Cognitive therapy for PTSD

Domain II · Behavioural & cognitive · Anke Ehlers, David M. Clark · 2000 · Oxford

What it is

CT-PTSD is an individual, trauma-focused cognitive therapy. Its developers recommend it as first-line, and they report that thousands of NHS therapists have been trained in it. How change happens: the model holds that PTSD persists when the trauma is processed in a way that creates a sense of…

Format

• CT-PTSD is not a session-by-session protocol. The core elements are the same for every client, but their order and delivery are fitted to the formulation, which the authors call "flexibility within fidelity". There is no formal stabilisation phase. Memory work usually begins in session 2.
• Format and dose

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• safety behaviours being swapped for new ones.
• fast drops in nowness, which show the update has landed.
• survivor guilt (D4, B6) and moral injury (see section 5).
• real, ongoing risk. Problem-solve that rather than reappraising it.
• the client going quiet, staring, or answering slowly. Step in early.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.