Behavioural and Cognitive Psychotherapy, 2002, 30, 37–56 Cambridge University Press. Printed in the United Kingdom Empirically Grounded Clinical Interventions Section COGNITIVE RESTRUCTURING WITHIN RELIVING: A TREATMENT FOR PERITRAUMATIC EMOTIONAL ‘‘HOTSPOTS’’ IN POSTTRAUMATIC STRESS DISORDER Nick Grey Centre for Anxiety Disorders and Trauma, London, UK Kerry Young Traumatic Stress Clinic, London, UK Emily Holmes Traumatic Stress Clinic, London, and University College, London, UK Abstract. This paper describes a distinct clinical approach to the treatment of Posttraumatic Stress Disorder (PTSD). It is theoretically guided by recent cognitive models of PTSD and explicitly combines cognitive therapy techniques within exposure/reliving procedures. A clinically pertinent distinction is made between the cognitions and emotions experienced at the time of the trauma and, subsequently, in flashback experiences, and secondary negative appraisals. The term peritraumatic emotional ‘‘hotspot’’ is used to describe moments of peak distress during trauma. It is argued that a focus on cognitively restructuring these peritraum- atic emotional hotspots within reliving can significantly improve the effectiveness of the treatment of PTSD and help explain some treatment failures with traditional prolonged expo- sure. An approach to the identification and treatment of these hotspots is detailed for a range of cognitions and emotions not limited to fear. Keywords: Posttraumatic stress disorder, PTSD, cognitive behaviour therapy, ‘‘hotspots’’. Introduction Traditional cognitive behavioural models of PTSD focus on the therapeutic strategy of ima- ginal exposure, which is also referred to as ‘‘reliving’’ (Foa & Kozak, 1986; Foa, Stek- Reprint requests to Nick Grey, Centre for Anxiety Disorders and Trauma, Institute of Psychiatry, 99 Denmark Hill, London SE5 8AF, UK. E-mail: n.grey@iop.kcl.ac.uk  2002 British Association for Behavioural and Cognitive Psychotherapies