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 Casebook to the APA
Clinical Practice Guideline
for the Treatment of

PTSD
 Casebook to the APA
Clinical Practice Guideline
for the Treatment of

PTSD
Edited by Lynn F. Bufka, Caroline Vaile Wright, and Raquel W. Halfond
Copyright © 2020 by the American Psychological Association. All rights reserved. Except
as permitted under the United States Copyright Act of 1976, no part of this publication
may be reproduced or distributed in any form or by any means, including, but not limited
to, the process of scanning and digitization, or stored in a database or retrieval system,
without the prior written permission of the publisher.

The opinions and statements published are the responsibility of the authors, and
such opinions and statements do not necessarily represent the policies of the American
Psychological Association.

Published by
American Psychological Association
750 First Street, NE
Washington, DC 20002
https://www.apa.org

Order Department
https://www.apa.org/pubs/books
order@apa.org

In the U.K., Europe, Africa, and the Middle East, copies may be ordered from Eurospan
https://www.eurospanbookstore.com/apa
info@eurospangroup.com

Typeset in Meridien and Ortodoxa by Circle Graphics, Inc., Reisterstown, MD

Printer: Sheridan Books, Chelsea, MI

Cover Designer: Nicci Falcone, Potomac, MD

Library of Congress Cataloging-in-Publication Data

Names: Bufka, Lynn F., editor. | Wright, Caroline Vaile, editor. | Halfond, Raquel W., editor.
Title: Casebook to the APA clinical practice guideline for the treatment of PTSD /
edited by Lynn F. Bufka, Caroline Vaile Wright, and Raquel W. Halfond.
Description: Washington, DC : American Psychological Association, [2020] |
Includes bibliographical references and index.
Identifiers: LCCN 2019059295 (print) | LCCN 2019059296 (ebook) |
ISBN 9781433832192 (paperback) | ISBN 9781433833588 (ebook)
Subjects: LCSH: Post-traumatic stress disorder—Treatment—Case studies.
Classification: LCC RC552.P67 C3735 2020 (print) | LCC RC552.P67 (ebook) |
DDC 616.85/21—dc23
LC record available at https://lccn.loc.gov/2019059295
LC ebook record available at https://lccn.loc.gov/2019059296

http://dx.doi.org/10.1037/0000196-000

Printed in the United States of America

10 9 8 7 6 5 4 3 2 1
CONTENTS

Contributors vii
Preface ix
Raquel W. Halfond, Caroline Vaile Wright, and Lynn F. Bufka

1. Overview of the Volume 3

Lynn F. Bufka and Jeffrey H. Sonis

2. Foundations of PTSD Treatments 21

Caroline Vaile Wright

3. Cognitive Behavior Therapy for PTSD 47

Dawn M. Johnson and Taylor L. Ceroni

4. Cognitive Processing Therapy for PTSD 69

Kathleen M. Chard and Ellen T. Healy

5. Cognitive Therapy for PTSD 91

Anke Ehlers and Jennifer Wild

6. Prolonged Exposure for PTSD 123

Thea Gallagher, Julie Petersen, and Edna B. Foa

7. Brief Eclectic Psychotherapy for PTSD 139

Berthold P. R. Gersons, Mirjam J. Nijdam, Geert E. Smid,
and Marie-Louise Meewisse

8. Eye-Movement Desensitization and Reprocessing Therapy

for PTSD 163
Louise Maxfield, Roger M. Solomon, and E. C. Hurley

v
vi Contents

9. Narrative Exposure Therapy for PTSD 187

Frank Neuner, Thomas Elbert, and Maggie Schauer

10. Pharmacotherapy for PTSD: What Psychologists Need

to Know 207
Matthew J. Friedman and Jeffrey H. Sonis

11. Conclusion: PTSD Treatment Themes, Shared Components,

and Future Research Directions 233
Raquel W. Halfond

Index 243
About the Editors 255
CONTRIBUTORS

Lynn F. Bufka, PhD, American Psychological Association, Washington, DC

Taylor L. Ceroni, PhD, University of Akron, Akron, OH; now at Southeast
Louisiana Veterans Health Care System, New Orleans, LA
Kathleen M. Chard, PhD, Cincinnati VA Medical Center and University
of Cincinnati, Cincinnati, OH
Anke Ehlers, PhD, Department of Experimental Psychology, University
of Oxford, Oxford, England
Thomas Elbert, PhD, Department of Psychology, Universität Konstanz,
Konstanz, Germany
Edna B. Foa, PhD, University of Pennsylvania Perelman School of Medicine,
Philadelphia
Matthew J. Friedman, MD, PhD, National Center for PTSD, U.S. Depart-
ment of Veterans Affairs and Department of Psychiatry, Geisel School of
Medicine at Dartmouth, Hanover, NH
Thea Gallagher, PsyD, University of Pennsylvania Perelman School of
Medicine, Philadelphia
Berthold P. R. Gersons, MD, PhD, ARQ National Psychotrauma Center,
Amsterdam University Medical Centers, Amsterdam, Netherlands
Raquel W. Halfond, PhD, American Psychological Association,
Washington, DC
Ellen T. Healy, PhD, VA Boston Healthcare System, National Center
for PTSD, and Boston University School of Medicine, Boston, MA
E. C. Hurley, DMin, PhD, Soldier Center, Clarkesville, TN
Dawn M. Johnson, PhD, Department of Psychology, University of Akron,
Akron, OH

vii
viii Contributors

Louise Maxfield, PhD (retired), Ridgetown, Ontario, Canada

Marie-Louise Meewisse, PhD, Abate, Center of Expertise in Trauma
and Anxiety, Enkhuizen, Netherlands
Frank Neuner, PhD, Department of Psychology, Universität Bielefeld,
Bielefeld, Germany
Mirjam J. Nijdam, PhD, ARQ National Psychotrauma Center, Amsterdam
University Medical Centers, Amsterdam, Netherlands
Julie Petersen, BS, Utah State University, Logan
Maggie Schauer, PhD, Department of Psychology, Universität Konstanz,
Konstanz, Germany
Geert E. Smid, MD, PhD, ARQ National Psychotrauma Center, Diemen,
Netherlands, and University of Humanistic Studies, Utrecht, Netherlands
Roger M. Solomon, PhD, Licensed Psychologist/Consultant, Arlington, VA
Jeffrey H. Sonis, MD, MPH, Departments of Social Medicine and
Family Medicine, University of North Carolina at Chapel Hill
Jennifer Wild, DClinPsy, Department of Experimental Psychology,
University of Oxford, Oxford, England
Caroline Vaile Wright, PhD, American Psychological Association,
Washington, DC
PREFACE
Raquel W. Halfond, Caroline Vaile Wright, and Lynn F. Bufka

