Post-traumatic stress disorder is a common problem, developing in 15-24% of people who are exposed to traumatic events. 1 2 General population surveys have suggested that 1 in 12 adults has experienced post-traumatic stress disorder, the commonest causes being violence (39.5%) and an unexpected bereavement (31.3%).3 Control studies have shown that cognitive behavioural interventions and antidepressant drugs are moderately effective treatments for fully developed post-traumatic stress disorder.4 Early psychological debriefing to prevent the development of post-traumatic stress disorder has had mixed results.5

Previous stress inoculation training might help in such situations that might cause post-traumatic stress,6 but little work has been done to evaluate the effectiveness of teaching cognitive behavioural coping strategies to people at risk of trauma. In this brief paper we report the experience of a trained cognitive behaviour therapist working in a post-traumatic stress clinic who was exposed to the trauma of being trapped underwater and near drowning. During this experience he was able to use a variety of cognitive coping strategies. He did not later develop post-traumatic stress disorder but did experience an alteration of his assumptions about risks of trauma in general and an increase in the strength of his spiritual values.