.⁸

Despite the modest quantitative support, physical activity is generally advisable for people with trauma.

There is a high confidence level that exercise will not worsen PTSD and there is ample empirical support for exercise as a treatment for depression (a common comorbidity of PTSD).

Effective management of traumatic memories should include lifestyle interventions. Provocation, solitude, and idleness should be kept under control. Regular exercise and artistic endeavors are also helpful to many people. Behavioral strategies are based upon an awareness of what exacerbates or alleviates your symptoms, so experiment and see what works for you.

Mental strategies of dealing with trauma can be learned independently or through a counselor. This section is focused on counseling modalities because most self-help techniques for trauma are the same as those described in the Anxiety guide. Each strategy or modality approaches trauma from a different angle. Cognitive behavioral and cognitive processing strategies seek to alter unproductive thinking related to the unpleasant memory. Eye Movement Desensitization and Reprocessing (EMDR) therapy reduces trauma by helping your brain process the traumatic memory in a more constructive way.

Imagery rescripting replaces the disturbing event with a more pleasant fictional version of the event. Narrative approaches take a step back to allow you to see your traumatic event in the broader context of your life and identity. Finally, mental exposure methods work by gradually reducing the power of triggers.

All forms of talk therapy (e.g., psychodynamic, CBT) can be applied to trauma. The most common modalities for trauma are cognitive behavioural therapy, cognitive processing therapy, prolonged exposure therapy, and EMDR therapy. Perhaps most obviously, supportive-expressive therapy is the foundation of trauma therapy. In that modality, the client expresses her feelings about the traumatic event and receives empathy and understanding from the counselor.

Expressing your feelings to a sympathetic ear is indispensable when dealing with bad memories. It can be to a family member, friend, or counselor. While not as good as being face-to-face with a kind person, conversing with an AI chatbot can also be therapeutic.

You decide what you will talk about. You may want to talk about your traumatic experience in detail. If you don’t feel comfortable with that, you can limit the discussion to your reaction to the event and your current symptoms. There is no one correct way.

Often, a discussion will begin with the intention of only giving a factual recount of the event. It then moves towards a discussion of feelings and their release (i.e. crying, yelling). If you have a good, patient listener, you will frequently end up talking about how you feel about yourself in general and other memories that have contributed to those feelings. That’s a good thing as it facilitates deeper healing and integration of your traumatic experiences into your personal growth.

By thinking differently about troubling events from your past, you can decrease their power to affect you when you recall them.

Reframing involves analyzing the offending memory and identifying how you can react to it or interpret it in a more productive way. The premise of reframing is that it is not the memory itself but how we relate to the memory that is the source of emotional distress.

Take, for example, a memory of failing a college course that has brought you long-term feelings of shame and inadequacy. When you think about that course, you feel stupid and inferior for not having passed. The source of the emotional pain is not the fact you got an F in the course but the interpretation that your inability to pass indicates notable faults in yourself. You may have failed other courses but not developed any trauma as a result.

If you analyse the situation and realize, for instance, that you would have passed if it wasn’t for the questionable way the instructor taught the course, you can reframe the event as a failure on the teacher’s part more than on your part. Now when you think about the course failure, you shouldn’t feel bad about yourself because the fact of the matter is that what happened has more to do with a mismatch between yourself and your teacher than anything that you did wrong.

Reframing memories can take many forms. Perhaps you are convinced that a traumatic event from your life was your fault. You can still reframe the memory, for example, as something that you have since learned from and which has subsequently helped you to mature as a person. If you flunked out of a college program and subsequently entered a different field, you may get relief from acknowledging that you are better suited to the new field than the one you originally studied.

If that is not that case, there is probably something about your existing field that you like better. Maybe the new field isn’t exactly fun but it has better job prospects. When you think about your failure in the college program, rather than feeling inadequate or disappointed, you could focus on the fact that you are less likely to be unemployed in your existing field. That is something to be happy about.

By thinking differently about troubling events from your past, you can decrease their power to affect you when you recall them. Reframing memories into more benign forms will also encourage your subconscious to consider it less of a threat and thus bring it to the attention of your conscious mind less often.

