No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Ehlers A, Clark DM. A cognitive model of posttraumatic stress disorder. Behav Res Ther 38: 319-345
Abstract
Posttraumatic stress disorder (PTSD) is a common reaction to traumatic events. Many people recover in the ensuing months, but in a significant subgroup the symptoms persist, often for years. A cognitive model of persistence of PTSD is proposed. It is suggested that PTSD becomes persistent when individuals process the trauma in a way that leads to a sense of serious, current threat. The sense of threat arises as a consequence of: (1) excessively negative appraisals of the trauma and/or its sequelae and (2) a disturbance of autobiographical memory characterised by poor elaboration and contextualization, strong associative memory and strong perceptual priming. Change in the negative appraisals and the trauma memory are prevented by a series of problematic behavioural and cognitive strategies. The model is consistent with the main clinical features of PTSD, helps explain several apparently puzzling phenomena and provides a framework for treatment by identifying three key targets for change. Recent studies have provided preliminary support for several aspects of the model.
... Observed ethnoracial differences in PTSD frequency and presentation may be, at least partially, explained by NPCs, defined as changes in one's beliefs about the self, world, and others related to a traumatic event (Ehlers and Clark, 2000;LoSavio et al., 2017). NPCs appear to be central to PTSD pathology, as these cognitions predict the transition from acute stress disorder to PTSD (Hansen et al., 2014) as well as treatment-related reductions in PTSD symptoms (Foa & Rauch, 2004;Kumpula et al., 2017;Zalta et al., 2014). ...
... Our general path model remained consistent in a sample of White veterans, whereas only negative beliefs about the self emerged as a significant predictor of NACM symptoms in a sample of Black veterans. While the directionality of these relationships cannot be determined in this cross-sectional study, the relationship between NPCs and the PTSD symptom clusters stated above are consistent with the cognitive theory of PTSD (Ehlers & Clark, 2000). Specifically, negative appraisals of the trauma and traumarelated symptoms cause a pervasive sense of threat, which in turn facilitates more negative appraisals and maintenance of PTSD symptoms over time. ...
... While Ehlers and Clark (2000) suggested NPCs impact all PTSD symptom clusters, our analysis did not find an association between NPCs and avoidance. Avoidance symptoms are typically considered to prevent natural recovery from trauma (Foa, 1989;McMillen et al., 2000) and are thus considered a primary treatment target in trauma-focused evidence-based therapies (Foa et al., 2019;Resick et al., 2017). ...
Past research supports the role of negative posttraumatic cognitions (NPCs) in the development and maintenance of posttraumatic stress disorder (PTSD). The relationship between NPCs and PTSD may be uniquely impacted by racial status and experiences of military sexual trauma (MST), both of which may have a unique impact on one’s understanding of self, others, and the world. We explored racial differences in the association between NPCs and PTSD symptom clusters in a sample of veterans endorsing MST ( N = 139; 74.8% White, 25.2% Black). A path model was created and analyzed both with the full sample and separately by racial group. In the full sample, NPCs about the self and world were significantly associated with intrusion, negative alterations in cognitions and mood (NACM), and arousal, but not avoidance. Self-blame was not a significant predictor of negative alterations in cognition in mood. This model was consistent in the White veteran model, whereas only negative cognitions about the self were associated with NACM in the Black veteran path model. NPCs about the self and world appear important to non-avoidance PTSD symptomatology related to MST and thus should be targeted in treatment. For Black veterans endorsing distress related to NACM symptoms, negative beliefs about the self should be specifically considered for intervention.
... Given the central role of AM in shaping an individual's life narrative, it is not surprising that maladaptive AM distortions can lead to psychological distress, which is especially observable in posttraumatic stress disorder (PTSD). In cognitive models of PTSD, it is posited that onset is due to an inability to integrate new and traumatic experiential information with prior AM, thus resulting in a disruption to one's overall life narrative or beliefs about oneself (Janoff-Bulman, 1992;Brewin et al., 1996;Ehlers and Clark, 2000). As such, it is wellestablished that AM distortions are a core symptom of PTSD and a critical component of the diagnostic criteria (The Diagnostic and Statistical Manual of Mental Disorders, 5th ed.; DSM-5;American Psychiatric Association, 2013). ...
