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     Coping with C-PTSD: Learning to Conquer Fear

    12 Minute Read

    Fear directs survival. A lot of fears are very rational: not only do they make sense, but they serve a critically important function of keeping us alive. For instance, if you’re afraid of heights, you will probably stay away from mountains and therefore reduce your risk of dying by falling off a cliff.

    Fear is a natural and healthy reaction to danger. Some fear can be beneficial, but persistent fear can be debilitating- even life-threatening. We can learn to better manage our fear by understanding the flight/fight process of the nervous system, and how this process impacts the brain and body. Learning how to heal after a traumatic experience will help you take control over fear, so fear stops controlling you.

    When humans are exposed to real threat to life- physical harm, childhood abuse or neglect, violence, sexual assault, or systematic oppression, your brain shifts in how it prioritizes fear. You become hyper-attuned to threats. When you don’t have adequate support after exposure to threat, this hyper-focus becomes semi-permanent. It’s an extended symptom to keep you on high alert to future threats.

    When this experience happens often or with great intensity, more and more resources are directed towards your survival mechanisms. The number one job of the nervous system is to protect your survival by any means necessary. Unfortunately, complex trauma rewires us to be hyper-focused on staying safe. Your nervous system becomes so overloaded with messages of threat that it comes unreliable and unpredictable. You feel fear everywhere, while also losing your ability to tolerate the fear. You can become so scared you actually lose the capacity to keep yourself safe.


    What is complex post-traumatic stress disorder (C-PTSD)?


    This slow pressure of threat on the nervous system is the main crux of complex post-traumatic stress disorder (also known as C-PTSD). C-PTSD results from repeated and prolonged exposure to traumatic events. It’s characterized by a range of symptoms such as difficulty regulating emotions, flashbacks, intrusive thoughts, difficulty in relationships, and an altered sense of self. C-PTSD is distinct from PTSD in that it involves multiple traumatic events and a longer duration of exposure.

    C-PTSD is most often diagnosed among people who have been victims of prolonged, repetitive trauma. It’s most commonly found in those who have experienced childhood abuse or neglect; domestic violence; and sexual assault.


    Coping with C-PTSD

    The impact of trauma on the brain, emotions, and behavior. 

    Trauma can have a profound effect on the brain, emotions, and behavior. Traumatic events can cause changes in brain chemistry and structure, leading to changes in behavior and emotional reactions. These changes can range from difficulty concentrating and problems with memory to feeling detached from reality, increased anxiety and depression, and changes in personality.

    Some people may also have difficulty regulating emotions, become more aggressive or impulsive, or have difficulty establishing close relationships. Trauma can also lead to an increased risk of physical health problems, substance abuse, and self-harming behaviors. Coping with C-PTSD poses its own set of challenges, and can be further complicated if an individual doesn’t have a support network or trusted individuals to lean on.

    The following are some common ways that trauma can affect one’s ability to function:

      • Memory problems – forgetting things more than usual, difficulty paying attention, or completing tasks.

      • Anxiety or panic attacks – feeling like your emotions or bodily sensations are out of your control.

      • Depression – feeling hopefulness, sad or not enjoying activities you normally enjoy.

      • Hypervigilance – feeling on edge or fearful in your day to day life, despite lack of actual threat.

      • Heightened startle response – exaggerated response to unexpected stimuli, especially sounds, that can feel intense and long-lasting (i.e.jumping at the sound of an ambulance siren, feeling physical sensations like heart palpitations, sweaty palms, or anxiety that takes awhile to dissipate).

      • Intrusive thoughts – Image-based memory is also tied to fear, along with belief systems. Your brain will prioritize these, earmarked as “urgent” increasing the frequency in which you experience negative thoughts and intrusive memories.

      • Depersonalization/Derealization – feeling disconnected from your thoughts, feelings, and physical sensations, or surroundings. You may experience yourself as an outside observer of your own life or experience a sense of unreality or dreamlike state, as if you’re living in a fog. 

    spring cleaning grounding
    C-PTSD is most often diagnosed among people who have been victims of prolonged, repetitive trauma.

    How does fear impact the nervous system?

    Fear is activated when we sense a threat in our environment. In a process called neuroception, skin receptors are scanning the environment for threat. Have you ever felt someone looking at you even if you couldn’t see them? That’s neuroception. This process allows our brain to be more active in other processes such as executive functions. But the moment we sense danger, there’s an immediate reaction. Trauma disrupts our capacity to accurately sense danger in our environment. 