This casebook is meant to illustrate how the treatments recommended by the

Clinical Practice Guideline for the Treatment of PTSD (American Psychological
Association [APA], 2017) are used in practice. As staff members at APA, housed
within the Practice Directorate in the Practice Research and Policy Department,
we were all involved in the development of this guideline.1
The purpose of the APA Clinical Practice Guideline was to make recom-
mendations regarding the efficacy of interventions for treating adults with
posttraumatic stress disorder (PTSD; see https://www.apa.org/ptsd-guideline/
ptsd.pdf). In addition, a website for the guideline with many resources
(including additional case examples) is available (see https://www.apa.org/
ptsd-guideline/). The information and case examples included in this book
represent each of the recommended treatments for PTSD and are intended to
illustrate distinct elements of treatment and how they are implemented in
practice. This casebook is educational, and, as is true with the APA Clinical
Practice Guideline, it is not intended to be a mandate or required standard
for practice. Furthermore, no attempt is made to match particular symptoms
to particular treatments. Rather, given that evidence-based practice in psychol-
ogy is the integration of the best available evidence with clinician expertise

1
Lynn Bufka is the senior director, practice transformation and quality and, together
with her counterpart in APA’s Science Directorate, oversees development of clinical
practice guidelines. Caroline Vaile Wright is the senior director, health care innovation
and conducted the additional searches for information on potential harms and
burdens for the PTSD guideline. Raquel Halfond is the director of evidence based
practice and worked most closely with the guideline development panel. All
three editors are licensed clinical psychologists.

ix
x Preface

and patients’ preferences, culture, and individual characteristics (APA, 2006),

the casebook describes the treatments, briefly summarizes their evidence
bases, and shows readers how some clinicians have used the treatments with
particular clients so that readers can make their own clinical choices.
Although the APA Clinical Practice Guideline was approved as policy with
a majority vote by APA’s Council of Representatives, there was and there
continues to be controversy surrounding this guideline. Concerns were raised
that the guideline did not include or did not give a strong enough recommen-
dation to some treatments that are commonly used in practice but for which
there is a less robust research base than is available for other treatments. This
situation stems in part from the decision to follow the standards for guideline
development from the former Institute of Medicine (IOM [now the National
Academy of Medicine], 2011), which some argue are a poor fit for mental
and behavioral health guidelines because they adhere to a medical model.
Others raised concerns that insufficient attention was given in the guideline
to aspects that are important to care, such as the nature and quality of the
therapeutic relationship and patient individual differences. While these areas
are indeed important, methods for evaluating the quality of this body of
research to inform guideline recommendations do not meet the rigor and
transparency of systematic reviews and established standards for evaluating
the efficacy of interventions, and the panel determined it could not make
recommendations in these areas.
To address these concerns, APA is developing a companion professional
practice guideline to address the role of contextual and nonspecific factors in
providing evidence-based practice and another to address issues relevant to
trauma-specific care. Professional practice guidelines are based in the profes-
sional literature but differ from clinical practice guidelines (CPGs) in that pro-
fessional practice guideline recommendations are developed through expert
consensus without a systematic search for and evaluation of the quality of the
evidence base. Furthermore, as APA has continued to produce additional CPGs,
its process has worked to address concerns raised about the PTSD guideline.
CPG development will continue to evolve, and as APA becomes a leader in
guideline development, APA will be positioned to identify and incorporate
new methodologies to evaluate evidence that could be well suited for mental
and behavioral health topics.
Combined, these efforts support the same goal: to help individuals living
with PTSD to cope, feel better, and lead productive and fulfilling lives through
informed, evidence-based care. Many of us in the mental and behavioral health
field have been touched professionally and personally by the horrible ravages
of PTSD in our patients, families, friends, loved ones, or even selves, and
many of us know firsthand the impact of PTSD and importance of treatment
that works. While much remains to be understood about the development,
maintenance, and treatment of PTSD, this is a starting point. It is our sincere
hope that this book will contribute to efforts to bridge this gap, more closely tie
research with pragmatic practice application, and ultimately better the lives
of individuals living with PTSD and of their family, friends, and loved ones.
 Preface xi

REFERENCES
American Psychological Association. (2017). Clinical practice guideline for the treatment of
PTSD. http://dx.doi.org/10.1037/e514052017-001
American Psychological Association, Presidential Task Force on Evidence-Based Practice.
(2006). Evidence-based practice in psychology. American Psychologist, 61, 271–285.
http://dx.doi.org/10.1037/0003-066X.61.4.271
Institute of Medicine. (2011). Clinical practice guidelines we can trust. Washington, DC:
National Academies Press.
 Casebook to the APA
Clinical Practice Guideline
for the Treatment of

PTSD
Exploring the Variety of Random
Documents with Different Content
perpendicular height.—The whole of its organic remains appears to
have been washed from other formations, to be deposited in it, and
it contains, mingled with them, fragments of almost every rock of
the secondary and primary series; comprehending immense blocks
of granite, porphry, greenstone, oolite, lias, chalk, pebbles, trap,
micaceous chist, sand-stones of various kinds, chert, marl, &c. Near
Hasborough it is much intermingled with chalk.
The second stratum, as we descend beneath the till, is the

Crag.
A layer of which, between the watch-house and coal gaps at Bacton,
has been termed by Mr. Lyell hard ferruginous crag. It consists of
several thin plates, containing compressed wood, fragmentary and
whole shells, intermixed with clay, gravel, and white sand. This bed
forms a dip towards the north-west, having a support of red sand on
the one side, and green sand on the other. A section of the crag is
more largely developed at Cromer, Runton, and Weybourne.
Between Bacton coal gap and Mundsley, vertical layers of crag occur,
composed of thickly cemented fragments of shells.
Immediately beneath the crag occur those formations which are
generally termed Fresh Water, consisting of lignite and lacustrine
deposits.

