Cognitive Restructuring on a PTSD Patient

Case:

Jacob Taylor recently separated from the U.S. Army after serving eight years as infantryman with three deployments to Iraq and Afghanistan. While he suffered no physical injuries, he did encounter a multitude of horrific sights to include several fire fights while on patrol and improvised explosive device (IED) detonations killing and injuring his fellow soldiers and civilians. As part of his separation process, his medical review determined he did suffer from post-traumatic stress disorder (PTSD), but his enrollment in Veterans Administration treatment program is delayed due to paperwork processing. In the meantime, the medications he received upon separation are providing little relief and Jacob has begun to see catastrophe around every corner. He's becoming more withdrawn from society and depressed as he perceives threats from ordinary daily encounters. Such a downward spiral could lead to suicide or even reverting back to his Army training - eliminating the threat by force. During Jacob's deployments to Iraq and Afghanistan, threats were dealt with using his with M-16 rifle or a grenade. The smallest perceived threat, even in his home, could lead to violence toward others or himself. Jacob is experiencing catastrophizing, a form of cognitive distortion, where only the worse is expected in each situation with no possibility of a positive result (Tull, 2013). Jacob's scenario may be indicative of many of our returning service personnel and veterans; in reality, they can be helped with the assistance of cognitive restructuring. (Lead in to applying CR steps and results) Jacob has been threatening violence against neighbors and has gotten into fights because of PTSD and catastrophizing everything. He's now meeting with a therapist from the local VA hospital to walk through the cognitive restructuring steps.

Question:

- What will be the most challenging element of cognitive restructuring in this case? Explain.