... Contrary to the typical cognitive processing that occurs in everyday settings, Ehlers and Clark (2000) argued that traumatic experiences are more likely to be processed in a "data-driven" (bottom-up; perceptual) manner, rather than a "conceptual" (topdown; episodic) manner, thereby resulting in fragmented memories characterized by perceptual and sensorial details (also see Roediger, 1990). In this theory, "conceptual processing" refers to one's ability to understand the meaning of a situation and organize it coherently with previous AM, whereas "data-driven processing" refers to a type of cognitive processing that simply gathers sensory-based information, without the conceptual organization. ...
... However, during the encoding and processing of traumatic memories, this dynamic integration of past memory into future simulation is clearly disrupted-resulting in a lack of coherence to the patient's internal storytelling. This cognitive processing theory, proposed by Ehlers and Clark (2000), is also supported by neurobiological evidence, as the association between the amygdala and the formation of highly emotional memories is well-established, particularly memories encoded during a fear-provoking experience (Fanselow and Gale, 2003;Rauch et al., 2003;McGaugh, 2004;Phelps and LeDoux, 2005;Sigurdsson et al., 2007;Kim et al., 2011;Paré and Duvarci, 2012). Research suggests that during a traumatic experience, the amygdala may become hyperfunctional as a protective mechanism due to an expectancy violation, preparing the organism for potential future experiences of a similar threat-level (for a review, see Diamond and Zoladz, 2016). ...
Introduction
The aim of this systematic review and meta-analysis is to evaluate the efficacy of narrative-based interventions (NBIs) for individuals with post-traumatic stress disorder (PTSD). Investigating the efficacy of NBIs should yield insight on autobiographical memory (AM) phenomena implicated in PTSD onset and recovery, leading to improved intervention protocols. Furthermore, by analyzing how NBIs influence maladaptive AM distortions, we hope to shed light on the theorized narrative architecture of AM more generally.
Methods
A systematic literature search was conducted according to PRISMA and Cochrane guidelines in MEDLINE, EMBASE, PsychINFO, and PubMed. Additional studies were then also identified from the reference lists of other relevant literature and considered for inclusion. Studies were then evaluated for adherence to the inclusion/exclusion criteria and assessed for risk of bias. Various meta-analyses were performed on included studies to understand how NBIs may or may not influence the overall effect size of treatment.
Results
The results of the meta-analysis of 35 studies, involving 2,596 participants, suggest that NBIs are a viable and effective treatment option for PTSD, yielding a statistically significant within-group effect size and decrease in PTSD symptomatology at both post-treatment [ g = 1.73, 95% CI (1.23–2.22)] and 3–9 month follow-up assessments [ g = 2.33, 95% CI (1.41–3.26)]. Furthermore, the difference in effect sizes between NBIs compared to active and waitlist controls was statistically significant, suggesting that NBIs are superior. Sub-analyses showed that NET provided a stronger effect size than FORNET, which may be due to the nature of the traumatic event itself and not the treatment protocol. While evidence of small study and publication bias was present, a weight-function model and trim-and-fill method suggested it was not influencing the overall results.
Discussion
This meta-analysis presents strong evidence supporting the use of NBIs in the treatment of PTSD. Clear similarities can be identified between NBIs included in this analysis that make them distinct from non-NBI interventions, which are reviewed in the discussion. Controlled comparisons between NBIs and non-NBIs would help to further understand AM mechanisms of action implicated in recovery and how various interventions facilitate them. Future research should also aim to elucidate the full range of AM impairment in individuals with PTSD to gain insight on how other memory capabilities, such as the ability to mentally simulate the future, are implicated in the pathogenesis of PTSD.
... of the self, others, and the world are common sequelae of trauma, suggesting that cognitive processes (i.e., how someone thinks rather than what they think) may be of relevance. The cognitive model of PTSD (Ehlers & Clark, 2000) posits that rigid thoughts play a crucial role in PTSD symptom development and maintenance. Cognitive functions that support adaptation to changing contexts may be of particular importance, with executive functioning emerging as a viable candidate. ...
... As a result, processes that serve to maintain the persistence of trauma responses following combat may be crucial to understanding influences on long-term Veteran health. The cognitive model of PTSD (Ehlers & Clark, 2000) posits that during and in the immediate aftermath of trauma exposure, threat responses (e.g., vigilance, hyperarousal) are normative shifts that help preserve safety and facilitate survival. Yet, some trauma-exposed individuals continue to experience a serious and persistent sense of threat beyond the original trauma context. ...
