Anke Ehlers

University of Oxford | OX · Department of Experimental Psychology

Background:Dissociation may be important across many mental health disorders, but has been variously conceptualised and measured. We introduced a conceptualisation of a common type of dissociative experience, ‘felt sense of anomaly’ (FSA), and developed a corresponding measure, the Černis Felt Sense of Anomaly (ČEFSA) scale. Aims:We aimed to develo...

Stress engages multiple neurobiological modifications and a failure to regulate these may lead to chronic psychiatric problems. Despite considerable research, it remains unclear how neural alterations of acute stress reflect the ability to cope with chronic stress. The current longitudinal study examined the whole-brain network dynamics following i...

Post-traumatic stress disorder (PTSD) after traumatic birth can have a debilitating effect on parents already adapting to significant life changes during the post-partum period. Cognitive therapy for PTSD (CT-PTSD) is a highly effective psychological therapy for PTSD which is recommended in the NICE guidelines (National Institute for Health and Car...

Background Bullying increases risk of social anxiety and can produce symptoms of posttraumatic stress disorder (PTSD). According to cognitive models, these are maintained by unhelpful beliefs, which are therefore assessed and targeted in cognitive therapy. This paper describes psychometric validation of a new measure of beliefs related to bullying...

Theories of posttraumatic stress disorder (PTSD) highlight the role of cognitive and behavioral factors in itsdevelopment, maintenance, and treatment. This study investigated the relationship between changes in factorsspecified in Ehlers and Clark’s (2000) model of PTSD and PTSD symptom change in 217 patients with PTSD whowere treated with cognitiv...

Background: Many patients are currently unable to access psychological treatments for post-traumatic stress disorder (PTSD), and it is unclear which types of therapist-assisted internet-based treatments work best. We aimed to investigate whether a novel internet-delivered cognitive therapy for PTSD (iCT-PTSD), which implements all procedures of a...

Background Dissociation may be important across many mental health disorders, but has been variously conceptualised and measured. We introduced a conceptualisation of a common type of dissociative experience, ‘felt sense of anomaly’ (FSA), and developed a corresponding measure, the Černis Felt Sense of Anomaly (ČEFSA) scale.AimsWe aimed to develop...

Background: Social support would be expected to influence grief processes positively. However, inconsistent empirical findings suggest the existence of moderating variables that determine whether social contact attenuates grief-related distress. The Oxford Grief-Social Disconnection Scale (OG-SD) measures the subjective experience of social disconn...

Sudden gains are large and stable decreases in clinical symptoms between consecutive therapy sessions. This work examined the frequency and possible determinants of sudden gains in Cognitive Therapy for Social Anxiety Disorder, comparing face-to-face (CT) and internet-based (iCT) formats of treatment delivery. Data from 99 participants from a rando...

Traumatic loss is associated with high rates of post-traumatic stress disorder (PTSD) and appears to inhibit the natural process of grieving, meaning that patients who develop PTSD after loss trauma are also at risk of experiencing enduring grief. Here we present how to treat PTSD arising from traumatic bereavement with cognitive therapy (CT-PTSD;...

Objectives: Trauma-focussed psychological interventions are the treatments of choice for post-traumatic stress disorder (PTSD). As many clinical services receive high demand for PTSD interventions, strategies to improve treatment efficiency are needed. Some people seek help in the early phase post-trauma, including as soon as the first few months....

The chapter begins by describing how PTSD is diagnosed, contrasting the ‘broad’, inclusive DSM formulations with the ‘narrow’ formulation focusing on core symptoms introduced in ICD-11. The ICD-11 distinction between PTSD and Complex PTSD is also described. We go on to consider why PTSD has been regarded as a disorder of memory, and the two signatu...

Background: The core clinical feature of posttraumatic stress disorder (PTSD) is recurrent re-experiencing in form of intrusive memories. While a great number of biological processes are regulated by sleep and internal biological clocks, the effect of 24-hour biological cycles, named circadian rhythm, has not been investigated in the context of in...

