Skip to main content

Post-Traumatic Stress Disorder (PTSD) and Complex Post-Traumatic Stress Disorder (CPTSD)

Experiencing frightening or traumatic events can result in a wide range of difficult symptoms: some people may become very anxious, whereas others may experience depression. For the first month following a traumatic event experiences of heightened vigilance and avoidance are so common as to be almost expected. Repeated experiences of neglect or abuse have been linked with the development of a wide range of mental health conditions including anxiety and mood disorders, psychosis, and personality disorders. Post-traumatic stress disorder (PTSD) is one common sequelae of trauma. Patients with PTSD experience unwanted memories of the traumatic event in the form of flashbacks or nightmares, and they report higher levels of anxiety, and vigilance. Reminders of the trauma often act as triggers for intrusive memories or heightened emotion and are frequently avoided. Individuals who have experienced repeated, prolonged interpersonal trauma may develop complex post-traumatic stress disorder (CPTSD) which is characterized by the symptoms of PTSD as well as alterations in attention (such as dissociation), difficulties in managing relationships, and very strong negative beliefs about the self, world, or future. Read more
Post-Traumatic Stress Disorder (PTSD) and Complex Post-Traumatic Stress Disorder (CPTSD)
62 of 62 resources

Search

Language

Resource type

Problem

Therapy tool

62 of 62 resources
Order by

Am I Experiencing Depersonalization And Derealization?

Depersonalization-derealization disorder is a condition characterized by feelings of unreality and detachment from your self (your emotions, thoughts, ... https://www.psychologytools.com/resource/am-i-experiencing-depersonalization-and-derealization

Exercises

Am I Experiencing Post-Traumatic Stress Disorder (PTSD)?

Post-traumatic stress disorder (PTSD) is a condition characterized by unwanted memories of trauma, high levels of arousal, and avoidance. Am I Experie ... https://www.psychologytools.com/resource/am-i-experiencing-post-traumatic-stress-disorder-ptsd

Exercises

Arbitrary Inference

The Arbitrary Inference information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effec ... https://www.psychologytools.com/resource/arbitrary-inference

Information handouts

Audio Collection: Psychology Tools For Overcoming PTSD

The Psychology Tools for Overcoming PTSD Audio Collection is designed for anyone with post-traumatic stress disorder (PTSD). This skills development p ... https://www.psychologytools.com/resource/psychology-tools-for-overcoming-ptsd-audio-collection

Audio

Autonomic Nervous System

The autonomic nervous system (ANS) automatically regulates the function of body systems outside of voluntary control. The Autonomic Nervous System han ... https://www.psychologytools.com/resource/autonomic-nervous-system

Information handouts

Barriers Abusers Overcome In Order To Abuse

Individuals who have experienced abuse often focus on their own actions (or inactions) and blame themselves for their own abuse. This client informati ... https://www.psychologytools.com/resource/barriers-abusers-overcome-in-order-to-abuse

Information handouts

Before I Blame Myself And Feel Guilty

Guilt is a common post-traumatic reaction and is often the result of cognitive bias. This CBT worksheet explores common cognitive biases that have bee ... https://www.psychologytools.com/resource/before-i-blame-myself-and-feel-guilty

Exercises

Behavioral Experiment

Behavioral experiments are planned experiential activities to test the validity of a belief. They are one of the most powerful techniques available to ... https://www.psychologytools.com/resource/behavioral-experiment

Worksheets

Behavioral Experiment (Portrait Format)

Behavioral experiments allow individuals to test the validity of their beliefs and assumptions. They are a core experiential technique for therapeutic ... https://www.psychologytools.com/resource/behavioral-experiment-portrait-format

Worksheets

Catastrophizing

The Catastrophizing information handout forms part of the cognitive distortions series. It is designed to help clients and therapists to work more eff ... https://www.psychologytools.com/resource/catastrophizing

