Recurrent nightmares, flashbacks that take you back to the moment of the traumatic experience, a constant feeling of being in danger, difficulty sleeping and concentrating, avoidance of places, people or situations that remind you of the trauma. If you identify with any of these experiences, it is possible that you are suffering from post-traumatic stress disorder (PTSD). The good news is that PTSD has effective treatment, and scientific research has shown that online PTSD therapy offers results equivalent to in-person therapy. Online EMDR, in particular, allows you to process traumatic experiences from the safety of your own space, with the same effectiveness as in-office treatment.
What is post-traumatic stress disorder (PTSD)?
PTSD is a mental health disorder that develops after experiencing, witnessing or learning about a traumatic event involving actual death or threat of death, serious injury or sexual violence. Not everyone who lives through a trauma develops PTSD — most people recover with the natural support of their environment — but between 5% and 10% of the general population will suffer from it at some point in their lives, and prevalence rises to 20-30% in people exposed to severe traumas such as sexual assault, combat or life-threatening accidents.
What differentiates PTSD from a normal stress reaction is that the brain fails to process and "file" the traumatic memory correctly. While in normal processing a painful memory loses intensity over time, in PTSD the memory is stored in a "raw" form, with all the emotional, sensory and bodily charge of the original experience. That's why, months or even years later, a sound, a smell, a gesture or a similar situation can reactivate the memory and cause the person to relive the experience with as much intensity as if it were happening again.
PTSD diagnostic criteria according to the DSM-5
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) establishes that for a PTSD diagnosis, a person must have been exposed to one or more traumatic events and present symptoms from the following four clusters for at least one month:
1. Re-experiencing (intrusion)
Flashbacks: the person relives the traumatic experience as if it were happening in the present moment, with images, sounds, smells and bodily sensations. During a flashback, contact with the reality of the present moment can be momentarily lost. Recurrent nightmares: repetitive dreams about the event or with similar emotional content. Involuntary intrusive memories: images or thoughts that burst in suddenly and unwanted during the day. Intense psychological distress when faced with internal or external reminders that symbolize or recall aspects of the trauma. Physiological reactions (rapid heartbeat, sweating, trembling) when faced with stimuli that recall the event.
2. Avoidance
Persistent efforts to avoid memories, thoughts or feelings associated with the trauma (internal avoidance) and to avoid people, places, conversations, activities, objects or situations that bring up memories of the event (external avoidance). Avoidance is an understandable survival strategy, but in the long run it perpetuates the disorder: by avoiding processing the memory, the brain has no opportunity to reprocess it correctly.
3. Cognitive and mood alterations
Inability to remember important aspects of the trauma (dissociative amnesia), persistent negative beliefs about oneself ("I'm to blame", "the world is completely dangerous", "I can't trust anyone"), cognitive distortions that lead to blaming oneself or others for what happened, persistent negative emotional state (fear, horror, anger, guilt, shame), loss of interest in previously enjoyable activities, feeling of disconnection from others and inability to experience positive emotions (emotional numbing).
4. Alterations in arousal and reactivity (hyperarousal)
Irritable behavior or angry outbursts, reckless or self-destructive conduct, constant hypervigilance (a permanent state of alert, as if danger could appear at any moment), exaggerated startle response (a disproportionate jump at an unexpected noise), concentration problems and difficulties falling asleep or staying asleep. This hyperarousal is a consequence of the brain's alarm system (the amygdala) remaining activated as if danger were present, because the traumatic memory has not been adequately processed.
Types of trauma: single vs. complex
Not all traumas are the same, and understanding the distinction is essential for guiding treatment:
Single-event trauma: Occurs as a consequence of a specific incident defined in time: a traffic accident, an assault, a natural disaster (earthquake, flood), a robbery, witnessing a violent death. Even though it is a single experience, it can generate full-blown PTSD if the brain fails to process it. In general, single-event PTSD responds very well to EMDR treatment, with significant improvement between 6 and 12 sessions.
Complex (prolonged) trauma: Results from repeated, prolonged and often inescapable exposure to traumatic experiences, especially during childhood or in contexts of relational dependency. It includes child abuse (physical, emotional or sexual), emotional neglect, gender-based violence, chronic school bullying, torture or captivity. Complex trauma profoundly affects the development of personality, self-concept, the capacity for emotional regulation and interpersonal relationships.
PTSD vs. Complex PTSD (C-PTSD)
The World Health Organization (WHO) recognizes Complex PTSD (C-PTSD) as a distinct diagnosis in the ICD-11. In addition to the "classic" PTSD symptoms, C-PTSD includes three additional areas of impact:
Difficulties with emotional regulation: Emotions are experienced with overwhelming, hard-to-control intensity. The person can move from a state of emotional emptiness (numbing) to outbursts of anger or crying without apparent provocation. The window of emotional tolerance is extremely narrow.
