This article describes the development and validation of a new measure of trauma-related thoughts and beliefs, the Posttraumatic Cognitions Inventory (PTCI), whose items were derived from clinical observations and current theories of post-trauma psychopathology. The PTCI was administered to 601 volunteers, 392 of whom had experienced a traumatic event and 170 of whom had moderate to severe posttraumatic stress disorder (PTSD). Principal-components analysis yielded 3 factors: Negative Cognitions About Self, Negative Cognitions About the World, and Self-Blame. The 3 factors showed excellent internal consistency and good test-retest reliability; correlated moderately to strongly with measures of PTSD severity, depression, and general anxiety; and discriminated well between traumatized individuals with and without PTSD. The PTCI compared favorably with other measures of trauma-related cognitions, especially in its superior ability to discriminate between traumatized individuals with and without PTSD.Many trauma theories hypothesize that traumatic events produce changes in the victim's thoughts and beliefs (e.g.,

the war in Iraq, and Hurricane Katrina have focused attention on posttraumatic stress disorder (PTSD), an anxiety disorder that can result from exposure to traumatic events like combat, rape, assault, and disaster. Posttraumatic stress disorder is characterized by symptoms of reexperiencing the traumatic event, avoiding reminders of the event or feeling emotionally numb, and hyperarousal. 1 The disorder is associated with psychiatric and physical comorbidity, reduced quality of life, 2-4 and substantial economic costs to society. 5 Lifetime prevalence in US adults is higher in women (9.7%) than in men (3.6%) 6 and is especially high among women who have served in the military. 3,7 Thus, research aimed at testing treatments for PTSD in this population is important.

Generalized anxiety disorder (CAD) is a chronic, pervasive disorder for which we have yet to develop sufficiently efficacious interventions. In this article we propose that recent research and theory regarding this disorder supports the integration of acceptance‐based treatments with existing cognitive‐behavioral treatments for CAD to improve the efficacy and clinical significance of such approaches. The bases for this proposal (from both the CAD and the acceptance‐based treatment literature) are reviewed, and a new treatment stemming from this conceptual integration is described.

Generalized anxiety disorder (GAD) is a chronic anxiety disorder, associated with comorbidity and impairment in quality of life, for which improved psychosocial treatments are needed. GAD is also associated with reactivity to and avoidance of internal experiences. The current study examined the efficacy of an acceptance-based behavioral therapy, aimed at increasing acceptance of internal experiences and encouraging action in valued domains, for GAD. Clients were randomly assigned to immediate (n=15) or delayed (n=16) treatment. Acceptance-based behavior therapy led to statistically significant reductions in clinician-rated and self-reported GAD symptoms that were maintained at 3-and 9-month follow-up assessments; significant reductions in depressive symptoms were also observed. Seventy-eight percent of treated participants no longer met criteria for GAD and 77% achieved high end-state functioning at post-treatment assessment; these proportions stayed constant or increased over time. As predicted, treatment was associated with decreases in experiential avoidance and increases in mindfulness. Keywordsgeneralized anxiety disorder; mindfulness; experiential avoidance; worry; RCT Although efficacious individual cognitive behavioral therapies (CBT) have been developed for Generalized Anxiety Disorder (GAD), a large proportion of individuals treated fail to meet criteria for high end state functioning (see Waters & Craske, 2005, for a review), suggesting that further treatment development may be needed. A range of novel approaches are being explored (see Heimberg, Turk, & Mennin, 2004, for reviews). Our efforts have focused on an individual acceptance-based behavior therapy (ABBT) that targets experiential avoidance (attempts to alter the intensity or frequency of unwanted internal experiences, Hayes, Wilson, Correspondence concerning this article should be addressed to Lizabeth Roemer, Department of Psychology, University of Massachusetts Boston, 100 Morrissey Blvd, Boston, MA 02125. Email: Lizabeth.Roemer@umb.edu. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at http://www.apa.org/journals/ccp/ NIH Public Access Gifford, Follette, & Strosahl, 1996), using strategies aimed at increasing awareness and intended action in important life domains.Research suggests that individuals with GAD negatively evaluate internal experiences such as thoughts, emotions, and physiological sensations, and use worry, along with other strategies, as a means of escaping or avoiding these experiences. Individuals with GAD report distress about a wide range of ...