Another way of lessening the effect of a recalled unpleasant memory involves changing the memory itself. While reframing changes how you think about the memory, imagery rescripting attempts to change the memory into something more pleasant.

Rescripting begins by visualizing the traumatic event in your mind. Next, change the event in your mind so that it is no longer disturbing, as if you were re-writing a movie. For instance, if the original memory involved a bully saying something mean to you, imagine now that the bully gets a text and picks up her phone before she has the chance to say the mean words.

If the troubling memory involves you falling off a ladder at work, you may imagine that you finished climbing the ladder without slipping or you started to fall but your lanyard prevented you from hitting the ground. Rescripting memories from childhood often involves imagining a powerful, benevolent adult protecting you or imagining yourself standing up for yourself as the adult you are today. Practice visualizing the ‘new memory’ a number of times so as to engrave it into your subconscious.

In another form of imagery rescripting, you can ‘re-shoot the scene live.’ In this form, treat the event like a lucid dream in which you decide what happens as it happens. For instance, when the memory of you falling off a ladder pops up, you can imagine something impromptu like you bouncing off the ground as if you were made of rubber.

Vision scanning is another way to deal with unpleasant memories. When your mind plunges you into the unpleasant memory, simply imagining yourself turning away from the unpleasant source can help. For example, you may turn away from the bully talking to you and towards the television which is already playing. That way, during the flashback, you end up seeing and hearing the TV rather than the bully. With vision scanning, you can try hearing and looking at different things each time the memory comes up.

A 2023 meta-analysis assessed 24 imagery rescripting trials for trauma, anxiety, depression, personality disorders, and bulimia.⁹ Each trial consisted of 1 to 6 sessions with the majority being one session. The analysis found that rescripting produced large improvements in symptoms for each disorder. The benefit from rescripting held steady for the follow-up period (usually 3 months).

In cognitive processing therapy (CPT), the client is asked to write a document about the traumatic memory in detail and read it to the therapist. From there, the client and counselor discuss the negative impact of the traumatic event on the client and systematically try to mitigate it. Negative thoughts pertaining to the event, trust issues, self-esteem effects, meaning, and other aspects of the trauma are explored.

Cognitive processing therapy is essentially a structured form of cognitive behavioral therapy (CBT) applied to trauma. The process does not always include a written account of the traumatic memory, but it does always include identifying and challenging negative or unproductive thoughts related to the memory. CPT is a 12-session program that can be done individually or as a group.

In this much-hyped ‘therapy,’ clients are forced to relive their traumatic experience over and over, focusing on the negative feelings that they felt during the event. The underlying theory is that by spending an enormous amount of time reliving a traumatic memory, the accompanying emotions will subside over time.

Months or years are spent intentionally reliving the traumatic event in the counselor’s office and at home. After that, clients are encouraged to physically place themselves in situations where they will be most triggered to re-experience their trauma for months more. The counseling business and their puppets aggressively push this modality because it is long-term and clients are threatened with the risk of worsened PTSD for ending it before the counselor says so. Thus, locked-in paying customers are a guarantee. And that’s just for one bad memory. What if the client has dozens of bad memories, each needing this prolonged torture ‘therapy’?

Prolonged exposure (PE) therapy is a scam. It is designed to break people down and trap them into a long course of expensive treatment. Clients are forced to spend so much time in mental hell, so what if their emotional response to triggers or flashbacks lessen afterwards? No matter how ‘effective’ upon conclusion, total suffering is usually greater than if the therapy was never undertaken. Not surprisingly, traumas often worsen with this type of therapy even when the entire program of treatment is completed.

A huge 25,000+ study of veterans undergoing PE or CPT found that 23% had a large increase in symptoms.¹⁰ The touted ‘effectiveness’ of PE refers only to people who complete the long course of therapy. However, 50% of people do not complete the treatment.¹¹ In a survey of PE counselors, 87% attributed the high drop out rates to the emotional distress inherent in the therapy.¹²

PE therapists actually label clients as mentally ill (possessing a “disassociation disorder”) for being able to think about a traumatic event without considerable negative emotions coming up. That is very revealing of their true intentions — to worsen your trauma so you never recover and remain dependent upon their overpriced services. Want to submit yourself to a mercenary who will slander you for being well-adjusted and openly try to make you suffer as much as possible? Then prolonged exposure therapy is for you, soldier!