Information handouts

Coercive Methods For Enforcing Compliance

Individuals who have experienced abuse often focus on their own actions (or inactions) and blame themselves for their own abuse. This client informati ... https://www.psychologytools.com/resource/coercive-methods-for-enforcing-compliance

Exercises

Cognitive Behavioral Model Of Depersonalization (Hunter, Phillips, Chalder, Sierra, David, 2003)

Depersonalization is an experience where an individual feels a sense of detachment from themselves, or estrangement from their perceptions, actions, a ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-depersonalization-hunter-phillips-chalder-sierra-david-2003

Information handouts

Cognitive Behavioral Model Of Post Traumatic Stress Disorder (PTSD: Ehlers & Clark, 2000)

Anke Ehlers' & David Clark's Cognitive Behavioral Model Of Post-Traumatic Stress Disorder (PTSD) is an influential account of the condition. The ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-post-traumatic-stress-disorder-ptsd-ehlers-clark-2000

Information handouts

Critical Care And PTSD

The Critical Care And PTSD information handout is designed to help clients to learn about the properties of critical care that can increase the likeli ... https://www.psychologytools.com/resource/critical-care-and-ptsd

Information handouts

Critical Illness Intensive Care And Post-Traumatic Stress Disorder (PTSD)

This is a free guide designed for people who have spent time in an intensive care unit and are experiencing symptoms of post-traumatic stress disorder ... https://www.psychologytools.com/resource/critical-illness-intensive-care-and-post-traumatic-stress-disorder-ptsd

Guides

Disqualifying Others

This Disqualifying Others information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more eff ... https://www.psychologytools.com/resource/disqualifying-others

Information handouts

Dissociation - Self-Monitoring Record

Developing self-monitoring skills teaches clients to systematically observe and record specific targets such as their own thoughts, body feelings, emo ... https://www.psychologytools.com/resource/dissociation-self-monitoring-record

Worksheets

EMDR Cognitions

The standard protocol in Eye Movement Desensitization and Reprocessing (EMDR) requires the identification of a target image and a negative cognition. ... https://www.psychologytools.com/resource/emdr-cognitions

Information handouts

EMDR Protocol (Standard)

The standard protocol in Eye Movement Desensitization and Reprocessing (EMDR) outlines information required to start processing and identifies a seque ... https://www.psychologytools.com/resource/emdr-protocol-standard

Worksheets

EMDR Protocol (With Interweave Guidance)

Cognitive interweaves are commonly used in Eye Movement Desensitization and Reprocessing (EMDR) to 'unblock' processing which has become 'stuck'. This ... https://www.psychologytools.com/resource/emdr-protocol-with-interweave-guidance

Worksheets

Emotional Reasoning

The Emotional Reasoning information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effec ... https://www.psychologytools.com/resource/emotional-reasoning

Information handouts

Externalizing

The Externalizing information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effectively ... https://www.psychologytools.com/resource/externalizing

Information handouts

Fight Or Flight Response

The fight or flight response is an automatic physiological reaction to an event that is perceived as stressful or frightening. The perception of threa ... https://www.psychologytools.com/resource/fight-or-flight-response

Information handouts

Flashbacks - Self-Monitoring Record

Developing self-monitoring skills teaches clients to systematically observe and record specific targets such as their own thoughts, body feelings, emo ... https://www.psychologytools.com/resource/flashbacks-self-monitoring-record

Worksheets

Fortune Telling

The Fortune Telling information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effective ... https://www.psychologytools.com/resource/fortune-telling

Information handouts

Grounding Objects (Audio)

The Grounding Objects exercise is a simple technique which teaches people with PTSD or dissociative disorders how to use objects with particular senso ... https://www.psychologytools.com/resource/grounding-objects-audio

Audio

Grounding Statements (Audio)

Grounding techniques are used to help people to reorient themselves to the present moment and to safety. Grounding Statements are a form of cognitive ... https://www.psychologytools.com/resource/grounding-statements-audio

