Working with Complicated and Complex PTSD

Dr Kerry Young

Thursday, 10 February 2022

Introduction

There are well-established protocols for the treatment of PTSD using trauma-focused CBT (TF-CBT) (e.g.  Ehlers et al., 2005). However, there is relatively little information about how to adapt TF-CBT for more complicated and/or Complex PTSD, such as that resulting from multiple traumatic events, or from prolonged exposure to threat, or where dissociation is a key feature of someone’s presentation. Many clinicians are confused about the about whether or not they need to phase-based interventions with this group of clients (e.g. De Jongh et al., 2016.)


The event will be equivalent to 5.1/4hrs of CPD.

Content

In this workshop, I will briefly review what evidence there is for treating more complicated/Complex PTSD presentations. Then, I will suggest a pragmatic clinical pathway for clinicians to follow. This will encompass the following:
• How to assess and formulate more complicated/Complex PTSD
• What to consider and what to do about difficulties with engagement
• What to consider and what to do about difficulties with emotional regulation
• How to understand and manage dissociation in this group
• How to treat complicated/Complex PTSD using Ehlers et al.’s tCT-PTSD (Trauma-focused Cognitive Therapy for PTSD) as a guiding framework
• Finally, how to work with some of the themes common in complicated/Complex PTSD e.g. shame, guilt, loss, contamination

I will assume a working knowledge of the model and treatment protocols for more straightforward PTSD (see Ehlers & Clark, 2000).
I will give out useful patient handouts and examples of scripts for explaining x or y. Thus, I hope that at the end of the day, participants will feel more confident about where to begin when seeing such patients, what sorts of things might genuinely help and where to look for further learning. I really enjoy the work that I do in this area and hope to spread some of that enthusiasm and knowledge to others.

Learning Objectives

1 To understand the literature about how to treat complicated and Complex PTSD
2 To be able to follow a clinical pathway for working with clients with complicated and Complex PTSD
3 To understand how to work with issues common to this client group such as mistrust, emotion dysregulation and dissociation
4 To feel able to ‘flex’ Ehlers and Clark’s (2000) Cognitive Model of PTSD for work with this client group
5 To feel hopeful about starting this work in clinical practice

Training Modalities

Didactic teaching with lots of videos and opportunities to ask questions.

Key References

Arntz, A. (2012) Imagery Rescripting as a therapeutic technique: Review of clinical trials, basic studies and research agenda. Jornal of Experiemental Psychopathology, 3(2), 189-208.
Cloitre, M. (2021) Complex PTSD: assessment and treatment. European Journal of Psychotraumatology, 12:sup1, DOI: 10.1080/20008198.2020.1866423.

De Jongh, A., Resick, P.A. et al. (2016). Critical analysis of the current treatment guidelines for Complex PTSD in Adult. Depression and Anxiety, 00, 1-11.
Ehlers, A. and Murray, H., (2020), Treating Complex Traumatic Stress Disorders in Adults, Second Edition Scientific Foundations and Therapeutic Models: Guilford Press.

Jung, & Steil, R. (2013). A Randomized Controlled Trial on Cognitive Restructuring and Imagery Modification to Reduce the Feeling of Being Contaminated in Adult Survivors of Childhood Sexual Abuse Suffering from Posttraumatic Stress Disorder. Psychotherapy and Psychosomatics, 82, 213–220.
Schauer, M. & Elbert, T. (2010) Dissociation following traumatic stress: Etiology and treatment. Journal of Psychology, 218, 109-127.

About the presenter

Dr Kerry Young is a Consultant Clinical Psychologist and Clinical Lead of the Woodfield Trauma Service in London, UK, a leading centre for the treatment of asylum seekers and refugees suffering from PTSD. She also works at the Oxford Rose Clinic, a service for the medical and psychological treatment of women who have experienced Female Genital Mutilation. She has advised national bodies in the UK on how to train clinicians to work with refugees, PTSD and Complex PTSD. Kerry works with research teams in Oxford University, Sweden, Germany, Iceland and The Netherlands on developing imagery-based interventions for PTSD, Bipolar Disorder and Schizophrenia. She trains nationally and internationally on how to treat PTSD and Complex PTSD.

Who should attend

CBT Therapists, IAPT High Intensity Therapists, Clinical Psychologists.