Trauma-focused cognitive behavioral therapy (TF-CBT) was developed in the 1990s, originally to help minors who have experienced sexual abuse. It is currently used as a treatment for children and youth who have experienced any sort of abuse or trauma. A parent or caregiver who has not abused the child is also involved.

TF-CBT lasts at least 3 months. The child and parent have sessions with the counselor individually as well as joint sessions together with the counselor. Besides parental involvement, the main difference between this and regular CBT is that it includes extensive exposure to triggers (mentally and physically). The theory is that the emotional response to triggers decreases after lengthy exposure. TF-CBT is similar to cognitive processing therapy in that it includes a written or oral recount of the traumatic event in detail.

Parts work involves an extensive exploration of your past and deep or buried aspects of your personality.

This form of therapy serves the needs of the parents more than the child. Usually, the child or youth is forced into TF-CBT by their parents due to perceived behavioral issues and the real goal of the treatment is to make the child easier to manage by decreasing avoidance or other reactions to triggers.

Everyone has different aspects to their personality. Since Freud proposed the ego, id, and superego paradigm one hundred years ago, numerous psychologists have proposed that all people have ‘multiple personalities’ inside them. According to these theories, mental afflictions arise out of conflict among the inner personalities or ‘parts.’

Internal Family Systems (IFS) created by Richard Schwartz, is probably the most developed and empirically studied ‘parts work’ system. IFS is a form of individual mental health counseling, not a system of couple/family counseling. Associated with childhood trauma counseling, the ‘family’ mentioned in the name refers to the different characters or family members that each person has in his or her mind.

In IFS, the client places negative thoughts into inner personas or parts. This modality theorizes that by allowing each part room to be heard without resistance, the needs of each part can be met and the criticism or unpleasant memories originating from each part will cease.

Internal family systems rates high in acceptance and compassion. You are not expected to feel like a failure for having troubling thoughts and feelings as you are with CBT. Each bothersome mental construct comes from a character inside you which will become quiet once it receives the attention and understanding that it needs.

Parts work involves an extensive exploration of your past and deep or buried aspects of your personality. It is thus suited to people who are interested in exploring their inner world including the distant past in which many parts still live. Parts work can be done on your own or with a counselor. 

Bilateral stimulation, also known as Eye Movement Desensitization and Reprocessing (EMDR), involves looking side to side with the eyes while thinking about the negative event and related feelings. Alternatively, one can tap oneself or listen to audible beeps on alternate sides of the body. The underlying theory posits that bilateral stimulation helps your brain ‘process’ bad memories such that you stop thinking about them excessively and you don’t feel bothered when you do think of them.

It is easy to dismiss bilateral stimulation as it sounds rather gimmicky. However, since its initial development in the late 1980s, it has both stood the test of time (it is currently a popular form of trauma therapy) and been validated by dozens of empirical studies.

Trials have demonstrated that 37% to over 90% of people who complete bilateral stimulation treatment for trauma see a major reduction in symptoms.¹⁴ Remission rates are highest when the modality is performed for a single traumatic event.¹⁵ Studies have also found that bilateral stimulation is more effective than other modalities, including CBT.¹⁶

Bilateral stimulation has undoubtedly helped many people recover from traumatic experiences. However, it has many considerable downsides. While not referred to as a type of prolonged exposure therapy by the counseling industry, that’s what it is. People undergoing bilateral stimulation are led to spend months (or years) intentionally mentally reliving the most horrible experiences of their lives, not only the specific experience that motivated them to seek counseling.

Bilateral stimulation treatment involves diving into the pain of those memories and the resultant negative view of oneself as intensely as possible. This is done repeatedly for each negative memory. Typically, long-forgotten disturbing memories arise throughout the course of treatment, in and out of session. Each of those memories are themselves treated with bilateral stimulation in the same way as the original targeted trauma. Thus, while many people who complete the treatment program see significant benefits to the original trauma, it can be a long, painful process that is a net negative for many.

