Cognitive therapy for PTSD (CT-PTSD) targets the psychological processes that maintain PTSD, according to Ehlers and Clark’s (2000) model. To measure these processes and to predict outcomes after trauma, we have developed a series of questionnaires. The timeframe for most of these questionnaires is given here as 1 month (as usual for initial assessments) but can be adjusted as needed (e.g., to 1 week for assessments during therapy). The word trauma can also be replaced with more specific terms as needed (e.g., assault).
Mental Defeat Questionnaire (MDQ)
Mental defeat during trauma, the perceived loss of all psychological autonomy, is a strong predictor of PTSD after interpersonal trauma (e.g., Dunmore et al., 2001, Ehlers et al., 2000; Kleim et al., 2007), and is related to poor outcome to prolonged exposure therapy (Ehlers et al., 1997). The 10-item Mental Defeat Scale is a modified version of the scale used in Dunmore et al. (2001). For patients who experienced mental defeat, cognitive therapy prepares the memory work carefully (see therapist guide). We recommend that patients with interpersonal trauma complete the scale before the initial assessment so that mental defeat can be addressed early in treatment. There is also a short 6-item form.
For statistical analysis, each of the 10 items is rated on a 4-point scale ranging from, 0 = “Not at all/never” through 1 = “A little”, 2 = “Moderately”, 3 = “Strongly” to 4 = “Very strongly”. We recommend using mean scores for the total scale for analyses. Higher scores indicate greater mental defeat.
Mental Defeat Scale – full scale (English)
Mental Defeat Scale – short version (English)
Trauma Memory Questionnaire (MQ)
The poor elaboration and disjointedness of trauma memories is one of the two processes driving a sense of current threat in Ehlers and Clark’s (2000) model. There is evidence from prospective studies and experiments (e.g., Halligan et al., 2003; Kleim et al., 2008; Beierl et al., 2019) The Trauma Memory Questionnaire was developed from earlier versions (e.g., Halligan et al., 2003) measuring a range of different indicators of trauma memory disorganisation. It assesses both problems with memory recall (items 1-4), which may contribute to appraisals about responsibility and ongoing danger, and the disjointedness of parts of the trauma memories from other moments in memory and relevant information, which is thought to hinder the updating of highly threatening meanings (items 5-8). At assessment, it can give therapists a first impression of the patient’s problems with recall and disjointedness. Therapists will also include questions about idiosyncratic appraisals of these memory features in the initial assessment and throughout treatment. We recommend that patients complete the MQ again at mid-treatment and post-treatment.
For statistical analysis, each of the items is rated on a 4-point scale ranging from, 0 = “Not at all” through 1 = “A little”, 2 = “Moderately”, 3 = “Strongly” to 4 = “Very strongly”. We recommend using mean scores for each of the subscales items (1-4 problems in recall, 5-8 disjointedness) for analyses. Higher scores indicate greater memory problems.
Trauma Memory Questionnaire (English)
Post-traumatic Cognitions Inventory (PTCI)
The PTCI was developed by Foa, Ehlers, Clark, Tolin & Orsillo (1999) to assess the degree to which patients endorse 36 excessively negative PTSD-related cognitions. At initial assessment, it can give therapists a first impression of what cognitions need to be addressed in treatment. Therapists will also include questions about idiosyncratic appraisals in the initial assessment and throughout treatment. We recommend that patients complete the PTCI again at mid-treatment and post-treatment. Re-administering the questionnaire at mid-treatment helps the patient and therapist spot cognitive themes that still need to be targeted in the second half of treatment. Alternatively, consider using the short PTCI before each treatment session
Each of the 36 cognitions is rated on a 7-point scale ranging from, 1 = “Totally Disagree” to 7 = “Totally Agree”. Lower scores indicate a better outcome. Subscores can be calculated for Negative Thoughts about the Self (mean of items 1, 4, 8, 9, 14, 15, 18, 21, 23, 25, 26, 27, 31, 32, 36, 38, 41, 44, 46, 49, 54), Negative Thoughts about Others (mean of items 5, 11, 17, 24, 29, 35, 43) and Self-Blame (mean of items 2, 10, 20, 39, 48). The total score is the sum of these items (items 13, 32 and 34 were only included after scale development and are not included). For comparison, the median for patients with PTSD was 133, compared to 49 for people without PTSD who had experienced trauma.
