Difficulties Managing Emotions in PTSD

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Many people experience difficulties managing emotions in posttraumatic stress disorder (PTSD). In fact, PTSD can make it feel as though the volume has been turned up on your emotions. As a result, you may frequently experience intense unpleasant emotions, such as fear, anger, sadness, guilt, and shame. The frequency and intensity with which these emotions occur can make it very difficult to manage them.

Difficulties Regulating Emotions in PTSD

Emotion regulation refers to the ways in which people respond to their emotions. Healthy emotion regulation is viewed as being aware and accepting of your emotions, recognizing that emotions provide us with useful information about ourselves and our environment, and being able to engage in healthy and adaptive behaviors (for example, going to work, maintaining relationships with others) even when we are experiencing high levels of distress.

Studies have shown that people with PTSD often experience difficulties in many of these areas of emotion regulation. For example, people with PTSD report the following problems in emotion regulation (compared to those without the disorder):

  • Lower awareness of emotions
  • Greater difficulties accepting emotions
  • More likely to respond to emotions with fear and shame
  • A greater tendency to avoid emotions
  • More problems controlling impulsive behaviors when experiencing distress
  • Difficulties engaging in goal-directed behavior when experiencing distress
  • More likely to feel that they don't have effective ways of managing their emotions

As a result of these difficulties with emotion regulation, many people with PTSD often turn to extreme and unhealthy ways of regulating their emotions, such as substance use, binge eating or self-injury.

These coping strategies may be initially useful in bringing down the intensity of an emotion; however, in the long run, they can cause these unpleasant emotions to intensify and stick around longer. They also will prevent people from working through these emotions.

Improving Emotion Regulation

Although emotion regulation difficulties are common in PTSD, there are a number of things you can do to improve your relationship with your emotions. In particular, there are coping skills you can use to improve your awareness of your emotions, reduce the extent with which you negatively react to emotions, improve your control over behaviors when distressed, increase your expression of emotions, help increase your willingness to accept emotions and manage intense emotional experiences.

In addition, many treatments that can be useful in reducing PTSD symptoms, such as acceptance and commitment therapy and dialectical behavior therapy, explicitly focus on ways of improving emotional acceptance and emotion regulation.


Cloitre, M., Koenen, K.C., Cohen, L.R., & Han, H. (2002). Skills training in affective and interpersonal regulation followed by exposure: A phase based treatment for PTSD related to childhood abuse. Journal of Consulting and Clinical Psychology, 70, 1067-1074.

Monson, C.M., Price, J.L., Rodriguez, B.F., Ripley, M.P., & Warner, R.A. (2004). Emotional deficits in military-related PTSD: An investigation of content and process disturbances. Journal of Traumatic Stress, 17, 241-248.

Tull, M.T., Barrett, H.M., McMillan, E.S., & Roemer, L. (2007). A preliminary investigation of the relationship between emotion regulation difficulties and posttraumatic stress symptoms. Behavior Therapy, 38, 303-313.

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