Behavioural and Cognitive Psychotherapy



Empirically Grounded Clinical Interventions Section

COGNITIVE RESTRUCTURING WITHIN RELIVING: A TREATMENT FOR PERITRAUMATIC EMOTIONAL “HOTSPOTS” IN POSTTRAUMATIC STRESS DISORDER


Nick Grey  a1 c1, Kerry Young  a2 and Emily Holmes  a2 a3
a1 Centre for Anxiety Disorders and Trauma, London, UK
a2 Traumatic Stress Clinic, London, UK
a3 University College, London, UK

Abstract

This paper describes a distinct clinical approach to the treatment of Posttraumatic Stress Disorder (PTSD). It is theoretically guided by recent cognitive models of PTSD and explicitly combines cognitive therapy techniques within exposure/reliving procedures. A clinically pertinent distinction is made between the cognitions and emotions experienced at the time of the trauma and, subsequently, in flashback experiences, and secondary negative appraisals. The term peritraumatic emotional “hotspot” is used to describe moments of peak distress during trauma. It is argued that a focus on cognitively restructuring these peritraumatic emotional hotspots within reliving can significantly improve the effectiveness of the treatment of PTSD and help explain some treatment failures with traditional prolonged exposure. An approach to the identification and treatment of these hotspots is detailed for a range of cognitions and emotions not limited to fear.


Key Words: Posttraumatic stress disorder; PTSD; cognitive behaviour therapy; “hotspots”.

Correspondence:
c1 Reprint requests to Nick Grey, Centre for Anxiety Disorders and Trauma, Institute of Psychiatry, 99 Denmark Hill, London SE5 8AF, UK. E-mail: n.grey@iop.kcl.ac.uk


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