Understanding Post-Traumatic Stress Disorder (PTSD)

Many of us will experience trauma at some point in our lives. With time, most people recover from their experiences without needing professional help. However, for a significant proportion of people the effects of trauma last for much longer, and they develop a condition called post-traumatic stress disorder (PTSD). It is thought that between 3 and 5 people out of every 100 will experience PTSD every year. Fortunately, there are a range of excellent psychological therapies for PTSD. 

The Understanding Post-Traumatic Stress Disorder (PTSD) guide is designed to help clients with PTSD and Complex PTSD to understand more about their condition. As well as a clear description of trauma, symptoms, and treatments, the guide explores key maintenance factors for PTSD including:

• Unprocessed memories.
• Beliefs about trauma and its consequences.
• Coping strategies, including avoidance.

• Scaffold knowledge. The guides are perfect during early stages of therapy to help your clients understand how their symptoms fit together and make sense.
• Reassure and encourage optimism. Many clients find it hugely reassuring to know there is a name for what they are experiencing, and that there are evidence-based psychological models and treatments specifically designed to help.
• De-mystify the therapy process. To increase your client’s knowledge of the therapy process and the ingredients that it is likely to involve. If you can help your clients to understand why an intervention is important (think exposure!) it can help encourage them to engage.
• Signposting. If you’re just seeing a client briefly for assessment, or you have a curious client who wants to know more, these resources can be a helpful part of guiding them to the right service.
• Waiting time not wasted time. When you’ve assessed someone but their treatment can’t begin right away, psychoeducation can help them learn about how therapy can help while they’re waiting.

• Case examples to help your clients relate to the condition, and to normalize their experiences.
• Jargon-free descriptions of symptoms, and descriptions of how they might affect your thoughts, feelings, and actions.
• A symptom questionnaire for screening assessment.
• An accessible cognitive-behavioral account of what keeps the problem going, or what stops it from getting better.
• A description of evidence-based treatments for that condition, including an overview of the ‘ingredients’ of a good cognitive behavioral approach.

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
• Brewin, C. R., Cloitre, M., Hyland, P., Shevlin, M., Maercker, A., Bryant, R. A., ... & Somasun- daram, D. (2017). A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Clinical Psychology Review, 58, 1-15.
• Brewin, C. R., Gregory, J. D., Lipton, M., & Burgess, N. (2010). Intrusive images in psychological disorders: characteristics, neural mechanisms, and treatment implications. Psychological Review, 117(1), 210.
• Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319-345.
• Gallagher, M. W., & Resick, P. A. (2012). Mechanisms of change in cognitive processing therapy and prolonged exposure therapy for PTSD: Preliminary evidence for the differential effects of hopelessness and habituation. Cognitive Therapy and Research, 36(6), 750-755.
• Gilbertson, M. W., Shenton, M. E., Ciszewski, A., Kasai, K., Lasko, N. B., Orr, S. P., & Pitman, R. K. (2002). Smaller hippocampal volume predicts pathologic vulnerability to psychological trauma. Nature Neuroscience, 5(11), 1242-1247.
• Grey, N., Young, K., & Holmes, E. (2002). Cognitive restructuring within reliving: A treatment for peritraumatic emotional “hotspots” in posttraumatic stress disorder. Behavioural and Cognitive Psychotherapy, 30(1), 37-56.
• Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5(3), 377-391.
• Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and co- morbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617-627.
• Kleim, B., Grey, N., Wild, J., Nussbeck, F. W., Stott, R., Hackmann, A., ... & Ehlers, A. (2013). Cognitive change predicts symptom reduction with cognitive therapy for posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 81(3), 383.
• National Institute for Health and Care Excellence (2018). Post-traumatic stress disorder. Retrieved from: https://www.nice.org.uk/guidance/ng116/resources/posttraumatic-stress-disor- der-pdf-66141601777861
• Robjant, K., & Fazel, M. (2010). The emerging evidence for narrative exposure therapy: A review. Clinical Psychology Review, 30(8), 1030-1039.
• Watkins, L. E., Sprang, K. R., & Rothbaum, B. (2018).Treating PTSD: a review of evidence-based psychotherapy interventions. Frontiers in Behavioral Neuroscience, 12, 258.
• Whalley, M. G., Kroes, M. C., Huntley, Z., Rugg, M. D., Davis, S. W., & Brewin, C. R. (2013). An fMRI investigation of posttraumatic flashbacks. Brain and Cognition, 81(1), 151-159.
• Zalta, A. K., Gillihan, S. J., Fisher, A. J., Mintz, J., McLean, C. P., Yehuda, R., & Foa, E. B. (2014). Change in negative cognitions associated with PTSD predicts symptom reduction in prolonged exposure. Journal of Consulting and Clinical Psychology, 82(1), 171.