Persistent negative self-concept: Deep feelings of shame, guilt and inadequacy. A sense of being "defective", different from others, of not deserving love or respect. Beliefs such as "I'm bad", "what happened to me was my fault" or "I'm worthless" that pervade the entire life experience.
Difficulties in interpersonal relationships: Dysfunctional relational patterns, such as avoiding intimacy out of fear of being hurt, or on the contrary, seeking intense and chaotic relationships that reproduce the dynamic of the original trauma. Generalized distrust, emotional dependence or inability to establish secure bonds.
Dissociation in PTSD
Dissociation is a defense mechanism that the brain activates when emotional pain is too intense to be processed. During an unbearable traumatic experience, the mind partially "disconnects" from reality as a form of protection. This response, which can be adaptive at the moment of trauma, can become chronic and turn into a persistent symptom of PTSD:
Derealization: The feeling that the environment isn't real, that one is looking at the world through glass or fog. Things seem strange, distant or artificial.
Depersonalization: The feeling of separation from one's own body, one's own emotions or one's own thoughts. As if you were observing yourself from the outside or as if your body weren't yours.
Dissociative amnesia: Inability to remember important periods of the trauma, even though you know they happened, or memory gaps in everyday life.
The DSM-5 recognizes a dissociative subtype of PTSD that requires a specific therapeutic approach: before processing traumatic memories with EMDR, stabilization and regulation work must be done to ensure that the person can tolerate processing without becoming destabilized.
Triggers: trauma activators
Triggers are stimuli that the brain has associated with the traumatic experience and that reactivate the alarm response. They can be sensory (a sound, a smell, a texture, a taste), visual (a place, a face, an object), situational (darkness, solitude, an enclosed space) or internal (an emotion, a bodily sensation, a thought). The distinctive feature of triggers in PTSD is that the reaction they provoke is automatic, immediate and disproportionate: the emotional brain responds as if danger were present, without the rational part having time to contextualize the situation.
Identifying and understanding one's own triggers is a fundamental step in treatment. Not in order to avoid them, but to anticipate them, regulate the response and finally process them with EMDR so that they lose their activating charge.
Types of trauma in adults
Traumatic events that can cause PTSD in adults include:
Accidents: Traffic, work, domestic or sports accidents involving life-threatening risk or serious injury. The experience of losing control, the unpredictability and the closeness to death or serious harm deeply mark the brain's alarm system.
Assaults: Physical or sexual assaults, attacks, robberies with violence. Interpersonal violence has an especially intense traumatic impact because it involves the intentionality of another human being, which breaks basic trust in relational safety.
Natural disasters: Earthquakes, floods, wildfires, hurricanes. The absolute uncontrollability of the experience and the massive destruction generate a deep feeling of helplessness and vulnerability.
Childhood abuse: Physical, emotional or sexual abuse during childhood has especially devastating consequences because it occurs at a time when the brain is in full development and in a relational context of dependency. Childhood abuse is the most frequent cause of complex PTSD.
Gender-based violence: Violence against women combines the trauma of the violence received with the systematic erosion of self-esteem, identity and autonomy. It often produces complex PTSD with deep dissociation, guilt and shame.
Traumatic losses: Sudden or violent death of a loved one, witnessing someone's death, near-death experiences, serious medical diagnoses. When loss is unexpected and violent, grief is complicated by PTSD symptoms.
How does online EMDR work for PTSD?
EMDR (Eye Movement Desensitization and Reprocessing) is one of the most scientifically supported treatments for PTSD, recommended by the WHO and leading international clinical guidelines. Its mechanism is based on bilateral stimulation (alternately activating both brain hemispheres) while the person accesses the traumatic memory, which facilitates adaptive memory reprocessing.
In an online format, EMDR has been shown to maintain its effectiveness thanks to specific adaptations:
Butterfly Hug
Developed by Lucina Artigas and Francine Shapiro herself, it consists of crossing your arms over your chest and tapping alternately with your hands on your pectorals at a regular rhythm. This bilateral tactile self-stimulation is the most widely used technique in online EMDR because the person can apply it autonomously, following the therapist's instructions via video call, and it activates the same processing mechanisms as in-person eye movements.
Bilateral auditory stimulation
Through headphones, the person receives sounds that alternate between the right and left ear. The therapist controls the sounds through specific online EMDR platforms. This modality is especially useful for people who prefer to close their eyes during processing, since it doesn't require visual tracking.
