Post Traumatic Stress Disorder (PTSD)
Post Traumatic Stress Disorder (PTSD) is characterised by a collection of symptoms that we can experience following a difficult and distressing experience.
This page tells you what PTSD is, signs and symptoms, and shows outcomes experienced by Dr Tony Weston’s clients. To July 2025 there were 252 clients who scored four out of a maximum of eight for trauma at the start of counselling, average changes after seven sessions are shown below:
At better than 99.9% confidence these are large improvements in symptoms of trauma (ES = 2.67). These difficulties with traumatic memories were ‘being disturbed by unwanted thoughts and feelings’ and ‘unwanted images or memories have been distressing me’.
Trauma (τραύμα) is the Greek word for wound and describes the aftermath of our terrible experience, an enduring wound that needs to heal. Ordinarily when we sleep we process upsets and wake up the next day with the upset processed and resolved. Sometimes the upset can be so frightening it wakes us up when we attempt to process it and this can prolong our suffering. In such cases, the usual ways our body utilises to process disturbances are insufficient and professional help can augment our recovery from the upsetting experience.
Post Traumatic Stress Disorder (PTSD) is the term for the collection of symptoms that accompany our lasting wound. Nowadays this is considered to have four groups of symptoms:
- Intrusion, the disturbing experience intrudes upon our awareness when we don’t want it to
- Avoidance, we try to avoid being reminded of what happened then
- Cognition and Mood Change, the bad experience changes how we think and feel
- Arousal and Reactivity, we are living at a high level of emotional arousal fearing a recurrence of the terrible experience and when we are reminded of it we are triggered into high emotional reactivity
Historically this phenomenon has been described using other terms such as ‘railway spine’, to describe what happened to people involved in the first railway disasters, and ‘shell shock’, to describe what happened to people involved in war. The symptoms experienced after highly disturbing events are now termed Post Traumatic Stress Disorder, see for example the NHS description of PTSD
If you are reading this, perhaps it is because you are (or someone you know is) having problems with PTSD. The problems caused by experiencing PTSD can be helped by counselling and psychotherapy.
Dr Tony Weston’s BACP award winning research showed how clients improved through counselling in terms of their anxiety, depression and general distress caused by a number of problems such as PTSD, abuse, addiction, anger, bereavement and relationship difficulties. Dr Weston works online from a thatched cottage in the South Cambridgeshire village of Horseheath. He enjoys working online with individuals, couples and work/family groups (e.g. employees, parent and child).
Contact him now at tony.weston5@btinternet.com to make an initial appointment.
The rest of this page gives you some more information about the nature of PTSD, some of the problems this can lead to and some of the outcomes experienced by clients working with Dr Tony Weston.
The American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-V) Fifth Edition defines Post Traumatic Stress Disorder and a standard assessment questionnaire for PTSD is the PCL5. This questionnaire asks clients about their experience of PTSD symptoms. This section describes in detail the symptoms of PTSD and progress by Dr Tony Weston’s clients in overcoming these symptoms. These 20-26 clients are a subset of the 252 clients shown above because for this subset more detailed information about their PTSD and it’s changes is available.
(Please note that successful outcomes for 18 clients measured using the previous version of PCL5, the PCL, based upon DSM-IV are not shown for brevity)
Referring to DSM-V, the PCL5 has four symptom groups and for a diagnosis of PTSD there is a requirement that the diagnostic criteria are met for each of the four symptom groups. At this counselling service, to July 2025 there were 20 clients who met the diagnostic criteria for all four symptom groups and by the end of counselling on average they met the criteria for only one symptom group and accordingly could be considered as having recovered from their PTSD:
After an average of 16 counselling sessions these 20 clients had made a statistically significant improvement (p < .001) in symptoms of PTSD with a ‘large’ effect size, ES(r) = .88. On average these 20 clients had started with clinical levels of symptoms across all 4 symptom groups and subsequently had symptoms in only 1.3 of the symptom groups; meaning they no longer had PTSD.
