Posttraumatic Stress Disorder 545
to troubleshoot various problems associated with this intervention, see Chapter 7 as
well as Foa and Rothbaum (1998) and Taylor (2006).
The imaginal exposure component of cognitive therapy ends with production of a
reformulated Trauma Narrative. This second account of the trauma should be a closer
approximation to the actual traumatic experience including important contextual infor-
mation and aspects of the trauma that may have been forgot ten or minimized in the origi-
nal accou nt. It should also incorporate more helpf ul interpretations of the client’s role and
responses during the trauma. The goal of this reformulated narrative is not to “normalize
the trauma” (this would be entirely inappropriate and insensitive), but rather to help the
client remember the traumatic experience in a way that brings new meaning and accep-
tance so it can be assimilated into general autobiographical memory. Producing a more
elaborated accou nt of t he t rau ma as wel l as repeated i mag i na l ex posu re play a crit ic a l role
in constructing a more integrated, conceptually based memory of the trauma.
Edward wrote down the following Trauma Narrative that became the basis for the
imaginal exposure component of his treatment:
“I remember going to an orphanage and we were tasked with providing supplies.
One day I am sitting having lunch and suddenly felt shocked; I felt something touch
me and beside me is a little girl in a pretty dress. She is 5 years old. She is badly
burned with no nose or fingers. She seems curious at what we are eating. After over-
coming my initial shock, I feel more composed and show her my lunch. She loves
the peaches I give her and then follows me the rest of the day. The other children
make fun of her but she ignores their brutal harassment. The little girl and I are in
our own world delivering supplies to the orphanage. Frequently she looks up at me
and smiles. I ask one of the nuns what happened to her and she says that the little
girl’s family and entire village was murdered or burned by soldiers. She hid under
the bed and saw everything. I told my family about the little girl and they mailed
me toys, cookies, and some clothes to give to her. The next week I return to the
orphanage but she is gone! I search for her, feeling tense, frantic, a terrible sick feel-
ing in my stomach. A lot of the children are missing. I ask a nun about the kids and
she tells me the Rwandan soldiers took all the children who were sick, damaged, or
showed signs of weakness. They were hacked alive. I feel a rage building inside, I
become tense all over and start to shake. I see a Rwandan soldier standing off to one
side, laughing at me as I am talking to the nun. The anger is so intense, I start yell-
ing and cursing the soldier. I lunge toward him with my knife, wanting desperately
to kill him. My fellow soldiers hold me back. He knows I can’t hurt him and so he
just keeps laughing at me. I am crying, screaming at him. God, I want to kill that
guy; I want to slit open his throat just like he butchered the little girl.”Clinician Guideline 12.25
Ask clients to generate a Trauma Narrative which then becomes the basis for repeated ima-
ginal exposure to the worst trauma aimed at disconfirming misinterpretations about the
dangerousness of trauma memories and reconstruction of a more organized, elaborated
memory of trauma that can be integrated into general autobiographical memory.