Atlas›Domain VI · Brief, integrative, trauma, hypnosis & coaching›Guide 062
Guide VI-062

Group stabilising treatment

Ethy Dorrepaal, Kathleen Thomaes, Nel DraijerNetherlands
A 25 · L 65 · M 1023 interventions in the Trinity explorer
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[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: "Vroeger en verder" ("Before and Beyond"), the Dutch 20-session stabilising CBT group for complex PTSD after childhood abuse, developed by Ethy Dorrepaal, Kathleen Thomaes and Nel Draijer and tested at four Dutch outpatient services (PsyQ, Altrecht, GGZ Noord-Holland-Noord, GGZinGeest) [source: Dorrepaal et al., 2013, full text]. This is the guide's single primary version. Other published stabilisation groups appear below only as variants. Sourcing: the following are based on the developers' full-text papers and an independent review summary [source: Dorrepaal et al., 2013; Thomaes et al., 2015; SBU 2024 appendix on Dorrepaal et al., 2012]:

  • the format: 20 weekly 2-hour sessions, 8–12 members, two trained therapists, added to individual treatment;
  • the trial inclusion and exclusion criteria;
  • the two-part structure and the session themes.

The therapist manual (Handboek voor cursusleiders, with slides) and the participant workbook (Werkboek voor deelnemers en cursusleiders, with the full lecture texts, homework sheets and a CD of recorded exercises) are sold, not publicly available. The developers' official method description (written by Thomaes for Dorrepaal and Draijer, published by Movisie in 2016 for the Dutch database of effective social interventions) gives each session's theme, plenary exercise and homework, the session structure, group rules and leader requirements [source: Movisie 2016 method description]. Steps beyond that are the writer's synthesis unless tagged otherwise [synthesis].

Which programme this is. "Group stabilising treatment" names a type of phase-1 treatment, not a single brand. The published group programmes that fit the label are:

  • Vroeger en verder (primary here). Dutch; 20 weekly 2-hour sessions combining psychoeducation, DBT-derived skills and cognitive therapy. It extends Zlotnick's affect-management group. Its trial papers are titled "stabilizing group treatment" [source: Dorrepaal et al., 2013].
  • Zlotnick's affect-management group (USA, 1997). The 15-session, 2-hour group that Vroeger en verder translated and extended [source: Cochrane characteristics table; Dorrepaal et al., 2013].
  • Skills group for trauma-related dissociation, based on Boon, Steele & van der Hart (2011), Coping with trauma-related dissociation. Tested at Modum Bad, Norway, for DID and OSDD (example 1) [source: Bækkelund et al., 2022]:
    • 20 psychoeducational group sessions of 90 minutes, covering 20 of the manual's 43 chapters chosen by Boon for early stabilisation;
    • nine members and two therapists per group, alongside individual therapy;
    • exercises included grounding and a safe-place technique;
    • members got written material and video recordings of each session to review at home.
    This is the published group option for clients with dissociative identity disorder, whom the Vroeger en verder trial excluded.
  • ESTAIR (extended STAIR group therapy). A 17-session group for complex PTSD covering emotion regulation, self-concept and relationships, built on STAIR/Narrative Therapy. The German manual is Borowski, Cloitre, Karatzias & Schäfer (Hogrefe, 2025). It requires knowledge of STAIR and says combining it with individual trauma-focused work is useful but not mandatory [source: Hogrefe publisher page]. Session contents are not published outside the manual [uncertain].
  • German imagery-based stabilisation groups in Reddemann's psychodynamic-imaginative (PITT) tradition, including any "Stabilisierungsgruppe" attributed to Lampe and colleagues. No published group manual or trial description is available for them, so this guide does not cover them [uncertain].
  • Norwegian "group-based stabilization and skill training" trial for lasting posttraumatic reactions. It is registered (ClinicalTrials.gov NCT03887559), but its content is not described here [uncertain].

Decision. This guide follows Vroeger en verder as its single primary version. It is the manualised programme whose own trial papers carry the name "stabilizing group treatment" [source: Dorrepaal et al., 2010, 2012, 2013], and its developers published a session table and a multisite RCT. The variants rest on different theories: structural dissociation (Boon et al.), STAIR (ESTAIR), and psychodynamic imagery (PITT-style groups). Run them from their own manuals, not from this guide. If you want the general type, you can use sections 2–5 as a template, but the session content here is Vroeger en verder's.

What it is. A trauma-informed CBT group, not a trauma-focused one. It combines three elements:

  • psychoeducation;
  • emotion-regulation skills, drawn mainly from Linehan's (1993) DBT skills;
  • cognitive therapy.

It is for adults with complex PTSD after childhood sexual and/or physical abuse, often with personality disorders and severe comorbidity. The developers describe it as a translation and extension of Zlotnick's affect-management group protocol. Sessions 1–13 and 20 are based mainly on that protocol [source: Thomaes et al., 2015; Dorrepaal et al., 2010 abstract].

How change is thought to happen. Current symptoms are explained as survival strategies that once helped the person get through the abuse, which gives the client "cognitive grip" on them. The client then:

  1. records the situations and triggers that set off symptoms;
  2. deliberately avoids those triggers for a while, so that daily activities and contacts can start again;
  3. learns emotion-regulation skills to tolerate pain, fear and sadness, so that less avoidance is needed;
  4. uses cognitive therapy to revise beliefs about self, relationships, the world and the future.

The group is phase 1 of a three-phase model. Its aim is to make later trauma processing with exposure or EMDR possible [source: Thomaes et al., 2015; Dorrepaal et al., 2015].

2. Framework

The wider phase model [source: Thomaes et al., 2015, which cites Herman 1992 and the Cloitre et al. 2011 expert consensus]:

  1. Stabilisation and symptom reduction: psychoeducation, emotion-regulation skills and cognitive techniques. Vroeger en verder sits here.
  2. Trauma processing with exposure or EMDR.
  3. Integration and rehabilitation.

Format.

