530 TREATMENT OF SPECIFIC ANXIETY DISORDERS
family, and friends? Or the opposite, did you see the world as a dangerous place
where you expected harm or physical injury to yourself or others? How strongly
did you hold to these assumptions about the world? Did you ever question them?
Were there important experiences in your past that confirmed or challenged your
assumptions about the world?”Given the central role of negative self- referent cognitions in PTSD, the clinician
must assess the patient’s preexisting self- schemas. The clinical interview should include
questions about self- evaluation involving competence/incompetence, success/failure,
acceptance/rejection, active/passive, loved/abandoned, liked/disliked, confident/unsure,
weak/strong, and so on. Again it is important to determine the degree of rigidity and
significance of the belief to the individual’s self-view. From this the clinician should be
able to conclude whether the trauma affected a person with a strong positive self-view
or an individual with a weak and vulnerable sense of self.
Preexisting beliefs and assumptions about other people are also an important part
of the assessment. Before the traumatic experience, did the client assume that people
tended to be kind, caring, compassionate, and gentle? Or were opposite beliefs held,
that people were basically selfish, cruel, manipulative, disinterested in others or hurt-
ful? Was the client open and accepting toward others or suspicious and avoidant? Was
the individual highly dependent on others (i.e., sociotropic) or more autonomous? From
these questions the clinician should be able to determine individuals’ level of acceptance
of others, their expectations of others, and how much they depend on family and friends
for emotional support.
Nature of Trauma
Like any assessment for PTSD, it is important that the cognitive therapist obtain a full
and complete account of the trauma(s), their severity, and consequences. Some of this
information is available from the diagnostic interview (e.g., CAPS) but this will have to
be supplemented with more specific and detailed questions. As discussed in the first part
of this chapter, there are many features of the trauma that are important to determine
because of their impact on the development of PTSD. The following are some suggested
questions that can be asked about the trauma.
••“What was the most recent traumatic experience? How many times have you
experienced a serious threat to your safety, health, or well-being? How severe
were these threats? Were they somehow related or quite different experiences?
Which one was most disturbing for you?”
••“Did the event cause you physical harm, injury, or threat of death? Did you think
you were going to die during the trauma? If the trauma did not happen to you,
did you witness a tragedy happening to others or were you involved in helping
victims of trauma? Or have you been mainly disturbed by hearing of an unex-
pected tragedy to a loved one?”
••“What effect has the trauma had on you? How has it changed the way you think,
feel, and behave? Has it changed how you relate to others? How has it affected
you in your daily living, in your work, family, and leisure time?”