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“ The dogs howl, but the moon still keeps on shining. ” - German Proverb

Here are a whole series of handouts and questionnaires on intrusive memories, imagery, trauma and PTSD.  They overlap with handouts listed in the "Life review, traumatic memories & therapeutic writing" section of this website.  The "tag cloud" provides links to further relevant information - for example by clicking on tags like "PTSD""trauma" or "imagery".  Also of specific relevance are three posts about Marylene Cloitre's treatment developments for complex PTSD, a post on Emily Holmes's work with imagery, a post on a PTSD lecture by Anke Ehlers, and seven posts on Nick Grey's workshop "Memory-focused approaches in CBT for adults with PTSD".

Flowcharts 1 & 2 (Ehlers & Clark) - here are a couple of Powerpoint slides that - although in colour - print out well in black & white.  I particularly use the second of these slides as a handout when working to process traumatic memories.  I use it to explain the why, what and how of the therapeutic approach we'll use.  I think this orientation is especially important when working with traumatic memories, so that the client understands why they're being asked to re-connect to painful experiences they may well have been trying hard - and in Type I trauma, unsuccessfully - to forget.

The Ehlers & Clark model for cognitive therapy treatment of PTSD involves particular focus on the trauma memory itself and on trauma-associated beliefs. Work on the trauma memory typically involves four methods - imaginal "reliving" or "revisiting", a written account, a "site visit", and discriminating triggers. See April 2012 blog posts for more on this. There is a detailed blog post on reliving/revisiting, a handout making suggestions on how to complete the written account downloadable both as a Word doc and as a PDF file, and more detailed descriptions of site visits & discrimination training.

Written exposure therapy - there are a couple of blog posts about this exciting development in writing treatment for PTSD - "One of the most exciting therapeutic writing studies for years" and "Written exposure therapy: how do you do it?". A handout giving background and describing how to use this form of expressive writing is available both as a PDF file and as a Word doc. I tend to use this handout in conjunction with the excellent one derived from the Ehlers & Clark model (see above). Fascinatingly, this approach is likely to be relevant for work with difficult memories associated with other disorders than formal PTSD e.g. may well be useful for depression, social anxiety disorder, etc.

PTSD diagnostic criteria page 1 & page 2 - these two handouts can be printed out as 2 slides to the page Powerpoint sheets.  They give the full DSM-IV diagnostic criteria.  They can be looked at with a client, if it seems appropriate, to discuss whether they are suffering from full or subsyndromal PTSD.

PTSD assessment & treatment - a useful aide-memoire to guide the therapy sequence for PTSD - put together from a seminar given by Ann Hackmann.

Processing traumatic memories: the factory metaphor - this is a simple one-page handout that can help orientate people when beginning to work on trauma processing.  It is downloadable both as a Word doc and as a PDF file.

Understanding our reactions: self monitoring - this is an assessment form that can be used to self-monitor or to complete within a therapeutic session.  It looks at experiences of strong emotional reactions and asks a series of questions that can clarify the source of the emotion (leading to ideas about appropriate responses). 

Standard questionnaire and Shortened questionnaire for Smucker-style imagery rescripting.  This more therapist-active style of trauma memory"rescripting"intervention may be particularly appropriate when the associated feelings involve emotions like shame, guilt or anger rather than just fear.

Memory, catharsis & health - I gave this 36 slide Powerpoint presentation back in 2004.  It still has much that's currently relevant to these subjects (including some information on therapeutic writing). 

Trauma memories in anxiety & depression - this is a 30 slide Powerpoint presentation I gave in late 2005.  It can still be helpful in highlighting the commoness and probable therapeutic importance of trauma memories in many other conditions besides formal PTSD.  Examples mentioned in the talk include depression, social anxiety disorder, agoraphobia & panic disorder, psychosis, OCD & BDD, and eating disorders.  There is also some data on Smucker's work as well as the key contributions of Ehlers & Clark.  

Smucker's work on trauma processing - here are a couple of slides illustrating points made by Mervyn Smucker at a conference in 2004 about the possible importance of more active rescripting of trauma memories associated with non-fear responses like anger, shame, guilt or mental defeat.  I think the jury is still out on how necessary this active rescripting is, but it does make a welcome therapeutic change sometimes from the straightforward 'reliving' work.

Trauma & PTSD are very common page 1 & page 2 - here are four Powerpoint slides, that I usually print out as a double-sided handout with 2 slides per page.  The slides highlight the commoness of PTSD - to an extent "normalizing" a client's experience. 

IES and scoring details - this is the classic 1979 Horowitz Impact of Event Scale that has been widely used in subsequent research.  A major problem with the scale is that it assesses only Intrusions and Avoidance and does not consider Hyperarousal symptoms.

IES-R - the revised Impact of Event Scale adds in a Hyperarousal assessment to the original IES.  This is the questionnaire recommended by the IAPT initiative.  You can download the scale & scoring information in both PDF and Word formats: IES-R.pdf, IES-R.doc, IES-R.scoring.pdf and IES-R.scoring.doc.  

The Posttraumatic Cognitions Inventory is probably the most widely used trauma beliefs assessment questionnaire.  It is detailed at the end of Foa et al's 1999 paper, which is downloadable in free full text from the Oxford Cognitive Therapy Centre at www.octc.co.uk/files/pdfs/PTCI.pdf.  Here is the questionnaire itself both as a Word doc and as a PDF file.  Another trauma cognitions questionnaire it's worth considering is given in Buck, Kindt, Arntz et al's 2008 paper "Psychometric properties of the Trauma Relevant Assumptions Scale".

PTSD with Pain screen - this is a quick screening questionnaire to help detect PTSD in people suffering with chronic pain disorders.

Intrusive memories assessment - this is a quick intrusive memories assessment scale developed by Professor Chris Brewin.

Posttraumatic growth inventory - this interesting scale was developed by Tedeschi & Calhoun.  They write that they are happy for the scale to be employed for research purposes as long as financial gain does not occur from its use.  See their website at UNC Charlotte for more information & freely downloadable research papers.  You can download the scale itself as either a Word doc or a PDF file.  See too a blog post I have written - "Writing (& speaking) for resilience & wellbeing 3: personal growth" .  The PTGI scale assesses areas where there may have been helpful learning & growth after trauma - for example, new possibilities, deepening of relationships, increased sense of personal strength, appreciation of being alive, and existential or spiritual change.  Clearly it is important to employ this measure sensitively and only when it seems it might be indicated e.g. if the client themself seems open to looking at possible posttraumatic growth.  When I use this scale, it is sometimes as much for its "educational function" in alerting the person to these issues.

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