  • 20 weekly group sessions of 2 hours each [source: Thomaes et al., 2015].
  • The group was added to the client's ongoing individual treatment as usual; the frequency of that treatment is not stated [source: Thomaes et al., 2015; Dorrepaal et al., 2013]. The manual is a structured session-by-session script with weekly topics, skills training, assignments and homework pages [source: Dorrepaal et al., 2013]. Participants have their own workbook, which comes with a website of relaxation and breathing exercises [source: bookseller description, ISBN 9789043036184].
  • The developers say to combine group skills training with individual contact. They cite a meta-analysis finding that group treatment with no individual contact was the least effective format [source: Dorrepaal et al., 2017].
  • They criticise a 5-session group stabilisation training as far too short. A single session in it covered lifestyle, daytime activities, self-care and relationships together [source: Dorrepaal et al., 2017].
  • Each group has 8–12 participants and two therapists [source: Dorrepaal et al., 2013, full text]. In the RCT the therapists were experienced psychotherapists, psychiatrists or psychiatric nurses trained by the first author. Sessions were recorded and therapist adherence was checked after each one [source: SBU 2024 appendix summarising Dorrepaal et al., 2012]. The 2016 method description gives 10–14 participants and two group leaders (psychotherapist, psychiatrist and/or psychiatric nurse) who between them bring CBT, group and target-population experience; leaders take a three-day train-the-trainer course; the 20 sessions are followed by two follow-up meetings, at three and at six months; leaders contact each member's individual therapist before the course and can consult during it [source: Movisie 2016]. A practical division of work: one therapist attends to a member in distress while the other keeps the session going [synthesis]. Whether groups were closed is not stated in the published papers; the fixed 20-session sequence suggests they were [uncertain].

Two parts [source: Thomaes et al., 2015]:

  • Part 1, psychoeducation and emotion regulation (about sessions 1–10). Goals: understand symptoms as survival strategies; record triggers; use temporary deliberate avoidance to restart daily life; learn skills to tolerate distress; make a crisis plan.
  • Part 2, cognitive therapy (about sessions 11–20). Goals: work on beliefs about self-image, relationships, the world and the future, through the themes of anger, mistrust, guilt and shame, assertiveness, the body and sexuality; then end the group.
SessionTheme (developers' table, translated)
1Complex PTSD: psychology and biology
2"Safe" sleep
3Dissociation and re-experiencing (flashbacks)
4–5Recognising emotions; introduction to the cognitive model
6–9Skills and CBT techniques: distraction, self-care and self-soothing, relaxation, self-image
10Making a crisis plan
11–12Cognitive techniques: false beliefs and thinking errors
13Anger: skills and cognitive techniques
14, 16, 18Assertiveness, body experience, sexuality
15Mistrust: skills and cognitive techniques
17Guilt and shame: skills and cognitive techniques
19–20Saying goodbye and future plans

[source: Thomaes et al., 2015, Table 1; it lists Meichenbaum 1994, Matsakis 1994/1996, Linehan 1993, McKay 1987/2003, Bouma 1999, Korsten 2004 and the authors' own material as the session sources.] The developers say they added sessions 14–19 to the Zlotnick-based protocol to cover all complex PTSD symptom domains. They describe sessions 11–20 as cognitive restructuring on anger, assertiveness, bodily experiences, shame, guilt and distrust [source: Dorrepaal et al., 2013]. The 2016 method description gives a session-by-session order: 1 complex PTSD; 2 sleep problems; 3 dissociation; 4 emotions; 5 the G-schema; 6 skills 1, distraction; 7 skills 2, self-soothing and self-care; 8 skills 3, relaxation, acceptance and rest; 9 skills 4, safety and self-trust; 10 crisis plan; 11 false beliefs; 12 distorted thoughts; 13 anger; 14 assertiveness 1; 15 guilt and shame; 16 assertiveness 2; 17 building trust; 18 assertiveness 3 and body experience; 19 farewell and the future; 20 farewell and moving on. It lists no separate sexuality session [source: Movisie 2016]. Section 4 below keeps the 2015 table's grouping and notes the 2016 placement under each item; follow the manual edition you hold.

Who it was developed with [source: Thomaes et al., 2015]:

  • Mostly women abused sexually and/or physically in childhood, usually by a parent or step-parent.
  • About 75% had a personality disorder, mostly borderline or cluster C.
  • Often low education, unemployment, heavy medication use and several earlier treatments.
  • The group was first tried with 11 patients, then in an open pilot (n=36) at four Dutch mental-health institutions, then in an RCT (n=71).

Criteria for entry.

  • Assess for the complex PTSD features before starting: emotion-regulation problems, dissociation, disturbed self-image, interpersonal problems, somatisation and problems of meaning. This avoids teaching skills the client already has [source: Dorrepaal et al., 2017].
  • Indications:
    • PTSD clients who drop out of, or cannot enter, exposure-based treatment because of complexity or comorbidity;
    • complex PTSD clients with personality disorders, as preparation for first-line trauma treatment [source: Thomaes et al., 2015].
  • For less severe presentations, the developers report good clinical experience with a tailored selection of sessions delivered individually, with optional reading and e-health homework [source: Dorrepaal et al., 2017].
  • Relatively well-adapted clients may not need long stabilisation and can move to exposure earlier [source: Thomaes et al., 2015].
  • Trial criteria [source: Dorrepaal et al., 2013]. The RCT included women who had been sexually and/or physically abused before age 16 and who met DSM-IV PTSD criteria and complex PTSD criteria (SIDES interview). It excluded antisocial personality disorder, a current psychotic episode, dissociative identity disorder, severe alcohol or drug dependence likely to interfere with attendance, and patients in or seeking exposure treatment. For DID, see the Boon et al. skills-group variant in section 1. Consider also deferring the group for [synthesis]:
    • acute psychosis;
    • acute suicidality that needs a higher level of care;
    • substance dependence that needs detoxification first;
    • no individual clinician available for crises [synthesis].

Moving on after the group.

  • In the pilot, 64% no longer met complex PTSD criteria after treatment (78% at six months). The developers report that exposure or another processing treatment was often possible afterwards. A subgroup no longer met PTSD criteria and may need no further PTSD treatment [source: Thomaes et al., 2015].
  • For clients with high dissociation or personality pathology, the developers think combining emotion-regulation training with exposure may fit [source: Thomaes et al., 2015].
  • The sources give no explicit readiness checklist. Working criteria for referring on to processing [synthesis]:
    • the client can name and use at least two regulation skills under moderate distress;
    • a crisis plan exists and has been used;
    • self-harm and suicidal crises have become manageable;
    • daily structure and sleep are reasonably stable;
    • the client chooses trauma processing.
  • After the group, reassess with the same measures used at intake. Do not extend stabilisation without a reason you can state [synthesis].

