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Negative cognitions about oneself, others, and the world are central to the development and maintenance of posttraumatic stress disorder (PTSD). We provide a comprehensive review of the literature examining the change in post-trauma negative cognitions in PTSD treatments. We explore the association between change in cognitions and change in PTSD sy...
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Despite much evidence concerning the importance of control over stressors in animal models of adaptation to stress, there is a dearth of experimental evidence for the role of controllability in posttraumatic stress disorder (PTSD). This study investigated whether perceived control over aversive stimuli influenced subsequent avoidance in a female co...
Objective
Posttraumatic stress disorder (PTSD) is often difficult to treat, and many patients do not achieve full remission. Complementary and integrative health approaches, such as mindfulness meditation, are intended to be integrated with evidence‐based treatment. This study examined the efficacy of mindfulness‐based stress reduction (MBSR) in th...
The aim of this study was comparison of the severity of the recurrent episode in the group of subjects suffering from Major Depressive Disorder with comorbid Posttraumatic Stress Disorder and the group of subjects suffering only from Major Depressive Disorder. A total of 120 subjects were assessed and divided into two groups. Group D/PTSD consisted...
Citations
... Cognition change is one of the most hypothesized mechanisms for posttraumatic stress disorder (PTSD) symptom improvement (Brown et al., 2019). Clinicians can facilitate cognition change through Socratic dialogue by helping individuals explore their beliefs and then evaluate and ...
... These findings align with the premise of CPT (Resick et al., 2024) and cognitive theory (Ehlers & Clark, 2000), which postulate that reductions in maladaptive beliefs produce symptom improvements. The findings also correspond with prior research demonstrating that reductions in traumafocused beliefs are associated with decreases in PTSD symptoms (Brown et al., 2019). As such, tracking and updating ISPs during the last 5 min of every session could be a useful way to clinically assess patient progress and help predict overall treatment outcomes. ...
Cognitive processing therapy (CPT) targets maladaptive beliefs called “stuck points,” which are typically assessed using standardized measures (e.g., the Posttraumatic Cognitions Inventory [PTCI]). This study examined whether changes in person‐specific individualized stuck points (ISPs) were associated with reductions in self‐reported and clinician‐rated posttraumatic stress disorder (PTSD) symptoms and whether ISPs predicted PTSD severity beyond general stuck points (GSPs) measured using the PTCI. Adults ( N = 57) with PTSD received 1‐week massed virtual CPT via one of two randomized controlled trials. ISPs were tracked, and ISP belief strengths were rated after every other session and at 1‐ and 3‐month follow‐ups. Linear mixed‐effects models examined associations between ISP changes and self‐reported (PTSD Checklist for DSM‐5 [PCL‐5]) and clinician‐rated PTSD (Clinician‐Administered PTSD Scale for DSM‐5 [CAPS‐5]) symptom reductions, adjusting for baseline depression, gender, age, and treatment condition. Participants showed large reductions in PTSD symptoms from baseline to 1‐month follow‐up, M PCL‐5 reduction = 29.4, d = 2.02; M CAPS‐5 reduction = 10.49, d = 0.72. Average ISP belief strength decreased by 50.2% during treatment and up to 1‐month follow‐up, d = 2.75. Higher numbers of ISPs also predicted reduced PCL‐5 scores, p = .021, R ² = .02. However, when controlling for PTCI score, ISPs no longer significantly predicted PTSD symptom change, p s = .352–.534, whereas PTCI scores remained significant predictors, p < .001. ISP reductions were associated with PTSD symptom improvements but did not predict outcomes beyond PTCI‐assessed GSPs. Tracking ISPs may still be valuable for tailoring therapy and enhancing patient engagement.
... There is convincing support for cognitive models of PTSD. Negative cognitive processes, including negative thought and maladaptive cognitive styles such as rumination (i.e., the tendency to passively perseverate on the causes, meaning, and consequences of one's negative emotions and symptoms; Nolen-Hoeksema et al., 2008), are robustly associated with PTSD diagnosis and severity (Brown et al., 2019;Losavio et al., 2017;Moulds et al., 2020). ...
... Extant research on negative thought in trauma-exposed adults is disproportionately based on retrospective selfreport measures that ask people how much they agree with statements about negative posttraumatic thought (Brown et al., 2019). Perhaps the most widely used instrument is the Posttraumatic Cognitions Inventory (PTCI; Foa et al., 1999), which asks respondents to report how much they agree with statements about negative posttraumatic thoughts such as self-blame and negative thoughts about the self and the world. ...