    Depersonalization or derealization may cause you to experience yourself as an outside observer of your own life or experience a sense of unreality or dreamlike state, as if you’re living in a fog. 

    Sometimes we have a sense that a threat could appear, and this sensation is called anxiety. Anxiety is the anticipation of something bad to come, which can present as lingering discomfort, easily tripped into fear. When a threat is observed or felt, fear kicks in.

    You might not always be in active fear, but you might be living every day with elevated anxiety. Anxiety is an uncomfortable sensation telling you that a threat could appear at any moment. Anxiety keeps you on edge, in the anticipation of something bad to come.

    When in a constant state of worry, there is a higher risk of tripping into a fear state. Once a threat is sensed, fear turns on, and this sets off a series of physiological reactions to bolster our capacity for self-defense and self-preservation.

    For example, imagine that you are walking in the woods. Anxiety keeps you on alert to possible threats, including signs of a bear. This is normal and important. When a bear steps into your line of vision, a fear response kicks in, your sympathetic nervous system turns on, and adrenaline is released in the body. Your muscles get tense, heart rate increases, breathing becomes more anaerobic, and one of ten fear modes will happen based on a few key observations.



    What are the 10 fear responses?

    1. Fight- I can beat the bear
    2. Flight- I can escape the bear
    3. Freeze- I can hide from the bear
    4. Flounder- I attempt self defense but struggle
    5. Fawn- I can please the bear
    6. Friend- I can become the bear
    7. Fright- I can scare the bear
    8. Flop- I can submit to the bear
    9. Faint- I can detach from the bear
    10. Face- I can control my response to the bear
    When we’re under threat, fear is responsible for creating a series of physiological reactions to bolster our capacity for self-defense and self-preservation.
    financial infidelity

    How fear hijacks the nervous system’s threat response.

    When faced with fear, your responses change based on your perceived ability to beat the threat, your ability to escape the threat, or your ability to evade harm. When you see the bear, a subconscious judgment is made and then a response is activated. This response is then either strengthened or changed based on your actual experiences.

    Fear is a normal reaction to trauma, and is your body’s way of protecting itself from danger – real or perceived.

    The more your system learns it has no power over the threat, the more it shifts down into helplessness. Chronic activation of fear, especially fear that led to actual harm or danger, can disrupt the way your nervous system regulates. Living with C-PTSD, you might stop feeling fearful at all, you might experience numbness or dissociation, or you might experience intense depressive episodes. For other people, you may be able to maintain elevated responses, where you find yourself activated constantly. Most people bounce between these two states.

    People who have experienced trauma may see bears everywhere, literally. This is because the amygdala- or the fear center of the brain– has adapted to see bears even when there aren’t any. Studies show that people coping with C-PTSD have amygdalas which are unable to recognize the difference between a threat in the past and a current threat. This means that if you’re reminded of a past experience, it’s as if you’re experiencing the traumatic event for the first time. This phenomenon is designed to keep you in a state of self-defense even when there is nothing to defend against. Our brain is trying to keep us safe, but it’s actually hurting us.

    With complex trauma disorders, the amygdala has become hyperactive. You might experience a trigger or emotional flashback by something completely unrelated to your trauma. This is because the amygdala also hijacks most emotional processing- meaning fear gets woven into almost all of your experiences- even post-trauma experience. Emotions, thoughts, beliefs, and memories can all become tainted by fear. This is made more complicated due to the under-active prefrontal cortex.

    So while your amygdala is overreacting to nonexistent threats, your prefrontal cortex (the rational, decision-making area of the brain) isn’t assessing threats as well as it should be. Having an underactive prefrontal cortex can mean slow learning of new information (which may help how you respond to fear), logical thinking, and having a harder time controlling your fear response.

    assessing threat and coping with c-ptsd

    Learn how to distinguish ‘real threat’ from ‘perceived threat.’


    One of the most important steps is to improve your capacity to assess threat, distinguish threat, and recover from fear. Though your experiences have given you very real evidence that the world is scary, healing needs you to believe that you have the potential to be safe. Which is why it’s vital to first extinguish any real threats. You won’t benefit from using coping skills during an active crisis or traumatic event. It’s important to prioritize getting to a safer environment or set of circumstances as soon as possible.