3. Guiding principles

  • Phase-oriented. Stabilise before you process, and treat stabilisation as preparation for processing, not a replacement for it. In practice: plan from the start what comes after the group [source: Thomaes et al., 2015; Dorrepaal et al., 2015].
  • Trauma-informed, not trauma-focused. Trauma history is asked about at intake, but going into trauma details is left for a later phase. In practice: in group, members talk about how the past affects them now, not about what happened [source: Thomaes et al., 2015].
  • Symptoms as survival strategies. Every symptom is presented as something that once made sense. In practice: link each symptom to the job it did during the abuse before you try to change it [source: Thomaes et al., 2015].
  • Understanding comes first ("cognitive grip"). Psychoeducation comes before skills. In practice: open each theme with a short explanation [source: Thomaes et al., 2015].
  • Avoid on purpose, then tolerate. Temporary deliberate avoidance of triggers is a step towards restarting daily life, not the goal. In practice: plan when each avoided trigger will be faced again with skills [source: Thomaes et al., 2015].
  • Skills reduce the need for avoidance. Skills mainly from DBT are for tolerating pain, fear and sadness. In practice: practise skills in session, not only explain them [source: Thomaes et al., 2015].
  • Skills first, then beliefs. Cognitive work on self, others, world and future comes in the second half. In practice: do not challenge core beliefs before members can regulate the distress this stirs up [source: Thomaes et al., 2015].
  • Group plus individual contact. In practice: each member keeps an individual clinician for crises and for applying what they learn [source: Dorrepaal et al., 2017].
  • Assess, then match the dose. Indication depends on documented complex PTSD features. In practice: offer a full group for severe presentations, a tailored individual selection for milder ones, and direct trauma processing for well-adapted clients [source: Dorrepaal et al., 2017; Thomaes et al., 2015].
  • Enough dose. In practice: do not shorten the programme to a few sessions [source: Dorrepaal et al., 2017].
  • Personality pathology is not a reason to exclude. In the trial data, clients with personality disorders dropped out less and improved more. In practice: do not screen out borderline clients by default [source: EJPT 2013 abstract; Thomaes et al., 2015].
  • Predictable structure. The manual is scripted session by session, with weekly topics, skills training, assignments and homework pages [source: Dorrepaal et al., 2013]. In practice: every session follows the same shape: an agenda, discussion of last week's homework, a new talk (usually with a plenary exercise) and a preview of the next homework [source: Movisie 2016]. Leaders act mainly as teachers: they pass on knowledge, show interest, motivate, and link the material to daily life [source: Movisie 2016].
  • Transparency and choice. In practice: explain each exercise and let members opt out of any exercise, especially body-based ones [synthesis].

4. Intervention inventory

Sourcing note. The session themes, their order and the Part 1 mechanisms (survival-strategy reframe, trigger registration, temporary deliberate avoidance, Linehan-derived skills, cognitive work on self, others, world and future) come from the developers [source: Thomaes et al., 2015]. Each session's plenary exercise and homework come from the developers' 2016 method description and are tagged [source: Movisie 2016]. The manual's own step-by-step session scripts and worksheets are not publicly available [uncertain], so the "Steps" lists below are the writer's synthesis of standard CBT and DBT-informed practice for that theme unless tagged otherwise [synthesis]. All example wording is illustrative.

0. Group frame: a trauma-informed group, not a trauma-focused one

  • Purpose: Keep the group safe for members with severe comorbidity. Trauma details are left for a later phase [source: Thomaes et al., 2015 on deferring trauma details]. The method description sets these group rules: what is said in the course is confidential; traumatic experiences are explicitly not discussed in the group (details belong with the individual therapist and later phase-2 treatment); contact between members outside the course is discouraged; crises and self-harm urges are taken to the individual therapist, not the group. Leaders keep time and limit members who take up too much space, and first ask what members have already tried before inviting other members' solutions [source: Movisie 2016]. Other steps below are [synthesis].
  • Steps:
    1. At the individual intake, take a brief trauma history (what kind, at what age, by whom), not a detailed account.
    2. In session 1, agree the rules:
      • keep what members say confidential;
      • talk about how the past affects you now, not what happened;
      • anyone may step out to use a skill, and a therapist will follow up;
      • contact between members outside the course is discouraged [source: Movisie 2016];
      • in a crisis, use your crisis plan and individual clinician, not other members.
    3. When a member starts describing abuse details, gently stop them, validate, and steer back to the present-day effect.
    4. Keep the same session shape every week: agenda, review of last week's homework, new theme as a short talk with a plenary exercise, preview of the next homework [source: Movisie 2016]. Report any unannounced absence to the member's individual therapist [source: Movisie 2016].
  • Example language (illustrative): "What happened to you matters, and there will be a place to work on it. In this group we look at how it affects you now and what helps you cope with that. Can you tell us what you notice in yourself right now?"
  • Watch for:
    • members getting triggered by another member's story;
    • one member dominating the time;
    • others staying silent because they fear exposure.
    • It is working when members can talk about current effects without flooding, and check-ins stay short.

1. Psychoeducation: complex PTSD, its psychology and biology (session 1)

  • Purpose: Give members a shared explanation of their symptoms. This is the first session theme [source: Thomaes et al., 2015]. The method description covers trauma, the stress response, PTSD and complex PTSD and how triggers set off symptoms; the plenary exercise is a senses exercise for orienting in the here and now (also on the course CD); homework is a week's log of symptoms and triggers, the basis for the later CBT work [source: Movisie 2016].
  • Steps [synthesis]:
    1. Name the PTSD symptom groups: re-experiencing, avoidance, hyperarousal and negative mood or thinking.
    2. Add the further complex PTSD problem areas the developers list: emotion regulation, dissociation, self-image, relationships, bodily complaints, and meaning [source for the areas: Dorrepaal et al., 2017].
    3. Explain the stress response in plain terms (alarm system, threat-detection set too sensitive). Avoid neuro-jargon.
    4. Ask each member to tick which areas apply to them on a blank list you make yourself.
    5. Normalise: these are common, understandable effects of long-term childhood abuse.
  • Example language (illustrative): "Your alarm system learned early that the world was dangerous. It still goes off quickly, even now that you are safer. That isn't weakness; it is a system that learned well."
  • Watch for:
    • shame ("so I'm damaged") or fatalism ("my brain is broken"). Answer that alarm systems can retrain.
    • It is working when members can name their own symptom areas in their own words.

