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Trauma and memory: What every clinician should know

Chris Brewin

28 Sept 2023


Posttraumatic stress disorder (PTSD) affects a minority of people exposed to trauma and can be, unless treated, a debilitating and chronic condition. It has been described as disorder of memory, and is associated with unusual and distressing symptoms such as flashbacks. It is not well recognised in general practice, however, and often remains untreated for long periods. This is sometimes because the person has developed PTSD to an event that is not obviously traumatic, and it is important to understand what conditions and vulnerabilities make PTSD more likely. The condition is associated with two alterations to normal memory that may appear contradictory: increased intrusion of vivid, distressing images of the traumatic event together with difficulty in producing a coherent verbal narrative of the event. The former often leads to avoidance and clinicians need to appreciate the role of triggers. Contrary to popular belief, traumatic events can sometimes be completely forgotten and the recovery of unexpected memories sometimes requires careful handling.

The event will be equivalent to 1.1/2hrs of CPD.


The way PTSD is diagnosed has recently changed with the introduction of the 11th edition of the International Classification of Diseases (ICD-11). The diagnosis of PTSD has been greatly simplified and a distinction has been introduced between PTSD and Complex PTSD. I will outline these changes and the new definition of flashbacks and intrusive memories. I will also present recent research on the kind of events that are associated with ICD-11 PTSD, which are broader than the traditional ones and include some types of experience (harassment, abuse, frightening hallucinations) not traditionally considered traumatic. Following this key memory concepts such as
intrusive memories, flashbacks, and hotspots will be distinguished, along with a discussion of how much they can be expected to reflect external reality. Research indicates that the origin of these intrusions is related to specific responses occurring during the traumatic event. I will describe how these intrusions can be triggered by aspects of the clinical environment as well as by the words and actions of the clinician, with the danger of disengagement from treatment. Clinicians must ensure that they help patients to feel in control of their interactions as much as possible. I will describe the impairments that are often found in traumatic memory, the evidence that traumatic events can be forgotten, and the reasons this may happen. A clinical strategy is described to deal with traumatic memories that are recovered from amnesia, involving the absence of any suggestion and neutrality about to what extent the memories correspond to reality.

Learning Objectives

Participants will be able to distinguish PTSD and Complex PTSD within ICD-11.
Participants will have greater awareness of the possibility of PTSD following events not traditionally regarded as traumatic.
Participants will be able to recognise intrusive memories, flashbacks, and hotspots.
Participants will be equipped for strategies for dealing with memories recovered from total amnesia.

Training Modalities

Presentation with two short Q&A sessions.

Key References

Brewin, C.R. (2014). Episodic memory, perceptual memory, and their interaction: Foundations
for a theory of posttraumatic stress disorder. Psychological Bulletin, 140, 69-97.
Brewin, C.R. (2015). Re-experiencing traumatic events in PTSD: New avenues in research on
intrusive memories and flashbacks. European Journal of Psychotraumatology, 6: 27180. doi:
Brewin, C.R. (2020). Complex posttraumatic stress disorder: A new diagnosis in ICD-11. British
Journal of Psychiatry Advances, 26, 145-152.
Brewin, C.R. & Ehlers, A. (in press). Posttraumatic stress disorder. In M. Kahana & A. Wagner
(eds.), Handbook of human memory: Foundations and applications. Oxford: OUP.
Gold, S.N. & Brown, L.S. (1997). Therapeutic responses to delayed recall: Beyond recovered
memory. Psychotherapy, 34, 182-191.
Raja, S., Hasnain, M., Hoersch, M., Gove-Yin, S. & Rajagopalan, C. (2015). Trauma informed care in
medicine: Current knowledge and future research directions. Family & Community Health, 38,

About the presenter

Chris Brewin is Emeritus Professor of Clinical Psychology at University College London. He is a Fellow of the British Academy and the Academy for Medical Sciences, and in 2013 was awarded the International Society of Traumatic Stress Studies Robert S. Laufer Memorial Award for Outstanding Scientific Achievement. His research has investigated the impact of traumatic events on memory and identity, including phenomena such as flashbacks, delayed onsets, and amnesia, and he was a member of the British Psychological Society’s Working Party on Recovered Memories which reported in 1995. He is particularly associated with the dual representation theory of posttraumatic stress disorder which has been updated to include a contemporary neuroscientific model of spatial memory and imagery. After the London bombings he was centrally involved in designing and implementing a unique outreach programme to ensure survivors had access to evidence-based treatment. He has contributed to recent international changes to the diagnosis of PTSD in DSM-5, and played a major role in the diagnostic formulation of disorders specifically associated with stress in ICD-11.

Who should attend

This webinar is suitable for any health professional who wishes to learn more about the impact of traumatic events on memory and the implications this has for service design, training, and clinical practice.

Low Intensity clinical contact hours survey - BABCP Low Intensity Special Interest Group

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The BACP Low Intensity SIG are interested in the impact of clinical contact hours on Low Intensity/Wellbeing Practitioner wellbeing. This questionnaire contains six multi-choice questions and a free text box for you to share your experiences. The answers to these questions will help the BABCP SIG plan how to meet CPD topics and other developments within the SIG.  The SIG hope to produce a write up of the answers to this questionnaire to be shared with SIG members and to be used in training.

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This FREE conference is for Psychological Wellbeing Practitioners working in Talking Therapies for Anxiety and Depression services and is brought to you by Bespoke Mental Health in collaboration with the NHS England Talking Therapies National PWP Leads Network

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