Sometimes people describe a body that seems to react before they have found words for what is happening. They may notice tension, disrupted sleep, a racing heart, numbness, a startle response or an urge to withdraw. These experiences can be distressing. They can also have many possible explanations. A blog cannot decide that a bodily response is caused by trauma or explain an individual’s history. New, severe, changing or worrying physical symptoms should be discussed with an appropriate medical professional. Chest symptoms, breathlessness, fainting, pain, weakness, neurological changes or medication effects should not automatically be attributed to stress, anxiety or trauma. Medical assessment and psychological support can both be important. For some people, a difficult event or a period of threat may be relevant to the way they feel now. For others, current health, work, relationships, sleep, grief or another experience may be more central. Trauma aware assessment makes room for uncertainty, consent, safety and choice. It does not require someone to disclose a story before they feel ready. CBT may be considered after assessment where appropriate. It is not a self directed instruction to revisit memories, expose oneself to distressing material, force relaxation or push through physical symptoms. If behavioural or trauma focused work is clinically indicated, it is planned collaboratively with a qualified clinician, at an agreed pace and with attention to medical advice, stability and personal circumstances. The aim is not to promise that a body will stop reacting or that recovery follows a fixed path. It may be to build a more workable understanding of patterns, support choice and reduce the impact distress has on daily life. Progress can be uneven, and taking a pause can be part of safe care. If distress comes with crisis, thoughts of self harm or an inability to keep safe, urgent appropriate help is needed. For related information, see trauma aware CBT support at lyceumclinic.co.uk/therapy/trauma/, the trauma and PTSD clinical guide at lyceumclinic.co.uk/guides/trauma ptsd cbt west london/ and complex trauma support at lyceumclinic.co.uk/guides/complex trauma cptsd cbt west london/. The Lyceum Clinic offers assessment led CBT online and in West London.