Narration can also make it easier to develop compassion and forgiveness for yourself as you see that each of your so-called mistakes or faults were reasonable given your situation.

BiRes

Brief Bilateral Stimulation-Imagery Rescripting therapy (BiRes) was designed to treat trauma faster and with less distress than conventional bilateral therapy. It combines bilateral stimulation with imagery rescripting. Lateral eye movements or tapping the body is performed while thinking about both the bad memory and the new positive version of that memory.

It is meant to be a one-session treatment for trauma and is ideally used on an individual bad memory. Counselor experience and limited empirical studies have shown it to be an effective treatment with little potential for making your trauma worse. It can be performed alone or with a counselor.

IMR

Interrupted Memory Reconsolidation (IMR) is also meant to be a one-session treatment for a traumatic memory. It involves tapping your legs while thinking about a happy memory or fantasy. Quickly blinking your eyes and thinking about your bad memory are done at intervals. 

Like BiRes, efficacy studies are few but impressive. In only 1-3 sessions, trauma is often relieved without experiencing almost any distress. It may be performed alone or with a counselor.

Oral or written accounts of one’s life and trauma history are frequently employed in the treatment of trauma. In narrative exposure therapy (NET), a detailed oral history of one’s traumatic memories is offered to the therapist along with a brief recounting of one’s overall life story. One’s entire life is examined for troublesome memories, along with some information on positive experiences. The therapist writes down the account, and in the final session, reads it to the client. NET was developed for people who have long-time or numerous traumatic memories. The objective is to produce a coherent life story that incorporates traumatic events into one’s overall life history and personal identity.

Narrative therapy (NT) contrasts with narrative exposure therapy in its general orientation. While NET is a trauma-specific modality, NT is used in trauma and many other mental health situations. One’s life history is recounted orally to a therapist in an attempt to put mental or life problems in context. Both the client and therapist look for patterns and come up with themes. By looking at one’s life as comprehensively as possible, narrative therapy seeks to help clients see all the positive things they have had in life, utilize strengths to overcome current challenges, and create more constructive patterns in the future.

Of course, you don’t need to see a counselor to utilize a narrative approach to dealing with your trauma. Life narration is easily performed by oneself. You may write down your life story or go through it in your head. By stepping back as far as possible, it should be easier to notice interrelations and identify sources of strength and positivity on which to focus.

Narration can also make it easier to develop compassion and forgiveness for yourself as you see that each of your so-called mistakes or faults were reasonable given your situation. The externalizing effect of narration can be powerful. Somehow it is easier to sympathize with the character of a story than with the “I”. Externalization can also make it easier to both identify problems and make a plan for their resolution.

Many people find the process of exploring their life story highly therapeutic. Written narration can take many forms. It can be written like a book and cover your entire life. It can also be limited to certain periods of your life and include only jot notes on major points. You may choose to focus on your traumatic memories or on the positive aspects of your life history. There are many ways to use narration to deal with trauma.

Disclaimer: Any medication, drug, herb, or medical procedure can have side effects. Psychelics carry major risks not mentioned in clinical trials including overdose, panic attacks, and nightmarishly bad trips. Do thorough research for yourself on the potential side effects for the specific product or procedure that you are considering. Do not rely on your doctor or pharmacist for informed consent. Effectiveness and side effects vary greatly from person to person.

The past 15 years have seen major breakthroughs in the medical treatment of trauma. Popularly viewed as an entirely cognitive issue, it turns out that there are effective medical options for symptoms of trauma. Serotonergic pills are sometimes used by people with trauma who have had limited success with psychotherapy alone. Stellate ganglion blocks and psychedelic medication have shown strong promise in treating serious trauma in recent years.

Since trauma symptoms originate in the brain,¹ it seems logical to have treatments that directly target the brain. Trauma is not a matter of personal failure or lack of self-discipline. It involves dysfunctional brain activity, making it amenable to lifestyle, cognitive, and medical interventions.