Surveys are a powerful technique in cognitive behavioural therapy (CBT). A form of behavioural experiment, surveys can be used to test beliefs, normalise symptoms and experiences, and generate compassionate perspectives. In this article, we discuss why and when to use surveys in CBT interventions for a range of psychological disorders. We also pres...

Therapist cognitions about trauma-focused psychological therapies can affect our implementation of evidence-based therapies for post-traumatic stress disorder (PTSD), potentially reducing their effectiveness. Based on observations gleaned from teaching and supervising one of these treatments, cognitive therapy for PTSD (CT-PTSD), ten common ‘miscon...

Background Cognitive therapy for social anxiety disorder (CT-SAD) is recommended by NICE (2013) as a first-line intervention. Take up in routine services is limited by the need for up to 14 ninety-min face-to-face sessions, some of which are out of the office. An internet-based version of the treatment (iCT-SAD) with remote therapist support may ac...

Background Elevated social anxiety is more likely among bullied children than those who have not been bullied but it is not inevitable and may be influenced by cognitive factors. Lower self-esteem and more external locus of control are associated with bullying and social anxiety but the impact of these factors over time among bullied children is le...

Objective To determine if guided internet based cognitive behavioural therapy with a trauma focus (CBT-TF) is non-inferior to individual face-to-face CBT-TF for mild to moderate post-traumatic stress disorder (PTSD) to one traumatic event. Design Pragmatic, multicentre, randomised controlled non-inferiority trial (RAPID). Setting Primary and seco...

What people find most distressing about a traumatic event varies greatly from person to person. The personal meanings of trauma and their relationship with features of trauma memories are central to Cognitive Therapy for PTSD, which builds on Ehlers and Clark’s (Behaviour Research and Therapy, 38, 319–345, 2000) model of PTSD. Treatment focuses on...

Latent change score models (LCSMs) are used across disciplines in behavioural sciences to study how constructs change over time. LCSMs can be used to estimate the trajectory of one construct (univariate) and allow the investigation of how changes between two constructs (bivariate) are associated with each other over time. This paper introduces the...

In posttraumatic stress disorder (PTSD), re‐experiencing of the trauma is a hallmark symptom proposed to emerge from a de‐contextualised trauma memory. Cognitive therapy for PTSD (CT‐PTSD) addresses this de‐contextualisation through different strategies. At the brain level, recent research suggests that the dynamics of specific large‐scale brain ne...

Introduction: Post-traumatic stress disorder (PTSD) is a disabling psychiatric condition that affects a significant minority of young people exposed to traumatic events. Effective face-to-face psychological treatments for PTSD exist. However, most young people with PTSD do not receive evidence-based treatment. Remotely delivered digital interventi...

Difficulties with loss-related memories are hypothesised to be an important feature of severe and enduring grief reactions according to clinical and theoretical models. However, to date, there are no self-report instruments that capture the different aspects of memory relevant to grieving and adaptation after bereavement over time. The Oxford Grief...

A large number of mechanisms, many relating to the processing of affect, have been proposed to cause dissociation. The aim of this study was to use network analyses to identify psychological processes most closely connected with ‘felt sense of anomaly’ dissociative experiences. Both an undirected model and a partially directed network model were es...

Dissociation is problematic in its own right for patients with psychosis but may also contribute to the occurrence of psychotic experiences. We therefore set out to estimate in a large cohort of patients with psychosis the prevalence of dissociative experiences, and assess using network models the relationships between dissociation, its potential m...

Background The availability of psychometrically sound instruments for the assessment of Post-Traumatic Stress Disorder (PTSD) is indispensable for clinical and scientific work with individuals suffering from trauma-related distress. Objective The aim of the present study was to translate the Post-Traumatic Diagnostic Scale for DSM-5 (PDS-5) into G...

Background Psychological models of posttraumatic stress disorder (PTSD) and prolonged grief disorder (PGD) make predictions about the role of unhelpful coping strategies in maintaining difficulties by blocking self-correction of negative appraisals and memory integration following stressful life events like bereavement. However, few studies have te...

