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Sofia Hall - Bulgarian Red Cross

Complex PTSD (CPTSD): Working with Imagery Across the Phases

Diagnosis of CPTSD in the proposed ICD-11 (due to be published in 2018) includes the defining criteria of PTSD (re-experiencing, avoidance, numbing, and hyperarousal), as well as the presence of at least one symptom in each of three self-organization features: affect, negative self-concept and relational disturbance. There is contention in the literature regarding whether simple and complex PTSD can be conceptualised as different disorders (see Resick et al., 2012 for discussion), and there is currently no consensus regarding whether current evidence-based interventions for PTSD (e.g. eye movement desensitisation and reprocessing [EMDR], trauma-focussed cognitive behavioural therapy [CBT]) need to be tailored for to better account for complex features (Cloitre et al., 2011; van Minnen, Harned, Zoellner, & Mills, 2012). Some argue that interventions for individuals who have experienced repeated interpersonal trauma should be adapted to address complex features. One recommended adaptation is to adopt a phase-based or sequenced approach, involving three phases, each with a distinct function (e.g. Cloitre et al., 2011). Phase one focuses on ensuring the individual’s safety, reducing symptoms, and increasing important emotional, social and psychological competencies. Phase two focuses on processing the unresolved aspects of the individual’s memories of traumatic experiences. Phase three involves consolidation of treatment gains to facilitate engagement in relationships, work or education, and community life. The use of imagery, including Imagery Rescripting (IR) is a transdiagnostic technique that is increasingly being used in a range of disorders. It has been incorporated into empirically validated CBT treatments and initial research shows that it can improve standard CBT, and can also be effective as a stand-alone treatment in several disorders, including with previous treatment failures (e.g., PTSD: Grunert, Smucker, Weis, & Rusch, 2003; Rusch, Grunert, Mendelsohn, & Smucker, 2000). The reasoning behind mental imagery work is that activation and modification of the verbal narrative alone is insufficient to reduce PTSD symptoms, and that imagery permits access to a primitive cognitive level that is more closely connected to emotional processing pathways (Edwards, 1990). Holmes et al. (2007) proposed that mental imagery can be used as an ‘emotional amplifier’ and a should be considered a “powerful psychotherapeutic tool for alleviating emotional distress” (p. 298). This workshop translates techniques from the empirical research and applies them in a clinical context for the treatment of CPTSD through the use of case studies, psychoeducation videos, practical exercises and group discussion.