What is CPTSD — and how is it different from PTSD?

Most of us have a complicated relationship with stress. We know chronic stress is bad for us. We try to manage it. And yet it keeps showing up — in our bodies, our moods, our reactions to things that seem, on the surface, like they shouldn't be a big deal. If that sounds familiar, it might help to understand what's actually happening in your nervous system when stress hits — and why the science of neuroplasticity offers genuine reason for hope.

Polyvagal theory, developed by neuroscientist Dr Stephen Porges, offers one of the most useful frameworks for understanding the nervous system's response to stress and perceived threat. At its core, the theory describes three distinct states the nervous system moves through — and understanding which state you're in can support how you respond to it.

The first state is the ventral vagal state — sometimes called the 'social engagement' state. This is where we feel safe, connected, and regulated. We can think clearly, access empathy, tolerate discomfort, and engage with the world around us. It's the state where learning, creativity, and genuine connection happen. When we talk about 'feeling like ourselves', this is usually what we mean.

The second state is the sympathetic state — the classic fight-or-flight response. When the nervous system detects threat (real or perceived), it mobilises the body for action: heart rate increases, muscles tense, breathing shallows, digestion slows. This is an intelligent, adaptive response. The problem is that in modern life, the 'threat' is often a difficult email, a tense conversation, or a long to-do list — and the body responds the same way it would to a predator. We're flooded with stress hormones, but there's nowhere to run.

The third state is the dorsal vagal state — a shutdown or freeze response. When threat feels overwhelming and fight-or-flight isn't an option, the nervous system can collapse into a state of disconnection, numbness, or exhaustion. This might look like dissociation, emotional flatness, difficulty getting out of bed, or a sense of going through the motions. It's the nervous system's last-resort protection — and it's often misread as laziness, depression, or lack of motivation.

Understanding these three states matters because it reframes what's happening when you're triggered. You're not overreacting. You're not weak. Your nervous system is doing exactly what it was designed to do — it's just doing it in response to cues that don't actually require a survival response. The technical term for these cues is 'neuroception': the nervous system's unconscious scanning for safety and danger, happening below the level of conscious thought.

This is where neuroplasticity becomes relevant. Neuroplasticity is the brain's capacity to change — to form new neural pathways, to rewire habitual patterns of response, to learn new ways of being in the world. For a long time, it was assumed that the brain was largely fixed after childhood. We now know that's not true. The brain retains the capacity for change throughout life, and the nervous system can learn — with the right conditions and the right support — to have more flexibility and more quickly transition between states.

What does this look like in practice? It starts with awareness. Simply noticing which state you're in — 'I'm in fight-or-flight right now, my chest is tight and I'm scanning for what's wrong' — creates a small but meaningful gap between stimulus and response. That gap is where choice lives. Over time, with repetition, that noticing becomes easier and faster. The neural pathway for self-awareness strengthens.

From there, certain practices have been shown to support a shift back toward the ventral vagal state. Slow, extended exhales activate the vagus nerve and signal safety to the nervous system — even a few slow breaths can begin to shift the physiological state. Physical movement, particularly rhythmic movement like walking, can help discharge the mobilised energy of the sympathetic state. Co-regulation — being in the presence of a calm, safe person — is one of the most powerful regulators of all, because the nervous system is fundamentally social and wired to take cues from others.

None of this is about eliminating stress. Stress is a normal, necessary part of life. The goal isn't to never be triggered — it's to build a nervous system that can move through activation and return to regulation more fluidly. That capacity is sometimes called 'resilience', but it's more specific than that: it's the ability to notice where you are, access tools that help, and trust that the state will shift; all tides change. With practice, and often with support, that trust becomes earned.

One of the things people often say when they're trying to make a change — or even do what they know will make their life easier — is: 'I know what I need to do. I just can't seem to make myself do it.' They might put off an important task, struggle to keep up a new routine, or feel frustrated when their motivation disappears.

It's easy to turn that frustration inward and call it laziness or a lack of discipline. But difficulty getting started doesn't mean you're failing. Our brains are more likely to repeat behaviours that feel manageable and rewarding — and more likely to avoid what feels overwhelming, unpleasant, or uncertain. When we're tired or under stress, even a small task can feel like a lot.

Instead of asking yourself to try harder, it can help to make the first step smaller. If exercising feels like too much, getting dressed and stepping outside might be enough for today. If a task feels daunting, try setting a timer for five minutes, or focus on just one part of it. You can decide what to do next once you've begun.