Response to Intrusions Questionnaire (RIQ) – full scale
According to Ehlers and Clark, unhelpful cognitive and behavioural strategies that maintain PTSD. The 19-item RIQ assesses the extent to which people engage in a range of unhelpful responses to intrusive memories of their traumas. It was developed from earlier versions used in Clohessy & Ehlers (1999) and Murray et al. (2002) and has been shown to predict PTSD in numerous studies (e.g., Ehring et al., 2008; Kleim et al., 2012; Wild et al., 2016). We recommend that patients complete the RIQ prior to the first assessment and again at mid-treatment and post-treatment. Therapists will also include questions about the patient’s way of coping with their intrusive memories in the initial assessment interview and throughout treatment to assess idiosyncratic strategies and assess the content of rumination. Re-administering the questionnaire at mid-treatment helps the patient and therapist spot those that still need to be targeted in the second half of treatment. Alternatively, consider using the short RIQ before each treatment session.
For statistical analysis, each of the 19 items is rated on a 4-point scale ranging from, 0 = “Never” through 1 = “Sometimes”, 2 = “Often” to 3 = “Always”. There are three subscales: “Suppression” (Items 1-6), “Rumination” (Items 7-14) and “Numbing” (Items 15-19). We recommend using mean scores for the total scale, and of the subscales, for analyses.
Safety Behaviours Questionnaire (SBQ) – full scale
The 14-item Safety Behaviours Questionnaire assesses the extent to which patients use a range of safety behaviours that are commonly observed after a wide range of traumas. It is adapted from earlier versions (e.g., Dunmore et al., 2001). We recommend that patients complete the scale prior to the first assessment interview and again at mid-treatment and post-treatment. Patients can also indicate whether they have used the safety behaviours more often since the trauma, which can help identifying the behaviours most affected by trauma. Therapists will also include questions about safety behaviours in the initial assessment interview and throughout treatment to assess idiosyncratic safety behaviours, and by directly observing the patient during initial behavioural experiments. Re-administering the questionnaire at mid-treatment helps the patient and therapist spot any safety behaviours that are still being used and to plan to target these in the second half of treatment. Alternatively, consider using the short SBQ before each treatment session.
For statistical analysis, each of the 14 behaviours are rated on a 4-point scale ranging from, 0 = “Never” through 1 = “Sometimes”, 2 = “Often” and 3 = “Always”. We recommend using mean scores for the total scale for analyses. Higher scores indicate more extensive use of safety-behaviours.
Safety Behaviours Questionnaire – Traffic
The 11-item Safety Behaviours Questionnaire – Traffic version assesses the extent to which patients use a range of safety behaviours that are commonly observed after road traffic accidents. It is adapted from earlier studies (Ehlers et al., 2003). We recommend that patients complete the scale prior to the first assessment interview and then weekly or at mid-treatment and post-treatment. Patients can also indicate whether they have used the safety behaviours more often since the trauma, which can help identifying the behaviours most affected by trauma. Therapists will also include questions about safety behaviours in the initial assessment interview and throughout treatment to assess idiosyncratic safety behaviours, and by directly observing the patient during initial behavioural experiments. Re-administering the questionnaire weekly or at mid-treatment helps the patient and therapist spot any safety behaviours still need to be targeted in the session. Alternatively, consider using the short SBQ before each treatment session.
For statistical analysis, each of the 14 behaviours are rated on a 4-point scale ranging from, 0 = “Never” through 1 = “Sometimes”, 2 = “Often” and 3 = “Always”. We recommend using mean scores for the total scale for analyses. Higher scores indicate more extensive use of safety-behaviours.
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