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PTSD / Trauma~25 min

PTSD Formulation (Ehlers & Clark)

A formulation based on Ehlers and Clark's cognitive model of PTSD — mapping the nature of the trauma memory, negative appraisals, sense of current threat, and the maintaining strategies.

Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed

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This formulation explains why trauma symptoms persist: the trauma memory is stored differently from normal memories (fragmented, vivid, lacking time context), leading to intrusions and a sense of current threat. Negative appraisals of the trauma and its aftermath maintain distress, while coping strategies (avoidance, rumination, suppression) prevent the memory from being properly processed. Work through it with your therapist — you do not need to describe the trauma in detail.

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Ehlers & Clark PTSD Model

PTSD Cognitive Model (Ehlers & Clark, 2000)

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Nature of Trauma Memory

How the memory is stored — not the content

Negative Appraisals

Of the trauma and/or its aftermath

Sense of Current Threat

Intrusions & Re-experiencing

Cognitive & Behavioural Strategies

Well-intentioned but maintain the problem

Prevents Processing

Strategies block memory elaboration and appraisal updating

Protective Factors & Strengths

What resources, strengths, and supports might help in recovery?

Reflection

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When to use the PTSD Formulation (Ehlers & Clark)

The PTSD Formulation (Ehlers & Clark) is an interactive cognitive behavioural therapy (CBT) worksheet, most often used in CBT for trauma and PTSD.

It is designed to be used within therapy rather than as a standalone self-help tool: a therapist introduces it, works through it collaboratively, and helps make sense of what it surfaces. You can preview the full worksheet above, then assign it digitally for clients to complete between sessions on any device — or download it as a print-ready PDF.

How it works

Most people work through it in around 25 minutes. It moves through three short steps:

  1. Ehlers & Clark PTSD Model
  2. Protective Factors & Strengths — What resources, strengths, and supports might help in recovery?
  3. Reflection

Completed on the Formulate platform, your client's answers are saved automatically and shared straight back to you, so you can review them before the next session rather than waiting for a paper copy to come back.

The CBT approach behind it

In common with other CBT methods, the PTSD Formulation (Ehlers & Clark) works by mapping how the parts of a problem connect and keep it going (formulation). The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going — and practical, testable ways to change it.

Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.

Evidence & sources

This worksheet is grounded in established cognitive behavioural therapy theory and practice. Key sources include:

  • Ehlers, A. & Clark, D.M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319-345. doi:10.1016/S0005-7967(99)00123-0
  • Resick, P.A. & Schnicke, M.K. (1993). Cognitive Processing Therapy for Rape Victims. Newbury Park: Sage.

For use alongside professional support

Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.

If you need urgent help now:

  • Emergency services: 999 — if you or someone else is in immediate danger
  • Samaritans: 116 123 — free, day or night, 365 days a year
  • SANEline: 0800 689 5555 — 4:30pm–10:30pm, every day

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