2. Reframing symptoms as survival strategies (throughout Part 1)

  • Purpose: Present each symptom as a strategy that once helped the person survive the abuse, to give cognitive grip [source: Thomaes et al., 2015].
  • Steps [synthesis]:
    1. Pick one symptom the member brings, for example dissociation, distrust, numbing or self-harm.
    2. Ask: "Back then, what did this protect you from?"
    3. Ask: "What does it cost you now?"
    4. Write a two-column board in the group: then-function versus now-cost.
    5. Frame the aim as "keep the protection, find a strategy that costs less."
  • Example language (illustrative): "Going numb meant you didn't have to feel what was being done to you. That was clever. Now it also switches off the good moments. We are looking for something that protects you without costing so much."
  • Watch for:
    • The reframe heard as justifying harmful behaviour. Stress both columns.
    • It is working when members spontaneously say "that's my old survival mode".

3. Registering symptoms and triggers (Part 1)

  • Purpose: Find the situations and triggers that set off symptoms [source: Thomaes et al., 2015]. In the method description this starts as the session 1 homework, a log of symptoms and triggers [source: Movisie 2016].
  • Steps [synthesis]:
    1. Give a simple daily log with columns for date and time, situation, trigger (sight, sound, smell, person, body sensation, date), symptom, intensity 0–10, and what the member did.
    2. Practise one entry together in session using a recent mild example.
    3. Set daily logging as home practice.
    4. At the next session, look for patterns: recurring triggers, times of day, people.
  • Example language (illustrative): "We want to become detectives of your own reactions. Every time you notice a jump in tension, a flashback or spacing out, write down what was happening just before."
  • Watch for:
    • Logging that turns into writing out memories. Keep entries short and in the present.
    • Non-completion from shame or overwhelm. Allow one entry a day.
    • It is working when members can predict some of their triggers.

4. Deliberate temporary avoidance to restart daily life (Part 1)

  • Purpose: First avoid identified triggers on purpose, so daily activities and contacts can start again. Later, skills replace the avoidance [source: Thomaes et al., 2015].
  • Steps [synthesis]:
    1. From the log, list the triggers that most disrupt daily life.
    2. For each, decide together whether it can reasonably be avoided or reduced for now (a TV programme, a route, a particular contact), and how.
    3. Use the freed capacity to plan one small daily activity or contact to restart.
    4. Write down a review date for each avoided trigger, when it will be approached again with skills (from sessions 6–9 on).
  • Example language (illustrative): "For the coming weeks it's fine to steer around this on purpose. That frees up energy for getting your days going again. We'll come back to it once you have more tools."
  • Watch for:
    • Avoidance spreading or becoming permanent. Check the review dates.
    • Avoiding things that are needed, such as medical care or the children's school.
    • It is working when daily activity goes up while overall distress stays the same or falls.

5. "Safe" sleep (session 2)

  • Purpose: Address the sleep problems and night-time fears common after abuse; this is the session 2 theme [source: Thomaes et al., 2015]. The method description covers how trauma affects sleep and how to improve it (removing or coping with triggers, healthy habits); homework is a "safe sleeping plan" and a sleep log [source: Movisie 2016]. The detailed content below is [synthesis].
  • Steps:
    1. Explain how hyperarousal and night-time triggers (darkness, bed, footsteps) disturb sleep.
    2. Each member reviews their own sleep habits: regular times, caffeine and alcohol, screens, and using the bed for worrying.
    3. Build a personal safety routine for the bedroom, chosen by the member: a light on, a lock checked, a comforting object, a door position, a grounding object by the bed.
    4. Plan what to do after a nightmare: sit up, lights on, orient to date and place, a soothing activity, return to bed when calmer.
    5. Home practice: one change for one week.
  • Example language (illustrative): "Your body may still treat night as the dangerous time. Let's make your bedroom tell your body, as clearly as possible, that it is now safe."
  • Watch for:
    • Sleep medication or substance use. Refer questions to the prescriber.
    • Night-time self-harm. Link this to the crisis plan.
    • It is working when members feel safer settling in, recover faster after nightmares, and sleep more regularly.

6. Dissociation and re-experiencing: psychoeducation and grounding (session 3)

  • Purpose: Explain dissociation and flashbacks and give ways to come back to the present. This is the session 3 theme [source: Thomaes et al., 2015]. The method description covers how dissociation arises, its triggers and consequences, with practice of grounding techniques including a clenched-fist exercise; homework is a dissociation log, a step towards the G-schema [source: Movisie 2016]. In the developers' data, clients with the most severe dissociation benefited as much as others [source: Thomaes et al., 2015]. The other grounding steps are [synthesis].
  • Steps:
    1. Describe the range: spacing out, feeling unreal, losing time, flashbacks that feel like the past happening now.
    2. Link it to survival: dissociation protected the person when escape was impossible.
    3. Teach grounding:
      • name five things you see, four you hear, three you can touch;
      • press your feet into the floor;
      • hold something cold or strongly scented;
      • say the date, place and your age aloud.
    4. Each member picks two grounding methods and practises them in the group.
    5. Agree a signal a member can give, or that the therapist may use, when they notice someone drifting off.
    6. Home practice: use grounding at the first sign of drifting, and log it.
  • Example language (illustrative): "Feel the chair under you. Look around and tell me three things you can see in this room. What is today's date? You are here, in this room, now."
  • Watch for:
    • Members dissociating during this very session. Use it as live practice.
    • Signs of a dissociative disorder (amnesia for daily life, being told of things you don't remember doing). Refer for specialist assessment [synthesis].
    • It is working when members come back faster and catch the early signs.

7. Recognising emotions (sessions 4–5)

  • Purpose: Build the ability to notice, name and tell apart emotions, the basis for regulating them [source: Thomaes et al., 2015 for the theme; Linehan 1993 is cited as the main skills source]. In the method description this is session 4: four basic emotions (in Dutch the "4 B's": angry, afraid, glad, sad), how trauma affects emotions, and an exercise in tuning in to one's feelings; homework is a feelings log and writing down healthy views of emotions [source: Movisie 2016].
  • Steps [synthesis]:
    1. Teach the parts of an emotion: trigger, body sensation, thought, urge to act, and action.
    2. Map basic emotions (fear, anger, sadness, shame, guilt, joy) to where each is felt in the body.
    3. Practise in session with a recent mild example from each member's log.
    4. Introduce a 0–10 intensity rating.
    5. Home practice: add an emotion name and intensity to the daily log.
  • Example language (illustrative): "Before we can change a feeling, we need to know which one it is. Where in your body did you notice it? What did it make you want to do?"
  • Watch for:
    • Alexithymia ("I just feel bad"). Start from body sensations.
    • Fear that feeling anything will flood the person. Use low-intensity examples.
    • It is working when members use more specific emotion words.