Background: Working alliance has been shown to predict outcome of psychological treatments in multiple studies. Conversely, changes in outcome scores have also been found to predict working alliance ratings. Objective: To assess the temporal relationships between working alliance and outcome in 230 patients receiving trauma-focused cognitive behavi...

Background Cognitive behavioural correlates to bereavement-related mental health problems such a Prolonged Grief Disorder (PGD) and Posttraumatic Stress Disorder (PTSD) are of theoretical and clinical importance. Methods Individuals bereaved at least six months (N = 647) completed measures of loss-related cognitions and behaviours (i.e., loss-rela...

Background Dissociative experiences occur across a range of mental health disorders. However, the term 'dissociation' has long been argued to lack conceptual clarity and may describe several distinct phenomena. We therefore aimed to conceptualise and empirically establish a discrete subset of dissociative experiences and develop a corresponding ass...

While trauma memory characteristics are considered a core predictor of adult PTSD, the literature on child PTSD is limited and inconsistent. We investigated whether children’s trauma memory characteristics predict their posttraumatic stress symptoms (PTSS) at 1 month and 6 months post-trauma. We recruited 126 6–13 year olds who experienced a single...

Background: Numerous studies have shown that trauma-focused psychological treatments for PTSD are effective (Lewis, Roberts, Andrew, Starling, & Bisson, 2020 Lewis, C., Roberts, N. P., Andrew, M., Starling, E., & Bisson, J. I. (2020). Psychological therapies for post-traumatic stress disorder in adults: Systematic review and meta-analysis. European...

Background: Cognitive therapies are developed on the principle that specific cognitive appraisals are key determinants in the development and maintenance of mental health disorders. It is likely that particular appraisals of the coronavirus pandemic will have explanatory power for subsequent mental health outcomes in the general public. To enable...

Moral injury is the profound psychological distress that can arise following participating in, or witnessing, events that transgress an individual’s morals and include harming, betraying, or failure to help others, or being subjected to such events, e.g. being betrayed by leaders. It has been primarily researched in the military, but it also found...

Posttraumatic stress disorder (PTSD) is a common and disabling condition that can arise following severely threatening events. It is characterized by the re-experiencing of trauma memories, such as through flashbacks, nightmares or emotional reactions, avoidance of memories and reminders of the trauma, negative trauma-related cognitions and affect,...

Background Catastrophic cognitive appraisals, similar to those in anxiety disorders, are implicated in depersonalisation, a form of dissociation. No scales exist to measure appraisals of dissociative experiences. Dissociation is common in psychosis. Misinterpretations of dissociative experiences may maintain psychotic symptoms. Therefore, assessing...

Objective: The study aimed to explore the content and features of loss-related memories in a sample of individuals bereaved by cancer with and without a probable diagnosis of prolonged grief disorder/persistent complex bereavement disorder (PGD/PCBD). Methods: Semi-structured interviews with 28 bereaved adults (PGD/PCBD = 12, NoPGD/ PCBD = 16) were...

Background: Evidence-based treatment for panic disorder consists of disorder-specific cognitive behavioural therapy (CBT) protocols. However, most measures of CBT competence are generic and there is a clear need for disorder-specific assessment measures. Aims: To fill this gap, we evaluated the psychometric properties of the Cognitive Therapy Co...

Dissociative experiences, traditionally studied in relation to trauma and PTSD, may be important phenomena across many different psychological conditions, including as a contributory causal factor for psychotic experiences. In this study, the aim was to explore, using network approaches, how dissociative experiences taking the form of a Felt Sense...

Remote delivery of evidence-based psychological therapies via video conference has become particularly relevant following the COVID-19 pandemic, and is likely to be an on-going method of treatment delivery post-COVID. Remotely delivered therapy could be of particular benefit for people with social anxiety disorder (SAD), who tend to avoid or delay...