Another way of looking at the same data is that the PCL5 can also be considered in terms of the total scores for the 20 symptoms across 4 symptom groups. With a maximum score of 80 on the PCL5, as at July 2025 these 20 clients started with an average score of 49.0, equivalent to a ‘severe’ level of PTSD and, after an average of 16 sessions, their average scores had reduced to 15.2, lower than the diagnostic criteria for PTSD; so no longer had PTSD. This was a ‘large’ effect size (ES(d) = 3.26) that was statistically significant at better than 99.9% confidence:
For these 20 clients, both in terms of overall scores on the PCL-5 and the number of PTSD symptoms, these clients had recovered from PTSD.
The American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-V) Fifth Edition defines Post Traumatic Stress Disorder as having four symptom groups and the rest of this pages looks at each of these in turn.
- Symptoms of Intrusion
There are five symptoms of PTSD Intrusion and these include:
- Repeated, disturbing and unwanted memories of the stressful experience
- Repeated disturbing dreams of the stressful experience
- Suddenly feeling or acting as if the stressful experience were actually happening again
- Feeling very upset when something reminded you of the stressful experience
- Having strong physical reactions when something reminded you of the stressful experience
The following graph shows outcomes for clients presenting at this counselling service with symptoms of PTSD Intrusion at a clinical level. As at July 2025 there were 25 clients who had started counselling with some level of PTSD Intrusion symptoms at a clinical level and who had a subsequent measurement of their symptoms. Having one or more symptoms of PTSD Intrusion at a clinical level fulfils the criteria for clinical levels of PTSD Intrusion and these 25 clients had on average 3.6 symptoms at the start of counselling and on average 0.7 symptoms at the end of counselling, meaning they no longer met the criteria for PTSD Intrusion:
This was after an average of 16 sessions and the improvements were statistically significant (p < .001) with a large effect size, ES(r) = .83.
In terms of client scores on the PTSD Intrusion subscale, the maximum score is 20 across the 5 symptoms, and as at July 2025 these 25 clients had on average a score of 11.5 that had reduced to 3.4 by the end of counselling:
This was after an average of 16 sessions and the improvements were statistically significant (p < .001) with a large effect size, ES(d) = 2.14.
For these 25 clients with PTSD Intrusion, both in terms of scores on the PCL-5 and the number of PTSD Intrusion symptoms, these 25 clients had recovered from PTSD Intrusion.
2. Symptoms of Avoidance
There are two symptoms of PTSD Avoidance and these include:
- Avoiding memories, thoughts or feelings related to the stressful experience
- Avoiding external reminders of the stressful experience, e.g., people, places, conversations, activities, objects or situations
The following graph shows outcomes for clients presenting at this counselling service with symptoms of PTSD Avoidance at a clinical level. As at July 2025 there were 20 clients who had started counselling with some level of PTSD Avoidance symptoms at a clinical level and who had a subsequent measurement of their symptoms. Having one or more symptoms of PTSD Avoidance at a clinical level fulfils the criteria for clinical levels of PTSD Avoidance and these 20 clients had on average 1.9 symptoms at the start of counselling and on average 0.5 symptoms at the end of counselling, no longer meeting the criteria for PTSD Avoidance:
This was after an average of 16 sessions and the improvements were statistically significant (p < .001) with a large effect size, ES(r) = .83.
In terms of client scores on the PTSD Avoidance subscale, the maximum score is 8 across the 2 symptoms, and as at July 2025 these 20 clients an average score of 6.0 that reduced to 2.0 by the end of counselling:
This was after an average of 16 sessions and the improvements were statistically significant (p < .001) with a large effect size, ES(d) = 2.79.
For these 20 clients with PTSD Avoidance, both in terms of scores on the PCL-5 and the number of PTSD Avoidance symptoms, these 20 clients had recovered from PTSD Avoidance.