Audio

Grounding Techniques

Individuals who have experienced trama often find it difficult to stay within the 'window of tolerance'. Grounding techniques (which can be sensory/pe ... https://www.psychologytools.com/resource/grounding-techniques

Exercises

Grounding Techniques Menu

Dissociation can be described as a shift of a person’s attention away from the present moment. When working with traumatized clients, this shift oft ... https://www.psychologytools.com/resource/grounding-techniques-menu

Information handouts

Habituation

The Habituation information sheets are designed to help clinicians to explain the concept of habituation and its role in exposure therapy. The handout ... https://www.psychologytools.com/resource/habituation

Information handouts

Hindsight Bias

The Hindsight Bias information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effectivel ... https://www.psychologytools.com/resource/hindsight-bias

Information handouts

Hindsight Bias (Archived)

Survivors of loss or trauma often think "If only …". Hindsight Bias is a cognitive bias / cognitive illusion which makes events seem more predictabl ... https://www.psychologytools.com/resource/hindsight-bias-archived

Archived

Hotspot Record

Enhanced 'reliving' in trauma-focused CBT for PTSD involves addressing the meaning associated with 'hot spots' of traumatic memory. This Hotspot Recor ... https://www.psychologytools.com/resource/hotspot-record

Worksheets

How Trauma Can Affect You (CYP)

Trauma can result in a wide variety of symptoms, experiences, and behaviors. As well as post-traumatic stress disorder (PTSD), prevalence rates of oth ... https://www.psychologytools.com/resource/how-trauma-can-affect-you-cyp

Information handouts

Intrusive Memory Record

Intrusive (unwanted, involuntary) memories are a common feature of PTSD, but also depression and other conditions. This Intrusive Memory Record is des ... https://www.psychologytools.com/resource/intrusive-memory-record

Worksheets

Maximizing The Effectiveness Of Exposure Therapy

Despite its position as the leading treatment technique for anxiety disorders, not all clients respond to exposure therapy and some individuals relaps ... https://www.psychologytools.com/resource/maximizing-the-effectiveness-of-exposure-therapy

Information handouts

Narrative Exposure Therapy (NET)

Narrative Exposure Therapy (NET) is an empirically validated treatment for survivors of multiple traumatic events who are suffering from post-traumati ... https://www.psychologytools.com/resource/narrative-exposure-therapy-net

Guides

Nightmare Exposure And Rescripting

Imagery rescripting is an effective treatment for intrusive and unwanted memories. Nightmare Exposure And Rescripting employs similar techniques and c ... https://www.psychologytools.com/resource/nightmare-exposure-and-rescripting

Exercises

Nightmare Rescripting (Audio)

Nightmare rescripting is an evidence based treatment for nightmares, with medium to large effect sizes on nightmare frequency, distress, intensity, an ... https://www.psychologytools.com/resource/nightmare-rescripting-audio

Audio

Personalizing

The Personalizing information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effectively ... https://www.psychologytools.com/resource/personalizing

Information handouts

Pie Charts

A common cognitive bias is to take an egocentric approach to events. When applied to negative events this can result in an exaggerated sense of respon ... https://www.psychologytools.com/resource/pie-charts

Exercises

Progressive Muscle Relaxation (Audio)

The Progressive Muscle Relaxation exercise guides the listener through a sequence in which muscle groups are tensed and relaxed. ... https://www.psychologytools.com/resource/progressive-muscle-relaxation-audio

Audio

Prolonged Exposure Therapy For PTSD: Therapist Guide

Prolonged Exposure Therapy For PTSD comes in two volumes. This page is for the Therapist Guide. Click on the following link to access the accompanying ... https://www.psychologytools.com/resource/prolonged-exposure-therapy-for-ptsd-therapist-guide

Treatments That Work®

Properties Of Trauma Memories

Important properties of trauma memories include involuntary recall, 'nowness', vividness, and immutability. People who have experienced trauma report ... https://www.psychologytools.com/resource/properties-of-trauma-memories

