Posttraumatic Stress Disorder 531
••“How would you describe your emotional response after the trauma? How have
you been feeling more generally (e.g., depressed, anxious, irritable)? What is your
emotional response when reminded of the trauma or when you have intrusive
memories of the trauma?”
••“What happened in the hours or days after you experienced the traumatic event?
How did your family and friends react? What did they think about what hap-
pened to you? Did the trauma change how people related to you? If so, how? Was
there any formal help offered to you such as medical or mental health services, or
crisis intervention?”Characteristics of Trauma Memory
Cognitive therapy for PTSD places considerable emphasis on modifying trauma- related
intrusive thoughts, images, or memories and their interpretation. Consequently, a care-
ful evaluation of the trauma memory is an important element of the case formulation. It
is recommended that the therapist begin by having clients write down what they remem-
ber of the traumatic event. If this is too disturbing to complete as a homework assign-
ment, the process could be started collaboratively in the therapy session. It should be
explained that this task is important because trauma memories play an important role
in the persistence of PTSD and being able to talk about the trauma is a critical step in
the therapeutic process. Naturally the cognitive therapist needs to be supportive, caring,
and understanding. For many clients this will be a very difficult process and they may
have to work on their Trauma Memory Narrative over a number of sessions. Construct-
ing a Trauma Memory Narrative has some similarities to the Impact Statement utilized
in cognitive processing therapy (Resick & Schnicke, 1992; Resick, Monson, & Rizvi,
2008) or the trauma imaginal exposure scripts described in Foa and Rothbaum (1998).
Table 12.4 lists a number of factors that the clinician should look for in the Trauma
Memory Narrative. What aspects of the trauma are especially well remembered? Are
there gaps in memory or aspects of the event that are poorly recalled? How selective is
the patient’s recall of the trauma? How well does the patient respond to probing ques-
tions in order to obtain a more complete account of trauma? Is the Trauma Memory
Narrative well elaborated or sketchy? Does it have coherence and organization, or is it
quite fragmented? Is there evidence that the memory is primarily data- driven? To what
extent are there attempts to derive some meaning or understanding of the trauma? How
does the patient interpret the trauma memory? What does it mean or what implication
does it have about the self, world, and future? What types of cues trigger or elicit the
trauma memory? What is the client’s emotional reaction when remembering the trauma?
How intense or severe is the felt emotion? By the end of the third or fourth session, the
cognitive therapist should have a fairly complete Trauma Memory Narrative as well as a
profile of the client’s interpretation and emotional response to the memory.
Trauma Beliefs and Appraisals
An in-depth account of the personal meaning of the trauma and its consequences is
a central component of the cognitive case formulation. It will be a primary focus for
cognitive intervention later in therapy. Trauma- related beliefs and interpretations fall