... Yet, some trauma-exposed individuals continue to experience a serious and persistent sense of threat beyond the original trauma context. In turn, efforts to control perceived threats (Ehlers & Clark, 2000) may inadvertently maintain PTSD symptoms. As a result, these control strategies may solidify now unhelpful and self-defeating beliefs which may be directed externally toward the world or others, or internally toward the self. ...
Objective
Posttraumatic stress disorder (PTSD) is prevalent among U.S. combat Veterans, and associated with poor health and wellbeing. As combat experiences are likely to significantly modify self-, other-, and society-oriented cognitions and heighten risk for PTSD, examination of related cognitive processes may yield new treatment strategies. The cognitive model of PTSD suggests that persistent threat perceptions contribute to symptom worsening. Thus, cognitive processes of shifting perspectives or generating novel interpretations may be particularly relevant to lessen PTSD symptoms. This cross-sectional study examined executive functioning as a moderator to the relationship between combat exposure and PTSD symptom clusters among post-9/11 Veterans.
Method
Data from 168 Veterans were drawn from a larger study examining post-deployment mental health and cognitive function. An executive functioning composite derived from Wisconsin Card Sorting Test Perseveration Errors, WAIS-III Similarities, Trail Making Test B, and Stroop Color-Word Inhibition scores was computed. Path analysis was used to test the moderation model.
Results
After accounting for age, sex, and estimated premorbid functioning, results indicated that combat exposure was associated with all symptom clusters on the PTSD Checklist–Military. Executive functioning was not significantly associated with the PTSD symptom clusters and did not moderate the relationship between combat exposure and any of the PTSD symptom clusters.
Conclusions
Combat exposure is an important dimension of risk related to PTSD in Veterans that warrants regular screening. Moderation by executive functioning was not observed despite theoretical support. Future work could test methodological and sampling reasons for this finding to determine if theoretical adjustment is necessary.
... How an individual appraises a traumatic experience is critical in determining whether post-traumatic stress disorder (PTSD) develops. Ehlers and Clark [1] hypothesized that PTSD develops if the individual processes trauma in a way that evokes a sense of continuing threat. This perceived threat is a consequence of negative appraisals of the trauma, which can either be external (e.g., viewing the world or others as dangerous) or internal (e.g., considering oneself incapable). ...
... Consequently, the individual responds with maladaptive coping strategies, such as avoidance, which maintains PTSD. Cognitive models emphasize these appraisal processes in the onset and maintenance of PTSD [1][2][3][4], and this central thesis is well-supported in the trauma literature [5][6][7]. ...
... Recently, we argued that a more constructive approach would be to conceptualize trauma in terms of perceived threat linked to reproductive success in the evolutionary history of our species [15]. This approach is more in line with current theoretical models of PTSD that emphasize the individual's appraisal of the threat rather than the event itself [1]. Indeed, perceived life threat is one of the most consistent predictors of PTSD [16,17], but other types of threat likely play a role. ...
Cognitive theories of post-traumatic stress disorder (PTSD) feature appraisal of trauma as a critical factor in the development and maintenance of the disorder. Here we explored appraisals of social trauma (severe rejection or humiliation). Participants were outpatients with social anxiety disorder (SAD) and clinically significant PTSD symptoms (PTSS) after social trauma (n = 15); two clinical control groups of either SAD (n = 32) or obsessive-compulsive disorder (OCD; n = 13); and a control group with no diagnoses (n = 38). Measures included a clinical interview to assess social trauma and related open-ended appraisals and the Posttraumatic Cognitions Inventory (PTCI). Raters blind to group assignment performed content analyses of appraisals. Results showed that the PTSS group scored significantly higher than either clinical group on the PTCI SELF subscale. Only the SELF subscale predicted a diagnosis of both PTSS and SAD. All but one PTSS participant reported primarily negative beliefs about their social trauma, and the most common categories were flawed self and others are critical or cruel. Post-traumatic appraisals implicated in the course of PTSD are significant in how individuals respond to social trauma, with negative self-cognitions linked to both PTSS and SAD.
... Given the complex relationship between pain, trauma, and memory, disagreement in the literature is not too surprising. While some experts believe that trauma and pain can lead to memory fragmentation or disorganization [92][93][94], others propose the dissociation of trauma memories from other autobiographical memories [94][95][96][97]. ...