Lacustrine.
At several spots between Hasborough and Mundsley, these deposits
may be examined. They contain many species of shells, with fish
and bones of mammalia.
The first of these occurs at a place called Ostend, between
Hasborough and Bacton, about half a mile from the latter place. It
is composed of bluish mud, with occasional patches of brown clay,
and extends several yards along the beach. This formation was
discovered by Mr. Green, in August, 1841.
About two hundred yards from the forest peat at Bacton, the second
lacustrine bed occurs. It is confined to occasional patches about the
middle of the cliff, near the watch-house gap. The shells are
deposited in thin layers of sand and blue clay, containing much
wood, which appears as if bored by some insect.
The third lacustrine formation is at the village of Mundsley, and is
distinguished from the other cliffs by its dark muddy appearance. Its
height is about twenty feet, and it extends one hundred yards along
the beach.
Mr. Lyell, referring to this bed, says, “It consists of brown, black, and
grey sand, and loam mixed with vegetable matter, sometimes almost
passing into a kind of peaty earth, containing much pyrites.”

Lignite.
This name has been given to extensive forest beds, containing much
carbonized wood.
The deposit prevails very generally along the Norfolk coast, and may
be instructively examined at Hasborough, Bacton, Mundsley,
Trimingham, and Cromer.
At Bacton extensive sections are laid bare after high tides. They are
mostly formed of black peaty earth, which may be separated into
thin layers, and has generally an aluminous taste, and abounds with
pyrites.
At Bacton the depth of these sections, from the top of the cliff, is
about five feet; at Ostend, between Bacton and Hasborough, about
thirty, and at Mundsley, one hundred feet.
These deposits are occasionally mixed with masses of red sand,
containing pipes of hard clay.
This formation presents the appearance of a wood, having been
overthrown and crushed in situ; for after strong north-west winds,
the stumps of the trees may be seen really standing, with their
strong roots extended, and intermingling with each other. In the
winter of 1840–41, Mr. Green measured some of these trunks, which
were then exposed about a foot from the root.—One measured five
feet eleven inches round, and the other five feet.
Whilst at Bacton this bed is formed of black peaty earth, at Ostend it
is mixed with a greenish sand. Mr. Lyell speaks of that at
Hasborough as “laminated blue clay, about one foot and a half in
thickness, part of the clay being bituminous, and inclosing
compressed branches and leaves of trees.”
Mr. R. C. Taylor, in his Geology of Eastern Norfolk, observes of the
deposit generally:—“It consists of forest peat, containing fir cones
and fragments of bones; in others of woody clay; and elsewhere, of
large stools of trees, standing thickly together, the stems appearing
to have been broken off about eighteen inches from the base.”
The Rev. James Layton, cited by Mr. Fairholme in his Geology, states,
in a letter, “the line of crushed wood, leaves, grass, &c., frequently
forming a bed of peat, extends just above low water mark. About
this stratum, numerous remains of mammalia are found, the horns
and bones of at least four kinds of deer, the horse, the ox,
hippopotamus, rhinoceros, and elephant. These fossil remains are
found at Hasborough and its neighbourhood, on the denuded clay
shore. At Mundsley, they are found in the cliff. This stratum may be
seen as the underlying formation, along the whole line of beach
from Eccles to Mundsley.”
At Cromer, Mr. Simons has observed, beneath the drift, several feet
below high water mark, a bed of lignite, in which were found the
seeds of plants, &c. He also observed ten or more trees, in the
space of half an acre, exposed below the cliffs eastward of that
town, the stumps being a few inches, all less than a foot, in vertical
height, some no less than nine or ten feet in girth, the roots
spreading from them on all sides, throughout a space of twenty feet
in diameter.
Mr. Richard Taylor believes this bed, as visible at Hasborough, to be
an extension of the well-known stratum at Watton cliff and Harwich.
“There is,” he says, “evidence sufficient to prove that it extends
more south than Palling, even as low down as Winterton, and
Caister; also at Lowestoft.”
The two last strata nearest the chalk are the

Blue Clay and the Red Gravel.

These two beds “seem to have been deposited contemporaneously,
as they are much intermixed, and every where contain the same
species of mammalian remains. From the unusual quantity of bones
contained in these strata, they have been provincially termed the
Bone Rocks, but from the immense quantity of elephants’ bones
annually exhumed, they may, for the sake of distinction, be termed
the Elephant Beds.” In some places the blue clay is deposited upon
the red gravel.
The red gravel appears to be composed of rolled materials, which no
doubt have been brought to this place from some distance. It
comprehends a mixture of red sand and gravel, ferruginous and
ochraceous nodules; blue clay, peat, sulphur, loam, flints, pebbles,
masses of granite, porphry, fragments of and whole bones, and is
much mineralized by iron.
These rocks are traceable to a considerable distance beyond Cromer.
The immediate bed upon which the strata rests appears to be

Chalk.
This is met with about half a mile north-west of Mundsley, about low
water mark, and for upwards of a mile forms the beach. Near
Trimingham three very remarkable protuberances, which rise up and
form a part of lofty cliffs. Further northward, masses of chalk are
included in the drift, or crop out in the interior, at a short distance
from the shore, as at Overstrand, near Cromer, where a pit has been
worked, in which the chalk is in a very disturbed and shattered
state. At Cromer, the chalk has been again detected, and is every
where the fundamental rock, lying about the level of low water, and
rising on the north of that town, to the height of some yards above
the level. At Sherringham it ascends above high water mark, and
enters largely, from thence to Weybourne, into the strata of the
cliffs.
From the appearance then of so much chalk in the immediate
neighbourhood, and some of it apparently in an undisturbed state,
as may be seen by its horizontal layers of flint at Sherringham,
beyond doubt its existence may be concluded both to the east as
well as the north.
In the year 1836, the humerus bone probably of the Great
Mastodon, was found at Bacton, after a very high tide, one side of
which, from the appearance it presents, must have reposed upon
chalk. This bone was discovered in the red gravel, which, in many
places, is the nearest bed to the chalk. Fragments of chalk are
attached to the bone.
In the early part of this year the tibia probably of the same animal,
was exposed, and obtained after a high tide by Mr. Green, in whose
possession it still remains.
 CHAPTER IX.