It also helps to notice the conditions around the habit. Is there a time of day when it feels easier? Could you get what you need ready beforehand, make distractions less accessible, or pair the task with something you enjoy? These aren't tricks or shortcuts. They're ways of making it easier to act on what matters to you.

How can you make things feel more manageable?

Reward the effort, not only the result

Notice and acknowledge the act of beginning, practising, or returning after a pause — not just whether you reached the final goal. This helps effort feel worthwhile along the way. Say it out loud — hell, do it looking at yourself in the mirror: "You showed up!"

Bring a reward to the doorway

Pair a task you tend to avoid with something you enjoy — listening to a favourite playlist while tidying, or having a comforting drink while you work. The enjoyable part can make it easier to approach the task.

Make the entry point smaller

Reduce the first step until it feels doable — ridiculously doable! You might open the document, put on your walking shoes, or spend just five minutes on the task. Starting small still counts. You build a house starting with stumps, not trees.

Design your surroundings instead of relying on resolve

Set things up in advance to support the action you want to take. Put the book where you'll see it, prepare what you need the night before, or move distractions out of reach.

Finding a workable rhythm isn't about proving you have enough willpower. It's about finding a way of beginning that feels possible — and meeting yourself with patience as you practise.

Sometimes the issue isn't that you have low self-worth. It's that your sense of worth has been placed somewhere outside your control.

Research suggests that our self-esteem can become tied to particular areas of life — appearance, achievement, approval, or belonging. Our self-regard can rise and fall according to how we think we're doing in the areas that matter most to us.

You might think of the mind as having a built-in gauge — a measure that picks up signs of acceptance, rejection, success, and failure. If your sense of worth is tied to being liked, for example, a friend's silence or a change in someone's tone may set the gauge off. You might feel exposed, anxious, or suddenly convinced you've done something wrong.

That reaction isn't a character flaw. The gauge is trying to tell you something about how secure or accepted you feel. But its reading isn't a verdict on your value as a person. It can register, 'I'm worried I've lost someone's approval' — it can't prove, 'I'm not worth caring about.'

The areas we invest with personal significance can have a powerful hold over us. It's as if we take the deed to our own value and sign it over to one particular domain — mother, partner, employee, athlete. From then on, that domain gets to pass judgement on us, and the gauge becomes especially sensitive to anything that might threaten it. We rarely sign that deed consciously.

Self-esteem can improve not only by achieving more, but also by easing unrealistic expectations. Each person knows and sees a different version of us — and since we can't satisfy every imagined opinion, some relief may come from letting go of the need to please everyone.

The aim isn't to silence the gauge or dismiss what you feel. It's to notice what it might be responding to, and to remember that a change in its reading doesn't define who you are. Over time, we can begin to place more of our self-worth in values we choose and actions we can stand by — not only in how other people respond to us.

Notice your gauge

What tends to affect your mood most? Is it approval, achievement, appearance, belonging, or something else?

Move the deed inward

Choose one value you want to represent — even if nobody notices.

Practise self-compassion

Instead of asking "Am I good enough?", ask: "What does the person in front of me need right now?"

A difficult moment can make everything feel too big to tackle. You might be replaying what happened, worrying about what comes next, or telling yourself you should be coping better.

Resilience doesn't mean staying calm all the time or getting over things quickly. It's not about pretending the hit didn't hurt. It can begin with a smaller question: what's the smallest thing I can do right now?

Imagine a room in darkness. You don't have to rebuild the house before you can see your way — you just look for the light switch. In a hard moment, your 'switch' might be sending one message, stepping outside for a few minutes, writing down the next task, or asking someone to sit with you. Small actions don't erase a big problem. They can help you find a little direction within it.

You don't have to feel ready, confident, or completely okay before taking a step. Start with the smallest thing that responds to you. Progress can begin there.

Find the smallest thing you can press

Choose one small action within your control.

Choose a challenge you can handle

Take a step that matters, at a pace you can sustain.

Practise flexibility

Notice what this moment needs, then choose a response that fits. Sometimes that means continuing; sometimes it means pausing, changing plans, or asking for support.

Build what the hit can't take all at once

Make room for the people, values, and interests that matter beyond the problem.

