After trauma, some people develop post-traumatic stress disorder (PTSD), a mental health condition that can involve intrusive nightmares, flashbacks and physical reactions when reminded of the traumatic event, such as a racing heart or difficulty breathing.

Some people with PTSD also develop profoundly negative beliefs about themselves – intense shame, guilt and even feeling responsible for what happened.

For example, someone who experienced a violent assault may believe they somehow deserved to be attacked. Such beliefs can cause significant distress and drive persistent PTSD symptoms.

There are multiple evidence-based forms of cognitive therapy, also called “talk therapy”, that can effectively treat PTSD by helping to reframe these negative self-beliefs.

However, some people don’t respond to these kinds of therapy much – or at all.

In our research, we scanned the brains of 136 people – half who had PTSD, and half who didn’t – while they used cognitive therapy techniques to challenge negative beliefs. We found the reason some people don’t respond to treatment may lie in the way PTSD has restructured their brains.

First, how does talk therapy work for PTSD?

Research shows talk therapies targeting negative beliefs – including cognitive processing therapy (CPT) and trauma-informed cognitive behavioural therapy (TF-CBT) – are broadly effective for PTSD. Most people show meaningful improvement in their symptoms.

Talk therapy for PTSD usually aims to equip patients with skills to challenge distorted negative beliefs through a structured dialogue, known as cognitive restructuring.

During therapy, a therapist might guide the person to counter the rationale underlying beliefs (for example, “who made the decision to commit the assault?”), or consider alternative perspectives (“is there another way of understanding what happened, which........

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