8. Introducing the cognitive model (sessions 4–5)

  • Purpose: Lay the groundwork for Part 2 by linking situation, thought, emotion and behaviour [source: Thomaes et al., 2015 for the theme]. In the method description this is session 5, the G-schema: five Dutch G-words for event, thoughts, feelings, behaviour and consequence, practised in plenary; homework is completing G-schemas for the member's own events. The G-schema is extended in later cognitive sessions [source: Movisie 2016].
  • Steps [synthesis]:
    1. Draw the situation → thought → feeling → behaviour sequence using a neutral example.
    2. Then use one member's mild logged example.
    3. Show how the same situation can lead to different feelings through different interpretations.
    4. Add a "thought" column to the daily log.
  • Example language (illustrative): "Someone doesn't greet you. If you think 'they didn't see me', you feel little. If you think 'they despise me', you feel ashamed. The situation is the same; the thought makes the difference."
  • Watch for:
    • Members hearing "your thoughts are wrong" as blame. Frame thoughts as learned, not chosen.
    • It is working when members can catch an automatic thought.

9. Distraction (sessions 6–9)

  • Purpose: A short-term distress-tolerance skill to get through peaks of emotion without harmful behaviour [source: Thomaes et al., 2015 for the theme; Linehan 1993 cited]. In the method description this is session 6: learning to postpone emotions, with distraction skills organised under the acronym VAARDIG (spelled out in the workbook); homework is skills practice [source: Movisie 2016].
  • Steps [synthesis]:
    1. Explain that distraction is for riding out a peak, not for permanent avoidance.
    2. Each member brainstorms a personal list across categories:
      • activity;
      • attention tasks, such as counting backwards or naming things by category;
      • contributing or helping;
      • strong but safe sensations;
      • leaving the situation.
    3. Rehearse one item in session after a brief, mild emotion induction such as recalling a minor irritation (not trauma).
    4. Put the list on a card or phone.
    5. Home practice: use it at least twice and log the intensity before and after.
  • Example language (illustrative): "When the wave is at its highest, the aim isn't to solve anything. The aim is to get through the next ten minutes without making things worse."
  • Watch for:
    • Distraction becoming chronic avoidance.
    • Risky "distractions" such as substances or bingeing.
    • It is working when the intensity at the peak drops and harmful actions become less frequent.

10. Self-care and self-soothing (sessions 6–9)

  • Purpose: Build kind, caring behaviour towards oneself that abuse often prevented, and soothing through the senses [source: Thomaes et al., 2015 for the theme; Linehan 1993 cited]. The method description places self-soothing and self-care in session 7, with skills practice as homework [source: Movisie 2016].
  • Steps [synthesis]:
    1. Review basic self-care: eating regularly, rest, hygiene, medical and dental care, and movement. Set no numeric targets.
    2. Each member picks one neglected area and one small step.
    3. Self-soothing: build a soothing kit with one item for each sense.
    4. Try one item in session.
    5. Explore the belief "I don't deserve care" briefly; it comes back in Part 2.
  • Example language (illustrative): "Maybe nobody looked after you when you were small. Today we look at how you can begin to do that for yourself, in small steps."
  • Watch for:
    • Guilt or shame when receiving care, and soothing that triggers memories (some scents, some touch). Let members choose freely.
    • It is working when self-care steps are kept up and members report using the kit.

11. Relaxation (sessions 6–9)

  • Purpose: Lower baseline arousal [source: Thomaes et al., 2015 for the theme]. The method description places relaxation, acceptance and finding rest in session 8, with a plenary muscle tension-and-release exercise (also on the CD) [source: Movisie 2016]. The method below is [synthesis].
  • Steps:
    1. Explain that relaxation can feel unsafe at first for trauma survivors. Lowering vigilance may feel dangerous.
    2. Offer choices: slow breathing with a longer out-breath, progressive muscle relaxation, or a safe-place image. Members keep their eyes open if they prefer.
    3. Keep the first practice short (3–5 minutes), with the therapist's voice present.
    4. End with orientation to the room.
    5. Home practice: once daily, briefly, and log the effect.
  • Example language (illustrative): "You can keep your eyes open and look at a spot on the floor. Breathe in normally, and let the breath out a little more slowly than usual. If anything feels uncomfortable, stop and look around the room."
  • Watch for:
    • Relaxation-induced anxiety or dissociation. Shorten the exercise, keep eyes open, switch to active grounding.
    • It is working when members report lower tension after practice.

12. Self-image (sessions 6–9)

  • Purpose: Begin work on the negative self-image linked to childhood abuse. This is continued in the Part 2 cognitive work on self-image [source: Thomaes et al., 2015]. The 2016 method description names session 9 "safety and trust in yourself", with a plenary imagery exercise and an anchor exercise (also on the CD) and skills practice as homework [source: Movisie 2016].
  • Steps [synthesis]:
    1. Ask members to write the words they use about themselves.
    2. Explore where each came from: whose voice is it?
    3. Start a positive-data log of one small thing a day that contradicts the negative view, however minor.
    4. Have group members give each other specific, observed positives, framed by the therapist.
  • Example language (illustrative): "When you call yourself worthless, whose voice does that sound like? Let's write down this week what you actually did, not what that voice says about you."
  • Watch for:
    • Rejecting positive feedback, or feeling unsafe when praised. Keep feedback small and factual.
    • It is working when members can note contradicting evidence without dismissing it.

13. Crisis plan (session 10)

  • Purpose: A written, personal plan for crises; this is the session 10 theme [source: Thomaes et al., 2015]. The method description gives ten rules for making and putting into use a personal crisis plan; members start the plan in plenary and finish it as homework [source: Movisie 2016]. The structure below follows standard safety-planning practice [synthesis].
  • Steps:
    1. Each member writes:
      • early warning signs;
      • triggers from the log;
      • their own skills in order (grounding, distraction, soothing);
      • people and places that help;
      • their individual clinician's contact details;
      • out-of-hours crisis services and emergency numbers.
    2. Add steps for making the environment safer. This means storing or removing things that could be used for self-harm, agreed with the individual clinician.
    3. Share the plan with the individual clinician (with consent) and, where wanted, with a trusted person.
    4. Rehearse the plan by walking through a recent near-crisis.
  • Example language (illustrative): "Let's make the plan now, while you're calm, so that in a crisis you don't have to think. Step one is what you notice first."
  • Watch for:
    • Plans that rely only on group members.
    • Current suicidal intent. Assess risk now with the individual clinician using standard practice; do not leave it for the group.
    • It is working when members use the plan in real crises and crises become shorter.