Antidepressants

Four antidepressant medications are currently used to treat trauma symptoms: sertraline, paroxetine, fluoxetine, and venlafaxine. The first three are SSRIs (selective serotonin reuptake inhibitors) and fourth is an SNRI (serotonin-norepinephrine reuptake inhibitor). These pills are usually prescribed for depression or anxiety but are also used for core PTSD symptoms such as hyperarousal and flashbacks.

Approximately 40% of people experience a meaningful improvement from these drug classes for core PTSD symptoms.¹⁷ Efficacy rates vary by drug and study. For instance, a 2025 meta-analysis concluded that antidepressants have a relatively small effect on PTSD.¹⁸ Another meta-analysis in the same year found that 62% of trauma patients had a major positive response to paroxetine.¹⁷

Antipsychotics

Antipsychotic medications are often prescribed for trauma if antidepressants haven’t produced good results. In VA Medical Centers, 89% of PTSD clients receive antidepressants and 34% receive antipsychotics.¹⁹ Doctors can be reluctant to prescribe antipsychotics because the weight gain and sedative side effects (among others) are more pronounced than with antidepressants. While the side effects can be substantial, antipsychotics can be a net benefit to people grappling with severe trauma.

A large 3,870-subject meta-analysis from 2025 concluded that efficacy and dropout rates for people with PTSD are statistically equal for antidepressant users and antipsychotic users.¹⁷ The authors state that antipsychotics, while not statistically different, have marginally higher efficacy and dropout rates. A 2020 systematic review also found that there were statistically no differences in dropout rates between the various classes of drugs used for PTSD.²⁰ The fact that the dropout rate of antipsychotics users is not significantly higher suggests that the greater efficacy is worth the extra side effects to a many people.

Among other antipsychotics, risperidone, topiramate, and quetiapine have demonstrated good efficacy for core PTSD symptoms. They can be used alone or in conjunction with an antidepressant. A 2022 systematic review concluded that risperidone and olanzapine worked especially well on veterans with the most severe traumas.²¹ A review of quetiapine in 2023 found that it was effective in all nine trauma-related symptoms and possessed adequate safety.²² Antipsychotics have also shown efficacy in treating nightmares and insomnia in PTSD victims.²³

Ketamine is generally administered in out-of-pocket private clinics for a few hundred dollars to upwards of $2,000 per dose.

Research on psychedelic drugs to treat trauma is in its infancy. To date, there have been a small number of clinical trials on a small number of psychedelics. There have been reports in the media that psychedelics can be highly effective for PTSD. Undoubtedly, psychedelics have worked extremely well for some people.

However, the likelihood of psychedelics working for your trauma and the frequency of administration remain open questions. Some psychedelic trials have found no improvement in trauma-related symptoms. Accessibility is also a major issue. Currently, only ketamine is legal (please verify for your country), and at very high cost (i.e. over $1,000/dose).

Medicinal psychedelics are not legal to take on your own. ‘Trips’ must be undertaken in a clinic under the supervision of a physician. Administration is usually intravenous. One form of ketamine (esketamine) is available as a nasal spray but it still must be clinic-administered. 

The psychological effects of psychedelics on trauma victims can be profound and paradoxical. You may be faced with your worst fears and memories during the trips. As scary as that sounds, trauma sufferers often report that their trips were positive, healing, and meaningful. Side effects are generally mild and transient when taken in a clinic.^24,25

Ketamine

In the past, ketamine has been used in anesthesia during surgery. It is well known in rave circles as Special K. For trauma, it is administered intravenously in a clinic. Most studies have used one to three infusion sessions lasting 6 to 8 hours each. Ketamine is generally administered in out-of-pocket private clinics for a few hundred dollars to upwards of $2,000 per dose.

Most mental health studies on ketamine have focused on depression. Only a handful of clinical trials have investigated the effectiveness of ketamine on trauma symptoms. Outcomes for trauma have varied tremendously, spanning no significant improvement to a large improvement.^26,27,28 Overall, ketamine performed considerably better than placebo—10 units better on the CAPS PTSD scale according to one meta-analysis.²⁹ The studies which showed the greatest effectiveness were fairly small, some of which actually looked at depression rather than more direct symptoms of trauma.

