Posttraumatic Stress Disorder 537
••Eliminate an overwhelming conviction of failure, of having been a profound dis-
appointment to himself and others.
••Regain his interest in life and minimize the effects of PTSD on daily living.There are a number of therapeutic ingredients in cognitive therapy of PTSD that
together serve to meet treatment goals and objectives. These are summarized in Table
12.6 and are discussed in greater detail below.
Education Phase
The initial sessions of cognitive therapy focus on educating the client about PTSD, pro-
viding the cognitive explanation for the persistence of posttrauma symptoms, presenting
the treatment rationale, and clarifying the goals of therapy. As in cognitive therapy for
other anxiety disorders, the education phase is critical for the success of treatment for
PTSD. The objectives are threefold: (1) to gain the client’s acceptance of the cognitive
model of PTSD and its treatment so that a collaborative therapeutic relationship can be
established, (2) to correct any faulty beliefs about PTSD and its treatment that might
interfere with cognitive therapy, and (3) to ensure treatment adherence and increase
compliance with homework exercises.
table 12.6. therapeutic Components of Cognitive therapy of posttraumatic stress Disorder
Therapeutic component Treatment objective
Education phase To provide information on posttraumatic stress disorder, correct any
misunderstandings about the disorder, gain patients’ acceptance of the
cognitive model and collaboration in the treatment process.
Trauma-focused cognitive
restructuring
To identify and then modify negative beliefs and appraisals about
the personal meaning of the trauma in terms of its cause, nature, and
consequences for the self, world, others, and future.Elaboration of and
repeated imaginal
exposure to the trauma
memory
To construct a more elaborated, organized, coherent, and contextualized
recollection of the trauma with a greater emphasis on its meaning so that
with repeated exposure the trauma memory eventually becomes more
conceptually based and better integrated with other autobiographical
memories.Disorder-focused
cognitive restructuring
To shift the client’s negative, threat-oriented interpretations and beliefs
about the symptoms of posttraumatic stress disorder and their consequences,
especially the reexperiencing symptoms of the disorder, toward a more
adaptive, functional coping perspective.In vivo exposure to
reexperiencing cues
To reduce avoidance and reliance on safety-seeking behaviors as well as
decrease anxiety in situations that elicit reexperiencing symptoms.Modify maladaptive
cognitive avoidance and
control strategies
To reduce or eliminate worry, rumination, dissociation, and difficulty
concentrating by targeting maladaptive cognitive strategies such as thought
suppression and overcontrol of unwanted thoughts and emotions, and
replace with more adaptive attentional control and acceptance of unwanted
thoughts and emotions.Emotion reduction
(supplemental)
To reduce general anxiety, hypervigilance, sleep disturbance, and anger/
irritability by developing a more relaxed, benign response style.