OBSERVATIONS UPON THE CLIFFS CONTINUED.—LAND-SPRINGS, THEIR INJURIOUS

EFFECTS, WITH PLAN TO COUNTERACT THEM.—REDUCTION OF THE CLIFFS
CONSIDERED ADVISABLE, ESPECIALLY WHERE GREAT IRREGULARITIES IN SAND
DUNES EXIST, WITH A PLAN TO INCREASE THEIR HEIGHT WHERE NECESSARY.

Having considered the cliffs with respect to the contour they present,
the different strata composing their structure, the injury they
experience from the atmospheric air, from drought, from heavy
rains, from severe and successive frosts, and from the formidable
visitations of the German Ocean against their base; yet, they
possess an internal enemy peculiar to themselves, which in certain
localities is more formidable than the ocean itself—these are the
Land-springs previously alluded to.
To check their baneful influence is a task that requires consideration,
for although we know their existence, we cannot tell whether they
arise from a broad or a narrow surface, at a great depth, or at a
considerable distance from whence they are seen to issue; and
although so serious in their consequences, yet the extent arising
from such contingencies, on this part of the coast, is generally
limited.
Wherever they abound, the cliffs ought, where practicable, to be
reduced from a perpendicular to an inclined plane; then let stakes,
or rather strong piles, be driven in a parallel direction to the extent
required, and sufficiently deep into the solid strata beneath, at short
distances one from another, with splines fastened horizontally, or
what would be preferable, strong wooden faggots interposed
between the piles and the cliffs, especially where the materials
consist of a loose texture; these would be found efficient, until a
more natural, solid, and lasting support could be obtained.
Great benefit might be derived by sinking wells on the inner or land
side of the cliffs, subjected to their influence; for at Trimingham, the
loss of four acres and a half of land, mentioned in a previous
chapter, is primarily attributed to a foolish individual, who a few
months before filled up three wells in the immediate neighbourhood.
The question now comes—would it not be advisable to remove
generally, where practicable, the taller, cliffs?—Possibly it would.
1st. The air in heavy gales of wind would not be so much
condensed against their base, and add so much weight to the waves
when nearing the shore as is now evidently the case, and the latter
would be less liable to disarrange the legitimate beach during its
formation.
2ndly. Wherever land-springs abound, an egress for the fresh water
would ensue, without causing shoots of land to take place, where
the former exist beyond or rather above the reach of the stakes
recommended, which might retard the formation of the legitimate
beach.
3rdly.—It will be decidedly applicable, where dunes or hills of blown
sand from their irregularity, produced from the north-east winds, are
reduced to an extent liable to admit an irruption of the sea,
observable at Eccles, Palling, &c.
And lastly. The application of a plough in a locality where such
fissures exist, upon the plan recommended in the ensuing chapter;
and due attention to the transplanting the marram [67] from time to
time as required, will accomplish the rest without directly interfering
with the land belonging to private individuals on the inner side of
those banks.
 CHAPTER X.

THE AUTHOR’S PLAN FOR EVENTUALLY COUNTERACTING THE INJURIOUS EFFECTS

OF THE GERMAN OCEAN ALONG THE EASTERN COAST OF NORFOLK, COMPRISED
WITHIN A DISTANCE OF THIRTY MILES, EXTENDING FROM WINTERTON-NESS TO OR
A LITTLE BEYOND CROMER.—A PLAN FOR THE ERECTION OF JETTIES SUBMITTED,
&C.

The knowledge gained upon this interesting subject, the instances

adverted to in the former chapter, prove almost beyond a doubt, that
the question—Whether art can arrest the progress of the German
Ocean along the Norfolk coast? may be answered in the affirmative.
The first and greatest desideratum necessary to be obtained is a
bold shore, formed by a legitimate beach, a term applied by the
eminent engineer, previously alluded to, who stated its ascent should
be three inches and a half in the yard, which would realize
seventeen feet and a half in two hundred and ten yards; a height
which no sea upon this coast could ever reach.
From there being plenty of materials in the offing, the ascent could
be more gradual, which would be preferable, for a two-fold object
must be kept in view; the one, for the preservation of the lands in
the interior; the other, for the safety of mariners, should misfortune
attend and compel them to run their vessel ashore. Besides the
more abruptly a body presents itself, whether natural or artificial, to
the almost irresistible force of the tidal wave, when called into
excessive action, the less it is likely to remain stable and compact.
It will therefore be necessary to ascertain the extent of the shoals
existing in the offing, and the elevation likely to be realized may
easily be calculated.
A single row of piles driven into the beach at right angles to the
shore, wherever a shallow exists, will be sufficient, with plank
fastened to them, to encourage the materials, brought by the tidal
wave and current, to be retained and lodged against them. The
length of the piles necessary, must depend upon the supposed
elevation required, taking into consideration, not only the depth of
the sand lying at the bottom of the shallow, but also the strata
beneath. In a very short time, by gradually adding the plank, the
shallow will become filled up, and the tidal wave will pass over
without disturbing its surface, the same plan must be adopted
wherever a shallow exists at low water mark, but possibly the
difficulty of applying the plank in that situation cannot be so easily
accomplished; consequently a greater number of piles will be
required, as they must be inserted near to each other.
After a shallow has been filled to the level of the beach then
existing, and the upper part of the pile still projecting, let plank, if
necessary, be gradually added about one or two feet in breadth at a
time, as the deposition accumulates.
Proceeding onwards into the sea as opportunity offers, some portion
of the shoals will be removed into the shallows; another, probably,
will be carried towards the cliffs. To facilitate this object, let a long
tined harrow be fastened to the stern of a boat, which being urged
by men, will loosen the materials on the surface of a shoal; and the
flowing of the water will carry them, if the wind is in a favourable
quarter, towards the shore, and thus will the beach become a
consolidated body, with superabundant materials deposited at high
water mark: these of course must be removed towards the cliffs. If
the materials consist principally of sand, a plough might be
employed with considerable advantage, turning the furrows inward
towards the cliffs; on the contrary, should stones predominate, they
must be deposited at the base of the cliffs. Easterly winds will
remove the loose dry sand towards and fill up the spaces between
them. Many suggestions, however, to expedite the work will present
themselves upon inspection and trial. [70]
The distance required from one row of piles to another must also
depend upon circumstances. Wherever the sea reaches in, should a
shallow or flat exist, there piles will be necessary, as well as to the
southward of it, which will greatly accelerate the deposition of
materials where they are so much required.

