Why CBT Can Trigger Complex PTSD or Emotional Neglect

People with complex PTSD and histories of emotional neglect often find Cognitive Behaviour Therapy (CBT) triggering. When they are trying to heal, they are faced with something that is supposed to be healing that is triggering for them. Some reasons for this go back to the deficiencies of your upbringing and how CBT is used without respect for your personal history.

What is Emotional Neglect?

Emotional neglect occurs when a person’s emotional or attentional needs are disregarded, ignored, minimized, invalidated, or unappreciated. When it happens in childhood, it can have devastating consequences. Emotional neglect can be intentional, unintentional, or unconscious. Often, it is due to parents who never learned to deal with emotions themselves and are unequipped to deal with their children’s emotions. Emotional neglect can be seen as a lack of affection, physical touch, or positive attention, leaving an individual feeling unloved or unwanted.

What is Complex PTSD?

Complex Post-Traumatic Stress Disorder (Complex PTSD) is a disorder that may develop following ongoing, inescapable, relational trauma. It usually involves being hurt by another person in an ongoing or repeated way. Complex PTSD often consists of a betrayal and loss of safety. It essentially is a more complicated version of PTSD where all diagnostic criteria for PTSD are met, plus some additional criteria, such as problems in affect regulation and relationships.

What is Cognitive Behaviour Therapy (CBT)?

Cognitive-behaviour therapy (CBT) raises awareness of thought patterns. It helps you adjust them with healthier, more flexible, and more accurate ways of thinking. Thought patterns develop over the years and become second nature to you. They influence your emotions and behaviour. Your perceptions are based on your thoughts, feelings, and previous experiences and can significantly affect you.

How Can CBT Be Triggering with Complex PTSD and Emotional Neglect?

Often, people with complex PTSD and childhood emotional neglect can find CBT triggering and experience an increase in distress and some other symptoms. There are several reasons for this.

They Lack a Stable Emotional Foundation

Most people with complex trauma and emotional neglect lack a stable emotional foundation. Their emotional well-being and development were neglected or harmed by their caregivers. They live in an emotional world built on a crumbling foundation, never knowing what could cause their world to fall around them. People with complex PTSD and childhood emotional neglect didn’t grow up in a world where they felt accepted and that it’s okay to make mistakes. They are in a state of hypervigilance, wondering if the next storm could bring it all crashing down. The state of their emotional foundation needs to be respected in therapy. However, too often, it is assumed that it is stable, which can be incredibly harmful.

They Have Learned Maladaptive Beliefs that Interfere with CBT Techniques

Through their developing years, they may have inquired beliefs based on the trauma and emotional neglect that have become so ingrained in their psyche that it becomes difficult to move or adjust without processing the underlying trauma. They may have learned that expressing emotions, opinions or needs is inappropriate. People with complex PTSD and emotional neglect may have learned that they are wrong; therefore, some of the re-framing techniques can trigger them because that wasn’t a way they were allowed to think growing up.

They Have Never Been Where They’re Being Asked to Go

Often, people who have endured trauma and emotional neglect growing up don’t have the same beliefs and thoughts about themselves as people who had secure attachments growing up. They may become uncomfortable or distressed when dealing with more positive statements about themselves because it is something that they don’t know what to do with, and it runs against the way they have thought about themselves.

It Feels Like They’re Lying to Themselves

When you think you are flawed, damaged, or something is wrong with you, it can be hard to think of yourself in a more positive light, and you may feel like you are lying to yourself. When changing your inner narrative runs against your core beliefs, it can be triggering and distressing. You may not know how to deal with or tolerate the emotions and sensations that are coming up. Sometimes, something deeper must be healed before dealing with the surface thoughts and emotions.

It Can Intensify Their Feelings of Being Flawed

When they are triggered by the CBT techniques that are supposed to help them, it can intensify the belief that they are flawed because something that is supposed to help them is triggering. The idea of “what’s wrong with me” gets intensified, especially when a therapist doesn’t have an answer to why the technique may trigger them and makes comments like “I don’t know why it’s not working for you.”

It Can Worsen Their Feelings of Chronic Guilt and Shame

Often, the thoughts around being triggered by CBT techniques can worsen their feelings of shame and guilt. They may feel guilty that the methods supposed to help them are not working. They may feel shame about how they reacted when the techniques triggered them.

How CBT Can Miss the Mark with Complex PTSD and Emotional Neglect

Focuses Too Much on the Cognitive, Rather than Somatic

People with complex PTSD and childhood emotional neglect often deal with their trauma interfering with their concentration. Their doubts may be what caregivers have told them throughout their developmental years. Unfortunately, this trauma goes much deeper than their cognitions; it goes into their emotional somatic being. They may experience physical discomfort with positive emotions and thoughts about themselves. CBT is often just not enough for their lived experience.

May Miss the Underlying Trauma that Holds the Symptoms

People who have complex PTSD or have experienced emotional neglect need to have the underlying wounds treated, and addressing the negative thinking may not get to the root cause. They need to make sense of their pain, understand how their caregiver’s behaviour led to their current symptoms, and how their past experiences affected them. Although some of this is addressed in CBT modalities like Cognitive Processing Therapy, it is often done in a way that can be very distressing and disturbing to people with complex PTSD.

CBT Can Be Helpful When Used in the Right Way

Often, there are beliefs and wounds from early trauma or emotional neglect that need to be healed for CBT to be used effectively. Using strength-based and self-esteem-building techniques can help someone with complex trauma or emotional neglect tolerate some of the uncomfortable aspects of CBT.

It can be used in combination with other trauma-focused therapies.

Flash Technique

The Flash technique enables complex PTSD clients to engage with other techniques like CBT sooner than they would have with traditional stabilization techniques, which focus exclusively on resourcing. Flash can desensitize traumatic or distressing memories and help process trauma in a less distressing way because they are focusing on a moving, engaging resource rather than a static resource. Once some of the most distressing memories are desensitized and processed, you may be able to use CBT techniques that were previously triggering without the same reactions.

EMDR

Eye Movement Desensitisation Reprocessing (EMDR) can be very effective for treating Complex PTSD. It can help to integrate the fragments of traumatic and distressing memories with adaptive memory networks. Through this process, core beliefs can be adjusted during EMDR to something more adaptive, often from something limiting to something more positive. For example, they may start with the belief “I am not good enough” and, by the end of EMDR processing, believe “I am good enough.” At this point, you can use CBT techniques that previously were triggering due to the belief that it was adaptively processed.

Somatic Trauma Therapies

Somatic therapies use the body as a starting point to achieve healing. These forms of treatment use psychoeducation, an awareness of bodily sensations, and help people feel safe in their bodies while exploring thoughts, emotions, and memories. Somatic therapies also help people release damaging emotions held in their bodies.

Narrative Therapy

Narrative Exposure Therapy (NET) is used to address complex trauma that has grown into something more significant than the sum of its parts. It helps your brain to anchor the traumatic memory to a specific time and place. By anchoring past threats in the past rather than a looming, present tragedy, you can rid your memories of some of their power. It’s at this point that CBT techniques can be less triggering because

Conclusion

People with complex PTSD and histories of emotional neglect often find Cognitive Behaviour Therapy (CBT) triggering. When they are trying to heal, they are faced with something that is supposed to be healing that is triggering for them. Some reasons for this go back to the deficiencies of your upbringing and how CBT is used without respect for your personal history.