Information handouts

PTSD And Memory

Alterations in the way the brain processes 'normal' vs. 'traumatic' material are thought to be responsible for the intrusive nature of memories in con ... https://www.psychologytools.com/resource/ptsd-and-memory

Information handouts

PTSD Film Projection Metaphor

Treatment for trauma often involves exposure to traumatic thoughts and memories, and many clients are understandably reluctant to attempt this. The PT ... https://www.psychologytools.com/resource/ptsd-film-projection-metaphor

Information handouts

PTSD Linen Cupboard Metaphor

Treatment for trauma often involves exposure to traumatic thoughts and memories, and many clients are understandably reluctant to attempt this. The PT ... https://www.psychologytools.com/resource/ptsd-linen-cupboard-metaphor

Information handouts

Reactions To Trauma

Traumatic events are shocking and it is normal to feel overwhelmed. Not everybody reacts in the same way though and there is no ‘right’ way to res ... https://www.psychologytools.com/resource/reactions-to-trauma

Information handouts

Reclaiming Your Life From A Traumatic Experience: Workbook

Prolonged Exposure Therapy For PTSD comes in two volumes. This page is for the Client Workbook. Click on the following link to access the accompanying ... https://www.psychologytools.com/resource/reclaiming-your-life-from-a-traumatic-experience-workbook

Treatments That Work®

Responses To Threat: Freeze, Appease, Flight, Fight

Human beings are programmed to respond automatically in a variety of ways to a threat including freezing, escaping, and dissociation. Traumatized indi ... https://www.psychologytools.com/resource/responses-to-threat-freeze-appease-flight-fight

Information handouts

Rewind Technique

The Rewind Technique is a simple technique for processing traumatic memories and involves an element of exposure. It is best practiced within a formul ... https://www.psychologytools.com/resource/rewind-technique

Information handouts

Self-Blame

The Self-Blame information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effectively wi ... https://www.psychologytools.com/resource/self-blame

Information handouts

Sensory Grounding Using Smells (Audio)

The Sensory Grounding Using Smells exercise is an audio track from the Psychology Tools For Overcoming PTSD Audio Collection. It is designed to teach ... https://www.psychologytools.com/resource/sensory-grounding-using-smells-audio

Audio

Sensory Grounding Using Your Five Senses (Audio)

The Sensory Grounding Using Your Five Senses exercise is an audio track from the Psychology Tools For Overcoming PTSD Audio Collection. It is designed ... https://www.psychologytools.com/resource/sensory-grounding-using-your-five-senses-audio

Audio

Social Comparison

The Social Comparison information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effecti ... https://www.psychologytools.com/resource/social-comparison

Information handouts

Stimulus Discrimination (Audio)

Stimulus Discrimination is designed to help people with post-traumatic stress disorder (PTSD) to ‘retrain their brain’ in order to attend automat ... https://www.psychologytools.com/resource/stimulus-discrimination-audio

Audio

Therapy Blueprint (Universal)

A therapy blueprint is CBT tool which summarizes the work a therapist and patient have completed together. It represents the past (the problems, what ... https://www.psychologytools.com/resource/therapy-blueprint-universal

Worksheets

Therapy Blueprint For PTSD

A therapy blueprint represents the past (the problems, what maintained them), the present (the therapy itself, new knowledge learned and skills develo ... https://www.psychologytools.com/resource/therapy-blueprint-for-ptsd

Worksheets

Trauma And Dissociation

Trauma and Dissociation is a guide written for clients who have experienced trauma and who are troubled by dissociation. It provides clear informatio ... https://www.psychologytools.com/resource/trauma-and-dissociation

Guides

Trauma, Dissociation, And Grounding (Archived)

NOTE: An improved version of this resource is available here: Trauma And Dissociation. Older versions of a resource may be archived in the event that ... https://www.psychologytools.com/resource/trauma-dissociation-and-grounding