Discrimination will also be necessary in the application of the piles;

for a minute and continuous observer will perceive it frequently
happens, the alteration of a current and the wind favouring it, the
sea will reach in towards the cliffs, and undermine and excavate one
locality, while another, previously visited, will become filled up by
materials dislodged from the former place. [71] In the latter instance,
piles will not be required to be applied immediately, for probably
some of the materials, irregularly accumulated, will be requisite to
be shifted to their former situation. Hence the reason of applying
piles to the southward and not to the northward of a locality
requiring immediate assistance.
Again, considerable difference in the insertion of the piles must be
made according to the contour the beach presents; between a
distance continuously flat, and a shallow that only requires to be
filled up. In the latter a few piles inserted from west to east, will
answer extremely well; in the former, an opposite direction must be
pursued; that is, from the north-west to the south-east, according to
the accompanying plate, for the sweep of the water must be taken
into consideration, and also the necessity for encouraging sea-beach
materials to accumulate to the southward of a groin, as well as to
the northward. Upon this our final success depends.
While the above plan presents the least resistance to the tidal wave
when most agitated, the tidal current will be checked and rendered
powerless, and the gradual elevation, from the deposition of
materials, will produce the effects exhibited by the breaking of the
waves on a shelving shore; and, as they roll onwards, their power
will become diminished, by wanting weight and depth to aid their
motion.
In several places on this beach, the sand, shingle, &c., do not
exceed four feet in depth, and in some instances are still shallower;
thus at Cromer, a large body of calcareous deposition exists, and
projects above the beach at low water mark; but between that and
the cliffs, now temporarily protected by a sea wall, a shallow or
cavity of considerable length and depth must have existed: this
induced the inhabitants, who had witnessed the good the jetty had
effected (previous to the injury Cromer sustained, and alluded to in
a former chapter), to insert a groin immediately to the southward, or
rather westward, of the town, eighty-four yards in length.
The shallow or cavity became filled up to the top of the groin, and a
quantity of sea-beach material, consisting principally of sand,
seemed disposed to accumulate against the base of the walls in
June, 1844, but unfortunately the groin was not sufficiently
extended towards the sea; the piles, instead of projecting above, did
not equal in height the mound alluded to, and consequently it is not
so efficacious as it would otherwise have been.
The jetty too has some influence towards prohibiting a still further
proof of the efficacy of this groin, at least along shore to the
northward, or rather eastward; for rude in construction, it is ill
calculated to effect a twofold object, which ought to arise from it.
The platform resting upon piles of huge dimensions in height and
diameter, appears to have been one continuous length, from the
base of the cliffs to the elevated rock at low water mark. Its
considerable altitude above the surface of the beach, its unwieldy
structure, from the timbers employed, and above all, its extent
towards the sea being limited, accounts for its partial destruction in
the storm alluded to. The dashing of the waves against the piles,
even in calm weather, gives an impetus to the water at their base,
and produces eddies or whirlpools, which prevent sea-beach
materials accumulating in the immediate vicinity.
The inhabitants, however, appear so far to have been aware of this
circumstance, that in repairing the jetty, they had recourse to iron
stanchions, presenting a flat surface towards the sea; but the same
impediment to utility still exists.
Let us now consider whether a jetty could not be constructed to
afford not only a delightful promenade, the necessary appendage to
a frequented watering place, but the retention of sea-beach
materials, and the consequent elevation of the beach.
For this purpose let wooden piles of English oak be employed, of
requisite length to enter the solid strata beneath the surface of the
beach. The extremity for insertion must be pointed and shod with
iron, and the opposite end must be protected with a rim of the same
material, which ought to project above each pile, so as to leave a
cavity sufficiently deep to receive the one end of an iron pillar, about
eight or more inches in diameter, if considered necessary; and the
length of this iron pillar being determined, its upper part can be
readily formed to support the wooden plank constituting the
platform of the jetty, to which it can be fastened. Now, if the piles
are inserted into the beach in a continuous range towards the sea,
leaving a space between each pillar, from two to three feet apart, it
may readily be inferred, that the desirable object will be realized,
and a permanent good will be obtained. The expense, in the first
instance, will of course be considerable, but its durability and
usefulness ought to supersede such an obstacle.
It is a source of congratulation to observe considerable economy in
the expenditure which so great an undertaking requires, can be
effected by using, in a general way, the Pinus Sylvestris, or red fir,
grown in the neighbouring plantations; [74] these, if taken down in
the winter months, trimming them, and depositing them in the sea,
in readiness for insertion as opportunity suits, will retain their
resinous properties in the greatest abundance, and prevent the
exudation, which an exposure to the spring and summer months
would inevitably produce. Upon the resin they contain their
toughness depends, and by adopting the above plan, and using
those small in diameter, the instrument necessary for propelling
them into the beach, will not disturb the surface of the pile most
exposed to its influence. The following instance will prove their
durability, and that a careful insertion of the piles is only necessary
to render their stability certain, even if extraordinary gales should
cause the legitimate beach to be disturbed.
At Mundsley, several years ago, not within the memory of the oldest
inhabitant, some fishermen drove four piles, six inches in diameter,
into the beach, between high and low water mark, for the purpose
of forming what is termed a coy, for containing lobsters caught at
sea, until an opportunity for their disposal occurred. To the piles
were attached some boards, so as to form a square, within which
was placed a box for their reception; and a piece of wood, fastened
upon the top, prevented the box from being disturbed by the water.
At length, however, it became disused, the boards attached to the
piles gave way, but the latter still remain firmly imbedded in the
strata beneath, and their tops are only visible when north and north-
west winds prevail, the sand lying around, above, and between them
being then removed.
The shipowner, and above all the hardy sailor, cannot but rejoice at
the prospect of obtaining a broad beach upon an inclined plane, for
should a vessel be driven on in ever so heavy a gale, instead of
having to contend with the cheerless prospect now before them,
rendered not only formidable, but terrible, from the numerous shoals
existing on this coast, there would be only one, and the vessel would
arrive at its destination in a more gradual manner; her keel would
become almost immediately impacted in the sand to such an extent,
as to render her steady; for the waves having to attain an ascent,
would be checked in their career, and for want of depth, would
neither be able to injure the vessel nor destroy the mariner: hitherto,
the great power they possess has, in many instances, dashed the
former to pieces after she had struck the beach, and the latter has
been hurled towards it, either too suddenly, or by their rebounding,
swept into the depths below; while he, poor creature, so long as
consciousness or presence of mind exists, uses his feeble efforts to
reach the blessed shore, but, alas! too frequently in vain; he either
sinks, to be wafted to another, a lifeless, mangled corpse, or arrives
too late to be saved, even if the vibration of the heart exists, for
want of proper accommodation and attention. If a legitimate beach
could be once formed, a little exertion and assistance from those on
shore, would be able to rescue him from the now almost inevitable
destruction.
 CHAPTER XI.

