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

PTSD and the Cognitive Therapies

Gerbode points out that some of the key cognitions contained in the memory of any traumatic incident that later cause trouble when they are restimulated are those specific conclusions, decisions, and intentions the individual generated during the incident itself in order to cope emotionally with the painful urgency of the moment. In such a circumstance, not only would certain pre-existing beliefs govern one's reaction to a traumatic event, but also the traumatic event itself would give rise to the formulation of new, potential errant cognitions. Viewed in this light, PTSD is very much a cognitive-emotive disorder and not nearly as Pavlovian as it at first appears to be. Accordingly, an effective cognitive-emotive approach is called for in its remediation, one in which the errant cognitions generated under the duress of the trauma are located and corrected.

Most cognitive therapists have traditionally favored challenging a client's current disturbance­causing belief system over directly confronting the earlier experience(s) responsible for its acquisition (Ellis, 1962, 1989). A therapist's decision to focus an intervention mainly on a client's responses to day­to­day stressors is most understandable when the client does not report flashing back at the time of the upsets. Most non­PTSD clients, after all, have no special awareness of their early acquisition experiences and, therefore, have little or nothing to say about them. Their attention is fixed on a steady stream of disturbance­provoking current events for which both we and they realize they do need more rational coping skills. In the clear­cut PTSD case in which flashback is evident, the client not only puts the acquisition experience (the primary trauma) in focus right at the start but also often seems virtually obsessed by it. Flashback content, which is often concurrent with the client's upset over something in present time, is so painfully "charged" that he or she is either barely able to shift attention from it or else must regularly struggle to resist attending to it (Solomon, 1991). In such a circumstance, the therapist who focuses intervention exclusively on the client's dramatic over­reactions to current (secondary) events (on the restimulator, rather than on what is being restimulated) bypasses the opportunity to address directly and resolve the core of the client's PTSD case. Such attention mainly to the present­time "cueing effect," according to Goodman and Maultsby (1974, p. 62), "explains many failures or partial successes in psychotherapy, despite the best intentions of patient and therapist."

Given the extreme volatility of the memory of a trauma, though, it's really no wonder that many therapists and their PTSD clients (tacitly) agree not to confront such incidents head on. To understand why this is so often the case, consider the following:

* It is nearly impossible to get PTSD clients to perceive or appraise objectively a traumatic experience they are in the midst of dramatizing;

* It is usually difficult, even when they are not dramatizing, to sell PTSD clients on the idea of re­evaluating a traumatic event that has given them nightmares for the last fifteen or twenty years;

* Cognitive re­structuring, thought stopping, and stimulus blunting techniques give PTSD clients little or no control over their tendency to flash back spontaneously and go into restimulation; and

* Helping PTSD clients minimize the disruptive impact of their intrusive thoughts and teaching them not to down themselves over the persistence of their symptoms is better than nothing.

It becomes understandable, then, that many therapists choose to assist clients in their ongoing struggles to distance themselves from the memories of their traumata in an attempt simply to limit the frequency and intensity of their post­traumatic episodes.

Therapists may actually bring superb therapeutic skills to bear on clients' over­reactions to a variety of contemporary stimulus­events (e.g., rage over a spill, anxiety at a meeting), but unless they help PTSD clients to resolve the prior trauma (e.g., auto accident, childhood abuse, war experience) that actively supports their current disturbance and to revise the errant cognition associated with that primary experience, they have elected not to address the PTSD at all. The result of such a purely secondary intervention is that clients' unresolved primary traumas continue intermittently to intrude into consciousness, and clients are left to struggle alone to secure a sense of rationality against the influence of these traumas.

Primary Approaches

Because a traumatic incident is, by definition, exceedingly unpleasant, there is an understandable tendency, at the moment one is occurring, to resist and protest it as best one can. It is at just such moments of extreme physical and/or emotional pain, according to Gerbode (1989), that one's thinking (evaluative cognition) is least likely to be well­reasoned and objective and most likely to be irrational and distorted. There is, moreover, a subsequent tendency to suppress and/or repress the memory of such an incident so as not to have to re­experience the painful emotional "charge" its restimulation carries with it. Unfortunately, suppression/repression of the memory of a traumatic incident effectively locks its distorted ideation and painful emotion away together (along with the incident's sensory and perceptual data) in long­term storage. Thus, the stage for PTSD is set. Fortunately however, when accessed with the specific cognitive imagery procedure of TIR, a primary traumatic incident can be stripped of its emotional charge permitting its embedded cognitive components to be revealed and restructured. With its emotional impact depleted and its irrational ideation revised, the memory of a traumatic incident becomes innocuous and thereafter remains permanently incapable of restimulation and intrusion into present time (Gerbode 1989).

As Manton and Talbot (1990) observe, "traumatic events...can bring into consciousness unresolved [prior] situations (with similar themes) such as incest, child abuse, or the death of an important person in the victim's life" (p.508). When clients have more than one trauma in their history, the only completely effective procedure is one that traces each symptom of the composite post­traumatic reaction back through sequence(s) of related earlier incidents to each of the contributing primaries. Interestingly, a very similar observation was made by one of our earliest colleagues, (Freud, 1984) who wrote:

What left the symptom behind was not always a single experience. On the contrary, the result was usually brought about by the convergence of several traumas, and often by the repetition of a great number of similar ones. Thus it was necessary to reproduce the whole chain of pathogenic memories in chronologic order, or rather in reversed order, the latest ones first and the earliest ones last (p. 37).

The simple fact is that in order to deal effectively with past trauma, we must guide the client through to its resolution in imagery. The imagery process itself, however, is just the means by which we help PTSD clients get through their residual primary pain. It is by revising the errant cognition associated with that pain that they are freed from the grip of their PTSD.