Screen-guided eye movements
The therapist uses a dot or bar that moves from one side of the screen to the other, which the person follows with their eyes. It works similarly to in-person eye movements and is effective when the screen size and distance allow for sufficient visual range.
Phases of EMDR treatment for PTSD
The EMDR protocol follows eight structured phases that adapt perfectly to the online format:
1. Clinical history and treatment planning: Gathering the patient's history, identifying target traumatic events and establishing a treatment plan. Online, this phase is conducted with the same depth as in person.
2. Preparation and stabilization: This phase is fundamental, especially in complex PTSD. Emotional regulation techniques are taught, the safe place, grounding exercises (anchoring to the present) and the patient's window of tolerance is developed. In complex PTSD, this phase can last weeks or months before reprocessing begins.
3-6. Assessment, desensitization, installation and body scan: Direct work on the traumatic memory. The person accesses the memory while receiving bilateral stimulation until the level of associated distress drops significantly and a positive belief about oneself naturally installs itself.
7-8. Closure and re-evaluation: Ensures that the person ends the session in a stable state and assesses in the next session that the changes have been maintained.
Cognitive Processing Therapy (CPT) for PTSD
In addition to EMDR, Cognitive Processing Therapy (CPT) is another scientifically supported treatment for PTSD that adapts excellently to the online format. CPT focuses on identifying and modifying the dysfunctional beliefs that trauma has generated, such as "I should have prevented it", "the world is completely dangerous" or "I'm incapable of protecting myself".
CPT uses writing exercises (such as the impact statement, where the person writes about the meaning the trauma has had for them) and worksheets to analyze cognitive "stuck points": thoughts that keep PTSD active. The online format makes it easier to carry out these exercises between sessions and allows texts to be shared in real time with the therapist.
When to seek professional help
It's advisable to consult a professional specialized in trauma when:
• PTSD symptoms persist for more than a month after the traumatic experience.
• Flashbacks, nightmares or intrusive memories interfere with daily, work or relational life.
• Avoidance of trauma reminders has spread to more areas of life (you stop doing things, going places, being with people who matter to you).
• Hypervigilance, irritability or sleep problems affect your quality of life.
• You have emotionally disconnected from the people you love (emotional numbing).
• You turn to alcohol, unprescribed medications or other substances to manage symptoms.
• You have thoughts of self-harm or self-injury.
• You notice dissociative symptoms (derealization, depersonalization, memory gaps).
PTSD doesn't simply improve "with time": without treatment, symptoms tend to become chronic and worsen, progressively affecting more areas of life. Seeking help isn't a sign of weakness, but the bravest and most intelligent step you can take for your recovery.
The safety and stabilization phase
Before processing traumatic memories with EMDR, it's essential that the person has sufficient resources to tolerate processing without becoming destabilized. This preparatory phase, known as the stabilization phase, is especially important in complex PTSD and includes:
Psychoeducation: Understanding what PTSD is, why symptoms appear and how treatment works reduces uncertainty and the "feeling crazy" that many people experience.
Emotional regulation: Diaphragmatic breathing techniques, grounding (sensory anchoring to the present), emotional containment and the safe-place exercise. These tools allow the patient to regulate emotional intensity during and between sessions.
Window of tolerance: Learning to identify when you leave the tolerance zone (toward hyperarousal — anxiety, racing heart — or toward hypoarousal — numbing, disconnection) and how to return to it.
Resources for connecting with the present: Exercises that help the person differentiate "there and then" (the past trauma) from "here and now" (the safety of the present moment). This is essential to be able to process memories without getting trapped in the past.
Advantages of online PTSD therapy
Online therapy offers specific benefits for PTSD treatment:
Safety of one's own space: Many people with PTSD feel safer processing traumatic material from their own space, especially if the trauma involves public spaces, commutes or exposure to unfamiliar environments.
Accessibility: Allows access to a trauma specialist from anywhere, with no need to travel. This is crucial considering that professionals specialized in PTSD and EMDR aren't available in every town.
Continuity: PTSD requires consistency in treatment. Online therapy eliminates commuting and makes it easier to maintain session regularity, which directly impacts treatment effectiveness.
Flexibility: Sessions in flexible time slots that adapt to daily life, with no need to request work permissions for long commutes.
Take the first step
If you're suffering from post-traumatic stress symptoms — flashbacks, nightmares, avoidance, hypervigilance, emotional numbing, dissociation — I want you to know that PTSD has treatment and that recovery is possible. As a licensed health psychologist specialized in trauma treatment with EMDR, I accompany you through the recovery process from online therapy, at your own pace and with the safety you need. Contact me for a first informational consultation.