In trauma studies showing participant improvement, the duration of the improvement varied greatly. The follow-up period on most studies ranged from one day to two weeks.³⁰ Most 2-week-long studies found that the therapeutic effect was maintained. One study showed that symptom improvement held study after 3 months.³¹ Another found positive effects after four weeks, following a course of 16 infusions.³² The high variability in degree and duration of positive outcomes led one systematic review to suggest that the placebo effect alone was responsible for ketamine’s reported effectiveness for trauma.²⁶

In one of the larger trials, 67% of subjects receiving MDMA ceased to meet the criteria for a PTSD diagnosis compared to 33% in the control arm.

MDMA

MDMA (3,4-methylenedioxymethamphetamine), the active ingredient in the recreational drugs ecstasy and molly, has also been investigated as a PTSD treatment, usually in combination with counseling. This synthetic compound has many effects on the brain related to traumatic symptoms, such as increasing pleasant neurotransmitters (dopamine, norepinephrine, and serotonin) and suppressing the left amygdala.³³

Like ketamine, systematic reviews for MDMA have included a small number of studies (~10), though with much more consistent results and far longer follow-up periods.³⁴ According to a 2021 meta-analysis, trials of MDMA for trauma administered an average of 2.4 doses of the drug.³⁵ Dosages were given orally in the range of 40 to 125 mg. Average reduction in the PTSD scale CAPS-4 was 40.1 points, placing the pill in the range of effectiveness for first-line PTSD therapies.

A 2019 analysis of six Phase II MDMA trials calculated that the overall resolution of clinical PTSD was 54.2% in the experiment group and 22.6% for the control.³⁶ A Phase III trial published in 2023 claimed that 86.5% of subjects receiving MDMA had at least a 10-point reduction in CAPS-5 scores. 69% of subjects receiving the placebo had that degree of improvement. 67% of subjects receiving MDMA ceased to meet the criteria for a PTSD diagnosis compared to 32% in the control arm.³⁷

Researchers have suggested that MDMA reduces PTSD symptoms through the enhancement of memory consolidation and fear reduction.³⁸ Interpersonal connection and trust are also heightened, leading to a stronger client-counselor bond for those receiving counseling. Neuroplasticity is believed to be significantly enhanced while on the drug.³⁹

MDMA experiments on people with trauma have demonstrated more consistent results than those using ketamine. Follow-up periods have also been much longer, in the range of 2 to 32 months.³⁵ Approximately two thirds of studies have had 12-month follow-ups. Participants demonstrating clinical benefit from this hallucinogen have usually maintained it throughout the follow-up period. Drop out rates in MDMA-assisted therapy have been exceptionally low (1.9%) compared to common PTSD psychotherapies (~50%).³⁷

A 2- or 3-dose regimen of MDMA pills (along with talk therapy) has demonstrated long-lasting relief of symptoms in many people with long-term, treatment-resistant PTSD. Think carefully before self-administrating, however. One study of 529 samples of street ecstasy found that only 40% actually contained any MDMA.⁴⁰

Cannabis

A handful of small, low-quality studies have investigated the effect of cannabis or cannabinoids on PTSD, usually via the oral route. In a 2024 systematic review published in The Journal of Clinical Psychiatry, a clear benefit to taking cannabis was not found. Interestingly, of the 10 studies reviewed that didn’t involve cannabis abuse, 5 studies showed a positive effect while the other 5 showed no effect or a negative effect.⁴¹ An earlier review from 2021 had found a significant reduction in PTSD symptoms from cannabis consumption.⁴²

Many people use cannabis to deal with trauma-related symptomatology. In Israel’s medicinal cannabis program, 10% of prescriptions are attributed to PTSD.⁴³ The effects of cannabis are known to be highly individual. For instance, it lowers anxiety in some people but raises it in others.

The degree to which cannabis use becomes problematic is also highly individual. Approximately 13% of users become dependent on the substance.⁴⁴ Personal experimentation is the only way to learn if cannabis will be a net benefit for your trauma.

