512 TREATMENT OF SPECIFIC ANXIETY DISORDERS
event(s) in their life. They believe that PTSD will continue to have an enduring negative
effect and this negative interpretation of PTSD symptoms, especially intrusive recollec-
tions of the trauma, will cause the individual to engage in maladaptive control strategies
that have the unintended effect of contributing to the persistence of the disorder (D. M.
Clark & Ehlers, 2004). In cognitive therapy of PTSD a great deal of effort is focused
on modification of these three types of core maladaptive schemas and their associated
appraisals.
How trauma is represented in working memory is an important aspect of the mal-
adaptive schema constellation in PTSD. There is general agreement among researchers
that trauma is stored differently in those with PTSD compared to those who experi-
enced trauma without persistent PTSD (see previous discussion of Brewin et al., 1996;
Dalgleish, 2004). Ehlers and Clark (2000) argue that the intrusive characteristics of
PTSD are due to poor elaboration (i.e., fragmentation) and integration of the trauma
memory into its context in time, place, and other informational sources as well as with
other autobiographical memories. In addition strong stimulus– stimulus and stimulus–
response associations as well as reduced perceptual threshold for trauma- related stimuli
causes unintended, cue- driven retrieval so that the individual has reexperiencing symp-
toms caused by exposure to triggers and activation of trauma memory that is outside
awareness (D. M. Clark & Ehlers, 2004; Ehlers & Clark, 2000). Ehlers and D. M. Clark
concluded that the disorganized, fragmented representation of trauma contributes to a
sense of current threat by creating selective recall of trauma details and forming strong
associations between certain trauma stimuli and appraisals of severe danger to self.
Faulty Trauma Memory Retrieval
In the current cognitive model, we propose that a sensory-rich, fragmented or poorly
elaborated memory of trauma that cannot be accommodated with other autobiographi-
cal memories will maintain a low activation threshold so that it provides recurring
table 12.3. (c o n t .)
Maladaptive beliefs Clinical example
Beliefs about the Posttraumatic Stress Disorder
••That the disorder has enduring negative
consequences
“I will never get over PTSD. It has ruined my life.”••The catastrophic misinterpretation of particular
symptoms of posttraumatic stress disorder“I must be going crazy because I keep having these
uncontrollable flashbacks.”
••The need to exercise greater self-control over
trauma-related symptoms“I will never get better as long as I keep thinking
about the trauma.”
••Self-blame for having posttraumatic stress
disorder“I have PTSD because I am a weak, helpless
person.”
••Thwarted life goals and purpose “I will never achieve my life goals or live a
productive, fulfilling life.”
••About the importance of controlling negative
emotions“I need to keep tight control over my emotions or I
will become overwhelmed by them.”
••The beneficial effects of avoidance “It is better to avoid anything that is potentially
upsetting or reminds me of the trauma.”