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Chapter 12
Cognitive Therapy
of Posttraumatic Stress Disorder
Vision without action is a daydream.
Action without vision is a nightmare.
—Ja p a n e s e p r o v e rBEdward was a 42-year-old man with 20 years of distinguished service in the
Canadian infantry. He joined the army after graduating from university with
a degree in philosophy. He was full of optimism about his career decision,
wanting to “see the world” and make a difference in the lives of people caught
in poverty and conflict. Edward’s potential was soon recognized by the mili-
tary and he received many promotions, commendations, and access to special
training. He was selected for three United Nations (UN) peacekeeping tours
that were viewed by soldiers as highly desired assignments, ones that afforded
unprecedented opportunities for advancement. Edward had a close, stable mar-
riage and two beautiful young daughters. They were financially secure and
had an active social life with their close military friends. For Edward life was
progressing in a predictable and highly fulfilling direction.
But all of this changed in 1994. Two years earlier Edward had accepted
a peacekeeping assignment that involved a 4-month tour of duty in the for-
mer Yugoslavia. The job was intense with long hours, life- threatening road
checks, and witnessing the death of his friend from a landmine. He returned to
Canada having increased his level of alcohol consumption, but threw himself
back into his work. His next assignment came in 1994 when he volunteered
for a 6-month tour of a small African country he barely knew, Rwanda. Unbe-
knownst to Edward, he was about to step into a country that would experience
one of the worst genocides in recorded history—the slaughter of 800,000 peo-
ple within a 3- to 4-month period. The consequences of the genocide were vis-
ible everywhere in Rwanda, and the images of slaughter and suffering became