Post-Traumatic Stress Disorder (PTSD) Formulation

A practical worksheet designed to aid mental health professionals in formulating symptoms of post-traumatic stress disorder (PTSD) including unwanted memories, trauma-related appraisals, and coping strategies.

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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.

Editable version (PPT)

An editable Microsoft PowerPoint version of the resource.

Overview

This PTSD Formulation worksheet provides a structured approach to understanding the elements of PTSD, focusing on trauma memories, appraisals, and coping strategies. It is designed to be user-friendly and client-centered, assisting clinicians in gathering essential information and facilitating effective therapy. The worksheet helps clients articulate their experiences and symptoms in a comprehensible way, aiding the therapeutic process.

Why Use This Resource?

Understanding PTSD requires a comprehensive approach that addresses both past trauma and current symptoms. This resource helps clinicians:

  • Clarify the relationship between experiences of trauma and present symptoms.
  • Assess cognitive appraisals and their impact on a current sense of threat.
  • Develop individualized therapy plans based on the client's formulation.
  • Encourage client engagement in their recovery process.

Key Benefits

Assessment

Provides a clear structure for evaluating PTSD symptoms and their origins.

Cognitive

Facilitates understanding of key peri- and post-traumatic appraisals.

Engagement

Encourages clients to explore their traumatic experiences in manageable steps.

Planning

Supports personalized therapy strategies and interventions.

Who is this for?

Post-Traumatic Stress Disorder (PTSD)

People struggling with symptoms of PTSD following a traumatic event(s).

Integrating it into your practice

01

Introduce

Facilitate understanding of the impact of the trauma in manageable steps.

02

Memory

Clarify which aspects of trauma memories are experienced involuntarily.

03

Triggers

Identify triggers and their role in the client's experience of PTSD.

04

Appraisals

Assess both peri- and post-traumatic appraisals that influence the client’s perception of threat.

05

Coping

Use the worksheet to explore coping strategies.

06

Plan

Formulate treatment plans that work with components of memories, appraisals, and behaviors.

Theoretical Background & Therapist Guidance

Ehlers and Clark’s cognitive model of PTSD proposes that the disorder is maintained by unprocessed trauma memories, maladaptive appraisals, and ineffective coping strategies. These elements create a persistent sense of threat, even when actual danger has passed. Grounded in this model, the worksheet aids in developing personalized formulations that inform trauma-focused therapy.

Trauma memories in PTSD tend to be fragmented, sensory-rich, and poorly integrated into the person’s broader life narrative. Because of this, they often intrude involuntarily and can feel as though they are happening in the present moment, which reinforces the sense of current threat.

In addition, people frequently develop negative appraisals of the trauma and its aftermath. These appraisals might involve distorted beliefs about responsibility, danger, or permanent change (e.g., “It was my fault,” “Nowhere is safe,” or “I’m permanently damaged”). These interpretations contribute to ongoing distress.

Coping strategies intended to manage distress — such as avoidance, suppression of memories, or hypervigilance — can unintentionally maintain symptoms. They prevent the trauma memory from being processed and stop individuals from updating their beliefs with new, corrective information.

This worksheet helps clients and therapists collaboratively explore how trauma memories, appraisals, and coping responses interact to maintain PTSD symptoms. By increasing understanding of these processes, the formulation can guide the development of targeted interventions that promote emotional processing, modify unhelpful appraisals, and support more adaptive coping.

What's inside

  • A case conceptualization diagram that visually maps the relationships between experiences of trauma, involuntary memory, appraisals, threat, and coping strategies.
  • Worked case examples to illustrate how the formulation can be applied in real therapeutic scenarios.
  • Therapist guidance to help you use the tool effectively.
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FAQs

This resource aids therapists by organizing key PTSD elements into a comprehensive, easy-to-understand format, supporting both assessment and intervention.
Use it as a collaborative tool to explore trauma-related experiences and help clients see patterns linking their memories, thoughts, and symptoms
Yes, this structured approach is suitable for both in-person and teletherapy settings.
It’s important to pace the work carefully, matching the depth of exploration to the client’s readiness. Therapists should prioritise emotional safety and ensure that the process remains collaborative and containing.

How This Resource Improves Clinical Outcomes

By systematically addressing the key elements of PTSD through a cognitive-behavioral lens, this resource:

  • Enhances client insight into the factors which maintain PTSD.
  • Supports adaptive changes in beliefs and coping mechanisms.
  • Increases client readiness for processing trauma memories.
  • Provides clinicians with a reliable framework for evidence-based PTSD intervention.

References And Further Reading

  • American Psychological Association. (2017). Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. Retrieved from: https://www.apa.org/ptsd-guideline/ptsd.pdf
  • Brewin, C. R. (2014). Episodic memory, perceptual memory, and their interaction: Foundations for a theory of posttraumatic stress disorder. Psychological Bulletin, 140(1), 69–97. https://doi.org/10.1037/a0033722
  • Brewin, C. R. (2015). Re-experiencing traumatic events in PTSD: New avenues in research on intrusive memories and flashbacks. European Journal of Psychotraumatology, 6(1), 27180. https://doi.org/10.3402/ejpt.v6.27180
  • 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., Clark, D. M., Dunmore, E., Jaycox, L., Meadows, E., & Foa, E. B. (1998). Predicting response to exposure treatment in PTSD: The role of mental defeat and alienation. Journal of Traumatic Stress, 11(3), 457–471. https://doi.org/10.1023/A:1024419714048
  • International Society of Traumatic Stress Studies. (2019). Posttraumatic stress disorder prevention and treatment guidelines. Retrieved from: https://www.istss.org/getattachment/Treating-Trauma/New-ISTSS-Prevention-and-Treatment-Guidelines/ISTSS_PreventionTreatmentGuidelines_FNL.pdf.aspx
  • Kilpatrick, D. G., Resnick, H. S., Milanak, M. E., Miller, M. W., Keyes, K. M., & Friedman, M. J. (2013). National estimates of exposure to traumatic events and PTSD prevalence using DSM‐IV and DSM‐5 criteria. Journal of Traumatic Stress, 26(5), 537–547. https://doi.org/10.1002/jts.21848
  • Murray, H., Merritt, C., & Grey, N. (2015). Returning to the scene of the trauma in PTSD treatment – why, how and when? The Cognitive Behaviour Therapist, 8, E28. https://doi.org/10.1017/S1754470X15000677
  • National Institute for Health and Care Excellence. (2018). Posttraumatic stress disorder. Retrieved from: https://www.nice.org.uk/guidance/ng116
  • Schauer, M., & Elbert, T. (2010). Dissociation following traumatic stress. Zeitschrift für Psychologie / Journal of Psychology, 218(2), 109–127. https://doi.org/10.1027/0044-3409/a000021
  • Wild, J., Warnock-Parkes, E., Murray, H., Kerr, A., Thew, G., Grey, N., … & Ehlers, A. (2020). Treating posttraumatic stress disorder remotely with cognitive therapy for PTSD. European Journal of Psychotraumatology, 11(1), 1785818. https://doi.org/10.1080/20008198.2020.1785818