Cognitive Behavioural Therapy for PTSD and Complex PTSD:

Module overview:

This module covers the major aspects of PTSD and Complex Trauma, offering participants advanced skills in assessment, formulation, and evidence-based interventions. The participants will understand PTSD in great detail through Anke Ehlers and David Clark's cognitive models, which emphasize distorted appraisals of trauma, memory processing, and maintaining factors like safety behaviors. It also covers challenges of complex traumas such as fragmented memories which include multiple traumatic events, and those related to developmental trauma, as well as emotional dysregulation, and dissociation. In addition, it integrates recent research findings, such as the advances in cognitive-behavioral techniques to improve treatment outcomes.

Through workshops, clinical supervision, and practical exercises, participants will be taught to apply adapted CBT techniques- including trauma-focused CBT, imaginal reliving, and strategies to trauma symptoms. The module covers the most up-to-date research and clinical guidance to equip participants with the knowledge to work with diverse and complex presentations of trauma.

 

Section 1: Post-Traumatic Stress Disorder (PTSD)

Module Content

1.Understanding PTS

Definition and diagnostic criteria (ICD-11/DSM-5).
Core features of PTSD:
Symptoms of re-experiencing, for instance flashbacks, intrusive thoughts.
Avoidance behaviors
Hyperarousal and hypervigilance
Negative alterations in mood and cognition

Epidemiology: prevalence, risk factors, and cultural considerations

2. Anke Ehlers and David Clark's Cognitive Model
Trauma Appraisals:

Discussing distorted appraisals of the trauma, such as "The world is completely dangerous," or "I will never be able to be safe again," which maintain the symptoms of PTSD.
Identify appraisals that interfere with recovery.

Memory Processing:
Understanding of fragmented trauma memories, nature of trauma memory
Address the sense of "nowness" in trauma recollections
Maintaining Factors:
Safety behaviors that prevent disconfirmation of fears.
Rumination and avoidance as barriers to recovery.
Updating Trauma Memories:
Integrating new perspectives into trauma memories to reduce distress.

3. Evidence-Based Interventions for PTSD
Trauma-Focused Cognitive Therapy:

Identifying and challenging unhelpful appraisals.
Updating trauma memories using imaginal reliving and cognitive restructuring.
Imaginal Reliving:
Revisiting the trauma in a safe and controlled way to process emotions and update meanings.
Behavioral Experiments:
Testing predictions to reduce avoidance and hypervigilance.
Grounding and Stabilization:
Distress Management Strategies during Trauma-Focused Interventions

4. Co-Occurring Conditions

How to address symptoms that intersect among depression, generalized anxiety, and substance use.
How to adapt the intervention given multiple diagnoses

 

5. Relapse Prevention ( PTSD)

Strategies to consolidate gains and prevent recurrence of PTSD symptoms.
Encourage client to orient to future directed goals and coping.

 

Section 2: Complex Post-Traumatic Stress Disorder (CPTSD)

1.Understanding Complex and Developmental Trauma

Explore the key features of complex trauma:
Complex Trauma is prolonged and often initiated early in life, consisted of a number of Trauma. Developmental trauma, long-term domestic violence and other traumas will be discussed. 
Emotional dysregulation, disturbed interpersonal relationships, negative self-concept

Differential diagnosis:  ICD-11 Differences between PTSD and Complex PTSD.
Prevalence and impact: High prevalence among survivors of childhood abuse, neglect, and interpersonal trauma.

Addressing Co-Occurring Conditions:

Discuss the overlap between CPTSD and conditions such as depression, generalized anxiety, and substance use.

Learn strategies to adapt interventions for clients with multiple diagnoses, ensuring comprehensive care.

2. Important Considerations for Treatment in Complex Trauma

Timeline of Trauma:

Conceptualizing the effects of repeated traumatic experiences over time.
Adapting interventions to past and current difficulties.

Faded and Fragmented Memories:

Working with partial and vague memories of events.
Techniques for reconstructing timelines and the validation of clients' experiences.

Dissociation:

Understanding the use of dissociation as a protective mechanism.
Strategies for grounding and reducing dissociative symptoms during treatment.

3. Advanced Techniques for Emotional Regulation and Stabilization
Affect Regulation Skills:

Teach the client DBT skills, such as distress tolerance and emotion regulation strategies.
Introduce mindfulness-based stress reduction to help modulate high states of arousal and intrusive thoughts.

Somatic Approaches:

Incorporate somatic experiencing (SE) for trauma stored in the body.
Progressive muscle relaxation, guided imagery, to reconnect the client with the patient physical self.

4. Grounding and Safety-Oriented Strategies
Structured Grounding Practices:

Develop a personal grounding toolkit with sensory-based activities/techniques (i.e., textures, smells, or sounds) and anchoring phrases.

5. Crisis Planning:

Develop with the client a safety plan in managing overwhelming feelings or situations where one may be taken back by dissociation or flashbacks.

6. Memory Work and Trauma Processing
Working with Fragmented and Implicit Memories:

Integrate trauma-focused CBT, TF-CBT, for elaborative processing of the fragmented memories.
Introduce the use of narrative therapy to help clients redevelop their trauma story in a manner that promotes empowerment and meaning-making.

7. Relational and Interpersonal Healing
Attachment-Based Interventions:

Integrate techniques from Emotionally Focused Therapy (EFT) 
Rebuilding Interpersonal Skills:

Role-playing and behavioral rehearsal in developing healthy communication and boundary-setting skills.
Teach the client to identify and withdraw from toxic patterns within relationships.

8. Self-Concept
Self-Compassion Training:

Provide elements of Compassion-Focused Therapy to enable the clients to become free from self-criticism by replacing judgments with self-kindness.
Use guided self-compassion meditation to reinforce positive self-concept.
Integration of Identity:

Fragmented identity will be worked with by using parts work as in IFS to help a client integrate conflictive internal states or "selves."

9. Culturally Sensitive and Individualized Care
Cultural Sensitivity:

Match the intervention to the client's cultural and spiritual background in order to make it relevant and sensitive to them.

Teaching Approach

Workshops: Interactive sessions covering CBT techniques for PTSD and Complex PTSD.

Supervision: Individual and group supervision to refine therapeutic skills.

Case Studies: Practical examples to develop formulation and intervention strategies.

Roleplays: Opportunities to practice skills with feedback.

Assessment

Participants will be assessed through:

Case conceptualization assignments incorporating cognitive models of PTSD and Complex Trauma.

Recordings of therapy sessions demonstrating trauma-focused CBT techniques.

Workshop participation and engaging in roleplays to practice clinical skills.

Recommended Reading and Resources

A comprehensive list of references will be provided in the course handouts and will be shared with participants upon registration.