We apply Evidence-based treatments such as Prolonged Exposure Therapy (PET) and trauma-focused CBT have been recommended by NICE guidelines for the second phase of treatment,  We also apply EMDR within our treatment framework for single incident PTSD.

Phase 3 focuses on increasing self esteem, self respect, increasing healthy connections and exploring and integrating one’s sense of identity. This phase is as important as the other two and gives an opportunity to re-evaluate current triggers and anticipatory fears towards change.

This initial phase focuses on the client’s inner experiences, addressing memories, emotions and sensations including flashbacks. We will aim to reduce self injurious behaviour, addictions, pathological dissociation and extreme emotion dysregulation, with the aim of creating internal and external safety to disengage the ‘emergency’ brain (limbic system) and to activate the thinking brain (prefrontal cortex). It is important to reduce any co-morbid issues and reduce all trauma related dysregulation to improve functioning and further preparation for trauma processing. These approaches are aimed at tackling the maladaptive defences so clients can increase affect tolerance without becoming overwhelmed. Cloitres Skills Training in Affect and Interpersonal Training (STAIR) has been recommended as a model that “integrates all that we have come to understand about the unique needs of individuals with complex PTSD and/or post traumatic dysregulation”.

Evidence-based treatments such as Prolonged Exposure Therapy and trauma-focused CBT have been recommended by NICE guidelines for the second phase of treatment. However, there is not one treatment recommended over another for cPTSD. CBT, CPT and PET have a similar approach, functioning from a top down process (driven by the neocortex not the limbic system), yet PET has an extra component of exposing the client to the stimulant. EMDR phases, relative to processing, are phase 3 through to 8 reprocessing trauma at the neurophysiological level by focusing on both executive functioning and the limbic system (emotional brain). IRRT is a model designed specifically for sexual abuse victims. IRRT aims to reduce PTSD symptoms and traumagenic schemas of survivors of sexual abuse. “To achieve this it combines imaginal exposure, mastery imagery, self nurturing imagery and cognitive reprocessing, which are designed to go beyond extinction models in order to alter recurring traumatic images, create adaptive schemas and enhance the clients capacity for self nurturance” (Smacker & Gonzalez). Each of these phases need to occur for successful emotional processing. This bottom up process incorporates socratic questioning during the imagery re-scripting, which helps the client to identify, challenge and modify maladaptive beliefs tied to the trauma whilst empowering them to take mastery of the imagery. Rescripting helps change the traumatic memory with an emphasis on positive, corrective cognitive changes to previous negative secondary beliefs and pathogenic schemas.

This phase is as important as the other two and gives opportunity to re-evaluate current triggers and anticipatory fears towards change.. Success of the phases is measured throughout by assessing if the client has the ability to effectively cope with previous triggers and move towards the desired goals of everyday life.