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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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Nightmare Rescripting Audio

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

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/

Exercise

Recovering From A Nightmare Audio

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 ... https://www.psychologytools.com/resource/recovering-from-a-nightmare-audio/

Audio

Assessment

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)

Intervention

Treatment guides

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Treatments for PTSD include:

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Presentations

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:

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

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