Posttraumatic Stress Disorder 513
confirmatory evidence for the negative beliefs about the self, world, future, and trauma.
In turn these negative core beliefs will bias memory recall so that individuals will recall
aspects of the trauma that are congruent with the dysfunctional PTSD schemas. Because
the memory structure for trauma is fragmented and poorly elaborated, the individual
experiences recurring intrusive recollections of the trauma that confirm the negative
core schemas of PTSD. Thus a reciprocal relationship exists between the way trauma
is represented in memory and the dysfunctional core schemas about the self, world,
and future. Aspects of the trauma will be recalled that confirm negative beliefs about a
dangerous world, a vulnerable self, and the enduring negative consequences of PTSD.
Information inconsistent with the posttrauma schemas will be inaccessible for retrieval
because it is not represented in the trauma memory.
An example of biased and fragmented trauma recall emerged during cognitive ther-
apy sessions with Edward. One of the traumatic events Edward experienced while in
Rwanda was the apparent murder of a 5-year-old orphaned girl and her friends by the
RPA. Edward assumed the children had been murdered because they were no longer
at the orphanage at his last visit and an RPA soldier was present, with a smile on his
face, and gesturing by sliding his hand across his throat toward the Canadian soldiers.
Edward interpreted this to mean that the soldiers had slaughtered the children. How-
ever, when we explored this memory in depth, it was clear there was other information
inconsistent with this assumption such as no indication from the nuns who cared for the
children that some of the children had been taken away and murdered. Also this inci-
dent occurred after the genocide had ceased when many children were being returned to
their villages. Edward was shocked to realize that all these years he had not remembered
other information that was incompatible with his immediate interpretation of the event.
It was clear that all he had encoded was the ominous presence of the RPA soldier and
the disappearance of the children. In cognitive therapy of PTSD, a great deal of effort
is directed toward evaluating and restructuring the trauma memory so that it ceases to
be a source of confirmatory evidence for the core negative schemas of self, world, and
future.
Attentional Threat Bias
Like other anxiety disorders, dominance of the maladaptive schematic constellation of
threat and vulnerability will lead to an automatic attentional bias for threat. Since the
traumatic experience has violated basic positive self- referent schemas about personal
safety and security, we expect that the attentional bias in PTSD is for generalized threat
and danger and not just information specific to the trauma. Trauma- related information
should have the greatest pull on attention but any information that represents a personal
danger is expected to have processing priority.
Traumatic Intrusions and Physiological Arousal
In the cognitive model (see Figure 12.1), the reexperiencing symptoms and physiologi-
cal hyperarousal in PTSD are products of maladaptive schema activation and frag-
mented, sensory-rich trauma memory, as well as consequent selective attention and
recall of trauma- relevant threat information. Researchers have proposed that Criterion
C symptoms (i.e., avoidance and numbing) are maladaptive responses to the symp-