Cognitive Restructuring Within Reliving: A Treatment for Peritraumatic Emotional “Hotspots” in Posttraumatic Stress Disorder

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.

What makes labour and birth traumatic? A survey of intrapartum ‘hotspots’

“…These have been described in the trauma literature as peritraumatic "hotspots" (Grey & Holmes 2008;Grey, Homes & Brewin, 2001;Grey, Young & Holmes, 2002;Holmes, Grey & Young, 2005) or "pathogenic kernels" (Van der Hart, Nijenhuis & Steele, 2006). Here we use the term hotspots to denote "specific parts of the trauma memory that cause highest levels of emotional distress" (Holmes et al, 2005).…”

“…Despite this, only a handful of studies have examined hotspots and these have all been carried out in small, clinical samples (Grey & Holmes, 2008;Grey, Young, & Holmes, 2002;Holmes, et al, 2005;Jelinek, et al, 2010). No published studies have looked at hotspots during birth.…”

Relating Differently to Intrusive Images: the Impact of Mindfulness-Based Cognitive Therapy (MBCT) on Intrusive Images in Patients with Severe Health Anxiety (Hypochondriasis)

“…First, enabling participants to let distressing images pass without reacting may enable those with hypochondriasis to break habitual responses, such as avoidance and reassurance seeking, which maintain both anxiety and intrusive imagery (Salkovskis & Campbell 1994;Speckens et al, 2007;Steil & Ehlers, 2000;Ehlers & Steil, 1995). Reduced experiential avoidance of distressing imagery may also facilitate exposure to and emotional facilitating emotional processing of associated cognitive distortions (Grey, Young, & Holmes, 2002). Second, MBCT encourages participants to adopt a more compassionate stance, which may help individuals to give less authority to self-judgment and blame (Kuyken et al, 2010) and thus to give less authority to the negative self-evaluative beliefs typically associated with intrusive imagery in patients with hypochondriasis.…”

What Services and Supports Are Needed to Enable Trauma Survivors to Rebuild Their Lives? Implications of a Systematic Case Study of Cognitive Therapy With a Township Adolescent Girl With PTSD Following Rape

“…A wide range of cognitive and behavioural techniques may be used in the process that might include: psychoeducation, Socratic questioning, cognitive restructuring, and behavioural experiments. Guided reliving of the trauma is particularly important for elaborating and restructuring the trauma memory (Grey, Young & Holmes 2002). Imagery techniques to replace images of traumatic memories are also used and Krakow, Hollifield, Johnston, Koss, Schrader et al's (2001) imagery rehearsal therapy was drawn on.…”