THE CONCLUSION.

Let not the plan proposed in the previous chapter make too hasty an
impression, or cause the reader to be too sanguine as to the result,
however it may bear the semblance to truth and reality; but, if upon
inquiry, consideration, and inspection, it is found to originate in facts,
not theory alone, let no longer time be wasted in delaying a trial of
its efficacy than is really necessary.
For a series of years, the wondrous body of waters has committed
most dreadful ravages upon this and other coasts, not only to the
loss of property, but what is of far greater consequence, human life.
Many countries, that have been destroyed, bear melancholy witness
to the truth of history, and show the tops of their houses and the
spires of their steeples, still standing at the bottom of the water.
The German Sea has advanced upon the shores of Holland near
Catt, that the ruins of an ancient citadel of the Romans, which was
formerly built upon the coast, are now actually under water. In
Friezland and Zealand, there are more than three hundred villages
overwhelmed, and their ruins continue still visible on a clear day.
The Baltic Sea has by slow degrees covered a large part of
Pomerania, and among others destroyed and overwhelmed the
famous port of Vineta.
One of the most remarkable inundations recorded in history,
occurred in the reign of Henry I., which overwhelmed the estates of
the Earl Godwin, and formed the bank now called the Goodwin
Sands.
In the year 1546, a similar irruption of the sea destroyed a thousand
persons in the territory of Dort, and a yet greater number round
Dullart. To these accidents several more might be added; our own
historians and those of other countries abound with them; almost
every flat shore of any extent being able to show something it has
lost, or something it has gained from the sea.
There are some shores on which the sea, where it has overflowed,
and after remaining perhaps some ages, has again retired of its own
accord, or been driven back by the industry of man, which, if applied
in the case submitted, would, we earnestly pray, verify the words
contained in the 5th chapter of the prophet Jeremiah, and the 22nd
verse. And should this design be found to answer, who is there can
deny that, by continued attention and perseverance, not only will the
lands in future be protected, but those which now appear lost, may
in after years be regained, and that the saving of human life will be
considerable.
There are many lands in Norway, Scotland, and the Maldivia Islands,
that are at one time covered with water, at another time free. The
country round the Isle of Ely, in the time of Bede, about a thousand
years ago, was one of the most delightful spots in the whole
kingdom; it was not only cultivated, and produced all the necessaries
of life, but grapes also, that afforded excellent wine. The accounts
of the time are copious in the description of its verdure and fertility,
its rich pastures covered with flowers and herbage, its beautiful
shades and wholesome air. But the sea breaking in upon the land,
overwhelmed the whole country, took possession of the soil, and
totally destroyed one of the most fertile vallies in the world; its air,
from being dry and healthful, from that time became unwholesome,
and the small part of the country, which by being higher than the
rest escaped the deluge, was soon rendered uninhabitable from its
noxious vapours. The island continued under water some centuries,
till at last the sea, by the same caprice which had prompted its
invasion, began to abandon the earth in like manner. It has
continued for some ages to relinquish its former conquests; and
although the inhabitants can neither boast the longevity nor the
luxuries of the original possessors, yet they find ample means of
subsistence, and if they happen to survive the first years of
residence there, they are often known to arrive at a good old age.
On this coast several manors and large portions of the neighbouring
parishes have been swallowed up; nor has there been any
intermission, from time immemorial, in the ravages of the sea within
a distance of twenty miles in length in which these places stood.
Many a poor fisherman has lost his life within sight of his parents,
wife, and children, whose uplifted hands, streaming eyes, and
shrieks of wild despair, proclaimed the pangs they endured, the
agony they suffered, at losing their offspring, their husband, their
father; and this too, when the tenderest ties of affection endeared
them to each other; on a sudden lost, gone for ever! leaving those
behind, who, if not bereaved of their senses entirely, remain during
their sojourn in this vale of tears, for ever broken-hearted and
disconsolate. This gloomy picture may appear over-drawn; but,
alas! it is too true and melancholy to think of, where such accidents
are frequent, and likely to continue till time shall be no more. But
there is a ray of hope, that the object which appears so difficult to
accomplish, may eventually be attained by the industry of man, with
the means given and transmitted from the acquisition of knowledge,
through an Allwise and Merciful Creator. Let us earnestly pray that
His blessing may be bestowed upon our humble endeavours, to the
fulfilment of this or a superior design.
 APPENDIX.