14. False beliefs and thinking errors (sessions 11–12)

  • Purpose: Begin the cognitive therapy of Part 2. Members identify and test distorted beliefs about self, others, world and future [source: Thomaes et al., 2015]. In the method description session 11 covers false beliefs and session 12 distorted ("crooked") thoughts: for each, how thoughts shape feelings and behaviour, where these come from, their drawbacks, ten types, and how to challenge and refute them; homework extends the G-schema and keeps a diary of positive or rational thoughts [source: Movisie 2016]. The developers note overlap with cognitive processing therapy (Resick et al., 2008) [source: Thomaes et al., 2015]. The steps are [synthesis].
  • Steps:
    1. Teach common thinking errors with everyday examples: all-or-nothing, overgeneralising, mind-reading, personalising, catastrophising, "should" statements.
    2. Members label the thinking errors in thoughts from their own logs.
    3. Use a thought record with these columns: situation, emotion and intensity, automatic thought, evidence for, evidence against, a balanced alternative, emotion re-rated.
    4. Work one member's example on the board as a group, with the member's consent.
    5. Home practice: two thought records.
    6. Find the trauma-linked themes that recur across records (safety, trust, control, worth, intimacy). Parking them on a list is a [synthesis] borrowing from the CPT overlap the developers note.
  • Example language (illustrative): "What's the evidence that everyone can see you're worthless? And what would you say to a friend in this situation?"
  • Watch for:
    • Challenging beliefs too fast, which can feel like being disbelieved again. Validate first.
    • Beliefs that are realistic (some people really are unsafe). Check accuracy and do not argue for optimism.
    • Thought records that slide into trauma narratives.
    • It is working when members produce alternatives they actually find believable and the re-rated emotion is lower.

15. Anger (session 13)

  • Purpose: Regulate anger, which may be explosive or suppressed, using skills and cognitive techniques [source: Thomaes et al., 2015]. The method description covers where anger comes from and recognising its early signs; homework is making a time-out contract, a G-schema, and applying learned skills to anger [source: Movisie 2016]. The steps are [synthesis].
  • Steps:
    1. Normalise anger as a signal of being violated. Separate the feeling from the behaviour.
    2. Map each member's anger pattern: triggers, body signs, escalation, and what they do (explode, turn it on themselves, shut down).
    3. Skills:
      • timeout: leave, calm down with a skill, return;
      • cooling the body;
      • paced breathing.
    4. Cognitive work on "hot" thoughts ("they did it deliberately", "I must not be angry").
    5. Practise saying an angry feeling in a non-aggressive sentence (links to assertiveness).
    6. Home practice: log anger episodes and a skill used.
  • Example language (illustrative): "Anger tells you that something crossed a line. The question isn't whether you may be angry, but what you then do with it."
  • Watch for:
    • Anger turned against the self (self-harm, self-hatred).
    • Anger inside the group directed at members or therapists. Use it as live practice, safely.
    • Clients who suppress anger feeling frightened by the topic.
    • It is working when outbursts or self-directed anger decrease and members can name anger early.

16. Assertiveness (one of sessions 14, 16, 18)

  • Purpose: Practise setting boundaries and stating needs, often impossible in an abusive childhood [source: Thomaes et al., 2015 for the theme]. The method description spreads assertiveness over sessions 14, 16 and 18: first its aims (reaching the goal, keeping the relationship good, self-respect) with an exercise called "up to here and no further"; then guidelines for assertive behaviour practised in role-play; then assertiveness in relation to body experience. Homework each time is an assertiveness diary [source: Movisie 2016]. The steps are [synthesis].
  • Steps:
    1. Explain passive, aggressive and assertive styles.
    2. Find beliefs that block assertiveness ("my needs don't count", "if I say no they'll leave").
    3. Teach a simple structure: describe the situation factually, say how you feel, ask for something specific, state the positive consequence.
    4. Role-play in pairs or with a therapist, starting with low-stakes scenarios (returning an item to a shop, declining an extra task).
    5. Give feedback on posture, voice and eye contact.
    6. Home practice: one small assertive act.
  • Example language (illustrative): "Let's try a small one first. You want to say no to your neighbour's request. Say what you'd like to say. The rest of us will notice what goes well."
  • Watch for:
    • Role-plays that resemble the abuser or the abuse situation. Avoid these.
    • Planned confrontations with perpetrators. Do not set these as homework in this phase [synthesis].
    • It is working when members report small real-life boundary-setting.

17. Body experience (one of sessions 14, 16, 18)

  • Purpose: Address a disturbed relationship with one's own body after physical and sexual abuse [source: Thomaes et al., 2015 for the theme]. The method description pairs body experience with the third assertiveness session (session 18) [source: Movisie 2016]. The steps are [synthesis].
  • Steps:
    1. Explore, in words only, how members relate to their body: neglect, disgust, numbness, feeling it is not theirs.
    2. Link this to survival (disconnecting from the body during abuse).
    3. Offer optional, gentle body-awareness: noticing feet on the floor, hands, the breath, with eyes open and full permission to stop. Never touch.
    4. Make one body-kind self-care choice (warmth, comfortable clothes, a chosen movement). Set no weight or exercise targets.
    5. Pick up the cognitive theme ("my body is dirty").
  • Example language (illustrative): "Just notice your feet on the floor for a moment, nothing more. If that's unpleasant, you can stop and look around the room. Whatever you notice is fine."
  • Watch for:
    • Dissociation or flashbacks set off by body focus. Return to external grounding.
    • Eating-disorder or somatisation features. Refer for appropriate assessment.
    • It is working when members tolerate brief, chosen body awareness and treat the body more kindly.

18. Mistrust (session 15)

  • Purpose: Work on generalised mistrust of others, using skills and cognitive techniques [source: Thomaes et al., 2015]. The method description places "building trust" in session 17: where mistrust comes from and trying out trust, with a G-schema and skills applied to mistrust as homework [source: Movisie 2016]. The steps are [synthesis].
  • Steps:
    1. Validate mistrust as protection learned from being betrayed by caregivers.
    2. Use a trust scale: trust as a range, not all-or-nothing. Members place different people on it.
    3. Gather evidence: how does a person show they are trustworthy over time?
    4. Plan small, safe tests of trust.
    5. Reflect on trust within the group itself.
  • Example language (illustrative): "Not trusting kept you safe. The question now is whether you can learn to trust in steps: a little with someone who has earned a little."
  • Watch for:
    • Mistrust of the therapists or the group surfacing here. Welcome it and explore it openly.
    • Naive over-trusting and re-victimisation risk. Both ends of the scale matter.
    • It is working when members make more nuanced judgements of trust.