Archived

Understanding Depersonalization And Derealization

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-depersonalization-and-derealization

Guides

Understanding Post-Traumatic Stress Disorder (PTSD)

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-post-traumatic-stress-disorder-ptsd

Guides

Assessment

Screening, diagnostic, and outcome-measurement tools for post-traumatic stress disorder (PTSD)

  • Clinician Administered PTSD Scale for DSM-5 (CAPS-5) (Past week version)
    • Scale download archived version
    • Weathers, F. W., Blake, D. D., Schnurr, P. P., Kaloupek, D. G., Marx, B. P., & Keane, T. M. (2015). The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) – Past Week [Measurement instrument].
  • Impact Of Events Scale – Revised (IES-R) | Weiss, Marmar | 1996
    • Scale download archived copy
    • Weiss, D. S., & Marmar, C. R. (1996). The Impact of Event Scale – Revised. In J. Wilson & T. M. Keane (Eds.), Assessing psychological trauma and PTSD (pp. 399-411). New York: Guilford.
  • Life Events Checklist for DSM-5 (LEC-5) | Weathers, Blake, Schnurr, Kaloupek, Marx, Keane | 2013
    • Scale download  archived copy
    • Weathers, F. W., Blake, D. D., Schnurr, P. P., Kaloupek, D. G., Marx, B. P., & Keane, T. M. (2013). The Life Events Checklist for DSM-5 (LEC-5) – Standard. [Measurement instrument].
  • PTSD Checklist for DSM-5 (PCL-5) | Weathers, Litz, Keane, Palmieri, Marz, Schnurr | 2013
    • Scale (Standard)  download  archived copy
    • Scale with criterion A download archived copy
    • Scale with life events checklist and criterion A download archived copy
    • Manual download archived copy
    • Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013). The PTSD Checklist for DSM-5 (PCL-5) – Standard. [Measurement instrument].
    • 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. doi: 10.1002/jts.22059
  • PTSD Symptom Scale – Interview Version for DSM-5 (PSS-I-5) | Foa, McLean, Zang, Zhong, Rauch, Porter, Knowles, Powers, Kauffman | 2016
    • Scale  download  archived copy
    • Foa, Edna B.,McLean, Carmen P.,Zang, Yinyin,Zhong, Jody,Rauch, Sheila,Porter, Katherine,Knowles, Kelly,Powers, Mark B.,Kauffman, Brooke Y. (2016) Psychological Assessment, Vol 28(10), 1159-1165
  • Severity Of Posttraumatic Stress Symptoms | Kilpatrick, Resnick, Friedman | 2013
  • Trauma Appraisal Questionnaire (TAQ) | DePrince, Zurbruggen, Chu, Smart | 2010
    • Scale download archived copy
    • DePrince, A. P., Zurbriggen, E. L., Chu, A. T., & Smart, L. (2010). Development of the trauma appraisal questionnaire. Journal of Aggression, Maltreatment & Trauma19(3), 275-299. download archived copy
  • Trauma Screening Questionnaire (TSQ) | Brewin, Rose, Andrews, Green, Tata, McEvedy, Turner, Foa | 2002
    • Scale  download  archived copy
    • Brewin, C. R, Rose, S., Andrews, B., Green, J., Tata, P., McEvedy, C. Turner, S, Foa, E. B. (2002). Brief screening instrument for post-traumatic stress disorder. British Journal of Psychiatry, 181, 158-162.

