Table Of ContentCOGNITIVE-BEHAVIORAL THERAPY FOR PTSD
Guides to Individualized Evidence-Based Treatment
Jacqueline B. Persons, Series Editor
Providing evidence-based roadmaps for managing real-world cases,volumes in this series help the
clinician develop treatment plans using interventions of proven effectiveness.With an emphasis on
systematic yet flexible case formulation,these hands-on guides provide powerful alternatives to
one-size-fits-all approaches.Each book addresses a particular disorder or presents cutting-edge
intervention strategies that can be used across a range of clinical problems.
Cognitive Therapy of Schizophrenia
David G.Kingdon and Douglas Turkington
Treating Bipolar Disorder:A Clinician’s Guide to Interpersonal
and Social Rhythm Therapy
Ellen Frank
Modular Cognitive-Behavioral Therapy for Childhood Anxiety Disorders
Bruce F.Chorpita
Cognitive-Behavioral Therapy for PTSD:A Case Formulation Approach
Claudia Zayfert and Carolyn Black Becker
Cognitive-Behavioral
Therapy for PTSD
A CASE FORMULATION APPROACH
Claudia Zayfert
Carolyn Black Becker
Series Editor’s Note by Jacqueline B. Persons
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LibraryofCongressCataloging-in-PublicationData
Zayfert,Claudia.
Cognitive-behavioraltherapyforPTSD:acaseformulationapproach/
ClaudiaZayfert,CarolynBlackBecker.
p.;cm.—(Guidestoindividualizedevidence-basedtreatment)
Includesbibliographicalreferencesandindex.
ISBN-13:978-1-59385-369-3(hardcover:alk.paper)
ISBN-10:1-59385-369-6(hardcover:alk.paper)
1. Post-traumaticstressdisorder—Treatment. 2. Cognitive
therapy. I. Becker,CarolynBlack. II. Title. III. Series.
[DNLM: 1. StressDisorders,Post-Traumatic—therapy. 2. Cognitive
Therapy—methods. 3. StressDisorders,Post-Traumatic—
psychology. WM170Z39c2007]
RC552.P67C6442007
616.85′21—dc22
2006027917
In memory of Sami
—C. Z.
In memory of Sue
—C. B. B.
About the Authors
ClaudiaZayfert,PhD,aclinicalpsychologistandanAssociateProfessorofPsychiatry
at Dartmouth Medical School, has been involved in treatment, research, and training
related to posttraumatic stress disorder (PTSD) for over 15 years. She completed her
doctoral degree at West Virginia University and was a Research Associate at the Na-
tionalCenterforPTSD.Currently,sheisDirectoroftheAnxietyDisordersServiceand
thePosttraumaticStressDisorderTreatmentProgramintheDepartmentofPsychiatry
at Dartmouth Hitchcock Medical Center. Her primary interests include promoting the
use of empirically supported treatments for anxiety disorders in clinical practice and
understandingbarrierstotheirimplementation.Dr.Zayferthaspublishedextensively
and presented at national and international conferences, and provides training and
consultation regarding cognitive-behavioral treatments.
CarolynBlackBecker,PhD,isanAssociateProfessorofPsychologyatTrinityUniver-
sity,SanAntonio.TrainedatRutgersUniversity,Dr.Beckerisapracticingclinicalpsy-
chologistwhospecializesinthetreatmentofPTSD,anxietydisorders,andeatingdisor-
ders. She has over 14 years of experience with cognitive-behavioral treatments for a
variety of anxiety disorders, including PTSD. The primary focus of her teaching, re-
search, and clinical work is the implementation of scientifically supported prevention
and treatment interventions in clinical settings. In addition to numerous publications
onthesetopics,Dr.Beckerregularlypresentsatnationalandinternationalconferences
and provides training and consultation to clinicians.
vii
Series Editor’s Note
Thepersonwhohasposttraumaticstressdisorder(PTSD)typicallyhasahostofprob-
lems.InadditiontoPTSD,thepersongenerallyhasseveralco-occurringdisordersand
difficulties,suchasbulimianervosa,borderlinepersonalitydisorder,substanceabuse,
chaoticandabusiverelationships,financialproblems,andmore.Althoughthetraumas
thatcausedthePTSDarelongpast—andinpartbecausetheyaresolongpastandhave
notbeentreated—theseindividuals’livesareoftenshattered,andtheyexperiencesig-
nificant suffering and extensive disability.
ThegoodnewsisthatseveraleffectivetreatmentsforPTSDhavebeendeveloped.
Ironically,thedevelopmentoftheseeffectivetreatmentsforPTSDisalsothebadnews
(Strosahl, 1998) because of all the questions they raise. The fact that multiple, similar
cognitive-behavioral treatments are available can lead to confusion for the treatment
provider,whohasdifficultysortingthroughthesetherapiestodeterminewhichareef-
fective.Aresomemoreeffectivethanothers?Howdotheydiffer?WhichoneshouldI
usetotreatthepatientwhoisinmyofficerightnow?Yourdifficultiesarecompounded
when you focus on your patient’s multiple, co-occurring disorders and difficulties,
whichraisethefollowingquestions:ShouldItreatthepatient’svariousdisordersand
problemssequentially?Ifso,inwhatorder?OrshouldItreatthemsimultaneously?Is
the answer to this question different for different patients? What strategy can I use to
determine the answer to this question?
Claudia Zayfert and Carolyn Black Becker answer all of these questions in this
book.ToanswerthequestionsaboutthetreatmentofPTSDitself,theauthorsdescribe
thevariousevidence-basedcognitive-behavioralmodelsofPTSDanddistillfromthem
theiressentialingredients.Theauthorsdescribebothconditioningandcognitiveviews
of the acquisition and maintenance of PTSD symptoms, and they describe cognitive-
behavioral views of fear, panic, anxiety, and the many other emotions that commonly
occurinPTSD(e.g.,anger,shame,guilt,andhopelessness).Theauthorsprovideforthe
clinician reader a sophisticated understanding of cognitive-behavioral conceptualiza-
tionsofPTSDatthelevelofgeneralprinciplesratherthanattheleveloftheprocedural
details of the currently available treatment protocols. Zayfert and Becker propose that
twobasicinterventions,exposureandcognitiverestructuring,areattheheartofeffec-
tive cognitive-behavioral therapy for PTSD, and they describe those interventions in
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