... One of these interventions is the directed forgetting paradigm adopted for patients suffering from PTSD, where participants are required to forget experimental items that have just been presented. Although these patients show great difficulties in performing this task, recent studies demonstrate that when they are taught to associate aversive scenes with naturalistic reminders and then to practice voluntarily suppressing the scenes when cued with the reminders, the inhibitory control of memory retrieval can be assessed [96]. ...
... Another approach widely used is retrieval-induced forgetting, which is an explicit unintentional form of forgetting whereby the selective retrieval of trauma-related stimuli leads to the enhancement of induced forgetting for individuals with traumatic and/or painful early-life experiences [129]. Thus, even if retrieval suppression is severely compromised in traumatized patients showing deficits in suppression-induced forgetting, these procedures and their promising results raise the possibility that therapeutic approaches that attempt to have patients confront and then suppress their traumatic memories might be a valuable addition to standard psychological treatments [96]. In this context, clinicians working with children or adults who have experienced trauma are called to create a therapeutic environment that supports the recollection and psychological processing of the impact and meaning of that trauma, not only the therapeutic environment but also the context in which these patients live may be beneficial for their recovery [130]. ...
The incidence and collective impact of early adverse experiences, trauma, and pain continue to increase. This underscores the urgent need for translational efforts between clinical and preclinical research to better understand the underlying mechanisms and develop effective therapeutic approaches. As our understanding of these issues improves from studies in children and adolescents, we can create more precise preclinical models and ultimately translate our findings back to clinical practice. A multidisciplinary approach is essential for addressing the complex and wide-ranging effects of these experiences on individuals and society. This narrative review aims to (1) define pain and trauma experiences in childhood and adolescents, (2) discuss the relationship between pain and trauma, (3) consider the role of biological memory, (4) decipher the relationship between pain and trauma using preclinical data, and (5) examine the role of the environment by introducing the importance of epigenetic processes. The ultimate scope is to better understand the wide-ranging effects of trauma, abuse, and chronic pain on children and adolescents, how they occur, and how to prevent or mitigate their effects and develop effective treatment strategies that address both the underlying causes and the associated physiological and psychological effects.
... Secondary psychotic symptoms have been reported in PTSD [132,133], while several studies have also suggested the experience of psychosis as a trigger for PTSD [134]. The pivotal role of memory deficits observed in PTSD [135,136] suggests that a memory framework can be helpful for furthering our understanding of the relationships between the two conditions. ...
... A range of memory-related phenomena can be seen in PTSD, such as persistent intrusive memories, which are typically dominated by impairments in sensory-perceptual processing of information and reduced contextual memory abilities [135,137,138]. The weakening of contextual memory in PTSD can lead to the inability to recall specific aspects of traumatic experiences, as well as reduced autobiographical memory specificity and a reduction in memory capacity [135,[139][140][141]. Notably, reductions in hippocampal volumes have been found in those with prior trauma exposure, with changes in hippocampal subfields being linked to core symptoms of PTSD, such as re-experiencing intrusive memories [142]. ...
... A range of memory-related phenomena can be seen in PTSD, such as persistent intrusive memories, which are typically dominated by impairments in sensory-perceptual processing of information and reduced contextual memory abilities [135,137,138]. The weakening of contextual memory in PTSD can lead to the inability to recall specific aspects of traumatic experiences, as well as reduced autobiographical memory specificity and a reduction in memory capacity [135,[139][140][141]. Notably, reductions in hippocampal volumes have been found in those with prior trauma exposure, with changes in hippocampal subfields being linked to core symptoms of PTSD, such as re-experiencing intrusive memories [142]. ...
