Does socio-economic deprivation impact therapy outcomes for PTSD?

Understand the latest research, and what this means for how we might approach PTSD treatment.

A recent study¹ adds to the growing body of evidence that there is a powerful interaction between socioeconomic status and mental health outcomes during psychological therapy, demonstrating that individuals experiencing higher levels of socioeconomic deprivation show poorer outcomes following treatment for post-traumatic stress disorder (PTSD).

Deprivation may be linked to a number of stresses, such as food poverty, disability benefits and caring roles, all of which may impact the development of mental health issues and outcomes from psychological therapy.

For CBT practitioners, these findings raise important clinical questions. How might deprivation affect engagement during therapy? Are standard CBT protocols sufficient for clients facing ongoing deprivation? What can we do to improve the effectiveness of treatment for these individuals?

The Evidence: What the Research Tells Us

Richardson et al. (2025) analysed data from 128 participants (predominantly female), assessing PTSD symptoms using the PTSD Checklist for DSM-5 (PCL-5)², pre- and post-intervention, in order to measure levels of symptom reduction. Participants living in more deprived neighbourhoods showed significantly smaller reductions in PTSD symptoms compared to those from less deprived areas.

This pattern reflects earlier research³, who identified low socioeconomic status as a key risk factor for a range of mental health conditions, including PTSD. Similarly, Finegan et al. (2020)⁴ found that individuals from economically deprived areas tend to report more severe anxiety and depression symptoms after treatment through IAPT services, and often require longer interventions.

These findings suggest a clear trend: socioeconomic deprivation is not only associated with greater vulnerability to trauma-related disorders, but may also limit the extent to which individuals benefit from psychological therapy.

Understanding the Relationship Between Therapy Outcomes and Deprivation

Several interlinked factors may explain this reduced effectiveness of treatment:

• Ongoing exposure to stress and trauma, including repeated victimisation

• Risk management priorities, such as safeguarding concerns or physical health conditions, which may divert focus away from trauma work

• Therapeutic avoidance, where clinicians may hesitate to use trauma-focused CBT components such as memory reliving with clients to prevent re-traumatisation

• Higher emotional and cognitive load, which can reduce engagement and retention

Furthermore, clients experiencing poverty may face practical barriers such as inconsistent appointment attendance due to caring responsibilities, financial instability, or limited access to reliable transport and/or digital resources.

Clinical Implications for CBT Therapists

So, what does this mean for your clinical work?

• Adaptation, not dilution: Be cautious not to dilute trauma-focused components with clients experiencing deprivation. Evidence-based trauma treatments may require additional preparation and support.

• Longer treatment: Clients from more deprived backgrounds may benefit from extended or phased interventions.

• Holistic support: Recognise that therapy alone may not be sufficient to treat PTSD for deprived individuals. Collaborating with crime victim support, housing organisations, or financial support advisors may help address external stressors that interfere with engagement during treatment.

• Alternative modalities: Where appropriate, consider therapies like Eye Movement Desensitisation and Reprocessing (EMDR), which may be less verbally intensive and potentially less distressing for individuals unable to articulate or tolerate trauma narratives.

Towards Trauma-Informed, Equity-Aware Practice

Understanding the broader social context in which your clients live is essential for delivering the most effective CBT. Socioeconomic deprivation is not just a background variable, it actively shapes symptom expression, treatment engagement, and the potential for recovery.

Integrating this awareness into assessments and structure of therapy can lead to more compassionate, targeted, and realistic planning, to ensure individuals can experience the maximal benefit of treatment.

This line of research calls for an evolution in the delivery of therapy to ensure they are responsive to the needs of clients facing systemic disadvantage. While more studies are needed, it is clear that effective PTSD treatment must consider the social and economic realities of each client, and not just their symptoms.

We’d love to hear from you:
How do you tailor your trauma work for clients affected by poverty and deprivation? Should services offer integrated practical support alongside therapy? Let us know your thoughts below!

Author: Chloe Williams

1. Richardson, T., Ferrie, O., Smith ,D., Ellis-Nee, C., Smart, T., Gray, E., Roberts, N., Delgadillo, J. & Simmons-Dauvin, M. (2025). Neighbourhood socioeconomic deprivation associated with poorer psychological therapy outcomes for PTSD: an audit of a single NHS Talking Therapies (IAPT) service. The Cognitive Behaviour Therapist 18 , e9. 10.1017/S1754470X25000029

2. Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The posttraumatic stress disorder checklist for DSM-5 (PCL-5): development and initial psychometric evaluation. Journal of Traumatic Stress, 28, 489–498. https://pubmed.ncbi.nlm.nih.gov/26606250/

3. Kivimäki, M., Batty, G. D., Pentti, J., Shipley, M. J., Sipilä, P. N., Nyberg, S. T., Suominen, S. B., Oksanen, T., Stenholm, S., & Virtanen, M. (2020). Association between socioeconomic status and the development of mental and physical health conditions in adulthood: a multi-cohort study. The Lancet Public Health, 5, e140–e149. https://pubmed.ncbi.nlm.nih.gov/32007134/

4. Finegan, M., Firth, N., & Delgadillo, J. (2020). Adverse impact of neighbourhood socioeconomic deprivation on psychological treatment outcomes: the role of area-level income and crime. Psychotherapy Research, 30, 546–554