Learn · Safety and suitability

Is a trauma intensive safe?

For people who have been properly assessed, the research so far is reassuring. Studies of intensive trauma treatment, mostly of prolonged exposure and EMDR in specialist clinics, report low dropout and few adverse events, including among people with long and complex trauma histories. Safety comes less from the number of hours than from three things around them: careful assessment beforehand, pacing within each day, and a clear plan for afterwards.

Written by Lucy Orton, MSc, PGDip, registered counsellor (ACA #27921), founder of The Centre for Intensives. Last reviewed .

What people usually mean by ‘safe’

When someone asks whether a trauma intensive is safe, they are rarely asking about physical risk. They are usually asking one of three things. Will I be overwhelmed by having so much opened up at once? Will I be worse off afterwards than I am now? And will I be left on my own with whatever comes up once the days are over?

Each of those is a fair question, and each has a different answer. The first is about pacing, the second about assessment, and the third about what is arranged for afterwards.

What the research shows

Most of the research on intensive trauma treatment comes from specialist clinics in the Netherlands, the United States and the United Kingdom, where established trauma therapies are delivered daily over one to three weeks instead of weekly over several months. Taken together, the findings on safety are reassuring.

  • People tend to complete intensive treatment. A 2020 systematic review of eleven studies found a pooled dropout rate of about 5.5% for intensive formats. Most of these studies had no comparison group, so this does not show that intensives have lower dropout than weekly treatment, but it does show that few people stopped early.
  • Complex histories have been included, not just excluded. One Dutch programme treated 347 adults with severe PTSD over eight days. All had experienced multiple traumas, most had a co-occurring mood disorder, and nearly three quarters reported suicidal thoughts at the start. Dropout was 2.3%.
  • Adverse events have been rare. A study of 73 adults with chronic PTSD, most with histories of repeated childhood trauma and several previous unsuccessful treatments, delivered twelve sessions over four days. Nobody dropped out during the intensive phase, adverse events were described as extremely low, and only a minority showed any rise in symptoms.

These studies have limits that are worth knowing. Most tested exposure-based therapy and EMDR, delivered by clinical teams, and many had no comparison group. Research on Internal Family Systems and Brainspotting delivered as intensives is at a much earlier stage. What the evidence supports is that concentrated, consecutive-day trauma work has not been found to be more dangerous than weekly work, and that few people stop intensive programmes early. It does not show that every intensive, with every method, suits every person.

Feeling worse for a while is not the same as harm

It is common to feel tired, tender or emotionally close to the surface for a few days after concentrated work. Dreams may be more vivid. Old memories may come to mind more often. This tends to settle, and it is not a sign that something has gone wrong.

Research on weekly trauma-focused therapy has found the same pattern. A temporary rise in symptoms happens for some people, it is not linked to dropping out, and those who experience it still tend to show clear improvement by the end of treatment.

Harm looks different. It means losing the ability to function day to day, becoming unsafe, or being pushed into material faster than you can take in. The work of a careful intensive is to stay on the right side of that line, and most of what makes it safe is designed with that in mind.

What makes an intensive safe in practice

  1. Assessment before anything is booked. History, current stability, any risk to life, support at home, medication, alcohol and drug use, and how someone tends to respond under stress are all looked at before an intensive is agreed. This is where the decision about whether an intensive is right, and right now, is made.
  2. A defined focus. The days are organised around something specific, agreed in advance. An intensive is not an attempt to work through a whole life at once.
  3. Pacing within each day. Active work is alternated with time to consolidate, eat, rest and come back to the present. Each day aims to finish with you settled enough to leave the room, or the call, and go about your evening.
  4. Methods that let you set the pace. In Internal Family Systems, the protective parts of a person are asked for permission before painful material is approached, and the work slows when they are not ready. Brainspotting includes a resourcing approach, where the focus is on finding a steadier place in the body before going further. Both methods are built to follow the client, not push them.
  5. A plan for afterwards. Follow-up sessions, contact with an existing therapist where there is one, and an agreed plan for what to do if things feel difficult between sessions are settled before the first day, not improvised after the last.

