542 TREATMENT OF SPECIFIC ANXIETY DISORDERS
“In the fall of 1993 I was in the coffee room when I heard of the possibility of a
UN Tour to a place in Africa called Rwanda. Never heard of it but a 7-month tour
sounded good. When we got to Kigali we knew we had hit rock bottom and the
feeling got very tense. Since the tour I have believed I have no future, I am a loser, I
am never going to achieve anything. I believe the world is on a tailspin downward
to self- destruction. We are going to run out of natural resources by 2015 and with
overpopulation there will be a depression all over the world which will make the
crash of 1929 look like child’s play. The Rwandans had the answer GENOCIDE
(original emphasis). Just kill everyone off—it worked. The people left are going to
be well off.”
“While you are overseas you are constantly on the lookout for snipers, the
enemy, and mines. For the longest time I would not walk on grass or dirt; I stayed
on pavement. You are constantly looking all around you and you never let your
guard down and to this day I still have problems with safety and fear. I trust no one
since Rwanda and I mean no one. You do this to survive. I have no self- esteem. You
have the power to choose who lives and dies overseas—it is a hard feeling to live
with. Did you make the right decision? I’ve had a lot of problems with intimacy—
I feel as though my heart is split wide open. I am a failure so why try. I failed in
Rwanda, my career, my marriage, my family, my future. I have no future; nothing
to live for, so why go on. My life has been one major disappointment.”As evident from Edward’s Impact Statement, many of the negative beliefs and apprais-
als were related to having witnessed the effects of genocide and other horrific acts of mur-
der, rape, torture, and intimidation as well as experiencing multiple life- threatening situ-
ations during his UN peacekeeping deployments. Numerous cognitive therapy sessions
were devoted to evidence gathering, cost– benefit analysis, and generating alternative per-
spectives on his negative beliefs about himself, his future, and the world. Edward had an
unyielding belief that he had failed in Rwanda and now he had completely failed in life.
He believed he was a disappointment to himself and to others. He was convinced that his
life was meaningless, he had achieved nothing, and that he had been permanently dam-
aged by his war- related experiences (i.e., a state of mental defeat). He believed his future
was bleak and contained only disillusionment and misery. He held a particularly cynical
view of the world which was doomed to be dominated by evil, greed, and exploitation. It
deserved the most severe punishment for its evil. He now rejected his previous religious
beliefs in a loving, caring God. He distrusted everyone because he believed people were
basically selfish, uncaring, and disinterested in others.
Our work on two of Edward’s most prominent negative beliefs, “I have been an
utter failure in life” and “I am partly to blame for failing to stop the genocide,” will
illustrate trauma- focused cognitive restructuring. In both cases we examined whether
these beliefs were accurate statements of reality by examining evidence that he achieved
nothing in his life, especially his military career. We used an imagery exercise to work
through what he could have done differently as one soldier to stop the genocide and
we listed all of the possible contributors to the Rwandan genocide. We examined the
personal cost associated with continuing to believe he was “an utter failure” and that
he should be held responsible for the genocide of innocent women and children. Alter-
native interpretations were constructed such as “Although I will now end my military
career with a medical discharge, I still achieved far more than I ever dreamed possible