Most psychedelic research for trauma has involved ketamine, MDMA, or to a lesser degree, cannabis. Research on other psychedelics is only starting. One study to date has been completed on psilocybin (magic mushrooms), although others are in the pipeline. Published in 2025, the 22-person trial with no control group consisted of a single oral dose of 25 mg.⁴⁵ Results were promising with a 30-point average reduction in CAPS-5 (an 80-point PTSD scale). The effect lasted for the duration of the 12-week trial.

Another small psychedelic study with no control group was published in 2025. This study administered ibogaine to people with traumatic brain injuries. Symptoms related to their injury, which included PTSD symptoms and depression, were found to decrease by over 80%. The effect was sustained for the one-month study period.⁴⁶

Acute symptoms of trauma, like flashbacks and compulsive anger, are based in the brain. Neural connections are dysfunctional.⁴⁷ Areas of the brain have fallen into long-term hyperactivity.⁴⁸ Since psychedelics have a powerful effect on the brain and open a window of heightened neuroplasticity, it is easy to see how they can provide effective treatment.

Everyone’s brain is different. Experimentation is required to see if psychedelics will work for you. If you go the black market route, it is safest to begin with very small doses and have a responsible friend nearby who is not under the influence.

In approximately 80% of people, the inferior cervical and first thoracic sympathetic ganglions fuse in the neck, forming a stellate ganglion. A stellate ganglion block (SGB) involves the injection of an anesthetic into the stellate ganglion in order to block sympathetic outflow. This should theoretically buffer an overactive sympathetic nervous system, which is responsible for the excessive irritability and tension that often accompany trauma. For the 20% of people with no stellate ganglion, this procedure cannot be performed.⁴⁹

A small number of (mostly case) studies have investigated SGBs for people with PTSD. Most of the studies have shown very positive outcomes and few side effects. A 2025 retrospective review of 75 SGB clients found that 96% had significant improvement with PCL-5 (a PTSD scale) scores decreasing by 55% on average.⁵⁰ That improvement held for the follow-up 6 months later. A 2016 clinical trial, conversely, did not find statistically significant improvement in the group receiving the SGB relative to the control group.⁵¹

In study participants who have responded to the block, results have typically been sustained for at least 3 to 6 months.⁴⁹ A viable option for people who don’t respond well to the original shot on the right side is to redo the procedure on the left side. In a 2022 study, 20 people out of 205 that received a SGB using the standard right-sided entry did not experience a response. Those 20 individuals were then given a left-sided shot to which 90% responded well.⁵² Side effects from SGBs are mild and transient.⁵³

Stellate ganglion blocks are available for mental health at a very small number of private clinics in the United States. Many people with trauma who have had the procedure have experienced significant symptom relief for at least a few months. If you have tried counseling and SSRIs to no avail and you have a stellate ganglion, this option could be worth looking into.

Stellate ganglion blocks have been used for pain for decades, but are not usually covered by insurance for mental health. Out-of-pocket, you will probably pay over $1,000 per injection — not necessarily a bad deal if it can provide a year’s worth of relief from trauma symptoms.

Trauma can cause dysregulation in the brain that is amenable to medication. Antidepressants and antipsychotics need to be taken daily and possess an overall response rate of 39% in trial participants.¹⁷ A psychedelic trip or stellate ganglion block can provide months of relief for the core symptoms of PTSD. Medical interventions for trauma may be used alone or in conjunction with other treatments.

It can be very difficult dealing with bad memories. It is common to think about them excessively and re-experience the pain over and over. This article has outlined a wide array of behavioral, cognitive, and medical strategies that can help restore your well-being if you suffer from traumatic memories. There is no way to know what will work for you personally other than trying out the variety of methods yourself.

If this was your first foray into trauma treatment, you may have been surprised at some of the options. Keep an open mind. Some methods may seem gimmicky (i.e., bilateral stimulation) or dangerous (i.e., hallucinogens) but have strong evidence for their safety and effectiveness.

For mild trauma, experimenting with self-help cognitive and behavioral strategies can help you find what works for you. If your trauma is more severe, it could be worth it to try out talk therapy and medication.