Hotspot Record

The Hotspot Record is a structured clinical worksheet designed to support the process of identifying, documenting, and updating traumatic appraisals in post-traumatic stress disorder (PTSD) therapy.

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Professional version

Offers theory, guidance, and prompts for mental health professionals. Downloads are in Fillable PDF format where appropriate.

Client version

Includes client-friendly guidance. Downloads are in Fillable PDF format where appropriate.

Fillable version (PDF)

A fillable version of the resource. This can be edited and saved in Adobe Acrobat, or other PDF editing software.

Editable version (PPT)

An editable Microsoft PowerPoint version of the resource.

Editable version (DOC)

An editable Microsoft Word version of the resource.

Overview

In PTSD therapy, identifying and updating traumatic appraisals can significantly support the therapeutic process. The Hotspot Record is used in trauma-focused therapy to help clients identify key “hotspots” — moments of intense emotion and unhelpful appraisals within traumatic memories. It supports the process of cognitive restructuring by encouraging clients to revisit these moments with current knowledge, allowing space to update distorted beliefs. This resource facilitates both the identification of peri-traumatic beliefs and the development of more adaptive appraisals. It is intended for off-line processing between reliving sessions and can be used in cognitive approaches to PTSD treatment.

Why Use This Resource?

This resource supports enhanced reliving in trauma focused therapy by:

Providing a structured approach to address peri-traumatic cognitions.
Helping clients articulate original appraisals and their emotional impact.
Guiding the process of updating beliefs with more accurate and compassionate perspectives.
Supporting clinicians in applying enhanced reliving techniques with cognitive restructuring.

Key Benefits

Structure

Provides a clear layout for recording traumatic hotspots, emotions, and appraisals.

Clarity

Encourages precise identification of peri-traumatic cognitions and their emotional intensity.

Integration

Facilitates belief updating and preparation for re-integration in reliving work.

Who is this for?

Post-Traumatic Stress Disorder (PTSD)

Identifying and updating traumatic appraisals to alleviate distress.

Integrating it into your practice

Record

Use the worksheet to document the worst trauma moments.

Appraise

Help clients identify the key images and rate the associated emotions (0–100) and appraisals.

Update

Facilitate the development of new adaptive beliefs.

Reintegrate

Revisit the hotspot during reliving to insert the updated belief.

Reflect

Support clients to reflect on updated beliefs and the therapeutic progress.

Theoretical Background & Therapist Guidance

PTSD symptoms persist when trauma memories are processed in ways that create a sense of ongoing threat. Peri-traumatic appraisals — often rigid, extreme, or self-blaming — are central to this experience (Ehlers & Clark, 2000). The enhanced reliving technique provides a structured way for clinicians to help clients identify, understand, and update these appraisals. This process involves recognising intense emotional responses and cognitive distortions that commonly accompany trauma memories. Through cognitive restructuring, therapists support clients in re-evaluating these beliefs, developing new insights, and embedding updated appraisals into the trauma memory. For example, a client might shift from “It was my fault” to “I did the best I could.”

Clients revisit emotionally intense “hotspots” during reliving, identifying the meaning they attributed at the time. Therapists then support the development of more balanced, compassionate beliefs, often integrating them into the memory by pausing and asking, “What do you know now?” This approach transforms trauma memories from fragmented and threatening to coherent and manageable. The worksheet offers a structured framework to support this cognitive shift, enhancing the effectiveness of memory-based interventions. This resource is informed by the cognitive model of PTSD (Ehlers & Clark, 2000) and the enhanced reliving procedure described by Grey, Young, and Holmes (2002).

What's inside

Worksheet to document traumatic hotspots and updates.
Guidance for identifying beliefs and facilitating cognitive change.
Therapist instructions for integrating new updates into trauma memories.

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FAQs

The Hotspot Record helps clients identify and update distressing appraisals associated with traumatic memories, supporting cognitive and emotional processing.

It is best used after a hotspot has been identified during reliving or imaginal exposure. It supports off-line elaboration and is revisited during later reliving sessions.

Use gentle prompts like: “In that moment, what did you think was going to happen?” or “What did that image mean about you or the world?”

How This Resource Improves Clinical Outcomes

By integrating the Hotspot Record into therapy, clinicians can offer structured support that:

Supports understanding of trauma memories and associated beliefs.
Facilitates the integration of new perspectives into traumatic memories.
Provides therapists with a flexible tool for enhancing reliving-based interventions.

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References And Further Reading

Brewin, C. R. (2006). Understanding cognitive behaviour therapy: A retrieval competition account. Behaviour Research and Therapy, 44(6), 765–784. https://doi.org/10.1016/j.brat.2006.02.005
Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319–345. https://doi.org/10.1016/S0005-7967(99)00123-0
Ehlers, A., Hackmann, A., & Michael, T. (2004). Intrusive re-experiencing in post-traumatic stress disorder: Phenomenology, theory, and therapy. Memory, 12(4), 403–415. https://doi.org/10.1080/09658210444000025
Foa, E. B., & Rothbaum, B. O. (1998). Treating the trauma of rape: Cognitive-behavioral therapy for PTSD. Guilford Press.
Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences – Therapist guide. Oxford University Press.
Grey, N., Young, K., & Holmes, E. A. (2002). Cognitive restructuring within reliving: A treatment for peritraumatic emotional “hotspots” in posttraumatic stress disorder. Behavioural and Cognitive Psychotherapy, 30(1), 37–56. https://doi.org/10.1017/S1352465802001049
Murray, H., Merritt, C., & Grey, N. (2020). Return to trauma: The role of memory processes in the treatment of PTSD. European Journal of Psychotraumatology, 11(1), 1785811. https://doi.org/10.1080/20008198.2020.1785811
Wild, J., & Clark, D. M. (2011). Imagery rescripting of early traumatic memories in social phobia. Cognitive and Behavioral Practice, 18(4), 433–443. https://doi.org/10.1016/j.cbpra.2011.03.002

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