... The goals of this study were to examine the temporal dynamics of negative thought in daily life among traumaexposed adults with varying PTSD severity. Consistent with a large body of retrospective self-report questionnaire research demonstrating associations between negative cognitions and PTSD (Brown et al., 2019;Losavio et al., 2017;Moulds et al., 2020), results showed that individuals with higher PTSD severity reported higher average levels of negative thought in daily life. Negative thought fluctuated considerably over time, however, and variability in negative thought was explained by both state (within-subjects) and dispositional (between-subjects) factors. ...
Purpose
Cognitive theory posits that negative posttraumatic thoughts play a critical role in the development, maintenance, and treatment of posttraumatic stress disorder (PTSD). Though negative thought in PTSD is often measured using static, between-subjects, and cross-sectional assessments via retrospective self-report, recent approaches have investigated negative thought as a dynamic process that unfolds within people over time. Here, we examine the temporal dynamics of negative thought in daily life (i.e., variability, inertia, and reactivity) and whether these dynamics are associated with PTSD severity in trauma-exposed adults.
Methods
Participants with (n = 39) and without (n = 41) a current PTSD diagnosis completed three days of ecological momentary assessment (n = 2158 observations; Mobs = 27) assessing four subdomains of negative thoughts.
Results
Participants reported variability in negative thought over time, and that variability was explained by both situational and dispositional factors. Higher PTSD severity was associated with higher mean levels, more variability, and more reactivity in negative thought over time, but not negative thought inertia.
Conclusions
Findings suggest that negative thought is a dynamic process that exhibits short-term fluctuations and that the temporal dynamics of negative thought help characterize the cognitive experience of PTSD. Future work should incorporate ambulatory assessment and interventions to better understand and intervene on negative thought in PTSD.
... er experiences, negative changes in thoughts and mood, and heightened arousal and reactivity (American Psychiatric Association, 2013). Research over the last years has explored the mechanisms contributing to the development and maintenance of PTSD to enhance understanding and identifying targets for interventions and treatment (Alpert et al., 2023;L. A. Brown et al., 2019). To date, the most supported mechanism of change in evidence-based treatments for PTSD is change in negative posttraumatic cognitions (Alpert et al., 2023). ...
Objective: The Metacognitions Questionnaire–30 (MCQ-30) was developed to measure individual differences in endorsement of maladaptive metacognitive beliefs. Previous research shows the MCQ-30 possesses good psychometric properties. However, there is limited research on psychometric properties of the MCQ-30 in clinical samples, and the scale has not previously been validated in patients with posttraumatic stress disorder (PTSD). The aim of this study was therefore to evaluate the psychometric properties of the MCQ-30 in a sample of PTSD patients. Method: A sample of 290 patients diagnosed with PTSD completed self-report questionnaires measuring trauma symptoms and metacognitive beliefs. The sample consisted of 225 women and 65 men (M = 33.90 years; range 18–69 years). Confirmatory factor analysis was used to investigate the factorial structure of the MCQ-30, and the internal consistency and convergent validity were evaluated. A linear regression analysis was used to evaluate unique associations between metacognitive subscales and trauma symptoms. Results: The confirmatory factor analysis supported the proposed five-factor structure of MCQ-30, and the subscales demonstrated good internal consistency. All five subscales were associated with trauma symptoms of which negative metacognitive beliefs and cognitive confidence showed unique relationships to symptoms. Conclusion: The MCQ-30 demonstrates promising validity in assessing generic metacognitive beliefs among PTSD patients, suggesting its utility in both clinical practice and research contexts.
... Why a traumatic event such as an earthquake causes different psychological outcomes in people has long been discussed in the literature (Nijdam & Wittman, 2015), and various theoretical explanations have been offered. Cognitive approaches that try to explain trauma argue that traumatic experiences can cause a disruption in individuals' cognition, and this can lead to mental problems (Bernardi et al., 2019;Brown et al., 2019;LoSavio et al., 2017). According to the cognitive approach, the most determinant of the initiating or sustaining factors of PTSD development in individuals are the dysfunctional thoughts that the individual has (Resick et al., 2008). ...
