536 TREATMENT OF SPECIFIC ANXIETY DISORDERS
DesCription of Cognitive therapy for ptsDThe overarching goals of cognitive therapy for PTSD are to reduce the posttrauma
reexperiencing symptoms, achieve significant reduction in anxiety and depression, and
improve level of social and occupational functioning (see Table 12.5 for a list of goals;
see also D. M. Clark & Ehlers, 2004).
It is important that the case formulation culminate in an individualized treatment
plan that will guide therapy (see Taylor, 2006). The treatment plan consists of the imme-
diate and long-term goals of therapy. These goals are established in a collaborative man-
ner by referring to the case formulation. The client should be given a copy of the therapy
goals and treatment progress should be periodically evaluated throughout therapy by
referring to the client’s specified goals. Edward’s treatment plan focused on a number
of specific goals.
••Reduce the frequency and intensity of intrusive images of the “little girl and
gorilla.”
••Eliminate the use of alcohol as a maladaptive coping strategy.
••Reduce avoidance and subjective anxiety when exposed to situations that trigger
reminders of Rwanda (e.g., crowded Wal-Mart store, certain stretch of highway
between home and work).
••Increase social contact and leisure activities.
••Reduce anger outbursts and low frustration tolerance.
••Reduce the level of generalized anxiety.
••Eliminate feelings of guilt, blame, and anger over the genocide.
••Improve a sense of confidence and hope for the future.
••Reduce hypervigiliance for threat.
••Recapture his past attitude of optimism and trust of others.table 12.5. goals and objectives of Cognitive therapy for posttraumatic stress Disorder
••Accept the cognitive rationale for the persistence of symptoms of posttraumatic stress disorder
••Improve the organization, coherence, integration, and elaboration of the trauma memory
by emphasizing conceptually based processing of the trauma (D.M. Clark & Ehlers, 2004;
Ehlers & Clark, 2000).
••Modify dysfunctional beliefs and appraisals of the trauma, its causes, and negative effects on
self, world, and future.
••Shift from a negative, threatening interpretation of unwanted trauma-related intrusive
thoughts, images, and memories to a more adaptive, accepting, and accommodating
perspective of trauma-relevant mental intrusions (i.e., a normalization process).
••Deactivate maladaptive beliefs of a weak and vulnerable self, a threatening or dangerous
world, and abandonment or insensitivity of others that have been reinforced by trauma;
instead promote the adoption of more constructive, alternative views of a strong self,
primarily safe world, caring people, and hopeful future.
••Eliminate maladaptive cognitive strategies such as thought suppression and rumination as
well as related processes such as emotional numbing or blunting and dissociation.
••Reduce escape, avoidance, and other safety-seeking behaviors employed to suppress
reexperiencing symptoms or minimize heightened anxiety.