3. Symptoms of Cognition and Mood Change
There are seven symptoms of PTSD Cognition & Mood Change (thinking and feeling differently after the stressful experience), these include:
- Trouble remembering important parts of the stressful experience
- Having strong negative beliefs about yourself, other people or the world, e.g. there is something seriously wrong with me, no one can be trusted, the world is completely dangerous
- Blaming yourself or someone else for the stressful experience
- Having strong negative feelings such as fear, horror, anger, guilt or shame
- Loss of interest in activities that you used to enjoy
- Feeling distant or cut off from people
- Trouble experiencing positive feelings, e.g., happiness, love for people close to you
The following graph shows outcomes for clients presenting at this counselling service with symptoms of PTSD Cognition & Mood Change at a clinical level. As at July 2025 there were 25 clients who had started counselling with some level of PTSD Cognition & Mood Change symptoms at a clinical level and who had a subsequent measurement of their symptoms. Having two or more symptoms of Cognition & Mood Change at a clinical level fulfils the criteria for clinical levels of PTSD Cognition & Mood Change and these 25 clients had on average 5.6 symptoms at the start of counselling and on average 0.8 symptoms at the end of counselling, no longer meeting the criteria for PTSD Cognition & Mood Change:
This was after an average of 16 sessions and the improvements were statistically significant (p < .001) with a large effect size, ES(r) = .88.
In terms of client scores on the PTSD Cognition & Mood Change subscale, the maximum score is 28 across the 7 symptoms, and as at July 2025 these 25 clients had on average a score of 17.4 that had reduced to 4.8 by the end of counselling:
This was after an average of 16 sessions and the improvements were statistically significant (p < .001) with a large effect size, ES(d) = 2.68.
For these 25 clients with PTSD Cognition & Mood Change, both in terms of scores on the PCL-5 and the number of PTSD Cognition & Mood Change symptoms, these 25 clients had recovered from PTSD Cognition & Mood Change.
4. Symptoms of Arousal and Reactivity
There are six symptoms of PTSD Arousal & Reactivity and these include:
- Irritable behaviour, angry outbursts or acting aggressively
- Taking too many risks or doing things that could cause you harm
- Being ‘super alert’ or watchful or on guard
- Feeling jumpy or easily startled
- Having difficulty concentrating
- Trouble falling asleep or staying asleep
The following graph shows outcomes for clients presenting at this counselling service with symptoms of PTSD Arousal & Reactivity at a clinical level. As at July 2025 there were 24 clients who had started counselling with some level of PTSD Arousal & Reactivity symptoms at a clinical level and who had a subsequent measurement of their symptoms. Having two or more symptoms of PTSD Arousal & Reactivity at a clinical level fulfils the criteria for clinical levels of PTSD Arousal & Reactivity and these 24 clients had on average 4.0 symptoms at the start of counselling and on average 0.7 symptoms at the end of counselling, no longer meeting the criteria for PTSD Arousal & Reactivity:
This was after an average of 16 sessions and the improvements were statistically significant (p < .001) with a large effect size, ES(r) = .86.
In terms of client scores on the PTSD Arousal & Reactivity subscale, the maximum score is 24 across the 6 symptoms, and as at July 2025 these 24 clients had on average a score of 12.3 that had reduced to 3.8 by the end of counselling:
This was after an average of 16 sessions and the improvements were statistically significant (p < .001) with a large effect size, ES(d) = 2.19.
For these 24 clients with PTSD Arousal & Reactivity, both in terms of scores on the PCL-5 and the number of PTSD Arousal & Reactivity symptoms, these 24 clients had recovered from PTSD Arousal & Reactivity.
Clinical trials typically exclude clients who have more than one presenting problem i.e., include clients who only have PTSD. This practice-based research included clients who are usually excluded from clinical trials and included clients who were at risk to themselves and/or others, and/or were also suffering with depression and other problems, and/or had a so-called ‘personality disorder’ and/or had problems with addiction (e.g. drink, drugs, gambling, pornography, etc.), in addition to their PTSD.
This naturalistic research showed on average a large improvement for clients with PTSD, even if there were other co-occuring symptoms.
Please note past performance is no guide to the future and there are no guarantees about outcome in therapy.
You can contact Dr Tony Weston by email at tony.weston5@btinternet.com to make an initial appointment.
References:
1. American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition, Text Revision). Washington DC: Author.
2. Jacobson, N S, and Truax, P, (1991) ‘Clinical significance: A statistical approach to defining meaningful change in psychotherapy research’. Journal of Consulting and Clinical Psychology, 59(1), 12-19.