528 TREATMENT OF SPECIFIC ANXIETY DISORDERS
(r’s of .57 to .79), depression, and general anxiety, and traumatized individuals with
PTSD score significantly higher than traumatized non-PTSD or nontrauma comparison
groups (Foa, Ehlers, et al., 1999).
The validity of the PTCI subscales have not been equally supported in subsequent
studies. J. G. Beck et al. (2004) found that the PTCI Self-Blame subscale did not corre-
late with PTSD symptom severity nor did it distinguish between those with and without
PTSD. The other two subscales and total score did show the expected convergent and
discriminant validity. In a 12-month prospective study of injury survivors, path analysis
revealed that the PTCI Negative Self was the most influential subscale in determin-
ing later PTSD symptoms whereas higher levels of PTCI Self-Blame in the acute phase
were actually associated with improved psychological functioning (O’Donnell, Elliott,
Wolfgang, & Creamer, 2007). All the PTCI subscales are sensitive to treatment effects,
although Foa and Rauch (2004) found in their regression analyses that only the Nega-
tive Cognitions about Self subscale emerged as a significant predictor of change in PTSD
symptoms. Samples with PTSD have a median score of 3.60 (SD = 1.48) and 5.00 (SD =
1.25) on the PTCI Negative Self and Negative World subscales, respectively, compared
to 1.08 (SD = 0.76) and 2.07 (SD = 1.43), respectively, for nontrauma groups (Foa,
Ehlers, Clark, Tolin, & Orsillo, 1999). Given the questionable validity of the Self-Blame
items, clinicians should only use the Negative Self and Negative World subscales of the
PTCI. The PTCI has been reprinted in Foa, Ehlers, et al. (1999).
Clinician Guideline 12.21
Cognitive assessment of PTSD should include (1) a diagnostic interview, preferably the
CAPS; (2) a measure of PTSD symptom severity such as the PCL or PDS; and (3) the PTCI
as a measure of appraisals and beliefs relevant to PTSD. Only the PTCI Negative Cognition
about Self and Negative Cognition about World subscales should be interpreted given the
questionable validity of the Self-Blame subscale.Case Conceptualization
The cognitive case conceptualization follows from the cognitive model of PTSD pro-
posed in this chapter (see Figure 12.1). Table 12.4 presents an outline of the various
components of a case conceptualization for PTSD (see also Taylor, 2006). Although
much of the information needed to develop a case formulation will be available from
the diagnostic interview and standardized questionnaires, it is likely that additional
questioning will be necessary to complete the cognitive case formulation described in
Table 12.4.
Pretrauma Assumptions and Beliefs
An important objective of the case formulation is understanding how trauma has
changed the client’s beliefs and assumptions about the world, self, and other people.
This requires an assessment of pretrauma beliefs, which in the clinical context requires
one to rely on retrospective self- report. If the client is a poor historian, a spouse or fam-
ily member can be interviewed to provide this crucial information.