Trauma focussed treatments for PTSD, have limited efficacy and utility. The purpose of this paper is to review a) the theoretical base of TFT’s, in particular the evidence that a flawed traumatic memory lies at the heart of the development of PTSD b) the evidence that a focus on the traumatic memory is a necessary part of the evidence based treatment of PTSD and c) to distil an alternative model of PTSD. The author reviews existing trauma focussed treatments to determine a) what may be the active ingredients for change and b) treatment acceptability. He suggests that it is not proven that the qualities of the traumatic memory are pivotal in the development and maintenance of PTSD. Psychogenic amnesia is not found to be significantly associated with outcome, compared to the bodily expressions of exaggerated startle response and hypervigilance. There appears no added value in re-living the traumatic event per se, rather the latter may prevent treatment compliance. The author suggests an alternative conceptualisation of PTSD, that does not appeal to a notion of arrested information processing but suggests instead that PTSD arises from a state of terrified surprise, (which is a combination of an exaggerated startle response and hypervigilance) which the person explains in terms of a hostile environment.
Michael James Scott,
Post Traumatic Stress Disorder: An Alternative Paradigm, American Journal of Applied Psychology.
Vol. 9, No. 1,
2020, pp. 1-6.
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