Delivering trauma-focused cognitive behavioural therapy to patients with PTSD during the COVID-19 pandemic poses challenges. The therapist cannot meet with the patient in person to guide them through trauma-focused work and other treatment components, and patients are restricted in carrying out treatment-related activities and behavioural experimen...

Background Most studies examining processes of change in psychological therapy for social anxiety disorder (SAD) have analysed data from randomised controlled trials in research settings. Method To assess whether these findings are representative of routine clinical practice, we analysed audit data from two samples of patients who received Cogniti...

Social support has been shown to facilitate adaptation after bereavement in some studies but not others. A felt sense of social disconnection may act as a barrier to the utilization of social support, perhaps explaining these discrepancies. Factorial and psychometric validity of the Oxford Grief-Social Disconnection Scale (OG-SD) was tested in a be...

Around a quarter of patients treated in intensive care units (ICUs) will develop symptoms of Post-Traumatic Stress Disorder (PTSD). Given the dramatic increase in ICU admissions during the COVID-19 pandemic, post-ICU PTSD is a relevant concern at the time of writing. Post-ICU PTSD can present various challenges to clinicians, and no clinical guidel...

Background: Over the last few decades, effective psychological treatments for posttraumatic stress disorder (PTSD) have been developed, but many patients are currently unable to access these treatments. There is initial evidence that therapist-assisted internet-based psychological treatments are effective for PTSD and may help increase access, but...

Background Wearables have been gaining increasing momentum and have enormous potential to provide insights into daily life behaviors and longitudinal health monitoring. However, to date, there is still a lack of principled algorithmic framework to facilitate the analysis of actigraphy and objectively characterize day-by-day data patterns, particula...

Background The aim of this study was to validate the English version of the Itch Cognition Questionnaire in a sample of patients with chronic itch due to psoriasis or atopic dermatitis. An English-language version of an instrument assessing itch-related cognitions is needed since cognitions can contribute to a worsening of itch, and chronic itch is...

Sudden gains are large and stable changes on an outcome variable between consecutive measurements, for example during a psychological intervention with multiple sessions. Researching these occurrences could help understand individual change processes in longitudinal data. Tang and DeRubeis (1999) suggested three criteria to define sudden gains in p...

Supplemental Materials for: Wiedemann, M., Stott, R., Nickless, A., Beierl, E. T., Wild, J., Warnock-Parkes, E., Grey, N., Clark, D. M., & Ehlers, A. (2020). Cognitive processes associated with sudden gains in cognitive therapy for posttraumatic stress disorder in routine care. Journal of Consulting and Clinical Psychology. https://doi.org/10.1037...

Sudden gains are large and stable improvements in an outcome variable between consecutive measurements, for example during a psychological intervention with multiple assessments. Researching these occurrences could help understand individual change processes in longitudinal data. Three criteria are generally used to identify sudden gains in psychol...

Objective: Although most studies investigating sudden gains in treatments for posttraumatic stress disorder (PTSD) report a positive association between sudden gains and outcomes at the end of treatment, less is known about sudden gains in routine clinical care and the processes involved in their occurrence. This study investigated changes in cogn...

Background Despite its long history, dissociation remains under-recognised clinically, partly due to difficulties identifying dissociative symptoms. Qualitative research may support its recognition by providing a lived experience perspective. In non-affective psychosis, identification of dissociation may be particularly important given that such ex...

Background: Cognitive behavioural pathways to bereavement-related mental health problems such a Prolonged Grief Disorder (PGD) and Posttraumatic Stress Disorder (PTSD) are of theoretical and clinical importance. Methods: Individuals bereaved at least six months (N = 647) completed measures of loss-related cognitions and behaviours (i.e. loss-relate...

Very little is known about the role of effective cognitive therapy in reversing imbalances in brain activity after trauma. We hypothesised that exaggerated threat perception characteristic of post-traumatic stress disorder (PTSD), and subsequent recovery from this disorder, are underpinned by changes in the dynamics of large-scale brain networks. H...