Bilişsel yaklaşıma göre bireylerin yaşadıkları travmatik bir olay karşısında vereceği tepkiler bireyin bilişleri ile ilişkilidir. Buradan hareketle deprem deneyimlemiş ergenlerin deprem sonrası ruh sağlığı sorunları yaşamalarında ve sorunların kronikleşmesinde bilişlerinin önemli rolü olduğu söylenebilir. Bu çalışmanın temel amacı, deprem deneyimlemiş olan ergenlerin deprem sonrası bilişlerini değerlendirmeye dönük olarak geçerli ve güvenilir ölçümler yapan bir ölçme aracı geliştirmektir. Çalışma 854 deprem deneyimlemiş lise öğrencisinin (Erkek = 337, %39,5; Kadın = 517, %60,5) katılımıyla gerçekleştirilmiştir. Ölçeğin geçerlik değerlendirmeleri için uzman görüşü, açımlayıcı ve doğrulayıcı faktör analizleri, ölçüt geçerliliği, yakınsak geçerlilik ve ayırt edici geçerlik analizleri yapılmıştır. Yapılan tüm geçerlilik ölçümleri neticesinde ölçeğin 16 maddeli ve 4 faktörlü yapısının bahsi geçen tüm geçerlilik kriterlerini sağladığı tespit edilmiştir. Güvenirlik ölçümleri için ise kompozit güvenirlik değerleri, iç tutarlılık katsayıları ve test-tekrar test korelasyonları incelenmiştir. Ölçeğin tüm güvenirlik ölçümlerinin de güvenirlik kriterlerini sağladığı görülmüştür. Tüm bunlardan hareketle 16 madde 4 boyutlu Ergenler için Deprem Sonrası Bilişler Ölçeği’nin lise öğrencilerinde geçerli ve güvenilir ölçümler yaptığı tespit edilmiştir.
... and the world. NPCs maintain PTSD symptoms by facilitating behavioral and cognitive avoidance, thereby interfering with adaptive processing of trauma-related information (Brown et al., 2019;Ehlers & Clark, 2000;Foa et al., 1999Foa et al., , 2019Resick et al., 2024). EBPs, such as cognitive processing therapy (CPT) and prolonged exposure (PE), are theorized to modify NPCs through cognitive restructuring (CPT) or emotional processing (PE; Zalta, 2015). ...
... Furthermore, EBPs are associated with reductions in NPCs in both randomized clinical trials (RCTs; e.g. Diehle et al., 2014) and real-world treatment settings (e.g., Brown et al., 2019). ...
Negative posttraumatic cognitions (NPCs) and cognitive emotion
regulation (CER) strategies have both been proposed as predictors of change in evidence-based cognitive behavioral therapies for posttraumatic stress disorder (PTSD). However, they are rarely studied simultaneously, with only one study examining these predictors in a randomized clinical trial of prolonged exposure therapy. It remains to be tested how these variables predict improvements in PTSD severity in real world clinical settings or different delivery formats. Data from 487 military service members and veterans that participated in a 2-week nonrandomized, uncontrolled cognitive processing therapy-based intensive treatment program (ITP) for PTSD were used to evaluate NPCs and CER strategies as predictors of improvements in PTSD severity. Results showed that, in a model with both predictors, decreases in self-focused NPCs, world-focused NPCs, and catastrophizing (CER strategy) were associated with reductions in PTSD severity during treatment and at follow-up. However, these effects were small (R2 ranging from .005 to.04) relative to reductions in depression severity (R2 = .40). Although NPCs and CER strategies significantly predicted reductions in PTSD severity, their overall impact was relatively small in this nonrandomized, uncontrolled ITP. Future research should continue to investigate these and other predictors in a variety of treatment settings.
... In different theoretical models of PTSD, negative trauma-related cognitions about the trauma and its sequala have been suggested to be central in PTSD symptom development and maintenance (Ehlers & Clark, 2000;Rauch & Foa, 2006;Resick & Schnicke, 1992). Indeed, many empirical studies have underscored the centrality of negative cognitions and its relationship with the onset, maintenance, and recovery from PTSD (Brown et al., 2019;Gómez de La Cuesta et al., 2019). With regard to PTSD treatment, changes in negative cognitions predict subsequent changes in other PTSD symptoms, and changing negative cognitions have therefore been proposed as one of the mechanisms of change during treatment (Alpert et al., 2023;Cooper et al., 2017). ...
... Additionally, to test sensitivity to change, a number of participants in the patient sample (n = 41, 32.8%) was asked to fill out the questionnaires pre and post PTSD treatment. Participants all received intensified Prolonged Exposure therapy for PTSD (iPE;Foa et al., 2019;Oprel et al., 2021), which was delivered in 12 to 14 face-to-face sessions of 90-minutes of PE, with 3 sessions per week for 4 weeks. Treatment included psycho-education, imaginal exposure, and exposure in vivo. ...
