Cognitive Therapy of Anxiety Disorders

Posttraumatic Stress Disorder 529

It is important to determine if the trauma shattered preexisting, rigid beliefs that the
world is generally a peaceful and safe place, or whether it reinforced extreme assump-
tions of the world as dangerous or violent. The following is an example of how clients
could be questioned:

“I would be interested to know how you viewed the world, that is your personal

world, before the trauma. Based on our experiences in childhood and adolescence,

we all develop ideas or assumptions about the world we live in. What were your

beliefs, your assumptions about the world before you had this traumatic experience?

Did you believe and expect that the world was a safe, secure place for you, your

table 12.4. Cognitive Case Conceptualization for posttraumatic stress Disorder
Components Specific elements

Pretrauma
assumptions and
beliefs

••Beliefs about world

••Beliefs about self

••Beliefs about other people

Nature of trauma ••Description of trauma, its severity, and interpersonal implications
••Level of personal involvement in trauma
••Negative effects of trauma on self and others
••Emotional reactions at time of trauma
••Level of social support and response of others to the trauma

Characteristics of
trauma memory

••Selective recall of trauma with some elements showing enhancement whereas

other features are poorly recalled

••Degree of organization, coherence, and elaboration of trauma memory

••Relative presence of data-driven versus conceptual-driven processing

••Range of cues that trigger trauma recollection

••Emotional reaction to trauma memory

Appraisals and beliefs
associated with
the trauma and its
consequences

••Causal attributions and beliefs about the trauma

••Negative self-referent thoughts and beliefs associated with the trauma

••Perceived enduring consequences of the trauma (i.e., danger, safety,

controllability)

••Expectancy about the future (i.e., pessimism, hopeless, helpless)

••Dysfunctional beliefs about the world and others

Interpretations
of trauma-related
intrusions and other
reexperiencing
symptoms

••Perceived enduring negative effects of intrusions and other symptoms of

posttraumatic stress disorder

••Presence of catastrophic thinking about posttraumatic stress disorder and its

symptoms

••Causal attributions of intrusive symptoms

••Perceived controllability of symptoms

••Personal meaning or significance of symptoms of posttraumatic stress

disorder

Adaptive and
maladaptive coping
strategies

••Attempts to suppress trauma recollections

••Presence of rumination

••Extent of dissociation, emotional numbing, or deliberate suppression of

expressive emotion

••Ability to engage in adaptive coping

Avoidance and safety-
seeking

••Nature and extent of avoidance

••Types of safety-seeking behaviors

••Perceived efficacy of safety seeking