HANDOUT 3.1 PTSD Checklist-5 (PCL-5): Scale and Scoring Date: Client: The PTSD Checklist (PCL) was recently revised for the DSM-5 (this version is known as the PCL-5). While this instrument alone is not sufficient to diagnose PTSD, it gives you a sense of whether an individual is experiencing PTSD symptoms and how severe his or her symptoms are. For your purposes, add up your client’s scores on the 20 items. If the total score is 38 or above, refer him or her for a PTSD assessment/evaluation, if needed, for confirmation of the diagnosis. You can track your client’s scores by plotting them on the PCL graph at the end of this handout. There are two versions of the PCL-5: 1. The PCL-5 Monthly is administered before the start of Session 1 of CPT. It uses the past month as the time frame reference. There is an alternative format of the PCL-5 Monthly, which may be used before the start of Session 1 in order to assess the Criterion A trauma in more depth (PCL-5 with a brief Criterion A assessment). 2. The PCL-5 Weekly is used during CPT for Session 2 and for all other sessions. Remind the client to use only the preceding week as the time frame for each item. Score it immediately upon receipt, and ask the client for any clarifications needed. If the client’s scores have not dropped significantly by Session 6, the therapist should explore whether the client is still avoiding affect, has been engaging in self-harm or other therapyinterfering behavior, or has not changed his or her assimilated beliefs about the traumatic event. Processing the lack of improvement with the client will be important at that point. Please note: Several important revisions were made to the PCL in updating it for DSM-5. Changes involve the rating scale (now a 0–4 range for each symptom) and an increase from 17 to 20 items. This means that PCL-5 scores are not compatible with scores on versions of the PCL for DSM-IV (e.g., the PCL-S, which is in previous editions of the CPT manual), and that the PCL-5 cannot be used interchangeably with these earlier versions. (continued) Both versions of the PCL-5 are from Weathers, Litz, Keane, Palmieri, Marx, and Schnurr (2013). The scale is available from the National Center for PTSD at www.ptsd.va.gov and is in the public domain. Reprinted in Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kathleen M. Chard. Copyright © 2017 The Guilford Press. Permission to photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details). HANDOUT 3.1 (p. 2 of 7) PCL-5 WITH BRIEF CRITERION A ASSESSMENT: MONTHLY Instructions: This questionnaire asks about problems you may have had after a very stressful experience involving actual or threatened death, serious injury, or sexual violence. It could be something that happened to you directly, something you witnessed, or something you learned happened to a close family member or close friend. Some examples are a serious accident; fire; disaster such as a hurricane, tornado, or earthquake; physical or sexual attack or abuse; war; homicide; or suicide. First, please answer a few questions about your worst event, which for this questionnaire means the event that currently bothers you the most. This could be one of the examples above or some other very stressful experience. Also, it could be a single event (for example, a car crash) or multiple similar events (for example, multiple stressful events in a war zone or repeated sexual abuse). Briefly identify the worst event (if you feel comfortable doing so): How long ago did it happen? Did it involve actual or threatened death, serious injury, or sexual violence? Yes No How did you experience it? It happened to me directly I witnessed it I learned about it happening to a close family member or close friend I was repeatedly exposed to details about it as part of my job (for example, paramedic, police, military, or other first responder) Other (please describe) If the event involved the death of a close family member or close friend, was it due to some kind of accident or violence, or was it due to natural causes? Accident or violence Natural causes Not applicable (the event did not involve the death of a close family member or close friend) Second, keeping this worst event in mind, read each of the problems on the next page and then circle one of the numbers to the right to indicate how much you have been bothered by that problem in the past month. (continued) HANDOUT 3.1 (p. 3 of 7) PCL-5: MONTHLY Instructions: Below is a list of problems that people sometimes have in response to a very stressful experience. Please read each problem carefully, and then circle one of the numbers to the right to indicate how much you have been bothered by that problem in the past month. In the past month, how much were you bothered by: Not at all A little bit Moderately 1. Repeated, disturbing, and unwanted memories of the stressful experience? 