... The first factor of the factor analysis was labeled 'losing control'. The idea that one is losing mental control is theoretically presumed to maintain a sense of current threat in those suffering from PTSD (Ehlers & Clark, 2000), and trauma-focused treatments, such as Prolonged Exposure, target the erroneous beliefs of 'loss of control' and 'going crazy ' (Foa et al., 2019). Our data shows more concretely what this losing control may look like. ...
Purpose
Dysfunctional threat appraisal plays a key role in both the development and treatment of PTSD. It is unclear how these appraisals can best be measured. This study aimed to explore the specific negative outcome predictions held by patients with PTSD and to develop and validate the Threat Appraisal in PTSD Scale (TAPS).
Methods
We used data from a non-clinical (N = 309) and clinical sample (N = 125) to assess the psychometric properties of the TAPS.
Results
The TAPS had excellent internal consistency and test-retest reliability, and convergent and discriminative validity were adequate. The TAPS showed to be sensitive to change following treatment. The TAPS demonstrated incremental validity beyond general cognitions in predicting PTSD symptoms in the combined sample, but not in the patient sample. An exploratory factor analysis suggested three factors: ‘losing control’, ‘externalizing reactions’, and ‘physical reactions’, and patients seemed most concerned about outcomes related to ‘losing control’.
Conclusions
These findings imply that the TAPS could be clinically beneficial, enabling patients and therapists to recognize dysfunctional expectancies and tailor therapeutic interventions accordingly.
... For these individuals, traditional therapies, such as CBT, made sense but did not always translate to improvements in the way clients felt. Clients described an inner voice that permeated anger, hostility and disgust, which could be likened to the powerful, negative and omnipotent "ED voice" described by many individuals who experience EDs (Aya et al., 2019) and negative self-directed cognitions associated with PTSD (Brown et al., 2019). CFT is a multimodal approach that incorporates various interventions and practices and strives to develop a client's capacity to show compassion towards difficulties and, therefore, to learn new patterns of approaching them and to altering their critical inner voice (Gilbert, 2014). ...
... For instance, research has indicated that both conditions share a number of negative cognitive biases, particularly a state of hypervigilance resulting from the perception of continuous threats, regardless of the presence of risks and dangers in the environment [20]. Other common symptoms reported by individuals in both conditions include re-experiencing/intrusion symptoms, avoidance symptoms, negative evaluations of the world, experience of self-disgust, poor sleep quality, and feelings of alienation, detachment, and estrangement from others [17,32]. ...
... It is evident that a state of loneliness increases the probability of developing PTSD and the duration of its symptoms. In fact, loneliness can lead to social withdrawal [2,4], which can be used as a coping strategy in response to PTSD symptoms, which actually ends up perpetuating PTSD symptoms [32,33]. ...
... Maladaptive personality traits are associated with an increased risk of psychological distress due to their tendency to be positively correlated with avoidant/maladaptive behaviors and negatively correlated with acceptance and positive reframing, which are forms of coping [32,42]. ...
Citation: Giordano, F.; Calaresi, D.; Saladino, V.; Verrastro, V. Perception of Loneliness in Adolescence: Role of Maladaptive Personality Traits and Trauma-Related Symptomatology. Brain Sci. 2025, 15, 86. https:// Abstract: Background/Objectives: Loneliness is a heterogeneous phenomenon, generally defined as an emotional experience based on the perceived distance between an individual's actual social relationships and those he or she would like to have. Adolescence is particularly vulnerable to loneliness because of the many changes in values, feelings, and emotions that characterize it. Among the aspects that may influence this feeling of discomfort, the literature identifies maladaptive personality and a dysfunctional response to traumatic events. Our study aims to identify the possible role that maladaptive personality traits and post-traumatic stress symptomatology in the form of Post-Traumatic Stress Disorder (PTSD) and Disturbance in Self-Organization (DSO) may play in the perception of loneliness in adolescents: Methods: We identified a mediation model constructed through structural equation modeling (SEM) to test PTSD and DSO post-traumatic stress symptomatology as independent variables and maladaptive personality as a mediator in the relationship between these and perceptions of loneliness in a population of adolescents of both sexes, Italian high school students; Results: Our study identifies the significant role of PTSD and DSO symptomatology in influencing the state of loneliness, both directly and indirectly through maladaptive personality traits, which appear to exert a substantial influence on the perception of loneliness, potentially functioning as mediators in the relationship between the latter and PTSD/DSO symptomatology. Presumably, a maladaptive personality may complicate recovery from adverse and traumatic experiences by preventing the implementation of functional coping strategies and promoting dysfunctional responses. Conclusions: Our findings underscore the importance of researchers and clinicians adequately considering different personality traits and the early identification of post-traumatic stress symptomatology. A focus on adolescents' communication and interpersonal skills and their ability to respond effectively to stressful and traumatic events may prove useful in identifying more effective strategies for preventing and managing loneliness and related distress in adolescents.