When an intensive is not the safe choice

An intensive is generally not the right answer where there is acute risk to life, such as recent suicidal behaviour or active plans. A higher level of care is needed then. It is also usually the wrong choice where someone is currently unsafe at home, is dependent on alcohol or drugs, or is going through an episode of psychosis or mania that has not yet stabilised.

Some situations call for a different order of work rather than a different format. Where someone has no reliable way to steady themselves when distressed, or where significant dissociation has not yet been assessed, stabilising work usually comes first, and an intensive may follow later.

None of these judgements can be made from a web page. They are made at assessment, with the full picture.

Questions worth asking any provider

Whoever you are considering working with, these questions will tell you a good deal about how seriously they take safety:

  • How do you assess whether an intensive is right for me, and what would lead you to say no?
  • What happens if I become overwhelmed or shut down partway through a day?
  • What is in place for the weeks after the intensive, and who do I contact if I am struggling?
  • What training do you have in the methods you use, and who supervises your clinical work?
  • Which professional body are you registered with, and how would I raise a concern?

A provider who answers these clearly and without hesitation is usually one who has thought about them before you asked.

Common questions

Can a trauma intensive make things worse?

Some people feel more tired, emotional or unsettled for a few days, in the same way that people sometimes do after weekly trauma work. Research on trauma-focused therapy has found that a temporary rise in symptoms is not linked to dropping out, and that people who experience one still tend to improve by the end of treatment. Lasting harm is a different matter, and the main protection against it is an assessment that screens out the situations where an intensive is the wrong choice.

What happens if I dissociate or become overwhelmed during the day?

The work slows down or stops, and the focus moves to getting you settled and present again before anything else happens. A well-run intensive has room for this built into the day. It is part of the work, not a failure of it, and it is one of the reasons the days are paced rather than filled.

Is an online trauma intensive as safe as one in person?

The research on remote delivery is newer, but a 2022 study of 73 people in a fully online four-day programme for PTSD and complex PTSD reported no dropout, no adverse events and large reductions in symptoms. It had no comparison group. Online work does need some extra planning, including a private space, a reliable connection and an agreed plan for what happens if the call drops.

Do I need to have had therapy before?

Not necessarily, but many people who choose an intensive have. Previous therapy often means someone already has ways to steady themselves when things get difficult, which makes concentrated work easier to hold. Where that is missing, some stabilising work may come first.

Lucy Orton offers trauma intensives using Internal Family Systems and Brainspotting, online worldwide and in person in South East Asia. Suitability is assessed before anything is booked.

Trauma intensives with IFS and Brainspotting

References

  1. Sciarrino, N. A., Warnecke, A. J., & Teng, E. J. (2020). A systematic review of intensive empirically supported treatments for posttraumatic stress disorder. Journal of Traumatic Stress. doi:10.1002/jts.22556
  2. Van Woudenberg, C., Voorendonk, E. M., Bongaerts, H., et al. (2018). Effectiveness of an intensive treatment programme combining prolonged exposure and eye movement desensitization and reprocessing for severe post-traumatic stress disorder. European Journal of Psychotraumatology, 9(1), 1487225. doi:10.1080/20008198.2018.1487225
  3. Hendriks, L., de Kleine, R. A., Broekman, T. G., Hendriks, G. J., & van Minnen, A. (2018). Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts. European Journal of Psychotraumatology, 9(1), 1425574. doi:10.1080/20008198.2018.1425574
  4. Larsen, S. E., Wiltsey Stirman, S., Smith, B. N., & Resick, P. A. (2016). Symptom exacerbations in trauma-focused treatments: Associations with treatment outcome and non-completion. Behaviour Research and Therapy, 77, 68-77. doi:10.1016/j.brat.2015.12.009
  5. Bongaerts, H., Voorendonk, E. M., van Minnen, A., Rozendaal, L., Telkamp, B. S. D., & de Jongh, A. (2022). Fully remote intensive trauma-focused treatment for PTSD and Complex PTSD. European Journal of Psychotraumatology, 13(2), 2103287. doi:10.1080/20008066.2022.2103287

This page is general information about intensive therapy. It is not a substitute for individual assessment or advice, and reading it does not create a therapeutic relationship. If you are in crisis or at risk of harm, contact local emergency services or a crisis line now. How these articles are written and checked: our editorial standards.

Read next