BACTON.
Bacton or Backton, termed in the Doomsday Book Baketuna, is
situated about four miles and a half north-east by east of North
Walsham. From bordering on the sea, it continually experiences its
devastating effects, which is the more to be regretted, as the land,
about 1600 acres, is extremely fertile.
The Church, dedicated to St. Andrew, is a neat edifice, situated on
elevated ground, about a quarter of a mile distant from the sea; and
the interior, though unadorned with costly monuments, contains
several neat stones to record departed worth.
The venerable relic of Norman grandeur Broomholme Priory,
generally termed Bacton Abbey, is situated in the centre of the
village, and from its being in a better state of preservation than
probably any other in this county, which possesses the astonishing
number of one hundred and twenty-two, is ever a source of interest
to the lovers of antiquity.
The architectural style of the Priory of Broomholme appears to be
that of the Norman and the early or lancet gothic united.
The editor of the General History of the County of Norfolk says: “A
part of its architecture is so entirely of the same style as Norwich
Cathedral, that it can scarcely be doubted but they are of the same
era.”
The north transept, with its triforium arches, many of which still
remain, bears some resemblance to those of Norwich Cathedral and
the Church of St. Nicholas, Yarmouth.
The churches generally were built in the form of the latin cross,
terminating at the end in a semi-circular apsis. The internal
elevations consisted of three divisions, the lower arches—the
triforium, occupying the space between the vaulting and external
roof of the side aisles—and the celestory.
The circular arched entrance north of the transept appears to be
built of Caen stone, and though plain, attests the origin of at least
this part of the building. To the east a very lofty arch presents itself
of the early gothic.
The chapter-house has a very large window of the early pointed
gothic, supposed to have been added in the reign of Henry the VII,
but it appears of a much earlier date.
The arcades of the face of the interior walls are very plain and
simple; and are intended to take off the effect of a large extent of
plain surface as the windows are but small. This appears to have
been general in all Norman architecture.
The chimney is very modern, as the builders of the middle ages gave
the preference to warming their halls by a central hearth, leaving the
smoke to blacken the roof and escape as it best might by an open
lantern.
The niche in the north transept, which bears traces of the
ornamental gothic, was probably added with other parts of the
building, as the abbey increased in fame and opulence.
The following are the supposed dimensions of the various buildings,
&c.:—

The church 112 feet

North transept 22 feet by 18 feet
 Chancel 23 feet
Quadrangle 73 feet by 47 feet
Cloister 76 feet by 21 feet
Large hall 100 feet by 24 feet

