NICE (2019) and international treatment guidelines recommend of Cognitive Therapy for PTSD as a first-line treatment for posttraumatic stress disorder (PTSD). The treatment has been shown to be highly effective and acceptable to adults and young people (Duffy et al., 2007; Ehlers et al. 2003, 2005, 2013, 2014; Gillespie et al., 2002; Meiser-Stedman et al., 2016; Smith et al., 2007). Ehlers and Clark’s (2000) cognitive model of PTSD guides treatment. This model suggests that people with PTSD perceive a serious current internal or external threat that has two sources, excessively negative appraisals (personal meanings) of the trauma and / or its sequelae and characteristics of trauma memories that lead to reexperiencing symptoms. The problem is maintained by cognitive strategies (such as thought suppression, rumination, safety-seeking behaviours) that are intended to reduce the sense of current threat but maintain the problem by preventing change in the appraisals and trauma memory, and/or lead to increases in symptoms.
Cognitive Therapy for PTSD has three goals. First, the idiosyncratic personal meanings are identified and changed. Therapeutic techniques include identification of hot spots during the trauma and associated meanings, Socratic questioning, and behavioural experiments. Second, the trauma memory is elaborated. Idiosyncratic personal meanings of the trauma are linked with information that makes them less threatening, using a range of techniques. In stimulus discrimination training, the patient learns to discriminate triggers of reexperiencing symptoms from the stimuli that were present during the trauma. Third, the patient experiments with dropping maintaining behaviours.
Treatment is tailored to the individual case formulation. The workshop will discuss how to develop a formulation with the client and how to tailor procedures to common cognitive themes in PTSD such as appraisals linked to guilt, shame, anger, loss and mental defeat. Techniques used in treatment are described and illustrated with case examples and videos. A workshop on memory work in CT-PTSD is available at https://oxcadatresources.com/ptsd-training-videos/ (free registration as a clinician is required).
Anke Ehlers is Professor of Experimental Psychopathology and Wellcome Trust Principal Research Fellow at the Department of Experimental Psychology, University of Oxford, UK. She is a co-founder of the Centre for Anxiety Disorders and Trauma at the Maudsley Hospital, London, and co-directs the Oxford Centre for Anxiety Disorders and Trauma. Anke Ehlers is a Fellow of the British Academy, Academy of Medical Sciences, the German Academy of Sciences Leopoldina, and Academia Europaea. Her main research interests are the anxiety disorders, in particular posttraumatic stress disorder, panic disorder, and social phobia. In her experimental work, she has established cognitive and psychophysiological factors that maintain these disorders. With her colleagues, she has developed and evaluated an effective psychological treatment for posttraumatic stress disorder.
Duffy, M, Gillespie, K, & Clark, D.M. (2007). Post-traumatic stress disorder in the context of terrorism and other civil conflict in Northern Ireland: randomised controlled trial. British Medical Journal, 334, 1147-50. DOI: 10.1136/bmj.39021.846852.BE
Ehlers, A., & Clark, D.M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319-345. DOI: 10.1016/S0005-7967(99)00123-0
Ehlers, A., Grey, N., Wild, J., Stott, R., Liness, S., Deale, A., Handley, R., Albert, I., Cullen, D., Hackmann, A., Manley, J., McManus, F., Brady, F., Salkovskis, P., & Clark, D. M. (2013). Implementation of cognitive therapy for PTSD in routine clinical care: Effectiveness and moderators of outcome in a consecutive sample. Behaviour Research and Therapy, 51(11), 742–752. DOI: 10.1016/j.brat.2013.08.006
Ehlers, A., Hackmann, A., Grey, N., Wild, J., Liness, S., Albert, I., Deale, A., Stott, R., & Clark, D. M. (2014). A randomized controlled trial of 7-day intensive and standard weekly cognitive therapy for PTSD and emotion-focused supportive therapy. American Journal of Psychiatry, 171(3), 294–304. DOI: 10.1176/appi.ajp.2013.13040552
Ehlers, A., Clark, D. M., Hackmann, A., McManus, F., & Fennell, M. (2005). Cognitive therapy for PTSD: Development and evaluation. Behaviour Research and Therapy, 43, 413-431. DOI: 10.1016/j.brat.2004.03.006
Ehlers, A., Clark, D. M., Hackmann, A., McManus, F., Fennell, M., & Herbert, C. M. R. (2003). A randomized controlled trial of cognitive therapy, a self-help booklet, and repeated assessment as early interventions for PTSD. Archives of General Psychiatry, 60, 1024-1032. DOI: 10.1001/archpsyc.60.10.1024
Gillespie, K., Duffy, M., Hackmann, A., & Clark, D. M. (2002). Community based cognitive therapy in the treatment of post-traumatic stress disorder following the Omagh bomb. Behaviour Research and Therapy, 40, 345-357. DOI: 10.1016/S0005-7967(02)00004-9
Meiser-Stedman, R., Smith, P., McKinnon, A., Dixon, C., Trickey, D., Ehlers, A., Clark, D.M., Boyle, A., Goodyer, I., Dalgleish, T. (2016). Cognitive therapy versus wait list as an early intervention for PTSD in children and adolescents: A randomized controlled trial. Journal of Child Psychology and Psychiatry, DOI:10.1111/jcpp.12673
NICE (National Institute for Health and Care Excellence). (2018). Posttraumatic stress disorder. NICE guideline 116. https://www.nice.org.uk/guidance/ng116/resources
Smith, P., Yule, W., Perrin, S., Tranah, T., Dalgleish, T., & Clark, D.M. (2007). Cognitive-behavioral therapy for PTSD in children and adolescents: A preliminary randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1051-61. DOI: 10.1097/CHI.0b013e318067e288