One of the most common things people say when they first come to counselling is some version of: 'I don't know why I react the way I do. It's like I can't control it.' They describe shutting down in the middle of conversations, becoming overwhelmed by things that seem small, or feeling constantly on edge even when nothing is actually wrong.

What's happening in these moments isn't a character flaw or a sign that something is fundamentally wrong with you. It's your nervous system doing exactly what it was designed to do — protect you from threat.

The autonomic nervous system has two primary modes: activation (fight or flight) and shutdown (freeze or collapse). In a healthy, safe environment, we move fluidly between these states and a third — social engagement — where we feel calm, connected, and present. But when we've experienced trauma, especially repeated or early trauma, the nervous system recalibrates.

Hypervigilance — that constant scanning for danger, the inability to fully relax — is the nervous system staying ready. Dissociation — that sense of floating above yourself, of things feeling unreal — is the nervous system protecting you from an experience it has decided is too much to process consciously.

Understanding this reframes everything. You're not broken. You're not weak. You're not 'too much'. You're a person whose nervous system learned, in very difficult circumstances, how to keep you alive. The problem isn't the nervous system — it's that those survival responses are now firing in situations that don't actually require them.

This is where therapy comes in. Not to override or suppress these responses, but to help the nervous system learn — slowly, gently, at its own pace — that it's safe to come out of survival mode. That's the work. And it's possible.

You ask how their day was. You get a shrug. You ask if something's wrong. 'I'm fine.' You try to start a conversation and they disappear into their room. If you're the parent of a teenager, this probably sounds familiar — and it probably worries you.

Here's the first thing to understand: withdrawal is developmentally normal. Adolescence is a period of intense individuation — the psychological process of becoming a separate person. Part of that process involves pulling away from parents, establishing privacy, and building an identity that isn't defined by the family.

That said, there's a difference between normal teenage privacy and genuine withdrawal that signals distress. Signs to watch for include: a significant change from their usual baseline, loss of interest in things they used to care about, changes in sleep or eating, declining school performance, or any signs of self-harm.

If you're worried, the instinct is often to push harder — to ask more questions, to insist on a conversation. This rarely works. Teenagers, particularly those who are struggling, tend to shut down further when they feel cornered or interrogated. What works better is staying present without pressure.

It also helps to examine your own reactions. If a teenager has learned that sharing difficult feelings leads to parental anxiety, lectures, or attempts to immediately fix the problem, they'll stop sharing. The goal is to become someone they can talk to — which means listening more than responding.

If you're genuinely concerned about your teenager's wellbeing, counselling can help — both for them, and sometimes for you as a parent navigating this. You don't have to have it all figured out before you reach out.

For many people, the hardest part of starting counselling is making the first appointment. The unknown is uncomfortable — and there are a lot of myths and misconceptions about what counselling actually involves. So here's an honest account of what you can expect from a first session.

A first session is primarily about getting to know each other. Your counsellor will want to understand what's brought you in — what's been happening, what you're hoping for, what feels most pressing. You don't need to have a clear answer to any of these questions.

You won't be expected to share everything in the first session. Good counselling moves at your pace. You're in control of what you share and when. A first session is also an opportunity for you to get a sense of whether this particular counsellor feels like a good fit.

There will likely be some practical questions: a bit of background about your life, your history, what support you currently have. There may be some paperwork around confidentiality and consent. Your counsellor will explain how they work and answer any questions you have.

What a first session is not: it's not an assessment where you'll be judged or diagnosed. It's not a situation where you'll be pushed to talk about things you're not ready for. It's not a test you can fail.

After the session, it's normal to feel a range of things — relief, or strangely tired, or uncertain. All of that is okay. If you'd like to talk through whether counselling might be right for you before committing to a session, a free 15-minute phone consultation is a good place to start.

When a young person you love is struggling, the instinct is to do something. To fix it, to find the right words, to make it better. When they start counselling, that instinct can sometimes get in the way — even when it comes from the best possible place.

The most important thing you can do to support a young person in counselling is to respect the process. Counselling works in part because it's a confidential space — a place where a young person can say things they might not feel safe saying at home, without worrying about how it will affect the people they love.

This doesn't mean you're excluded. It means your role is different. Your job is to be a stable, non-reactive presence at home. To keep routines consistent. To make it clear, through your actions more than your words, that you're not going anywhere and that your love isn't conditional on them getting better quickly.

