Ehlers & Clark (2000) · Post-traumatic stress disorder
Ehlers & Clark (2000)
Trauma Memory
A trauma memory that is poorly elaborated and not fully integrated into the past — fragmented, disjointed and easily triggered. Strong perceptual priming and a 'here and now' quality mean reminders provoke vivid intrusions and flashbacks that feel current.
Negative Appraisals
Excessively negative appraisals of the trauma and its aftermath — of the event ('it was my fault'), of one's own reactions ('I'm falling apart'), of other people ('no one can be trusted') and of the future ('I'm permanently damaged', 'nowhere is safe').
Current Sense of Threat
A sense of serious, current threat — felt internally (the body braced for danger) and externally (the world seems dangerous). This is the central feature that the trauma memory and the negative appraisals combine to produce.
Emotional Responses
Strong emotions following from the appraisals — fear and anxiety, but also shame, guilt, anger, sadness and feeling let down, depending on how the event is interpreted.
Coping Strategies
Coping and control strategies meant to reduce the threat — avoidance of reminders, thought suppression, rumination, hypervigilance, safety behaviours and numbing (e.g. alcohol). These maintain PTSD by preventing change in the memory and appraisals, and by increasing symptoms directly.
The published model, shown for reference. Switch to “Blank” to see the empty template you complete with a client.
After a frightening or traumatic event, it's normal to feel shaken for a while, and usually the memory settles over time. In PTSD, though, the memory stays raw and the past keeps breaking into the present. This model explains why.
Two things keep the trauma feeling current. First, the memory of what happened is stored in a jumbled, fragmented way, without a clear sense that it is over. So reminders can trigger vivid intrusions — images, sounds or flashbacks — that feel as if the danger is happening now.
Second, the mind makes very negative sense of the event and its aftermath — 'I'm not safe anywhere', 'it was my fault', 'I've changed for ever'. Together these create a constant sense of present threat, with fear, shame, anger or sadness, and a body on high alert.
Understandably, people try to cope by pushing the memory away, staying on guard, avoiding reminders, or going over the event again and again. These strategies bring short-term relief but keep the memory from updating and stop the frightening beliefs being challenged — so the sense of threat carries on.
How to introduce the model, guided-discovery questions, treatment targets and a behavioural experiment are available to signed-in therapists.
This diagram is a reconstruction of the published model for clinical and educational use, grounded in the sources above.
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:
Sign up free to open the interactive formulation builder, complete this model collaboratively, and export it as a PDF or share it with your client.