Trauma-focused cognitive behavioural therapy (TF-CBT) is beneficial for individuals with post-traumatic stress disorder (PTSD); however, a subset of clients struggle to engage with traditional methods, due to high levels of avoidance and dissociation. This paper aims to describe an adapted approach to imaginal reliving and prolonged exposure, to facilitate subsequent cognitive updating. The paper demonstrates the technique with veterans, who are a client group that may struggle with some aspects of traditionally implemented TF-CBT. Two case studies are described, both with PTSD symptoms stemming from traumatic military experiences. An adapted exposure technique is utilized to address the barriers of high dissociation, poor access to trauma-related cognitions and fixed intrusive imagery. The approach involved three stages: (1) reliving the trauma outdoors, (2) manipulating the perspectives of the imagery, and (3) restructuring the narrative with new perspectives. Both clients showed decreased dissociation and improved toleration of their traumatic imagery. Improvement of PTSD symptoms and quality-of-life functioning was observed for both clients on objective measures. Adapting TF-CBT to have a stronger emphasis on grounding and allocentric processing may be helpful for a subset of patients with PTSD that present with high levels of dissociation and avoidance. Further research and investigation into alternative populations is needed.

This study tested the hypothesis that trauma memories are disjointed from other autobiographical material in posttraumatic stress disorder (PTSD). Assault survivors with (n = 25) and without PTSD (n = 49) completed an autobiographical memory retrieval task during script-driven imagery of (a) the assault and (b) an unrelated negative event. When listening to a taped imagery script of the worst moment of their assault, survivors with PTSD took longer to retrieve unrelated non-traumatic autobiographical information than those without PTSD, but not when listening to a taped script of the worst moment of another negative life event. The groups also did not differ in general retrieval latencies, neither at baseline nor after the imagery tasks. The findings are in line with suggestions that traumatic memories are less integrated with other autobiographical information in trauma survivors with PTSD than in those without PTSD.

Ehlers and Clark (2000) hypothesize that persistent PTSD is explained by a predominance of data-driven processing and a lack of conceptually-driven processing of the trauma. Data-driven/conceptually-driven processing is thought to relate to perceptual memory representations and memory fragmentation. The present study measured the result of data-driven/conceptually-driven processing in three ways: on utterance level by assessing 1) the ratio between perceptual and conceptual memory representations and 2) utterance disorganization, and 3) on narrative level by assessing the incoherence of the trauma narrative. Twenty-nine patients discharged from the Intensive Care Unit (ICU) were assessed within two weeks after ICU discharge and at 4 months follow-up. The present study tested whether perceptual memory representations, narrative disorganization and narrative incoherence immediately after ICU discharge are related to post-trauma symptomatology. If so, whether these variables are specific for PTSD as compared to depression. Data-driven/conceptually-driven processing was related to PTSD and Depression symptoms on utterance level. Although narrative incoherence did not predict PTSD symptoms, it was predictive of depression symptoms. The present study showed the viability of the data-driven/conceptually-driven conceptualization in explaining post-trauma symptomatology.