    By reducing the fear reactions you experience when no threat is present, you’re retraining our nervous system to become more accurate and less reactive. 

    Once real safety has been established, it’s key to learn the signs of your fear responses and understand what happens when you perceive a threat. You’ll first want to understand what triggers your fear and how to determine real threat versus the perceived threat. When no threat is present, you’ll be able to practice shifting down your physiological response and grounding into safety. It’s important to trust that you are not presently at risk or in danger. The more safe environments that you can create or join, the more you can practice felt-safety and give your nervous system a rest. This in turn helps your nervous system better signal threat through neuroception- eventually it only goes off when you see real bears.

    Engage in activities or grounding exercises that you find calming or enjoyable can help you better manage fear and your stress response. Try yoga, meditation, or even just going for a walk in nature.
    group of women sitting in front of NYC skyline

    How to improve coping with C-PTSD and managing fear

    Fear is a normal reaction to trauma, it’s your body’s way of protecting itself from danger (or perceived danger). It can be managed consciously and by taking steps to reduce stress and anxiety.

    You do this through repeated practice of regulating our reactions to stress, seeing it like a form of physical therapy for your nervous system. We can’t stop the train from leaving the station- our nervous system is reflexive and autopilot shifts on easily. Coping with C-PTSD means that we can catch the train quicker, slow it down quicker, and rope it back into the station more effectively.

    Here are things you can do that will help you feel safer when you’re feeling fearful, including:

      • Practice mindful breathing: Take slow, deep breaths, focusing on your breath and trying to relax your body.

      • Practice progressive muscle relaxation: Slowly tense and relax each muscle group in your body, starting with your feet and working up to your head.

      • Engage in activities or grounding exercises that you find calming or enjoyable: Try yoga, meditation, or even just going for a walk in nature.

      • If possible, remove yourself or take a break from whatever situation makes you feel anxious until your nervous system calms down.

      • Take care of  your basic needs and your health make sure you are: eating well, getting enough sleep and exercise, engaging in activities you enjoy (like drawing, socializing, or playing music)

      • Challenge your negative thought patterns: Identify the negative thoughts that come up when you feel fear and challenge them with positive, more realistic thoughts.

      • Talk to friends and family: Sharing your experiences with someone can be a great way to reduce fear reactions and build a support system.

      • Seek professional help: If your fear reactions are persistent and affecting your quality of life, it might be beneficial to speak to a trauma-informed therapist who specializes in working with people who’ve experienced trauma.

    Coping with C-PTSD can look like sharing your experiences with someone to reduce stress and build a support system.
    group of women sitting in front of NYC skyline

    learn the signs of your fear responses to retrain your nervous system


    When you can reduce the fear reactions you experience when NO threat is present, you’re retraining your nervous system to become more accurate and less reactive. This triggers a slow but important domino effect where your thoughts are less connected to fear, your emotions are less connected to fear, and your behaviors are less driven by fear.

    The result is that you’re in better control of your physical symptoms, you improve your self-care, and begin to feel more present in life. When we aren’t motored by worry, we have space for more emotions and can experience true safety.

    Here are some things you can do when you’re not in a fearful state to begin to retrain the nervous system:

      • What were the real threats, or your “bears?” How did you respond to stay safe? Why was this most likely the safest way to react to the bear?
      • Identify any coping mechanisms or strategies that may no longer be serving you.
      • What is a non-threat that triggers fear? Can you notice and manage symptoms that come up? Why does this feel so much like a bear?

    Healing from C-PTSD is possible

    The journey toward healing and recovery from Complex Post-Traumatic Stress Disorder (C-PTSD) is a process. There is no one size fits all approach, and it can be particularly challenging when you’re working on your own. You need to be patient with yourself, but also know that it’s okay if you need help from others along the way.

    Coping with Complex-PTSD and learning how to heal is ideal in the presence of a trained trauma therapist. A trauma-informed therapist can help give you the necessary tools to practice soothing yourself out of fear, and help you distinguish between real and perceived threats. If you’re ready to take control of your own safety and stop living in fear, reach out to begin the process of healing with trauma therapy today.

    Monica Amorosi

    Monica Amorosi is a licensed trauma therapist who specializes in helping clients develop distress tolerance, and making stress feel less overwhelming. She enjoys working with clients to help them develop a deeper sense of compassion, reduce self-sabotaging behaviors, and lead more fulfilling lives.
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