Psychotic disorders are complex disorders with multiple etiologies. While increased dopamine synthesis capacity has been proposed to underlie psychotic episodes, dopamine-independent processes are also involved (less responsive to dopamine receptor-blocking medications). The underlying mechanism(s) of the reduction in antipsychotic responsiveness over time, especially after repeated relapses, remain unclear. Despite the consistent evidence of dopamine overactivity and hippocampal volume loss in schizophrenia, few accounts have been provided based on the interactive effect of dopamine on hippocampal synapse plasticity mediating autobiographical memory processes. The present hypothesis builds upon previous works showing the potential effects of dopamine overactivity on hippocampal-mediated neuroplasticity underlying autobiographical memory, alongside known patterns of autobiographical memory dysfunction in psychosis. We propose that spurious autobiographical memory of psychosis (SAMP) produced during active psychosis may be a key mechanism mediating relapses and treatment non-responsiveness. In a hyperdopaminergic state, SAMP is expected to be generated at an increased rate during active psychosis. Similar to other memories, it will undergo assimilation, accommodation, and extinction processes. However, if SAMP fails to integrate with existing memory, a discontinuity in autobiographical memory may result. Inadequate exposure to normalizing experiences and hyposalience due to overmedication or negative symptoms may also impede the resolution of SAMP. Residual SAMP is hypothesized to increase the propensity for relapse and treatment non-responsiveness. Based on recent findings on the role of dopamine in facilitating hippocampal synapse plasticity and autobiographical memory formation, the SAMP hypothesis is consistent with clinical observations of DUP effects, including the repetition of contents in psychotic relapses as well as the emergence of treatment non-responsiveness after repeated relapses. Clinical implications of the hypothesis highlight the importance of minimizing active psychosis, integrating psychosis memory, avoiding over-medication, and fostering normalizing experiences.
... The cognitive model of PTSD posits that experiencing trauma, such as CM, engenders negative cognitions about the world, other people, and oneself (Ehlers & Clark, 2000). ...
... Compared to the trust game that was previously used in individuals with trauma history (Lenow, Cisler & Bush, 2015;Sellnow, Esbensen & Cisler, 2019), the distrust game enables a more straightforward assessment of the expected trustworthiness of the interaction partner (Thielmann & Hilbig, 2014). Thus, previous work suggests that CM entails increased distrust toward others and a more negative appraisal of emotional expressions, potentially due to higher sensitivity for possible signs of interpersonal threat, as suggested by cognitive models of PTSD (Ehlers & Clark, 2000;Resick & Schnicke, 1993). ...
... Hypotheses were derived from the cognitive model of PTSD, which suggests that trauma engenders increased distrust and interpersonal threat sensitivity (Ehlers & Clark, 2000;Resick & Schnicke, 1993), and on previous empirical work that showed this extends to individuals with CM (Catalana et al., 2020;Hepp et al., 2021;Pepin & Banyard, 2006;Pfaltz et al., 2019;Vaile Wright et al., 2010). In addition, hypotheses are rooted in the feeling-asinformation theory (Schwarz & Clore, 1983), which has seen empirical support in previous work (Dunn & Schweitzer, 2005;Mislin et al., 2015;Schmid & Schmid Mast, 2010;Schmitz et al., 2021). ...
Evidence on individuals affected by posttraumatic stress disorder (PTSD) following childhood maltreatment (CM) supports cognitive models suggesting that trauma engenders distrust and interpersonal threat sensitivity. We examined the associations between CM and both distrust and interpersonal threat sensitivity in daily life and investigated whether momentary negative affect (NA) provides a context that strengthens this association. Hypotheses were based on cognitive models of trauma and the feelings-as-information theory. In a 7-day ambulatory assessment study with six semirandom daily prompts (2,295 total), we measured self-reported momentary NA and assessed behavioral trust as well as interpersonal threat sensitivity via facial emotion ratings with two novel experimental paradigms in 61 participants with varying levels of CM (45,900 total trials). As hypothesized, NA was associated with increased momentary distrust, β = .03, p = .002, and interpersonal threat sensitivity, β = -.01, p = .021. Higher levels of CM were associated with more negative emotion ratings, independent of affective context, β = -.07, p = .003. Momentary behavioral distrust was associated with CM at high levels of momentary NA, β = .02, p = .027. The findings for both tasks support the feelings-as-information theory and suggest that cognitive alterations surrounding distrust and interpersonal threat, which were originally proposed for PTSD, likely also affect individuals with a history of CM.
preprint available at https://psyarxiv.com/8fuw4/
... In summary, the present study elucidated time-variant associations between PTSD symptoms across four prototypical PTSD trajectories by using CLPN analysis, and identified which symptoms were most central to prospective prediction by computing symptom centrality indices across prototypical PTSD trajectories. In particular, because the anniversary of an earthquake can easily trigger perceptual information regarding the earthquake experience, which would in turn induce as strong stress symptoms as the original trauma did; therefore, understanding the dynamics of PTSD symptoms and their development of PTSD symptoms after the anniversary date is important (Ehlers & Clark, 2000;Fan et al., 2015). Hence, we examined the distinct trajectories of PTSD symptoms from 12 months to 24 months post-earthquake. ...