0 1 2 3 4 2. Repeated, disturbing dreams of the stressful experience? 0 1 2 3 4 3. Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)? 0 1 2 3 4 4. Feeling very upset when something reminded you of the stressful experience? 0 1 2 3 4 5. Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)? 0 1 2 3 4 6. Avoiding memories, thoughts, or feelings related to the stressful experience? 0 1 2 3 4 7. Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)? 0 1 2 3 4 8. Trouble remembering important parts of the stressful experience? 0 1 2 3 4 Quite a bit Extremely (continued) HANDOUT 3.1 (p. 4 of 7) In the past month, how much were you bothered by: Not at all A little bit Moderately 9. Having strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous)? 0 1 2 3 4 10. Blaming yourself or someone else for the stressful experience or what happened after it? 0 1 2 3 4 11. Having strong negative feelings such as fear, horror, anger, guilt, or shame? 0 1 2 3 4 12. Loss of interest in activities that you used to enjoy? 0 1 2 3 4 13. Feeling distant or cut off from other people? 0 1 2 3 4 14. Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)? 0 1 2 3 4 15. Irritable behavior, angry outbursts, or acting aggressively? 0 1 2 3 4 16. Taking too many risks or doing things that could cause you harm? 0 1 2 3 4 17. Being “superalert” or watchful or on guard? 0 1 2 3 4 18. Feeling jumpy or easily startled? 0 1 2 3 4 19. Having difficulty concentrating? 0 1 2 3 4 20. Trouble falling or staying asleep? 0 1 2 3 4 Quite a bit Extremely (continued) HANDOUT 3.1 (p. 5 of 7) PCL-5: WEEKLY Instructions: Below is a list of problems that people sometimes have in response to a very stressful experience. Please read each problem carefully, and then circle one of the numbers to the right to indicate how much you have been bothered by that problem in the past week. In the past week, how much were you bothered by: Not at all A little bit Moderately 1. Repeated, disturbing, and unwanted memories of the stressful experience? 0 1 2 3 4 2. Repeated, disturbing dreams of the stressful experience? 0 1 2 3 4 3. Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)? 0 1 2 3 4 4. Feeling very upset when something reminded you of the stressful experience? 0 1 2 3 4 5. Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)? 0 1 2 3 4 6. Avoiding memories, thoughts, or feelings related to the stressful experience? 0 1 2 3 4 7. Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)? 0 1 2 3 4 8. Trouble remembering important parts of the stressful experience? 0 1 2 3 4 Quite a bit Extremely (continued) HANDOUT 3.1 (p. 6 of 7) In the past week, how much were you bothered by: Not at all A little bit Moderately 9. Having strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous)? 0 1 2 3 4 10. Blaming yourself or someone else for the stressful experience or what happened after it? 0 1 2 3 4 11. Having strong negative feelings such as fear, horror, anger, guilt, or shame? 0 1 2 3 4 12. Loss of interest in activities that you used to enjoy? 0 1 2 3 4 13. Feeling distant or cut off from other people? 0 1 2 3 4 14. Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)? 0 1 2 3 4 15. Irritable behavior, angry outbursts, or acting aggressively? 0 1 2 3 4 16. Taking too many risks or doing things that could cause you harm? 0 1 2 3 4 17. Being “superalert” or watchful or on guard? 0 1 2 3 4 18. Feeling jumpy or easily startled? 0 1 2 3 4 19. Having difficulty concentrating? 0 1 2 3 4 20. Trouble falling or staying asleep? 0 1 2 3 4 Quite a bit Extremely (continued) HANDOUT 3.1 (p. 7 of 7) PCL-5 SCORE SHEET 80 75 70 65 60 PCL-5 Score 55 50 45 40 35 30 25 20 15 10 5 0 0 1 2 3 4 5 6 7 Session # 8 9 10 11 12 13