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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
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A Guide To Emotions (Psychology Tools For Living Well)

Cognitive behavioral therapy can help your clients to live happier and more fulfilling lives. Psychology Tools for Living Well is a self-help course ...


Autonomic Nervous System

The autonomic nervous system (ANS) automatically regulates the function of body systems outside of voluntary control. The Autonomic Nervous System han ...

Information Handout

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 ...


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 ...


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 ...


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 ...


CBT Thought Record

The CBT Thought Record is an essential tool in cognitive behavioral therapy. Thought challenging records help people to evaluate their negative automa ...


Challenging Your Negative Thinking

A cornerstone of cognitive behavioral therapy is that an individual’s interpretation of an event determines how they feel and behave. We all experie ...


Classical Conditioning

Classical conditioning is a process by which stimuli become associated with responses. This information handout describes key principles of Classical ...

Information Handout

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 ...


Cognitive Behavioral Model Of Post Traumatic Stress Disorder (PTSD) (2000)

The Cognitive Behavioral Model Of Post-Traumatic Stress Disorder (PTSD) identifies alterations in memory, cognitions, and behavior as critical mainten ...

Information Handout

Dissociation Record

Dissociation is a set of physical and behavioral adaptations (‘skills’) that human beings have developed because they can help us to survive extre ...


EMDR Cognitions

The standard protocol in Eye Movement Desensitization and Reprocessing (EMDR) requires the identification of a target image and a negative cognition. ...

Information Handout

EMDR Protocol (Standard)

The standard protocol in Eye Movement Desensitization and Reprocessing (EMDR) outlines information required to start processing and identifies a seque ...


EMDR Protocol (With Interweave Guidance)

Cognitive interweaves are commonly used in Eye Movement Desensitization and Reprocessing (EMDR) to ‘unblock’ processing which has become & ...


Exposure Practice Form

Exposure is an effective treatment for many forms of anxiety. The Exposure Practice Form is a CBT worksheet which guides therapists and clients throug ...


Fight or Flight (CYP)

The Fight Or Flight (CYP) information handout has been specifically designed for younger children and includes carefully simplified language. The full ...

Information Handout

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 ...

Information Handout

Forgiveness Is

Forgiveness is an effectvie treatment for anger and relieving hurt. Sadly, many people dismiss forgiveness due to misconceptions regarding its nature. ...

Information Handout

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 ...


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 ...


Grounding Techniques

Individuals who have experienced trama often find it difficult to stay within the ‘window of tolerance’. Grounding techniques (which can b ...


Guidelines For Better Sleep

Some sleep experts recommend that sleep hygiene issues be attended to as one component of treatment for poor sleep. This sleep hygiene information wor ...

Information Handout


The Habituation information sheets are designed to help clinicians to explain the concept of habituation and its role in exposure therapy. The handout ...

Information Handout

Hindsight Bias

Survivors of loss or trauma often think “If only …”. Hindsight Bias is a cognitive bias / cognitive illusion which makes events seem mor ...

Information Handout

Hotspot Record

Enhanced ‘reliving’ in trauma-focused CBT for PTSD involves addressing the meaning associated with ‘hot spots’ of traumatic me ...


How Breathing Affects Feelings

Normal, anxious, and exercise breathing have significant effects upon our physiology and our emotions. This information handout explains the physiolog ...


Intrusion Diary

Self-monitoring of thoughts, feelings and symptoms is an essential skill for clients engaged in cognitive behavioral therapy (CBT). The Intrusion Diar ...


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 ...


Intrusive Thoughts Brain Metaphor

Intrusive thoughts are a common but sometimes distressing cognitive phenomenon. This information handout uses a simple metaphor to explain why we expe ...

Information Handout

Learning To Relax (CYP)

Stress and tension are prevalent complaints amongst children and young people. Teaching relaxation exercises can engender a beneficial sense of contro ...


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 ...

Information Handout

Mindful Attention (Audio)

Mindful Attention is a technique for becoming aware of one’s thoughts and experiences, and being able to observe these as transient mental events. ...


Motivational Systems (Emotional Regulation Systems)

At the heart of Compassion Focused Therapy (CFT) is an evolutionary model of human motivational systems. Developed by Paul Gilbert it is a helpful len ...

Information Handout

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 ...

Information Handout

Nightmare Exposure And Rescripting

Imagery rescripting is an effective treatment for intrusive and unwanted memories. Nightmare Exposure And Rescripting employs similar techniques and c ...


Nightmare Rescripting (Audio)

Nightmare rescripting is an evidence based treatment for nightmares, with medium to large effect sizes on nightmare frequency, distress, intensity, an ...


Peaceful Place (Audio)

The Peaceful Place exercise guides the listener through a short imagery exercise designed to facilitate the visualization of soothing imagery and noti ...


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 ...