... The reasons for the differences in central symptoms may be due to differences in sample characteristics, methodological choices in the centrality metric, and the network statistical methods (Birkeland et al., 2020;Isvoranu et al., 2021). Indeed, intrusive thoughts are a prototypical symptom of PTSD (Birkeland et al., 2020) and are regarded as a threat stimulus that can easily trigger a resemblance to the perceptual information of the trauma experience, in turn, which would induce as strong PTSD symptoms as the original earthquake did (Ehlers & Clark, 2000;Hackmann et al., 2004). As time elapses after the earthquake, intrusive thoughts may be centrally associated with other symptoms in the later phase, thus potentially indicating the utility of addressing this symptom in chronic PTSD treatment. ...
... traumatické udalosti, môžu viesť k dlhodobým závažným dôsledkom podobne ako chronické stresory. Chronickosť ich pôsobenia môže spočívať v mentálnom návrate k stresoru, v ruminácii a intruzívnych spomienkach, ktoré sú charakteristickými príznakmi PTSD (Cohen et al., 2019;Ehlers & Clark, 2000). Časové trvanie nie je jedinou dôležitou vlastnosťou stresorov, keďže iné normatívne teórie sa sústredia na ich ďalšie aspekty. ...
... Taktiež sa môže stať, že straty, ku ktorým došlo v minulosti, daná osoba stále vyhodnocuje ako aktuálne ohrozenie. Takýto spôsob hodnotenia je podľa kognitívneho modelu charakteristický pre ľudí trpiacich PTSD (Ehlers & Clark, 2000). ...
... Post-traumatic stress disorder (PTSD) is a common sequela following experiences perceived as life-threatening or terrifying (American Psychiatric Association, 2013;Ehlers & Clark, 2000;van der Kolk, 2014). Symptoms include intrusions (flashbacks, intrusive memories), avoidance, negative alterations in mood and cognition, and alterations in arousal and reactivity (American Psychiatric Association, 2013). ...
... These individuals often have a more limited repertoire of coping strategies (Bakken et al., 2016;Kildahl et al., 2020b) and poorer access to social support (Mevissen et al., 2016). Their communication difficulties are often more extensive (Bakken et al., 2016), and it has been suggested that lack of access to conceptual, typically verbal language-based, processing strategies involves an increased risk of PTSD (Ehlers & Clark, 2000). In the general population, higher intelligence quotients (IQs) appear to be a protective factor for the development of PTSD (Breslau et al., 2006), and lower verbal IQs appear to be associated with increased risk of forming intrusive memories (Sündermann et al., 2013). ...
Autistic people appear to be at increased risk of post-traumatic stress disorder, and experiences involving violence or sexual abuse appear to be common in this population. However, knowledge concerning trauma in autistic people with co-occurring intellectual disabilities is limited. In this cross-sectional study, we explored the prevalence of post-traumatic stress disorder, as well as the prevalence and clinical correlates of reported experiences of violence and sexual abuse, in a clinical sample of 88 autistic adults with intellectual disabilities referred for mental health assessment. Only three participants (3.4%) were diagnosed with post-traumatic stress disorder, even if experiences involving violence (34.1%) or sexual abuse (17.0%) were common. Anxiety and affective disorders were common diagnoses among participants with these experiences. Controlling for autism characteristics, level of intellectual disability and communication skills, experiences of violence/sexual abuse were found to be associated with a measure of ‘challenging’ behaviours (Aberrant Behaviour Checklist). These results indicate that potentially traumatic experiences are common in autistic adults with intellectual disabilities referred for mental health assessment and that post-traumatic stress disorder may be under-recognised. The findings highlight the importance of trauma screening and post-traumatic stress disorder assessment, as well as the importance of trauma-informed care, in this population.