19. Sexuality (one of sessions 14, 16, 18)

  • Purpose: Address the effects of abuse on sexuality and intimacy [source: Thomaes et al., 2015 for the theme]. The 2016 method description lists no separate sexuality session [source: Movisie 2016], so check whether your manual edition includes it. The steps are [synthesis].
  • Steps:
    1. Announce the topic the week before and confirm that members can choose how much to say.
    2. Give psychoeducation in general terms about common effects: avoidance, numbing, flashbacks during intimacy, compulsive or risky sexual behaviour, shame.
    3. Talk about the right to say no, to stop, and to set pace.
    4. Work cognitively on beliefs ("I'm only worth something sexually", "sex is dirty").
    5. Suggest how to talk with a partner about triggers and boundaries.
    6. Members may write rather than speak.
  • Example language (illustrative): "Many people who were abused notice that intimacy brings up old feelings. You don't have to say anything personal today. Just notice what applies to you."
  • Watch for:
    • High shame and dissociation in session.
    • Disclosures of current sexual violence or exploitation. Follow safeguarding procedures.
    • It is working when members can name a boundary they want to keep.

20. Guilt and shame (session 17)

  • Purpose: Address misplaced guilt and pervasive shame about the abuse, using skills and cognitive techniques [source: Thomaes et al., 2015]. The method description places guilt and shame in session 15, with a G-schema and skills applied to guilt and shame as homework [source: Movisie 2016]. The steps are [synthesis].
  • Steps:
    1. Separate guilt (about an act) from shame (about the whole self).
    2. Find guilt-related beliefs ("I should have stopped it", "I went along with it").
    3. Use cognitive tools:
      • the responsibility pie: list everyone and everything involved and assign shares;
      • the child-perspective question: what would you say to another child of that age?
      • hindsight bias: you now know what you could not have known then.
    4. For shame: counter it with being seen and accepted in the group, and with self-compassionate statements.
    5. Home practice: a letter of understanding to oneself (not about trauma details).
  • Example language (illustrative): "If a girl of eight in your class went through this, how much would you blame her? Why does a different rule apply to you?"
  • Watch for:
    • Responsibility work drifting into recounting the events. Keep it at the level of meaning.
    • Real guilt about adult actions. Acknowledge it and repair where possible; do not explain it away.
    • It is working when members state less self-blame and more often show self-compassion.

21. Saying goodbye and future plans (sessions 19–20)

  • Purpose: End the group carefully and plan the next steps [source: Thomaes et al., 2015 for the theme]. In the method description session 19 covers why a good goodbye matters and future goals (homework: work them out further); session 20 is a group review of positive and negative experiences and of each member's future goals; two follow-up meetings, at three and six months, revisit goals and experiences [source: Movisie 2016]. The steps are [synthesis].
  • Steps:
    1. Each member reviews their log and measures: what has changed, and which skills worked.
    2. Write a personal maintenance plan: skills to keep up, warning signs, the updated crisis plan.
    3. Discuss what comes next with the individual clinician: trauma processing (exposure or EMDR), continued skills work, or no further trauma treatment [source for these options: Thomaes et al., 2015].
    4. Name feelings about the ending, which can echo earlier abandonment.
    5. Close with a goodbye round in which each member gives every other member one specific wish or observation.
  • Example language (illustrative): "Endings can bring up old losses. Let's take time to say goodbye properly. What will you take with you from this group?"
  • Watch for:
    • Crises timed around the ending.
    • Members feeling dropped. Confirm the individual follow-up is in place before the last session.
    • It is working when each member leaves with a written plan and an agreed next step.

22. Individually delivered, tailored selection of sessions

  • Purpose: For less severe presentations, the developers report good clinical experience with delivering a selection of Vroeger en verder sessions individually. This can optionally be blended with reading and e-health homework [source: Dorrepaal et al., 2017].
  • Steps [synthesis]:
    1. Assess which complex PTSD areas are affected.
    2. Select only the matching modules, for example emotion recognition, crisis plan, and guilt and shame.
    3. Deliver them in individual sessions with workbook-style home reading.
    4. Reassess after each module.
  • Example language (illustrative): "You already manage your emotions well, but shame and trust come up a lot. Let's do those parts together and then look at whether you're ready for trauma treatment."
  • Watch for:
    • Under-dosing severe presentations. The developers caution against very brief stabilisation for complex PTSD [source: Dorrepaal et al., 2017].
    • It is working when the targeted areas improve, measured before and after.

