514 TREATMENT OF SPECIFIC ANXIETY DISORDERS
toms of Criteria B (reexperiencing) and D (physiological/emotional arousal) (Ehlers
& Steil, 1995; Wilson, 2004; see Resick et al., 2008, for discussion). Thus automatic
faulty infor mation processing of trauma is the basis for the persistence of reexperienc-
ing intrusions and physiological/emotional arousal, whereas avoidance and numbing
are maladaptive coping responses that are a product of more conscious, elaborative
processing efforts.
Clinician Guideline 12.12
Intrusive recollections of trauma and physiological/emotional hyperarousal symptoms are
due to automatic information processing involving (1) activation of maladaptive schematic
structures about self, vulnerability, world, others, and future; (2) fragmented mental repre-
sentation of the traumatic experience; (3) selective retrieval of trauma information; and (4)
attentional bias for personal threat. Consequently cognitive restructuring of negative beliefs
about self, world, future, trauma, and PTSD symptoms as well as promotion of a more elab-
orated, integrated, and conceptually based trauma memory are key elements in cognitive
therapy for PTSD.Elaborative Processing
Negative Appraisals of Trauma- Related Intrusions and Arousal
The frequent intrusion of trauma- related thoughts and images as well as heightened
physiological arousal will lead to a conscious, deliberate reappraisal of current threat,
personal vulnerability, and the enduring negative effects of the trauma. In fact it is
this deliberate reappraisal of the trauma intrusions that produces the sense of a serious
current threat (Ehlers & Clark, 2000). Because trauma- related intrusions are usually
inaccurate recollections of what happened that are highly distressing, uncontrollable,
and more reflective of data- driven processing (i.e., processing of sensory perceptions
more than the meaning of the event), the individual with PTSD will misinterpret the
intrusive symptoms in a threatening, even catastrophic manner (see Falsetti, Monnier,
& Resnick, 2005, for discussion). For example, Edward experienced intrusive memories
of Rwanda as well as flashbacks about the little orphan girl many times throughout the
day and as terrifying nightmares during the night. He interpreted these symptoms as
an indication that he was not getting better and that his life was ruined by PTSD. He
wondered if the flashbacks in particular might eventually “drive him crazy.” His height-
ened state of arousal was perceived as highly aversive and a sign of losing control. He
concluded that he must be weak and incompetent for losing control of his thoughts and
emotions, and considered his future bleak, characterized by persistent distress and an
inability to achieve anything worthwhile or satisfying in his life.
Ehlers and Steil (1995) proposed that the negative appraisal of intrusive symptoms
was an important contributor to the persistence of PTSD. Negative idiosyncratic mean-
ings of intrusive symptoms will cause an associated level of distress that confirms their
threatening nature. In addition negative interpretations of the intrusive symptoms will
motivate the person to employ cognitive and behavioral avoidance strategies that inad-