On 6 December 2019 we start the 10th year of the European Journal of Psychotraumatogy (EJPT), a full Open Access journal on psychotrauma. This editorial is part of a special issue celebrating the 10 years anniversary of the journal and acknowledging some of our most impactful articles of the past decade. In this editorial the editors present a dece...

Objective: The identification of modifiable cognitive antecedents of trajectories of grief is of clinical and theoretical interest. Method: The study gathered 3-wave data on 275 bereaved adults in the first 12-18 months postloss (T1 = 0-6 months, T2 = 6-12 months, T3 = 12-18 months). Participants completed measures of grief severity, cognitive f...

Background Individual differences in cognitive responses to trauma may represent modifiable risk factors that could allow early identification, targeted early treatment and possibly prevention of chronic posttraumatic stress disorder (PTSD). Ehlers and Clark's cognitive model of PTSD suggests that negative appraisals, disjointed trauma memories, an...

There is growing interest in interoception, the perception of the body's internal state, and its relevance for health across development. Most evidence linking interoception to health has used the heartbeat counting task. However, the temporal stability of the measure, particularly during childhood, and the etiological factors that underlie stabili...

Background: Pre-sleep cognitive activity and arousal have long been implicated in the maintenance of insomnia. However, despite high comorbidity between insomnia and posttraumatic stress disorder (PTSD), pre-sleep thoughts in PTSD and their associations with disturbed sleep, have not yet been investigated. Objective: This study presents the develop...

Clinical theories of posttraumatic stress disorder (PTSD) suggest that trauma memories are disorganized. In the present study, we examined how trauma-film exposure affects two aspects of memory disorganization, poor memory recall and memory disjointedness, and their relationship to PTSD-like symptoms. In Session 1, 90 healthy participants were expo...

Heart rate (HR) alterations in the immediate aftermath of trauma-exposure have been proposed to be potentially useful markers for child and adolescent posttraumatic stress disorder (PTSD). However, it is not yet clear if this holds true for measures taken more distal to the trauma, and no studies have investigated the predictive validity of more se...

Background The cognitive process of worry, which keeps negative thoughts in mind and elaborates the content, contributes to the occurrence of many mental health disorders. Our principal aim was to develop a straightforward measure of general problematic worry suitable for research and clinical treatment. Our secondary aim was to develop a measure o...

There is growing interest in interoception, the perception of the body’s internal state, and its relevance for health and higher-order cognition across development. To date, most evidence linking interoception to health and cognition has used the heartbeat counting task. However, the stability of the measure across time, particularly during childho...

Cognitive theories of posttraumatic stress disorder (PTSD) suggest that negative appraisals play an important role in the development and maintenance of PTSD. It has not yet been examined experimentally how people with PTSD appraise strangers. Twenty-two trauma survivors with PTSD and 26 non-traumatised controls completed a person impression updati...

Identifying early predictors for psychiatric disorders, such as post-traumatic stress disorder (PTSD), is crucial for effective treatment and prevention efforts. Obtaining such predictors is challenging and methodologically limited, for example by individuals' distress, arousal, and reduced introspective ability. We investigated the predictive powe...

Introduction Emergency workers dedicate their lives to promoting public health and safety, yet suffer higher rates of post-traumatic stress disorder (PTSD) and major depression (MD) compared with the general population. They also suffer an associated increased risk for physical health problems, which may be linked to specific immunological and endo...

Safety‐seeking behaviors (SSBs) may be employed after exposure to a traumatic event in an effort to prevent a feared outcome. Cognitive models of posttraumatic stress disorder propose SSBs contribute to maintaining this disorder by preventing disconfirmation of maladaptive beliefs and preserving a sense of current threat. Recent research has found...

Cognitive models of posttraumatic stress disorder (PTSD) highlight maladaptive posttrauma appraisals, trauma memory qualities, and coping strategies, such as rumination or thought suppression, as key processes that maintain PTSD symptoms. Anxiety, depression and externalising symptoms can also present in children in the aftermath of trauma, yet the...

