In this guide, we will discuss the definitions that the authors Ehlers and Clark have about PTSD
Ehlers and Clark PTSD Formulation
Ehlers and Clark’s formulation of PTSD is based on a cognitive model that seeks to explain the persistence of PTSD symptoms while providing a framework in the design of cognitive-behavioural treatment for the disorder.
Ehlers and Clark PTSD Formulation expresses that the pathological response to trauma increases when the individual processes the traumatic event and/or its sequelae in such a way that they cause a sensation of continuous threat and strong emotional reactions. The authors focus their interest in various processes.
In the beginning, the negative evaluation of the trauma and its consequences is given: After exposure to the traumatic event or event, the person tends to generalize every situation that it lives as dangerous.
The person can see daily activities as highly dangerous events, refusing to carry them out.
People who manifest initial reactions to trauma such as intrusive memories, flashbacks, irritability, changes in mood, and lack of concentration, not as normal symptoms of a recovery process, but as a threat to their overall health, will execute coping strategies to control the threat and discomfort it generates.
The next process is how traumatic memory is linked to other autobiographical memories.
The person suffering from PTSD has trouble evoking a total memory of the traumatic event, so it remembers it in a fragmented, disorganized way and with difficulties in the configuration of what happened.
Another event that occurs is the appearance of involuntary memories, where the person is exposed to stimuli that remind him of the traumatic event.
Another focus of interest for Ehlers and Clark PTSD Formulation is the relationship between the nature of trauma memory and the evaluation of trauma.
The authors explain that when a person remembers the traumatic event, they do so based on partial evaluations made of the event.
The selective recovery of memory means that the person does not have an idea about everything that happened.
Remembering specific parts of the event makes the person keep its ideas about what happened, preventing from moving forward in its recovery.
Another relationship is that of cognitive processes and maladaptive behaviours.
The person’s perception of the event will lead to performing maladaptive behaviours.
If the person has an element that was part of the traumatic event, they will remove that element that reminds them of the event.
Take precautions to avoid that element that was part of the trauma.
An important aspect for Ehlers and Clark PTSD Formulation is cognitive processing at the time of the traumatic event.
The authors express that, if the person has thoughts of mental defeat, they will develop negative beliefs that will interfere with the ability to face PTSD, leading to their permanence.
Finally, Ehlers and Clark PTSD Formulation highlights the type of trauma, beliefs and experiences before the traumatic event, where there are factors that influence both the evaluation and its memory.
In trauma, the duration and prediction of the event are two fundamental elements.
The authors express that a person who has experienced a traumatic event during its childhood may have greater problems to face the last event it has been through.
The beliefs that a person may have influenced the confirmation of the event.
Post-traumatic Stress Disorder or PTSD is an anxiety disorder that develops when the person has been confronted with a greater risk to their safety, a traumatic event associated with death, death threat or serious injury, own or a third party.
PTSD can also be linked to continuous emotional trauma, such as violence within a relationship.
The person after having lived an experience that has negatively marked its life begins to live with the continuous feeling that something bad can happen. It loses total confidence in the things it did.
The person relives the symptoms through flashbacks or terrifying dreams, causing the person to emotionally and psychologically relive the traumatic experience, leading to the unleashing of a lot of stress and anguish.
The person who has PTSD tends to avoid the things or situations that the event reminds it of.
An example would be a person who had a car accident, at all costs will avoid getting into a car.
The person suffering from the disorder tends to be very nervous and take care of himself at all times.
They get scared easily and have trouble concentrating since they are only thinking about the possible danger that may appear at any time.
There are situations where the onset of PTSD symptoms may occur years after the event occurred.
The most characteristic signs and symptoms are:
- Remembrance of trauma or flashbacks, nightmares or constant and involuntary memories concerning the event at any time of the day.
- Hallucinations with the idea that the traumatic event will be repeated.
- Extreme anxiety when coming into contact with places, events or people that remind the person of the traumatic event.
- Acceleration of heart rate, palpitations, sweating and difficulty breathing every time you remember the traumatic event.
- Inability to remember important details of the event.
- Loss of interest for activities that were once liked by the person.
- Trouble sleeping, irritability, inability to concentrate.
Treatment according to Ehlers and Clark PTSD Formulation
Several authors over the years have presented various theories regarding the treatment of PTSD.
According to Ehlers and Clark PTSD Formulation, they created a cognitive therapy based on the explanatory model of the disorder.
