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

Brief Dissociative Experiences Scale (DES-B) | Dalenberg, Carlson | 2010
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- DES-B (Dalenberg C, Carlson E, 2010) modified for DSM-5 by C. Dalenberg and E. Carlson.
- Scale
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Dissociative Experiences Scale – II | Carlson, Putnam | 1993
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- Carlson, E.B. & Putnam, F.W. (1993). An update on the Dissociative Experience Scale. Dissociation 6(1), p. 16-27.
- Scale
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Shutdown Dissociation Scale (Shut-D) | Schauer, Schalinski, Elbert | 2015
- Scale (English)
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- Scale (German)
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- Scale (Norwegian)
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- Reference Schalinski, I., Schauer, M., & Elbert, T. (2015). The Shutdown Dissociation Scale (Shut-D). European Journal of Psychotraumatology, 6
Clinician Administered PTSD Scale for DSM-5 (CAPS-5) (Past week version) | Weathers, F. W., Blake, D. D., Schnurr, P. P., Kaloupek, D. G., Marx, B. P., & Keane, T. M. | 2015
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- Scale archived version
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- 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].

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

Impact Of Events Scale – Revised (IES-R) | Weiss, Marmar | 1996
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- 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.
- Scale
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Life Events Checklist for DSM-5 (LEC-5) | Weathers, Blake, Schnurr, Kaloupek, Marx, Keane | 2013
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- 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].
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PTSD Checklist for DSM-5 (PCL-5) | Weathers, Litz, Keane, Palmieri, Marz, Schnurr | 2013
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- 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
- Manual
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- Scale (Standard)
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- Scale with criterion A
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- Scale with life events checklist and criterion A
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PTSD Symptom Scale – Interview Version for DSM-5 (PSS-I-5) | Foa, McLean, Zang, Zhong, Rauch, Porter, Knowles, Powers, Kauffman | 2016
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- 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
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Severity Of Posttraumatic Stress Symptoms | Kilpatrick, Resnick, Friedman | 2013
- Scale – Adult
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- Scale – Child Age 11-17
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Trauma Appraisal Questionnaire (TAQ) | DePrince, Zurbruggen, Chu, Smart | 2010
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- 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.
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- Scale
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Trauma Screening Questionnaire (TSQ) | Brewin, Rose, Andrews, Green, Tata, McEvedy, Turner, Foa | 2002
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- 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.
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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.

Guides

Trauma And Substance Use | NDARC: Mills, Ewer, Marel, Baker, Teesson, Dore, Kay-Lambkin, Manns, Trimmingham | 2011
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Abuse – Information For Adults Physically, Emotionally, Or Sexually Abused As Children (An NHS Self-Help Guide) | Lesley Maunder, Lorna Cameron | 2020
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Posttraumatic stress disorder: patient treatment manual | Clinical Research Unit for Anxiety and Depression (CRUfAD)
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Your very own TF-CBT workbook | Alison Hendricks, Judith A. Cohen, Anthony P. Mannarino, Esther Deblinger
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Information Handouts

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

Narrative Exposure Therapy (NET) | Shauer, Neuner, Elpert
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Prolonged Exposure (PE) | Edna Foa
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Understanding traumatic intrusions (OCTC Practical Guides) | Helen Kennerley | 2016
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Presentations

Dissociative phenomena in the everyday lives of trauma survivors | Janina Fischer | 2001
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Modulation, mindfulness, and movement in the treatment of trauma-related depression (window of tolerance) | Pat Ogden | 2009
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Cognitive therapy for PTSD | Nick Grey | 2016
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Beyond reliving in PTSD treatment: advanced skills for overcoming common obstacles in memory work | Hannah Murray, Sharif El-Leithy archive.org
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Dissociation and PTSD | Fiona Kennedy | 2010
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Using compassionate imagery in shame based flashbacks in PTSD | Deborah Lee | 2009
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Introduction to traumatic stress | Kitchiner & Roberts archive.org
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Using exposure to treat PTSD: why, when, and how? | Fyvie archive.org
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A trauma-focused cognitive behavioral therapy case conceptualization: from assessment to termination | Alison Hendricks archive.org
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PTSD as a shame disorder | Judith Herman | 2014
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Treatment Guide

Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders (2014) | Katzman et al | 2014
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Post-traumatic stress disorder (PTSD) | National Institute for Health and Care Excellence (NICE) guidelines | 2018
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Clinical practice guideline for the treatment of PTSD | American Psychological Association (APA) | 2017
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Guidelines for Treating Dissociative Identity Disorder in Adults | International Society for the Study of Trauma and Dissociation (ISST-D) | 2011
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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
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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
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Cognitive Processing Therapy (CPT) Veteran/Military Version | Patricia Resick, Candice Monson, Kathleen Chard | 2006
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Trauma focused CBT for chronic whiplash
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CBT-3M (Meanings, Memories and Management) - A trauma- based cognitive therapy protocol for young children aged 3-8 years | Based on the treatment developed by Smith, Yule, Perrin, & Clark (2006)
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Video

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