Cognitive therapy for PTSD (CT-PTSD) targets three psychological processes that maintain PTSD, according to Ehlers and Clark’s (2000) model. To help therapists track change in these processes during treatment and to facilitate decisions about what to focus on in treatment sessions, we have developed a series of short questionnaires. The timeframe for most of these questionnaires is given here as 1 week for monitoring these processes during therapy but can be adjusted as needed (e.g., to 1 month for initial assessments). The word trauma can be replaced with more specific terms as needed (e.g., assault).
Post-traumatic Cognitions Inventory (PTCI) – short version
Negative appraisals of the trauma and its aftermath are one of the two processes driving a sense of current threat in Ehlers and Clark’s (2000) model. Ehlers et al. have developed a shorter 20-item version from the original PTCI (Foa et al., 1999) and new items that measure cognitions (thoughts/felt sense) representing a range of cognitive themes: vulnerable self, self-criticism, overgeneralised danger, preoccupation with unfairness, perceived permanent change, alienation, hopelessness and negative view of body.
At the initial assessment this questionnaire (or the longer original PTCI) gives 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 administration of the short PTCI throughout treatment to monitor cognitive change with the interventions and identify cognitive themes that still need to be addressed in treatment. Each of the 20 items is rated on a 7-point scale ranging from, 1 = “Totally Disagree” to 7 = “Totally Agree”. The total score is the sum of the items. Lower scores indicate a better outcome. Changes in appraisals as measured by the short PTCI have been shown to drive symptom change in two cohort studies (Kleim et al., 2013; Wiedemann et al., 2020).
Memories Questionnaire – Unwanted Memories
Characteristics of trauma memories are one of the two processes driving a sense of current threat in Ehlers and Clark’s (2000) model. A sense that the content of the intrusions is happening in the here and now and the easy triggering of reexperiencing by many stimuli in everyday life are particularly relevant for monitoring change in therapy. We recommend giving this questionnaire at initial assessment and before every treatment session. It builds on the studies by Hackmann et al., (2004), Michael et al. (2005) and Speckens et al. (2006). Therapist will also ask about the content of the intrusive memories as these may indicate hot spots that need to be addressed in treatment. Ratings of memory nowness and distress are also taken during the memory updating procedure (see therapist guide).
Response to Intrusions Questionnaire (RIQs) – short scale
According to Ehlers and Clark, unhelpful cognitive behavioural strategies maintain a sense of current threat by increasing symptoms directly or preventing change in problematic appraisals and memory characteristics. This 12-item scale is a short version of the RIQ (see below). It assesses the extent to which people engage in a range of unhelpful responses to intrusive memories of their traumas, i.e. suppression, rumination and numbing. We recommend that patients complete the RIQ-s (or the original full RIQ below) prior to the first assessment, and before every treatment session to monitor improvement. 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 and monitor changes in idiosyncratic strategies and content and triggers of rumination.
For statistical analysis, each of the 12 items is rated on a 4-point scale ranging from, 0 = “Never” through 1 = “Sometimes”, 2 = “Often” to 3 = “Always”. There are three subscales: “Thought Suppression” (Items 1-3), “Rumination” (Items 4-9) and “Numbing” (Items 10-12). We recommend using mean scores for the total scale, and of the subscales, for analyses.
Safety Behaviours Questionnaire (SBQs) – short scale
The 7-item scale is a short version of the SBQ (see below). It assesses the extent to which patients use a range of safety behaviours that are commonly observed after a wide range of traumas. We recommend that patients complete the SBQs (or the SBQ) prior to the first assessment interview, and before every treatment session to monitor improvement. Therapists will also include questions about safety behaviours in the initial assessment interview and throughout treatment to assess and monitor changes in idiosyncratic safety behaviours and plan behavioural experiments.
For statistical analysis, each of the 7 behaviours is 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.
Trait-State Dissociation Questionnaire (TSDQ)
While dissociative symptoms are common in the immediate aftermath of trauma, persisting dissociative symptoms contribute the maintenance of PTSD (Murray et al., 2002; Halligan et al., 2003; Beierl et al., 2019). For patients with high levels of dissociation, treatment procedures are adapted in CT-PTSD (see therapist guide). The 15-item Trait-State Dissociation Scale assesses a range of dissociative experiences adapted from the State (SDQ) and Trait Dissociation Questionnaires (TDQ) developed by Murray et al. (2002). At assessment, it can give therapists a first impression of whether dissociation needs to be addressed in treatment. Therapists will also include questions about dissociative experiences and observe the patient for dissociative responses in the initial assessment and throughout treatment. We recommend that patients complete TSDQ prior to the first assessment interview, and before every treatment session to monitor improvement.
For statistical analysis, each of the 15 items is rated on a 5-point scale ranging from, 0 = “Not at all” through 1 = “A little”, 2 = “Moderately”, 3 = “Strongly” and 4 = “Very strongly”. We recommend using mean scores for the total scale or subscores 1-9 (from SDQ) and 10-15 (from TDQ) for analyses. Higher scores indicate more severe dissociation.
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