Screening, diagnostic, and outcome-measurement tools for dissociation

  • Brief Dissociative Experiences Scale (DES-B) | Dalenberg, Carlson | 2010
    • Scale download archived copy
    • DES-B (Dalenberg C, Carlson E, 2010) modified for DSM-5 by C. Dalenberg and E. Carlson.
  • Dissociative Experiences Scale – II | Carlson, Putnam |1993
    • Scale download archived copy
    • Carlson, E.B. & Putnam, F.W. (1993). An update on the Dissociative Experience Scale. Dissociation 6(1), p. 16-27.
  • Shutdown Dissociation Scale (Shut-D) | Schauer, Schalinski, Elbert | 2015

Resources related to the assessment of post-traumatic stress disorder (PTSD)

  • Wilson, J.P., & Keane, T.M. (Eds.). (2004). Assessing psychological trauma and PTSD: A practitioner’s handbook (2nd ed.). New York, NY: Guilford Press.
  • Orsillo, S. M. (2001). Measures for acute stress disorder and posttraumatic stress disorder. In M.M. Antony, S.M. Orsillo & L. Roemer (Eds.), Practitioner’s guide to empirically based measures of anxiety (pp. 255-307). Boston, MA: Springer.
  • Steel, J. L., Dunlavy, A. C., Stillman, J., & Pape, H. C. (2011). Measuring depression and PTSD after trauma: Common scales and checklists. Injury, 42(3), 288–300.

Intervention

Treatment guides

  • Post-traumatic stress disorder (PTSD) | National Institute for Health and Care Excellence (NICE) guidelines | December 2018 download  archived copy
  • Clinical practice guideline for the treatment of PTSD | American Psychological Association | 2017 download archived copy
  • Guidelines for Treating Dissociative Identity Disorder in Adults | International Society for the Study of Trauma and Dissociation (ISST-D) | 2011 download archived copy
  • Guidelines for the Evaluation and Treatment of Dissociative Symptoms in Children and Adolescents | International Society for the Study of Trauma and Dissociation (ISST-D) | 2003 download archived copy
  • Guideline for the treatment and planning of services for complex post-traumatic stress disorder in adults | UKPTS: McFetridge, Hauenstein Swan, Here, Karatzias, Greenberg, Kitchiner, Morley | 2017 download archived copy
  • Dissociative phenomena in the everyday lives of trauma survivors | Janina Fischer | 2001 download archived copy
  • Posttraumatic stress disorder: patient treatment manual | Andrews, Crino, Hunt, Lampe, Page | 1994 download archived copy
  • Modulation, mindfulness, and movement in the treatment of trauma-related depression (window of tolerance) | Pat Ogden | 2009 download archived copy

Treatments

Treatments for PTSD include:

Information Handouts

  • Coping with trauma (workbook) | Good Thinking download archived copy
  • Post-traumatic stress disorder (PTSD) patient handout | Royal College Of Psychiatrists | 2005 download archived copy
  • Surviving torture: understanding the nature and purpose of torture | Christian Peacemaker Teams download  archived copy
  • Understanding traumatic intrusions | Helen Kennerley | 2016 download archived copy
  • Processing trauma: the factory metaphor | Hawkins download archived copy
  • Explaining the rationale for trauma focused work: why it’s good to talk (children & young people) | Trickey | 2012 download archived copy
  • After the event: supporting children after a frightening event | Trickey, Bailie, Serpell | 2010 download archived copy
  • The Power and Control Wheel diagram: for understanding abusive and violent behaviors | National Centre on Domestic and Sexual Violence download archived copy
  • Was it my fault? Self-blame and survivors | PANDYS / Shannon | 2007 download archived copy
  • Coping with trauma | Dr Jim White | 2006 download archived copy
  • Grounding Techniques CAMH.net archived copy
  • Detaching from emotional pain e-tmf.org archived copy
  • Grounding techniques list link archive.org
  • A collection of soothing activities wwu.edu archived copy