Ehlers and Clark PTSD Formulation express that for each patient an individualized version of the explanatory model is developed in which the components that cause problems and those factors that retain it are identified.
The factors that retain the PTSD are addressed as follows:
- Correct the disturbance of the autobiographical memory of the trauma
- Modify excessive negative ratings
- Eliminate dysfunctional behavioural cognitive strategies
To correct the disturbance of the autobiographical memory of the trauma, the person has to try to remember the complete trauma and learn to discriminate the trigger stimuli.
It must be understood that suppressing or avoiding memories only leads to maintaining it.
In this process, three main techniques are used: reliving the event in the imagination in the present tense, giving all possible details.
Write a detailed account of the event in the present tense, where it involves how it felt and everything that happened.
And finally, visiting the place where the trauma occurred, to understand that the event was part of the past and that returning to the place does not mean that it happens again.
To modify the excessively negative assessments of trauma, asking questions is crucial to know the meaning of the critical points.
The therapist may ask the person to draw or through a scale that expresses that it values both the event and the negative.
As more details are known, the therapist helps the person to eliminate each of those negative assessments they have.
One way is to visit the place where the traumatic event happened, where the person recognizes that the negative perception it has about the place can change since it is there and nothing bad has happened.
The therapist also motivates the person to gradually perform the activities he enjoyed doing before the traumatic event.
And finally, abandon the dysfunctional behavioural cognitive strategies.
The person, to avoid remembering or feeling the traumatic event, chooses to avoid talking about the event and not being in places and with people who remind the person the event.
These techniques only work in the short term and the purpose is that the person can cope with the moment the memory of the traumatic event arises.
The therapist explains to the patient the reason why this type of technique does not work and uses others where the person comes into contact with the fact and identifies that the danger it feels will not occur again.
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FAQs about Ehlers and Clark PTSD Formulation
Why should the person relive the traumatic event as part of the cognitive therapy of Ehlers and Clark PTSD Formulation?
Reliving the traumatic event helps the person to discover what are the critical points that make the trauma continue to affect the person negatively.
When the event is avoided and not worked, the person can at any time revive it and since it does not have the necessary tools to face the memory, it may experience symptoms that seem to be repeating the event.
How can a person change the negative thoughts they have after the traumatic event?
The cognitive therapy of the Ehlers and Clark PTSD formulation model expresses that, through actions such as cognitive restructuring, the person relives the facts and changes the meanings that it has about the event.
How is Ehlers and Clark’s Cognitive Theory different from other models that talk about PTSD?
Ehlers and Clark PTSD Formulation is an integrative model where several aspects are developed within the trauma, individual differences are emphasized and the characteristics of the trauma, previous experiences and beliefs are considered relevant.
This model offers explanations for somatic reactions not consciously processed.
How effective is Cognitive Therapy for PTSD?
Several studies have been conducted to identify the efficacy of cognitive therapy in PTSD.
The results express that cognitive therapy is effective in reducing PTSD symptoms, as well as mental illnesses such as depression and anxiety.
How can a person with PTSD receive this type of therapy?
For a person to receive a treatment base on Ehlers and Clark PTSD Formulation, this should be administered by a mental health professional.
A cognitive behavioural therapist is a person who has the techniques necessary to work for a person with PTSD.
The Ehlers and Clark PTSD Formulation expresses in its cognitive theory the processes that occur when a person develops PTSD.
The model also shows the techniques used so that the person can recover from the symptoms and return to their daily activities.
Revoke the symptoms for many can be somewhat contradictory since the person does not want to live the traumatic event but the theory of Ehlers and Clark expresses that reliving the fact and recognizing the emotions it causes will help to give it another interpretation.
Changing the negative thinking about the fact makes the person when it has a memory about it again, know how to revoke the discomfort it causes.
- Cognitive- Behavioral Therapy for PTSD A Case Formulation (Guides to Individualized Evidence-base Treatment
- Post Traumatic Stress Disorder: Cognitive Therapy with Children and Young People (CBT with Children, Adolescents and Families)
- Treating Psychological Trauma and PTSD
What we recommend for PTSD
If you have PTSD, then ongoing professional counselling may be your ideal first point of call. Counselling will allow you to practice various habits that improve your overall quality of life.
- Ehlers, A. & Clark, M. (1999). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(2000), 319-345.