Progressive Muscle Relaxation

Progressive relaxation training originated in the 1930’s as a treatment for tension and anxiety. Edmund Jacobsen developed a systematic and lengthy ...


Progressive Muscle Relaxation (Audio)

The Progressive Muscle Relaxation exercise guides the listener through a sequence in which muscle groups are tensed and relaxed. ...


Progressive Muscle Relaxation (Edition 1)

Muscle tension is one reaction to stress and anxiety. This exercise includes instructions for Progressive Muscle Relaxation, a technique for promoting ...


Psychology Tools For Overcoming PTSD Audio Collection

The Psychology Tools for Overcoming PTSD Audio Collection is designed for anyone with post-traumatic stress disorder (PTSD). This skills development p ...

Audio Collection

PTSD And Memory

Alterations in the way the brain processes ‘normal’ vs. ‘traumatic’ material are thought to be responsible for the intrusive n ...

Information Handout

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 ...

Information Handout

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 ...

Information Handout

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 ...

Information Handout

Recognizing Post Traumatic Stress Disorder (PTSD)

Post-Traumatic Stress Disorder (PTSD) follows an experience of trauma and is characterized by recurrent involuntary memories or other re-experiencing ...

Information Handout

Recovering From A Nightmare (Audio)

The Recovering From A Nightmare exercise gives straightforward information, advice, and strategies on how to quickly reorient oneself after a nightmar ...


Relaxed Breathing

Practising Relaxed Breathing serves to reduce physiological arousal and can be an excellent grounding technique. This client information handout descr ...


Relaxed Breathing Exercise 1 (Audio)

Breathing Exercise 1 guides the listener through simple instructions to make their breathing slower, deeper, and more regular. ...


Relaxed Breathing Exercise 2 (Audio)

Breathing Exercise 2 uses the imagery of inflating a balloon to help the listener make their breathing slower, deeper, and more regular. ...


Relaxed Breathing Exercise 3 (Audio)

Breathing Exercise 3 uses the imagery of breathing air of different colours to help the listener make their breathing slower, deeper, and more regular ...


Relaxed Breathing Exercise 4 (Audio)

Breathing Exercise 4 guides the listener through simple instructions to breathe in a more relaxed fashion. ...


Relaxed Breathing Record Form

Practising relaxed breathing serves to reduce physiological arousal and can be an excellent grounding technique. This record form helps clients to mon ...


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 ...

Information Handout

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 ...

Information Handout

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 ...


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 ...


Sleep Hygiene (Audio)

Sleep hygiene is a commonly utilized treatment option for insomnia and is offered as a stand-alone treatment and as part of multimodal treatments. ...


Stimulus Discrimination

Stimulus discrimination is a component of cognitive behavioral treatment for post-traumatic stress disorder (PTSD). Clients are guided to deliberately ...


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 ...


Therapy Blueprint

Since the publication of this version of the therapy blueprint we have also developed a more sophisticated version: Therapy Blueprint (Universal) A th ...


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 ...


Thought Challenging Record 7 Column

The thought record is an essential tool in cognitive behavioral therapy (CBT). Thought challenging records help people to evaluate their negative auto ...


Trauma, Dissociation, And Grounding

Trauma, Dissociation, and Grounding is a guide written for clients who have experienced trauma and who are troubled by dissociation. It provides clear ...


Types Of Dissociation

The Types Of Dissociation information handout is designed for clients who have experienced trauma and describes dissociation using accessible terminol ...

Information Handout

Understanding PTSD

Ehlers & Clark’s cognitive model of PTSD outline key maintaining factors. Understanding PTSD is a simple pictorial explanation of the mainte ...

Information Handout

Unhelpful Thinking Styles

Human thinking is subject to a number of characteristic biases. Cognitive restructuring is the process of helping individuals to overcome their biases ...

Information Handout

What Is Compassion Focused Therapy (CFT)?

Compassion focused therapy (CFT) was developed to work with issues of shame and self-criticism. The CFT model complements and expands the traditional ...

Information Handout

What Is EMDR? (Eye Movement Desensitization and Reprocessing)

Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based treatment for trauma. Its theoretical basis is described by the Adaptive Inf ...

Information Handout

What Is Exposure Therapy?

Exposure is an effective evidence-based treatment for fear. This information handout describes the key principles of Exposure Therapy. Clients who are ...

Information Handout

What Is Imagery Rescripting?

Unwanted images are a feature common to a variety of problems including PTSD and depression. Imagery rescripting is an evidence-based treatment techni ...

Information Handout

What Is TF-CBT?

Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based treatment for post-traumatic stress disorder (PTSD). This information handou ...

Information Handout


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

Screening, diagnostic, and outcome-measurement tools for dissociation

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


Treatment guides


Treatments for PTSD include:

Information Handouts


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.

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.

Other papers

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:


  • 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