510 TREATMENT OF SPECIFIC ANXIETY DISORDERS
corresponding inability to process positive or more benign features of the situation will
contribute to activation of the maladaptive PTSD schema structure. In addition Ehlers
and Clark (2000) noted that if primarily data- driven processing (i.e., processing sen-
sory impressions) occurs during encoding rather than a contextualized, more organized
conceptual- driven processing (i.e., processing the meaning of the event), than trauma
memories will be more unorganized, fragmented, and susceptible to strong perceptual
priming. They also suggested that an inability to adopt a self- referential perspective
during the trauma will contribute to difficulty integrating trauma memory with the
person’s other autobiographical memories. In the cognitive model represented in Figure
12.1, this maladaptive processing during trauma contributes directly to activation of
the dysfunctional schematic structure of PTSD, whereas the poorly elaborated, unor-
ganized, or fragmented trauma memory is primarily responsible for the occurrence of
trauma- related reexperiencing intrusions (see D. M. Clark & Ehlers, 2004, for further
discussion).
Core Schematic Structure and Trauma Memory
A central argument in social- cognitive theories of PTSD is that traumatic events dra-
matically alter basic assumptions about the self, world, and other people because they
can not be readily assimilated into existing schemas (Shipherd et al., 2006). Brewin et
al. (1996) indicated that the trauma involves a violation of basic assumptions about (1)
personal invulnerability from death or disease, (2) one’s status in a social hierarchy, (3)
a person’s ability to meet personal moral standards and achieve life goals, (4) the avail-
ability and reliability of significant others, and (5) the existence of order between actions
and outcomes. Brewin and colleagues suggest that the violation of these assumptions
causes the individual with PTSD to perceive that the world is an uncontrollable, unpre-
dictable, and more dangerous place (see also Foa & Rothbaum, 1998). Janoff- Bulman
(1992) argued that trauma shatters the individual’s assumptions about personal invul-
nerability, the world as meaningful and benevolent, and the self as positive or worthy.
On the other hand, a traumatic experience can confirm or strengthen previously held
negative beliefs about the self and the world (D. M. Clark & Ehlers, 2004). Horowitz
(2001) emphasized that emotional alarms occur when internal representations of the
trauma do not match preexisting schemas of self and others. This incongruity will evoke
unpleasant emotions such as anxiety, panic, or guilt, which leads to overcontrol pro-
cesses designed to avoid the dreaded emotional states.
Researchers have proposed a number of negative schemas that are characteristic
of PTSD (see Ehlers & Clark, 2000; Foa & Rothbaum, 1998; Janoff- Bulman, 1992;
McCann, Sakheim, & Abrahamson, 1988; Taylor, 2006). These are summarized in
Table 12.3.
There are three classes of maladaptive schemas that define the schematic struc-
ture of PTSD; (1) negative beliefs about the self, (2) negative schemas about the world
including other people, and (3) negative beliefs about the trauma and PTSD symptoms.
Depending on the nature and frequency of trauma, individuals believe they are vulner-
able, scarred by the traumatic experience, and likely to face more harm and danger
in the future. They see the world as a dangerous, selfish, and cruel environment in
which people are callous, critical, and untrustworthy. They may hold themselves partly
responsible for the trauma and believe they have been forever damaged by the terrible