Background: There is good evidence that trauma-focused therapies for Post-Traumatic Stress Disorder are effective. However, they are not always feasible to deliver due a shortage of trained therapists and demands on the patient. An online trauma-focused Guided Self-Help (GSH) programme which could overcome these barriers has shown promise in a pil...

Die Geschichte der kognitiven Verhaltenstherapie (KVT) ist besonders eng mit der Psychologie des Lernens verknüpft. In diesem Kapitel werden experimentelle Befunde zur klassischen und operanten Konditionierung dargestellt und der Zusammenhang zur Entstehung und Therapie von psychischen Störungen erläutert. Weiterhin werden die Prinzipien des Modell...

Anxiety disorders are the most common mental disorder worldwide. Although anxiety disorders differ in the nature of feared objects or situations, they share a common mechanism by which fear generalizes to related but innocuous objects, eliciting avoidance of objects and situations that pose no objective risk. This overgeneralization appears to be a...

Acquisition phase post-training select25_75. (CSV)

Generalization phase pre-training select25_75. (CSV)

Acquisition phase pre-training select25_75. (CSV)

Generalization phase post-training selection 25_75 USexpectancy CS-s GSs CS+s. (CSV)

Generalization phase post-training selection 25_75 avoidance CS-s and GSs. (CSV)

Value names and descriptions excel files S1–S5. (DOCX)

Background: While parental post-trauma support is considered theoretically important for child adjustment, empirical evidence concerning the specific aspects of parental responding that influence child post-traumatic distress, or the processes via which any such impacts occur, is extremely limited. We conducted a longitudinal examination of whether p...

The effectiveness and mechanisms of psychotherapies for PTSD in treating sleep problems is of interest. This study compared the effects of a trauma-focused and a non-trauma-focused psychotherapy on sleep, to investigate 1) whether sleep improves with psychotherapy for PTSD; 2) whether the degree of sleep improvement depends on whether the intervent...

To accelerate recovery after traumatic events and prevent posttraumatic stress disorder (PTSD), it is critical to understand the dynamic interplay of acute stress symptoms and how they develop over time into chronic PTSD. Bryant et al¹ examined relationships among PTSD symptoms during the acute posttrauma period using network analyses. They conclud...

Mental health problems are inseparable from the environment. With virtual reality (VR), computer-generated interactive environments, individuals can repeatedly experience their problematic situations and be taught, via evidence-based psychological treatments, how to overcome difficulties. VR is moving out of specialist laboratories. Our central aim...

Evidence from self-reports and laboratory studies suggests that recall of nontrauma autobiographical memories may be disturbed in posttraumatic stress disorder (PTSD), but investigations in everyday life are sparse. This study investigated unintentional nontrauma and trauma memories in trauma survivors with and without PTSD (N = 52), who kept an au...

This treatment is based on a developmentally sensitive adaptation of Ehlers and Clark’s (2000) model of PTSD, empirical evidence and our own clinical experience. Central to this model is the experience of a sense of current threat despite the fact the traumatic event happened in the past and which arises from two sources:

Background: Few efficacious early treatments for post-traumatic stress disorder (PTSD) in children and adolescents exist. Previous trials have intervened within the first month post-trauma and focused on secondary prevention of later post-traumatic stress; however, considerable natural recovery may still occur up to 6-months post-trauma. No trials...

Background: Randomised controlled trials have established that face-to-face cognitive therapy for posttraumatic stress disorder (CT-PTSD) based on Ehlers and Clark's cognitive model of PTSD is highly effective and feasible with low rates of dropout. Access to evidence-based psychological treatments for PTSD is insufficient. Several studies have sh...

The role that cognitive processing of a recent trauma has in the occurrence of hallucinations has not been examined longitudinally. This study investigated trauma-related cognitive predictors of hallucinations in the months following an interpersonal assault. Four weeks after treatment at an emergency department for interpersonal assault injuries,...