Clinical Psychology in Practice: Working with PTSD

A set of vocabulary flashcards covering the treatment of PTSD including NICE guidelines, Ehlers & Clark's CBT model, and EMDR techniques.

Debriefing

A type of intervention that NICE guidelines state should not be offered after traumatic events.

Watchful waiting

An approach recommended by NICE for PTSD symptoms that have lasted less than $4$ weeks.

Trauma-focused CBT

Individual intervention including Cognitive processing therapy and Narrative exposure therapy, offered to adults with PTSD symptoms presenting more than $1$ month after an event.

EMDR (Eye Movement Desensitisation and Reprocessing)

A therapy recommended for non-combat-related trauma presenting $1$ to $3$ months post-trauma (if preferred) or more than $3$ months post-trauma.

Hotspots

Moments of greatest distress during a trauma that create a sense of "nowness" in the memory.

Imaginal reliving

A method of confronting trauma memories by describing the event in the present tense with eyes closed or in written accounts.

In vivo exposure

Conducting behavioral experiments with now-safe stimuli or revisiting trauma-related sites, such as driving a car or going in a lift.

Stimulus discrimination

A technique used to break the link between trauma triggers and memories by identifying differences between the "Then" of the trauma and the "Now" of the present.

Responsibility pie technique

A cognitive tool used to help individuals change their perspective on self-blame by visually distributing responsibility among various factors.

Therapy blueprint

A document created in session $12$ used as a relapse prevention tool.

STOPP technique

A practice used to notice intrusive memories: Stop, Take a breath, Observe, Pull back, and Practice what works.

Adaptive Information Processing Model (AIP model)

The model developed by Shapiro ($2001$) which posits that distressing incidents are 'frozen' in time and unable to connect with adaptive memory networks. This results in the inability to process traumatic memories adequately, leading to persistent emotional distress and symptoms of PTSD. The AIP model suggests that the integration of these memories into existing memory networks can alleviate symptoms, facilitating recovery.

Bilateral eye movement

A distinct feature of EMDR involving side-to-side eye movements to enhance information processing and forge new associations.

Desensitisation (EMDR Phase $4$)

The phase where bilateral eye movements are initiated for $15-20$ seconds while focusing on disturbing memories until distress decreases.

Installation (EMDR Phase $5$)

The phase of EMDR where the focus is on the event alongside a positive cognition while bilateral eye stimulation continues.

Body Scan (EMDR Phase $6$)

The phase in EMDR where uncomfortable physical sensations are identified and diminished using eye movements until physical and psychological distress is removed.

Safety behaviours

Dysfunctional behaviors, such as avoiding family or driving cautiously, that maintain the feeling of threat in PTSD.

Thought suppression

A maintaining factor for PTSD often illustrated by the "White bear experiment" where an individual tries to push memories away.

Cognitive processing therapy

One of the trauma-focused CBT interventions specifically named in the NICE guidelines for adults with PTSD.

Narrative exposure therapy

A specific trauma-focused CBT intervention included in the treatment options for adults presenting more than $1$ month after a trauma.

CBT and PTSD Treatment Effectiveness

Key Points

• PTSD can be treated using several psychological therapies.

• Common treatments include Trauma-Focused CBT, exposure therapy, cognitive therapy, stress inoculation training, and EMDR.

• Trauma-focused approaches aim to reduce avoidance and process traumatic memories.

• CBT-based treatments are among the most researched PTSD interventions.

Key Research Findings Mendes et al. (2008)

• Conducted a systematic review of CBT treatments for PTSD.

• Found Trauma-Focused CBT and exposure-based therapies highly effective in reducing PTSD symptoms.

• EMDR was also found effective, though CBT had the strongest evidence base overall.

Evaluation

• Supports CBT as one of the most evidence-based treatments for PTSD.

• Trauma-focused therapies appear more effective than non-trauma-focused approaches.

• Some treatments can be emotionally demanding, leading to dropout for some clients

EMDR and Mechanisms of Change

Key Points

• EMDR (Eye Movement Desensitization and Reprocessing) is a PTSD treatment involving recall of traumatic memories while performing bilateral stimulation, usually eye movements.

• EMDR aims to reduce emotional distress linked to trauma memories.

• The therapy is structured and trauma-focused.

Key Mechanisms of Change van den Hout & Engelhard (2012)

• Proposed that eye movements tax working memory while recalling traumatic memories.

• This makes memories feel less vivid and less emotionally distressing over time.

• Suggested EMDR works through memory processing mechanisms rather than eye movements alone being “magical.”

Evaluation

• EMDR is supported by evidence and recommended in treatment guidelines.

• Working memory explanation has strong experimental support.

• Debate continues over whether bilateral stimulation adds benefits beyond exposure techniques.