Traumatic Incident Reduction:
Cognitive-Emotive Resolution of the Post-Traumatic Stress Disorder by Robert H. Moore, Ph. D.

Problem Profile | Primary and Secondary Trauma | PTSD and Cognition |
Traumatic Incident Reduction | Notes | Bibliography | The Author

Problem Profile

In recent years, significant media attention given to the Post­Traumatic Stress Disorders (PTSD) of Vietnam veterans, whose post­war "nervous" problems (i.e., sleep disturbances, hypervigilance, paranoia, panic attacks explosive rages, and intrusive thoughts) were known to veterans of earlier campaigns as "battle fatigue," "shell shock," and "war neurosis" (Kelly, 1985). As any number of mugging, rape, and accident victims have demonstrated, however, one need not have been a casualty of war to experience the problem (APA, 1987). PTSD appears in children as well as adults (Eth & Pynoos, 1985) and has been attributed to abuse, abortions, burns, broken bones, surgery, rape, overwhelming loss, animal attacks, drug overdoses, near drownings, bullying, intimidation, and similar traumata. It manifests as a wide range of anxieties, insecurities, phobias, panic disorders, anger and rage reactions, guilt complexes, mood and personality anomalies, depressive reactions, self­esteem problems, somatic complaints, and compulsions.

The PTSD reaction is most easily distinguished from emotional problems of other sorts by its signature flashback: the involuntary and often agonizing recall of a past traumatic incident. It can be triggered by an almost limitless variety of present cognitive and perceptual cues (Kilpatrick, 1985; Foa, 1989). Lodged like a startle response beyond conscious control, the reaction frequently catapults its victims into a painful dramatization of an earlier trauma and routinely either distorts or eclipses their perception of present reality. Although we can't confirm that any of the countless animal species with which researchers have replicated Pavlov's (1927) conditioned response ever actually flashed back to their acquisition experiences, the mechanism of classical conditioning is apparent in every case of PTSD. As salivation is to Pavlov's dog, so PTSD is to its victims.

Like emotional problems of other sorts, however, PTSD is not accounted for solely in terms of antecedent trauma and classical conditioning. In order to provoke a significant stress reaction, as Ellis (1962) and others observe, an experience must ordinarily stimulate certain components of an individual's pre­existing irrational beliefs. Veronen and Kilpatrick (1983) confirm that the rule holds for trauma as well as for more routine experience. Errant beliefs ­­ related to the tolerance of discomfort and distress; performance, approval, and self­worth; and how others should behave­­ "may be activated by traumatic events and lead to greater likelihood of developing and maintaining PTSD symptomatology and other emotional reactions. Individuals who premorbidly hold such beliefs in a dogmatic and rigid fashion are at greater risk of developing PTSD and experiencing more difficulty coping with the resulting PTSD symptomatology" (Warren & Zgourides, 1991, p. 151). Also activated and often shattered by trauma are assumptions regarding personal invulnerability; a world that is meaningful, comprehensible, predictable and just; and the trustworthiness of others (Janoff­Bulman, 1985; Roth & Newman, 1991). Such pre­existing beliefs and assumptions, plus the various conclusions, decisions and attitudes specific to a particular traumatic incident (especially when held as imperatives) constitute the operant cognitive components of PTSD.