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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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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
- Scale – Adult download archived copy
- Scale – Child Age 11-17 download archived copy
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 & Trauma, 19(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
- Scale (English) download archived copy
- Scale (German) download archived copy
- Scale (Norwegian) download archived copy
- Schalinski, I., Schauer, M., & Elbert, T. (2015). The Shutdown Dissociation Scale (Shut-D). European Journal of Psychotraumatology, 6

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:

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), which includes ‘enhanced reliving’ / updating of ‘hotspots’ (e.g. Ehlers & Clark, 2000; Grey, Young & Holmes, 2002)
Eye Movement Desensitization Reprocessing (EMDR)
Narrative Exposure Therapy (NET) (Shauer, Neuner, Elpert) Definition at commonlanguagepsychotherapy.org
Prolonged Exposure (PE) (Foa) Definition at commonlanguagepsychotherapy.org
Cognitive Processing Therapy (CPT) (Resick) CPT treatment manual Free online training course in CPT available from cptforptsd

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

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:

dissociative symptoms such as depersonalization or derealization
difficulty managing emotions
loss of the sense of self
finding relationships very difficult

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:

psychological models of post-traumatic stress disorder (PTSD)
information handouts for post-traumatic stress disorder (PTSD)
exercises for post-traumatic stress disorder (PTSD)
CBT worksheets for post-traumatic stress disorder (PTSD)
self-help programs for post-traumatic stress disorder (PTSD)

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

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

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