5. Handling problems

Guidance found in the developers' publications

  • Well-adapted clients drop out. In the trial, clients without a personality disorder (mostly relatively well-adapted) dropped out far more often (44%) than those with one (10%). The developers suggest these clients may have felt less at home in the group or did not need long stabilisation [source: Thomaes et al., 2015].
    • Response: assess complex PTSD features before referral, and offer such clients a tailored individual selection of sessions or direct trauma processing [source: Dorrepaal et al., 2017; Thomaes et al., 2015].
  • Personality pathology. Clients with personality disorders, in both "withdrawn" and "aggressive" profiles, stayed in treatment and were equally compliant [source: EJPT 2013 abstract].
    • Response: do not exclude them by default. Plan for both styles (see below).
  • Severe dissociation. In the developers' data, clients with the most severe dissociation benefited as much as others [source: Thomaes et al., 2015]. The RCT did exclude dissociative identity disorder [source: Dorrepaal et al., 2013]. For DID or OSDD, the published group option is the Boon, Steele & van der Hart skills group (section 1). Its trialists suggest approaching dissociative parts more gradually so members are not overwhelmed. They add that some patients may do better with individual stabilisation [source: Bækkelund et al., 2022].
    • Response: dissociation alone is not a reason to exclude. Teach grounding early (session 3) and keep individual contact.
  • Group without individual contact. This was the least effective format [source: Dorrepaal et al., 2017].
    • Response: confirm that an individual clinician is in place before the group starts. If one is missing, defer entry [synthesis].
  • Stabilisation that is too short. A 5-session group training was on average ineffective, with high dropout [source: Dorrepaal et al., 2017].
    • Response: do not shorten the programme drastically. If resources are limited, prefer individual tailored modules to a mini-group.
  • Endless stabilisation. The developers place the group as preparation for exposure or EMDR, and note that the Dutch guideline recommends trauma processing first [source: Thomaes et al., 2015]. There is a published Dutch debate on whether stabilisation is needed at all ("Stabilisatie in traumabehandeling bij complexe PTSS: noodzaak of mythe?") [uncertain].
    • Response: set a review at session 20 and refer on to processing when the readiness criteria in section 2 are met. Do not use the group to postpone processing for clients who could tolerate it [synthesis].
  • Overload from the amount of material. Members can feel flooded by the volume of information [source: Movisie 2016].
    • Response: point out that the material comes back repeatedly, that members can reread it at home in the workbook, and that nobody is expected to master everything at once [source: Movisie 2016].
  • More symptoms early in the course. Some members get more complaints, especially in the first period [source: Movisie 2016].
    • Response: forewarn members and their individual therapists, and present it as a common step on the way to change rather than a sign of failure; full freedom from symptoms by the end of the course is not expected [source: Movisie 2016].
  • Unannounced absence, or concern about a member. [source: Movisie 2016]
    • Response: always report an unannounced absence to the member's individual therapist. If leaders are worried about a member, they ask the member to contact the individual therapist and agree who will follow up [source: Movisie 2016].
  • Crises or self-harm urges raised in the group. [source: Movisie 2016]
    • Response: ask the member to discuss these with their individual therapist rather than in the group; in a crisis, leaders contact the individual therapist themselves [source: Movisie 2016].
  • Reasons for dropout. The developers' 2015 process evaluation (an unpublished internal report summarised in the method description) names poor contact with the individual therapist, feeling unsafe in the group, intense anger at the perpetrator, too little room for self-care and a small or absent support network [source: Movisie 2016].
    • Response: check these at intake and at any sign of withdrawal, starting with the link to the individual therapist [synthesis].

Guidance not given in the published sources (writer's synthesis) [synthesis]

  • A member starts telling trauma details in group. Interrupt warmly and early, validate, and redirect to present effects. Offer the member a brief grounding exercise. Check how the other members are. Afterwards, tell the individual clinician so the story has a place later.
    • Illustrative wording: "I'm going to stop you there, not because it isn't important, but to protect you and the group. What are you feeling right now, and what do you need?"
  • Overwhelm or dissociation during a session.
    • The co-therapist uses grounding with the member: orientation questions, a sensory object, feet on the floor, standing up.
    • Keep the member in the room if possible. If they leave, one therapist goes with them.
    • Before the member leaves the building, check that they are oriented and safe to travel.
    • Review afterwards which early signs were missed.
  • Suicidality or self-harm between sessions. The crisis plan and the individual clinician take the lead. The group therapist assesses risk using current standard practice and informs the individual clinician the same day. Means safety (safe storage or removal) is agreed in the individual setting. Address self-harm in the group as behaviour to understand and replace, without method detail. Agree a rule that members do not describe methods or wounds.
  • Home practice not done. Treat it as information, not failure. Ask what got in the way (shame, chaos, literacy, fear of writing about feelings).
    • Reduce it: one log line a day, voice notes, or pictures instead of writing.
    • Review home practice at the start of every session so it matters.
    • The developers' population often had low education [source for population: Thomaes et al., 2015]; use visual, simple materials.
  • Withdrawn members. Use structured rounds so everyone speaks briefly. Allow passing. Give pair exercises before whole-group sharing. Check privately whether silence means dissociation, shame or mistrust.
  • Aggressive or dominating members. Restate the group rules. Use time limits in rounds. Name the pattern privately first. Use the anger session for live practice. If a member threatens others, stop the session segment and meet with them individually.
  • Conflict or alliances between members. Contact outside the course is discouraged [source: Movisie 2016]; where it happens anyway, discuss it openly. Address scapegoating directly. Draw on the mistrust and assertiveness themes.
  • Comparing traumas ("mine was worse"). Redirect from comparing what happened to the shared present-day effects. All suffering counts.
  • Rupture with the therapists (feeling unheard, controlled or unsafe). Name it, invite feedback, acknowledge your part, and adjust. It is expected given abuse by caregivers, and it offers material for the trust and assertiveness themes.
  • Disclosure of current abuse, or risk to children. Follow local safeguarding and reporting duties. Inform the individual clinician. Safety planning comes before skills work.
  • Substance misuse. Ask about it at intake and in check-ins. Note substance use in the log as a coping strategy. Refer to addiction care where dependence makes participation unsafe.
  • Stuck clients (no change in the log by about session 10). Review in an individual session:
    • Is a skill being practised in real life?
    • Is avoidance growing?
    • Is there an undetected dissociative disorder, ongoing threat or untreated depression?
    • Adjust goals with the individual clinician.
  • Fear of the ending and crises timed around it. Name the ending from session 15 on. Confirm the next step before session 19. Keep the crisis plan active after the group.
  • Group make-up. The RCT included women only [source: Dorrepaal et al., 2013], and the developers' samples were women abused in childhood [source: Thomaes et al., 2015]. Mixed-gender or male groups were not tested in these trials [uncertain]. Decide in advance whether to run single-gender groups. Sexuality and body sessions may need same-gender groups or individual delivery [synthesis].

Sources

Web pages

Also cited

  • Dorrepaal, E., Thomaes, K., & Draijer, N. (2008). Vroeger en verder: Handboek voor cursusleiders and Werkboek voor deelnemers en cursusleiders. Pearson (formerly Harcourt). Publisher and year as given in the 2016 method description; a participant workbook is also listed by a bookseller under ISBN 9789043036184.
  • Dorrepaal, E., et al. (2012). Stabilizing group treatment for complex PTSD related to child abuse based on psychoeducation and cognitive behavioural therapy: a multisite randomized controlled trial. Psychotherapy and Psychosomatics, 81, 217–225.
  • Zlotnick, C., et al. (1997). An affect-management group for women with PTSD and histories of childhood sexual abuse. Journal of Traumatic Stress.
  • Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder and Skills training manual. Guilford.
  • Session sources as listed by Thomaes et al. (2015): Meichenbaum (1994); Matsakis (1994, 1996); McKay (1987, 2003); Bouma (1999); Korsten (2004).
  • Herman, J. L. (1992). Trauma and recovery. Basic Books. Cited for the phase model.
  • Boon, S., Steele, K., & van der Hart, O. (2011). Coping with trauma-related dissociation: Skills training for patients and therapists. W. W. Norton. The manual for the dissociation skills-group variant.
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