Mervin Smucker. The combination of exposure and cognitive restructuring interventions when the predominant posttraumatic stress (PTSD) emotions are other than fear.

When an individual who is suffering from a posttraumatic reaction, reports non-fear emotions (e.g., guilt, shame, anger) as the predominant PTSD emotion(s), cognitive restructuring interventions that employ imagery rescripting can often be very useful. This involves identifiying challenging, and transforming the traumatic imagery into adaptive-coping imagery, and replacing related maladaptive trauma-related beliefs with adaptive beliefs. As such imaginal exposure interventions are used, not for habituation, but for enhancing cognitive restructuring via the activation of the traumatic images so that the trauma-related cognitions can be identified, challenged, and modified. Once the intrusive images have either ceased or have lost their emotional impact and the individual is able to create adaptive imagery at will (e.g., mastery imagery, self-calming imagery), one needs to assess whether or not malaptive trauma-related beliefs remain that will require further cognitive and emotional processing. Frequently, Type II trauma victims will continue to be plagued with maladaptive beliefs (e.g., faulty attributions, self-deprecating schemas) about their traumatization long after the disturbing, intrusive images of the traumatic event have abated.

Mervin Smucker