Cognitive therapy for people with post-traumatic stress disorder to multiple events: Working out where to start

Many people presenting for help with post-traumatic stress disorder (PTSD) have re-experiencing symptoms relating to more than one traumatic event and this can be daunting to clinicians. Although there is now a substantial literature on working with single-incident PTSD, less is available to help clinicians working with those with PTSD to multiple events. The exception to this relatively neglected area is the literature addressing PTSD in survivors of childhood sexual abuse (Herman, 1992; Smucker, Dancu, Foa, & Niederee, 1995), personality disorders (Arntz & Weertman, 1999), veterans (Creamer & Forbes, 2004) and refugees (Schauer, Neuner, & Elbert, 2005). However, whilst these authors acknowledge that people may have PTSD to more than one event, and propose techniques to assist in their treatment, the developments that have improved outcomes for single-incident PTSD are only just beginning to be extended to the treatment of those with PTSD to multiple events (Lee, 2006; Duffy, Gillespie, & Clark, 2007).