ABSTRACT
Trauma-focussed cognitive behaviour therapy (TFCBT) and eye movement desensitisation reprocessing (EMDR) are the internationally recognised and recommended first-line treatments for PTSD. Whilst they are efficacious, in that about half of the sufferers recover with these treatments, half do not. The evidence for the effectiveness of these treatments in routine practice is however less compelling. The two established treatments require the PTSD sufferer to engage with the traumatic memory. It appears that this is easier to achieve when sufferers are part of a randomised controlled trial in a prestigious research centre than in routine mental health services. The theoretical justification for the trauma focus is that people with PTSD remember the worst part of their trauma in a disjointed way. Thus, there is a need to elaborate the traumatic memory and properly integrate it within the context of the trauma. But the evidence on ‘disjointedness’ is found to be lacking. It is suggested that traumatic memories are not different in kind to autobiographical memories and do not have a unique neural basis. The TFCBT interventions are multi-faceted and the active ingredients may not be those espoused by the developers of the interventions.