Presentations

  • Cognitive therapy for PTSD | Nick Grey | 2016 download archived copy
  • Beyond reliving in PTSD treatment: advanced skills for overcoming common obstacles in memory work | Hannah Murray, Sharif El-Leithy  download  archive.org
  • Dissociation and PTSD | Fiona Kennedy | 2010 download archived copy
  • Using compassionate imagery in shame based flashbacks in PTSD | Deborah Lee | 2009 download archive.org
  • Introduction to traumatic stress | Kitchiner & Roberts   download archive.org
  • Using exposure to treat PTSD: why, when, and how? | Fyvie download archive.org
  • A trauma-focused cognitive behavioral therapy case conceptualization: from assessment to termination |  Alison Hendricks download archive.org
  • PTSD as a shame disorder | Judith Herman | 2014 download archived copy

Video

  • What is post-traumatic stress disorder? (Animation) | UK Trauma Council | 2023 download
  • What is trauma-focused CBT? (Animation) | UK Trauma Council | 2023 download
  • Coping with scary and distressing memories (Animation) | UK Trauma Council | 2023 download
  • Absolutely not: an other thoughts you might have about mental health support (Animation) | UK Trauma Council | 2023 download

Recommended Reading

These papers are recommended reading if you intend to work with PTSD. Ehlers & Clark (2000) present a comprehensive cognitive model, Grey et al (2002) present a framework for working with the meaning of the worst moments, and Brewin et al (1996) present a model for understanding what is happening to memory in PTSD.

  • Brewin, C. R., Dalgleish, T., Joseph, S. (1996). A dual representation theory of posttraumatic stress disorder. Psychological Review, 103, 670-686 download archived copy (Useful for understanding the neural basis of memory in PTSD)
  • Brewin, C. R., Gregory, J. D., Lipton, M., Burgess, N. (2010). Intrusive images in psychological disorders: Characteristics, neural mechanisms, and treatment. Psychological Review, 117(1), 210-232 download archived copy
  • Ehlers, A., Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319-345 download archived copy (The canonical reference for the treatment of PTSD: Trauma-Focused Cognitive Behavioural Therapy [TF-CBT]. This model is suitable even for more complex PTSD, within a phased approach)
  • Grey, N., Young, K., & Holmes, E. (2002). Cognitive restructuring within reliving: a treatment for peritraumatic emotional “hotspots” in posttraumatic stress disorder. Behavioural and Cognitive Psychotherapy, 30, 37-56 download archived copy
  • Schauer, M., Elbert, T. (2010). Dissociation following traumatic stress. Journal of Psychology, 218(2), 109-127 download archived copy

Complex PTSD

Complex PTSD (cPTSD) has been a somewhat disputed diagnostic category. Some argue that it is simply a severe form of PTSD, whereas others believe that it represents a distinct cluster. DSM5 has a single PTSD category with degrees of severity, ICD-11 is expected to have PTSD and complex PTSD categories.

  • ISTSS guidelines position paper on complex PTSD in adults | ISTSS | 2017 download archived copy
  • Friedman, M. J. (2013). Finalizing PTSD in DSM-5: Getting here from there and where to go next. Journal of Traumatic Stress, 26, 548-556 (Not strictly about complex PTSD but speaks about definitions) download archived copy
  • Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5(3), 377-391 download archived copy 
  • Terr, L. C. (1991). Childhood traumas: An outline and overview. American journal of psychiatry, 148(1), 10-20 download

Other papers

  • Arntz, A., & Weertman, A. (1999). Treatment of childhood memories: Theory and practice. Behaviour Research and Therapy, 37(8), 715-740 download
  • Chessell, Z. J., Brady, F., Akbar, S., Stevens, A., & Young, K. (2019). A protocol for managing dissociative symptoms in refugee populations. The Cognitive Behaviour Therapist, 12. download
  • Levin, R. J., & van Berlo, W. (2004). Sexual arousal and orgasm in subjects who experience forced or non-consensual sexual stimulation–a review. Journal of Clinical Forensic Medicine11(2), 82-88. download archived copy
  • Medford, N., Sierra, M., Baker, D., David, A. S. (2005). Understanding and treating depersonalisation disorder. Advances in Psychiatric Treatment, 11, 92-100 download  archived copy
  • Read, J., Hammersley, P., Rudegeair, T. (2007). Why, when and how to ask about childhood abuse. Advances in Psychiatric Treatment, 13, 101-110  download archived copy

What Is Post-Traumatic Stress Disorder?

