Cognitive Therapy for PTSD (Ehler's and Clark's Model)

Ehlers and Clark propose that PTSD develops if and when the traumatised person makes maladaptive interpretations of the event(s) and of the consequences those event(s) have for them. Examples of appraisals about the event or the consequences are "It was my fault, I should have run faster to get help, I need to avoid talking about it, or I will get upset, my life has been ruined, I will never recover, I must be defective if I am not able to cope with this situation, I cannot trust anybody."

Therefore, an essential component of the treatment focuses on identifying all possible appraisals maintaining the dysfunctional meaning of the traumatic event. A narrative of the incident is produced in order to reconstruct the event with as many details as possible. From the worst moments (hotspots), you will be helped to identify the emotions, meanings, and appraisals associated with each hotspot.

A second factor, which may explain why the person perceives a current threat is due to the nature of the trauma memory by itself. When traumatic information has to be processed, sometimes it does not fit with pre-existing templates or autobiographical memories resulting in poor elaboration and integration of the memory, which may be triggered unintentionally and make the person feel like it is happening all over again.

When memories are not properly integrated, they are experienced as if they were out of context, time, or place.

The second component of this treatment focuses on updating and contextualising the traumatic event, and this is necessary in order to achieve a less fragmented elaboration of the memory. This is done by restructuring the meaning and appraisals found from the hotspots of the reconstruction of the event captured in the narrative. Therefore, beliefs such as "I didn't do enough to protect myself" are modified and updated in order to be able to create a different meaning for the various aspects of the traumatic event.

Once the cognitive restructuring process is completed, a new narrative is created, introducing the latest insights about the traumatic event. This new updated information can be either relevant details from the course, circumstances, and outcome of the trauma or the result of cognitive restructuring of the highly idiosyncratic meanings of the trauma.

PTSD symptoms continuation can be explained by how the person deals with traumatic memories once the event has occurred. Once the traumatic materials are triggered, and the current threat is perceived, it is normal (although dysfunctional) to develop thought control mechanisms, rumination, safety behaviours, avoidance of reminders, etc., in order to gain a sense of control over the memories and their consequences. However, this does not allow elaboration and integration of traumatic material, perpetuating the PTSD. These coping strategies prevent change in meaning or memory structure.

Therefore, another component of the treatment addresses and attempts to eliminate safety behaviours, avoidance of triggers, and thought suppression. We use "Behavioural Experiments" in order to test predictions about the need to use avoidance, safety behaviours, or any other maladaptive strategies maintaining PTSD symptoms.

Other components of this intervention include reclaiming your life, dealing with triggers of intrusions, including discrimination of "Then" vs. "Now" in intrusions and site visits where the trauma occurred when appropriate.