This priory was founded in 1113, by William de Glanville, in the reign

of Henry the First, for monks of the order of Cluni, as a cell to
Castleacre priory. Here the monks of the latter sent their junior
brethren, when too much crowded at home, or refractory monks, to
do penance for non compliance with monastic rules. Subsequently,
Bartholomew de Glanville, who was Sheriff of Norfolk and Suffolk,
confirmed the priory of Castleacre to this priory.—The first prior was
inducted to the abbey in the reign of Henry the First, and the last in
the reign of Henry the Eighth.
The monks attached to this establishment appear, according to early
historians, to have derived great profit from a cross, said to have
been made out of that part of the Saviour’s cross to which the hands
and feet were attached, particularly the part where it was most
sprinkled with his blood; and Capgrave informs us, “that no fewer
than thirty-nine were raised from the dead, and nineteen blind
persons had their sight restored by it.”
In this priory were also preserved the “girdle for Zona, and milk of
the blessed Virgin, and fragments of the crosses of St. Peter and St.
Andrew.”
Such was the rage for relics in former times, that Mabillon, a
Benedictine, complained that the altars were loaded with
counterfeits; numerous spurious ones being every where offered to
the piety and devotion of the faithful. He also observes, “that bones
were often consecrated, which so far from belonging to the saints,
probably never belonged to Christians!” To shew how far this fraud
extended, the “girdle” of the Virgin Mary, said to have been
possessed by the monastery of Broomholme, was shown to the
visitors appointed by Henry the Eighth, in eleven different places.
The following “Legendary Fragment,” written by an intimate friend of
the Author’s, may not be deemed inappropriate:—
Broomholme, thy ruined grandeur tells
A saddening tale of man’s decay,
It speaks how all his glories pass,
How all his relics droop away;
How all his efforts fall a prey
To Desolation’s ruthless reign,
How all the records he would trace
The hand of Time outblots again.
Thou hast looked forth for ages past,
And seen the unwearying ebb and flow
Of yonder calm and azure sea,
Glittering in summer’s golden glow;
And oh! how many a winter’s snow
Hath wrapped thee in its spotless vest,
How many a Spring with cheerful hand
Thy fair domain in beauty drest.
How oft within thy ruined fane
Has many a haughty zealot knelt,
And muttered o’er some holy prayer
His thankless heart had never felt:
Thou’st heard the groans of souls that melt
With anguish and repentance cleft,
Who, though engulphed in blood and crime,
Had yet the hope of mercy left.
Oh! could yon gloomy pile reveal
The thousand tales its records bear,
And rend the dark mysterious seal
That Time has fixed for ever there,
Perchance ’twould tell of pain and care,
The same unvarying round of woe,
The same dark chain of human ills
That links us all to life below.
’Twould tell of horrors dark and dire,
That well the sternest heart might thrill,
How man with rapine, sword, and fire,
Had wrought with zeal his brother’s ill.
Strange that ungrateful man should fill
The cup of woe, for pride or pelf,
Yet madly, fondly, vainly hope,
To taste the streams of bliss himself.
’Twould tell how bright, to Childhood’s eyes,
The glory of existence seems,
How swiftly life’s ensuing hours
Lose one by one their golden gleams.
How fondly Hope’s delusive dreams
The hearts of men with smiles enslave,
How those forlorn and weary here,
May learn to look beyond the grave.
And Fancy often wanders back,
Through Time on her enchanted wings,
To snatch one legend from the gloom
That age about thy ruin flings.
And thus Imagination sings
In fond conceit and varied lay,
With all a Poet’s trembling pride,
“A tale of Broomholme’s Abbey grey.”
The northern blast is sighing now,
In every withered leafless bough,
The dirge of the departed year;
And the lone sea-bird’s dismal wail,
That ever comes in storm and gale,
Foretells the gathering tempest near.
The gloom of night is deepening fast,
And on the wild and fitful blast
The stormy clouds like shadows fly;
And darkened by their rapid flight,
The pale and placid orb of night
Is shrouded from the seaman’s eye.
The vivid lightning’s transient flash,
And then the deafening thunder crash,
Proclaims the elemental war;
And when the lightning leaves the skies,
And when the rolling thunder dies,
Hark, how the raging waters roar.
The wild waves that in wanton play
Fling to the winds their feather’d spray,
But seem to mock the angry sky;
But seem to sport in maddening pride,
When all is dread and dark beside,
And ghastly Death is hovering nigh.
******
Morn: oh! how many anxious eyes
Have watched the live-long night for thee,
That from the threshold of the skies,
Now looks o’er a tempestuous sea;
The ocean that so softly bright
Hath mirror’d oft the Queen of Night,
In lustrous lines of liquid light,
And, oh! hath looked so calm and fair,
As if no storm could gather there.
Like to those living lights that shine
So pure and placid from the eyes,
When at Religion’s holy shrine
The humble soul in rapture lies,
And gloomy passions wake within,
That lead away the heart to sin;
Then all that looked so fair and bright,
So pure in its own sportive glee,
Becomes a torture and a blight,
And wilder than the raging sea.
The gale now slowly dies away,
With the approach of dawning day,
And every wave that chafes the shore,
Salutes the strand with sullen roar,
And on the beach in sadness flings
All that to Hope was once so sweet,
Like trophies which a warrior brings,
And lays them at his country’s feet.
Records that blood and death had earned,
When mercy from her shrine was spurned.
Alas! when angry storms break forth,
And wake the waters into wrath;
Ah! then the treacherous heaving wave
Rolls over many a wanderer’s grave,
And striving winds and foaming surge
Sing many a mournful funeral dirge.
******
Oh, Heaven! that such a lovely form
Could brave so dread and fierce a storm,
That one so beautiful and frail
Could bide the harsh and bitter gale;
And she who angels might have kept
In hallowed watches while she slept,
Is pillowed on the sandy shore,
Her lullaby the waters’ roar:
And frowning skies in sorrow spread
Their canopy around her head.
And now beside the maiden kneels
A messenger of fond relief,
One who with sweet religion heals
The wounded spirit’s cankering grief;
And raises from the chilly sand
The form that cold and lifeless lay,
Sustains it with a trembling hand,
And wraps it in his mantle grey.
And from that frontlet wipes away
The wanton water’s brackish spray.
And now her wild and anxious gaze
Is fixed upon his swarthy cheek,
And faint and feebly she essays
Her wonder and despair to speak;
And he who looked so calm before,
Is moved to tears of sorrow now,
That as he bends the maiden o’er,
Those drops of pity damp her brow.
He turns as though ashamed to own
His heart has soft and yielding grown.
And now is many an offer made
Of home and hospitable aid,
By those who throng around the maid,
To them the monk his charge commends,
With promises of bounteous pay,
And with a heart of trouble wends
His steps to Broomholme Abbey “grey.”
******
What charm is there in Nature’s smile,
When Hope be dead the weary while,
Or what in all the world can please,
When aching hearts are ill at ease.
And, oh! what rapture could he feel,
Who left the fair and beaten track
Of sweet Religion’s holy zeal,
And to the cold world wandered back;
Whose only oriflamme should be
The sanguine cross of Calvary.
Yes, he whose life had aye been spent
In self denial’s lowly creed,
In turning sinners to repent,
And share the Abbey’s thrifty meed.
Yes, he who taught that heavenly love
Should all absorb the anxious mind,
That hearts should look to hopes above,
And leave the thoughtless world behind:
Yes, he whose years though few had been,
In much of deep devotion past,
Who joy’d the smiling summer scene,
And braved the winter’s bitter blast;
Yes, he who told how dear and sweet
Was holy influence to the mind,
Who walked the world with weary feet,
To succour helpless human kind;
Yes, he forgot for beauty’s smile,
His oath to Heaven, his hopes above,
He gave his heart to pleasures wile,
And lost his soul for woman’s love.
Yes, he forgot the lowly mien,
The holy mass, the rosary,
And all that he had ever been,
For hopeless love and misery.
Alas! that grief should ever wear
So pale a cheek with sorrow’s tear,
That anguish and remorse should trace
Their furrowed lines on Beauty’s face,
And early troubles lead the way
For dread disease and slow decay.
There is a canker of the breast
That pleasure cannot charm away,
When the young heart becomes a prey
To dread disquiet, and un-rest.
Day after day—day after day,
Along that smooth and sandy shore,
Did Herbert with fair Edith stray,
Oft listening to the angry roar
Of the wild ocean’s troubled sound,
Till the fair earth had wandered round
The presence of the glorious sun;
And when the winter had begun
To shackle every limpid river,
And silence every gurgling rill,
And in the woodland on the hill
The aspen leaves had ceased to quiver,
And every minstrel in the wood
Was silent in its solitude,
Those lovely birds that gaily chanted
Their songs of gladness from the grove;
Ah! oft had Edith’s bosom panted
With silent and supreme delight,
When they have woke the lovely night
With their melodious songs of love.
Ah! many and many a lovely eve,
Beneath the Heaven’s bespangled roof,
Did her young heart delight to weave
The future like a fairy woof:
And with her Herbert by her side,
In the sweet hush of eventide,
When night-blown flowers of beauty rare
With perfume filled the stilly air;
Often in those delightful hours,
When the young dreamy heart of youth
Plucks many a wreath from Fancy’s bowers,