222 ASSESSMENT AND INTERVENTION STRATEGIES
obvious initial step in exposure. This is followed by asking clients to write out a nar-
rative of the traumatic memory or imagined catastrophe (for further discussion, see
Chapter 12 on PTSD). This narrative should be as detailed as possible so it can be used
as the basis of repeated exposure to the traumatic memory (i.e., reliving the experi-
ence).
Standard cognitive restructuring strategies are employed to modify faulty apprais-
als and beliefs associated with the memory or imagined catastrophe (Ehlers & Clark,
2000). The goal is to arrive at an alternative perspective toward the memory or anxious
fantasy that is more adaptive and less anxiety- provoking. In addition, efforts should be
made to construct a more balanced memory of the traumatic experience itself that is a
closer approximation to reality. For individuals who are troubled by images of antici-
pated catastrophe, again a more realistic scenario can be developed. The client can be
encouraged to practice replacing the maladaptive memory or fantasy with the more
adaptive alternative. Behavioral exercises can be assigned that would strengthen the
alternative memory or fantasy and weaken the traumatic recollection or anxious imag-
ery. Given the extensive use of cognitive restructuring and construction of an alternative
perspective, this form of imaginal intervention is better described as a “reprocessing
intervention” (i.e., a reprocessing of the memory or anxious fantasy) rather than simply
repeated exposure to an internal fear stimulus.
The contribution of memory or imagery reprocessing to the effectiveness of cogni-
tive treatment for the anxiety disorders is unknown. Research that has focused specifi-
cally on the active ingredients of CBT for PTSD indicates that imaginal and situational
exposure are critical components of the treatment’s effectiveness (see review by Taylor,
2006). Moreover, Pennebaker (1993) found that thinking and talking about a traumatic
event immediately after its occurrence is an important phase in the natural adaptation
to traumatic events. More recently, Pennebaker and colleagues demonstrated that a rela-
tively brief intervention in which individuals write on their deepest thoughts and feel-
ings about an emotional upheaval produces positive emotional, behavioral, and health-
related benefits including reductions in depressive symptoms for individuals who tend
to suppress their thoughts (e.g., Gortner, Rude, & Pennebaker, 2006; see Pennebaker,
1997; Smyth, 1998). These findings, then, suggest that modification of highly distressing
memories of past experiences or fantasies of future catastrophes is an important target
for cognitive intervention when this phenomena plays a critical role in the maintenance
of an individual’s anxiety state.
Mindfulness, Acceptance, and Commitment
Segal, Williams, and Teasdale (2002) describe an eight- session group intervention for
individuals who recovered from major depression aimed at reducing depressive relapse
through training in mindfulness approaches that help individuals “decenter” from their
negative thinking. Called mindfulness-based cognitive therapy (MBCT), the intent is
to teach individuals a different way to become aware of and relate to their negative
thinking. Rather than become engaged with their negative cognitions in an evaluative
manner, individuals are taught to “decenter” from their thoughts, feelings, and bodily
sensations. That is, negative thoughts are to be observed and described but not evalu-
ated (Segal, Teasdale, & Williams, 2005). Group participants are taught to focus their
awareness on their experience in the moment in a nonjudgmental manner. Eight-week