... However, it may be that SNAMs result in memory-related psychological symptoms that are not assessed by typical anxiety and OCD symptom questionnaires and that these symptoms may contribute to the maintenance of anxiety and OCD symptoms even if they do not result in greater symptom severity. For example, research suggests that negative cognitions about traumatic events are central in maintaining PTSD symptoms and targeting such cognitions in treatment results in a reduction in PTSD symptoms (Brown et al., 2019). Future research could examine whether negative cognitions about SNAMs in anxiety-related disorders function similarly. ...
Although negative autobiographical memories play a defined etiological role in trauma-related disorders, it is less clear what role they play in other anxiety-related disorders. Understanding the prevalence of negative autobiographical memories that are conceptually related to a patient’s symptoms (i.e., symptom-relevant negative autobiographical memories [SNAMs]) in anxiety-related disorders may help inform the development of novel memory-based interventions. The current scoping review examined the prevalence of SNAMs in anxiety disorders and obsessive-compulsive disorder, including SNAMs that were reported to have occurred around symptom onset (i.e., symptom onset SNAMs) and SNAMs that were reported to have occurred at any time (i.e., Lifetime SNAMs). Lifetime SNAMs also included a subcategory of SNAMs associated with intrusive imagery. The relationship of the presence of SNAMs to symptom onset, disorder status, and symptom severity was also examined. A systematic search identified 39 relevant articles. The prevalence of symptom onset SNAMs assessed by the Phobic Origins Questionnaire, interviews, and the Origins Questionnaire ranged from 30% to 89% (interquartile range [IQR] = 50%–68.5%, samples = 23), 23%–61% (IQR = 30%–49%, samples = 11), and 17%–37% (samples = 6), respectively. The prevalence of lifetime SNAMs ranged from 89% to 100% (samples = 6) and intrusive imagery-related lifetime SNAMs ranged from 38% to 100% (IQR = 60.5%–79%, samples = 12). Five of 14 studies observed a significantly higher rate of SNAMs in patients relative to control samples. Findings are discussed with regard to limitations of the current evidence and future research that can inform the value of targeting SNAMs in treatment.
... Secondly, it is unknown whether these relationships between interpersonal trauma and IU are specific, over and above other broader negative affective traits (e.g. negative beliefs about the self and others), which have been associated with interpersonal trauma (Brown et al., 2019;Kouvelis & Kangas, 2021). Addressing these questions is important to establish how experiences of early adversity may shape individual differences in IU, and how this relates to psychological mechanisms within transdiagnostic models of psychopathology (McLaughlin & Lambert, 2017). ...
... In the absence of previous research examining the specificity of the relationship between interpersonal trauma and IU (Dirican et al., 2023;Hayward et al., 2020), we also explored whether any relationships between interpersonal trauma and IU were unique, over and above negative beliefs about the self and others. These control variables are appropriate, given that prior research has established relationships between interpersonal trauma and negative beliefs about the self and others (Brown et al., 2019;Kouvelis & Kangas, 2021). ...
... When comparing across the interpersonal trauma types and IU, emotional neglect compared to the other types of abuse, was specifically related to higher IU. All of these effects remained when controlling for broader negative beliefs about the self and others, which have been commonly associated with interpersonal trauma (Brown et al., 2019;Kouvelis & Kangas, 2021). ...
Prior psychologically traumatic experiences have been linked to increased risk for mental health conditions. However, there remain questions about the relationship between prior interpersonal trauma, particularly that of neglect and abuse, and transdiagnostic dimensions such as intolerance of uncertainty (IU: the tendency to find uncertainty aversive). To address this gap, we conducted a secondary analysis of survey data from an international multi-site sample (n = 2510). Questionnaires included: Interpersonal trauma by type (e.g. emotional neglect, physical abuse, psychological abuse, sexual abuse) and IU. The findings revealed that: (1) experiencing different forms of interpersonal trauma was associated with higher IU, and (2) experiencing multiple forms of neglect and abuse was associated with higher IU. When comparing across the interpersonal trauma types and IU, emotional neglect compared to the other types of abuse, was specifically related to higher IU. These effects remained when controlling for broader negative beliefs about the self and others. However, the observed relationships and overall amount of variance explained by IU was rather small. Overall, these findings demonstrate that interpersonal trauma, particularly emotional neglect, is associated with IU. Future longitudinal research is required to examine if, how, and when after adversity, higher IU may emerge.