It also means managing your own anxiety about the process. Counselling can sometimes look like things are getting worse before they get better — a young person might become more emotional, more withdrawn, or start talking about things they've never mentioned before. This is often a sign that the work is happening, not that something has gone wrong.

If you have concerns about your young person's safety, share them directly with the counsellor — you don't need to go through your child to do this. A good counsellor will be transparent with you about the limits of confidentiality and what would prompt them to involve you.

Finally: look after yourself. Supporting someone who is struggling is hard. You're allowed to find it difficult. You're allowed to need support too.

The 'window of tolerance' is a concept developed by psychiatrist Dan Siegel, and it's one of the most useful frameworks for understanding what happens in the nervous system during and after trauma.

The idea is simple: there's a zone of arousal — a window — within which we can function well. Inside this window, we're able to think clearly, feel our emotions without being overwhelmed by them, connect with other people, and engage with difficult material without shutting down. This is the zone where learning and healing happen.

Outside this window, in either direction, our capacity to function is compromised. Too much activation — the hyperarousal zone — and we're flooded: anxious, reactive, overwhelmed, unable to think straight. Too little — the hypoarousal zone — and we're shut down: numb, disconnected, exhausted, unable to feel much at all.

This is why trauma therapy can't simply involve talking about what happened. If a person is already outside their window of tolerance — flooded or shut down — they can't process the material in a way that leads to healing. They're just re-experiencing it. Good trauma therapy is therefore partly about widening the window.

Practically, this means that early trauma therapy often focuses on stabilisation and resourcing — developing tools for self-regulation, building a sense of safety in the therapeutic relationship, and learning to recognise when you're moving outside your window so you can bring yourself back.

If you've tried therapy before and found it overwhelming or unhelpful, it's possible that the work moved too quickly — before your window was wide enough to hold it. That's not a reflection of your capacity to heal. It's a reflection of the approach. The right pacing makes all the difference.

One of the most common questions people have about counselling — often unspoken — is: how do I know if this is actually working? It's a reasonable question. Counselling involves a significant investment of time, money, and emotional energy. It makes sense to want to know if it's paying off.

The honest answer is that progress in counselling is rarely linear, and it doesn't always look the way people expect. In the early stages, things sometimes feel harder before they feel better. You might find yourself more aware of difficult feelings, not less. This can feel like going backwards — but it's often a sign that the work is happening.

Some signs that counselling is moving in the right direction: you're starting to understand yourself better — why you react the way you do, where certain patterns come from. You're able to sit with difficult feelings for a little longer without immediately needing to escape them.

Signs that something might not be working: you consistently leave sessions feeling worse with no sense of why. You feel judged or misunderstood. You feel like you're performing wellness rather than actually working toward it. You've been in therapy for a significant period and nothing has shifted at all.

If you're unsure, the most useful thing you can do is bring it into the room. A good counsellor will welcome the conversation — 'I'm not sure this is working' is important information, not a criticism. It might lead to a shift in approach, a clearer articulation of goals, or an honest conversation about whether a different kind of support might be more helpful.

Counselling isn't a passive process. The more you can bring your honest experience into the room — including your doubts — the more useful it tends to be.

School refusal — the persistent difficulty attending school, despite parental pressure and awareness of the expectation — is one of the more distressing things a family can navigate. It's also widely misunderstood.

The first thing to understand is that school refusal is almost never actually about school. It's a symptom, not a cause. Underneath it, there's usually anxiety — social anxiety, generalised anxiety, or specific fears about something happening at school.

What makes school refusal particularly difficult to manage is that the short-term solution — staying home — provides immediate relief from the anxiety, which reinforces the avoidance. Every day at home makes going back feel harder.

This means that the goal of intervention isn't simply to get the young person back to school as quickly as possible — it's to understand and address what's driving the refusal, while also working on a gradual, supported return. Forcing a return without addressing the underlying anxiety tends to produce short-term compliance and longer-term deterioration.

For parents, school refusal is exhausting and often isolating. There can be pressure from schools and other parents that feels like judgment. It's important to know that school refusal is not a parenting failure. It's a sign that a young person is struggling and needs support.

If your family is navigating school refusal, counselling can help — both to work with the young person on the underlying anxiety, and to support parents in managing the situation without inadvertently reinforcing the avoidance. Early intervention tends to produce better outcomes, so it's worth reaching out sooner rather than waiting to see if it resolves on its own.