Frozen in time:

Transforming images of loss linked to traumatic bereavement, PTSD and grief

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ABSTRACT

Approximately 500,000 people die in the UK every year, leaving behind 5 very close loved ones.  When the death is sudden and traumatic, risk for developing

PTSD and prolonged grief disorder is increased.  Distressing images of the person may repeatedly come to mind and trigger intense sadness and yearning.  The images may be snapshots of the moments of death, painful points during an illness, or suffering the person may have experienced or the patient perceives them to have experienced. The images maintain distress because they link to worst meanings related to permanent change, continued suffering or loneliness, which are difficult to update in the context of repeated re-experiencing.  The persistent images block the capacity to recall memories of the deceased before they died and as such, prevent the loss memory from being more fully integrated with autobiographical memories.  When the images are in mind, patients feel as though they are losing their loved one all over again.  Transforming the distressing images is one of the core components of interventions used in trauma-focused cognitive therapy for PTSD to update the trauma memory and linked appraisals.  The aim of imagery transformation is to create a sense of continuity so that the patient can move forward with their grief, update appraisals linked to continued suffering, and update the trauma memory so that it becomes less threatening.  Imagery transformation used in CT-PTSD for traumatic bereavement is associated with high rates of recovery, is often described as life-changing, supports natural grieving, and can be adapted for remote delivery during pandemic working.

By the end of the session, attendees will be able to:

Recognise what imagery transformation is, why it is important, how to incorporate it within PTSD and grief treatments and when

Identify core cognitive themes linked to loss trauma and ways of working with them

Describe ways of integrating updated meanings into traumatic loss memories

Describe steps in transforming images of loss and permanent change

Overcome obstacles to transforming loss images

Identify ways of adapting procedures to working remotely

Key references

Wild, J., Ehlers, A. & Duffy, M. (under review).  Frozen in time:  How to transform images of loss linked to traumatic bereavement. In special issue:  Disseminating CBT: 50 years and beyond. The Cognitive Behavioural Therapist.

Duffy, M., & Wild, J. (2017). A cognitive approach to persistent complex bereavement disorder (PCBD). The Cognitive Behaviour Therapist, 10, e16. https://doi.org/10.1017/S1754470X17000034

Wild, J., Warnock-Parkes, E., Murray, H., Kerr, A., Thew, G., Grey, N., Clark, D.M. & Ehlers, A. (2020). Treating posttraumatic stress disorder remotely with Cognitive Therapy for PTSD. European Journal of Psychotraumatology, 11:1, 1785818 doi: 10.1080/20008198.2020.1785818

Ehlers, A. & Clark, D.M. (2000).  A cognitive model of posttraumatic stress disorder, Behaviour Research and Therapy, 38, 319-345.

Wild, J. (2009).  When the injuries are disabling:  Cognitive therapy for PTSD and permanent change.  In N. Grey (Editor).  A Casebook of Cognitive Therapy for Traumatic Stress Reactions.  Routledge: Hove.

Ehlers, A. & Wild, J. (2021). Cognitive behavior therapies for posttraumatic stress disorder. In A. Wenzel (Ed.), Handbook of cognitive behavioral therapy: Applications (pp. 99–147). American Psychological Association. https://doi.org/10.1037/0000219-004