538 TREATMENT OF SPECIFIC ANXIETY DISORDERS
Often individuals with PTSD explain the disorder solely in terms of a “brain chem-
istry imbalance” or the result of an inherent psychological or emotional predisposition.
Both explanations could undermine their acceptance of cognitive therapy. Alternatively
the cognitive therapist explains that PTSD is a natural psychological response to trau-
matic events. Foa and Rothbaum (1998) provide a client handout entitled “Common
Reactions to Assault” that explains fear/anxiety, reexperiencing the trauma, increased
arousal, avoidance, anger, guilt/shame, depression, and negative self-image as immedi-
ate reactions to trauma experienced by the majority of survivors. Although the handout
deals with physical and sexual assault, slight modifications can be made to include all
traumatic experiences. Of course, the therapist’s account for PTSD must include an
explanation of why PTSD symptoms persist in only a minority of individuals exposed
to trauma. The client handout developed by Taylor (2006) is especially helpful in this
regard. Persistent PTSD is explained as a “hypersensitivity of the brain’s stress response
system” which is determined by a person’s genetic makeup and the nature and sever-
ity of the traumatic experiences. It is explained that everyone has a “breaking point”
for the development of PTSD. A person with a strong genetic predisposition for PTSD
will develop the disorder in response to less intense trauma, whereas a severe trauma or
multiple traumatic experiences may be required to push someone with minimal genetic
predisposition over his “breaking point.” It is important to emphasize with clients that
everyone has a breaking point; it is only a question of how much trauma is needed for
the occurrence of PTSD. A copy of Taylor’s (2006) handout can be purchased from the
Anxiety Disorders Association of Canada (www.anxietycanada.ca).
The cognitive account for PTSD must also include an explanation of the role of
negative thoughts and beliefs, trauma memory, negative emotion, and avoidance in the
persistence of posttrauma symptoms. The therapist explains that whether the initial
posttrauma symptoms persist or eventually disappear after a few weeks depends on
our response. The following is a possible cognitive explanation for the persistence of
PTSD:
“If many of the PTSD symptoms you experience are a common response to trauma
and everyone has a ‘breaking point’ in their stress response system, you might be
wondering why your PTSD symptoms have persisted whereas for others the symp-
toms disappear within a few weeks. In the last few years researchers have discov-
ered a number of factors that appear to contribute to the persistence of PTSD. First,
traumatic experiences often cause people to view themselves, their world, future,
and other people in a very negative and threatening manner. During the assessment
interview you described a number of ways in which you believe you are weaker and
more vulnerable and the world is a more dangerous place. [Therapist lists some of
the client’s dysfunctional thoughts and beliefs.] The problem with this thinking is
that it becomes more highly selective over time so that it increases one’s sensitivity
to threat and perpetuates a sense of fear and anxiety, which are the main negative
emotions of PTSD. A second contributor is how the trauma is remembered. When
some aspects of a trauma are remembered too clearly, other aspects are forgotten,
and when one can not arrive at a satisfactory meaning or understanding of the
trauma, an individual is more likely to have repeated unwanted vivid and intrusive
recollections of the trauma that are highly distressing. In some cases it may feel as if