Cognitive–behavioural therapy for complex post-traumatic stress disorder

Summary & key facts

This review explains complex post‑traumatic stress disorder (CPTSD), a diagnosis added to ICD‑11 in July 2018. CPTSD includes the three usual PTSD clusters plus three extra clusters involving problems with emotion regulation, a negative sense of self, and relationship difficulties. The article says trauma‑focused cognitive–behavioural therapy (CBT) is proven for PTSD and that early evidence for its use in CPTSD is promising but less clear. It also describes how CPTSD often follows prolonged or repeated trauma, how it differs from borderline personality disorder, common co‑occurring problems (for example depression, substance use and dissociation), and two CBT approaches used in clinics: phas

Key facts:

• CPTSD was added to ICD‑11 in July 2018 and requires six symptom clusters: the three core PTSD clusters (re‑experiencing, avoidance, hyperarousal) plus three ‘disorders of self‑organisation’ (affect dysregulation, negative self‑concept, and
• CPTSD is typically linked to prolonged or repeated trauma, such as childhood abuse, domestic violence, or community violence, rather than a single traumatic event.
• Trauma‑focused CBT is recommended as a first‑line treatment for PTSD (NICE 2018). The review states that evidence for trauma‑focused CBT in CPTSD is less well established but remains promising.
• Two CBT approaches currently used in practice for CPTSD are a phase‑oriented approach (which separates stabilisation and trauma work into phases) and a unimodal approach (which uses trauma‑focused techniques more directly).
• People with CPTSD commonly have additional diagnoses, including depression, anxiety disorders, substance misuse, dissociative symptoms, somatic symptom disorders, and sometimes quasi‑psychotic symptoms.
• Research cited in the review reports that dissociation levels are higher in ICD‑11 CPTSD than in PTSD, so dissociative symptoms are especially relevant when assessing and formulating treatment for CPTSD.
• The CBT model described in the article highlights three processes that keep a sense of current threat going: how traumatic events are stored in memory, the personal meanings (appraisals) people form after trauma, and unhelpful cognitive or

Abstract

SUMMARY Complex post-traumatic stress disorder (CPTSD) was adopted as a new diagnosis in ICD-11. Trauma-focused cognitive–behavioural therapy (CBT) is effective in treating PTSD but with CPTSD being a recently defined diagnosis, the evidence for its effectiveness in that disorder is not as clear, but it is still promising. This article reviews the diagnosis, psychopathology and some key differential diagnoses, and looks at the two CBT approaches that are currently used in clinical practice: the phase-oriented approach and the unimodal approach. The key aims of this article are to clarify the concept of CPTSD, its differentiation from borderline personality disorder and prominent comorbidities, how it develops and how CBT is used to treat it.

Topics

Child Abuse and Trauma Child and Adolescent Psychosocial and Emotional Development Posttraumatic Stress Disorder Research

Categories

Clinical Psychology Psychology Social Sciences

Tags

Clinical psychology Cognition Psychiatry Psychology Psychotherapist Traumatic stress

Conditions & symptoms

Anxiety Depression PTSD Substance abuse disorder Anxiety or worry Feeling disconnected from others Poor sleep Sadness or low mood