Symptoms of PTSD

The DSM criteria for PTSD require that an individual has experienced a traumatic event and include symptoms in four categories:

  • re-experiencing memories of the trauma
  • heightened anxiety and hypervigilance
  • avoidance of reminders of the trauma
  • negative beliefs or feelings

People who develop complex PTSD have typically experienced prolonged and repeated trauma and may experience symptoms in addition to PTSD including:

Incidence, Prevalence, and Predictors of PTSD

Depending upon the type of trauma experienced, approximately 10% to 30% of trauma survivors will develop PTSD (Santiago et al., 2013). Some of the strongest predictors of whether an individual will develop PTSD is how severe they perceived the trauma to be, and levels of social support post-trauma (Brewin, Andrews & Valentine, 2000).

Psychological Models and Theory of PTSD

One of the most influential models of PTSD is the cognitive model published by Anke Ehlers and David Clark in 2000. They propose that distress in PTSD is maintained by:

  • A disturbance of autobiographical memory characterized by poor elaboration and contextualization, strong associative memory, and strong perceptual priming. (The ‘unprocessed’ qualities of trauma memories makes them particularly intrusive.)
  • Excessively negative appraisals of the trauma and events surrounding it. (The thoughts and beliefs that survivors of trauma hold about themselves, others, and the world may be inaccurate or counterproductive.)
  • Problematic behavioral and cognitive strategies. (The avoidance and safety behaviors which people with PTSD engage in can act to perpetuate distress in PTSD.)

Other theories of particular relevance to PTSD include:

  • Emotional processing theory (Foa & Kozak, 1986) which proposes that emotions are information structures in memory (i.e., fear is associated with a ‘fear structure’). Changes in a structure require the integration of information that is incompatible with some elements of the fear structure.
  • The dual-processing model of memory in PTSD (Brewin, Dalgleish, & Joseph, 1996) which helps to explain some of the important and unusual properties of memory in PTSD such as ‘nowness’ and sensory vividness.

Evidence-Based Psychological Approaches for Working with PTSD

A variety of different therapeutic approaches have demonstrated effectiveness in the treatment of PTSD. A common factor in all of these approaches is that they are trauma-focused: at least some of the work in therapy addresses what happened to the patient. Evidence-based treatments for PTSD include:

  • cognitive behavioral therapy (CBT) / trauma-focused CBT
  • cognitive processing therapy (CPT)
  • eye movement desensitization and reprocessing (EMDR)
  • narrative exposure therapy (NET)
  • prolonged exposure therapy (PE)

Resources for Working with PTSD

Psychology Tools has an extensive library of therapy resources devoted to the effective treatment of PTSD. Many patients report finding the Psychology Tools for Overcoming PTSD Audio Collection helpful in teaching a set of skills that can help them to feel more stable and to approach subsequent phases of trauma treatment. There are also a range of information handouts, exercises, and worksheets for working with PTSD. Psychology Tools resources available for working therapeutically with PTSD may include:

References

  • Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology, 68(5), 748–766.
  • Brewin, C. R., Dalgleish, T., & Joseph, S. (1996). A dual representation theory of posttraumatic stress disorder. Psychological Review, 103(4), 670.
  • Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. BehaviourResearch and Therapy, 38(4), 319–345.
  • Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99(1), 20–35.
  • Santiago, P. N., Ursano, R. J., Gray, C. L., Pynoos, R. S., Spiegel, D., Lewis-Fernandez, R., … & Fullerton, C. S. (2013). A systematic review of PTSD prevalence and trajectories in DSM-5 defined trauma exposed populations: Intentional and non-intentional traumatic events. PloS one, 8(4), e59236. doi: 10.1371/journal.pone.0059236