Lay abstract
Post-traumatic stress disorder is a mental health disorder that may be triggered by the experience of events perceived as terrifying or overwhelming. Examples of such events include being the victim of violence or sexual abuse. Compared with other people, autistic people have increased risk of being exposed to violence or sexual abuse. In addition, autistic people may be more vulnerable to developing post-traumatic stress disorder following such exposure. However, knowledge is limited concerning the prevalence of experiences involving violence and sexual abuse, and post-traumatic stress disorder, in autistic people with co-occurring intellectual disabilities. Detection of these experiences, and identification of post-traumatic stress disorder, may be challenging in these individuals, and previous research indicates that post-traumatic stress disorder symptoms may be overlooked or misinterpreted. In this study, we examined prevalence of post-traumatic stress disorder, violence and sexual abuse in a clinical sample of 88 autistic adults with intellectual disabilities referred for mental health assessment. Only 3.4% were diagnosed with post-traumatic stress disorder, even if experiences involving violence (34.1%) or sexual abuse (17.0%) were common. Anxiety and affective disorders were common diagnoses among participants with these experiences. Controlling for autism characteristics, level of intellectual disability and communication skills, experiences of violence/sexual abuse were found to be associated with a measure of ‘challenging’ behaviours. These results indicate that potentially traumatic experiences are common in autistic adults with intellectual disabilities referred for mental health assessment, and that post-traumatic stress disorder may be under-recognised. The findings highlight the importance of trauma screening and post-traumatic stress disorder assessment, as well as the importance of trauma-informed care, in this population.
... For example, research has shown that PTSD following a burn injury can be triggered beyond the scope of the incident itself [13], and invasive medical procedures can increase trauma symptoms [14,15]. The Cognitive Model of PTSD [16] posits that individuals who are 'reminded' of a traumatic events experience negative somatic, cognitive, affective symptoms, leading to avoidance. The psychology team is part of the Burns MDT, and therefore may serve to 'remind' patients of their traumatic experience, prompting avoidance. ...
... It is widely acknowledged that there is a stigma related to mental illness and treatment [33,34] and that this stigma acts as a motivational barrier to professional support [35]. Consistent with cognitive theories of PTSD, it is understandable that those who fear 're-traumatisation' through therapy choose to avoid psychological services [16]. Participants perceived that increased education and information resources about mental health and treatment would reduce this barrier and increase motivation to engage with support. ...
Burn injuries can be traumatic and distressing for patients, with a prolonged period of recovery. This qualitative study aimed to explore adult burn patients’ perceptions of the barriers and facilitators to accessing psychological support in a Regional Burns Service in Southeast England. Participants (five females and six males) were under the care of the burns unit and were not currently accessing psychological support. Eleven semi-structured interviews were conducted. Responses were analysed using thematic analysis. Four main themes highlighted how access to psychology was influenced by communication between the patient and service, beliefs about mental health, environmental challenges, and patient hope. Recommendations for improving access to burn psychological care included (1) the provision of patient resources to increase awareness and reduce stigma; (2) psychological skills training to encourage staff to recognise distress and respond appropriately; (3) staff training in the practice of cultural humility; (4) increasing psychological presence in outpatient appointments and via routine follow-ups.
... Intrusive memories are brief sensory fragments of traumatic memories, with the vast majority being visual images (Brewin et al., 2010;Ehlers et al., 2002). Due to the nature of traumatic memories (e.g., disjointed, decontextualized, poorly elaborated), intrusions have low triggering thresholds and are activated by a wide range of stimuli (Brewin, 2001;Ehlers et al., 2004), especially those temporally or physically related to stimuli present during the traumatic event (Ehlers & Clark, 2000). Notably, Ehlers and colleagues (2002) found that the majority of intrusive images represent stimuli present immediately before the worst part of the traumatic event, leading to speculation that intrusions represent a warning signal, designed to serve a protective function. ...
... Essentially all effective psychological interventions (Prolonged Exposure, Cognitive Processing Therapy, Eye Movement Desensitization and Reprocessing, Cognitive Therapy, and Written Exposure; Bryant, 2019) place a significant emphasis on "processing" intrusive memories (e.g., organizing the trauma memory, creating a chronological narrative, reducing the negative emotional impact of intrusions). While various strategies have proven effective toward this end, such as imaginal exposure, written exposure, and visualizing trauma images, they typically strive to achieve the following aims: reduce the frequency and distress of intrusions, foster more helpful appraisals, enhance self-efficacy, and decrease the use of unhelpful safety behaviors related to trauma memories (Ehlers & Clark, 2000;Goodson & Haeffel, 2022;Oman & Bormann, 2015;Hackmann et al., 2004). ...
Intrusive memories and the associated clinical features (e.g., sense of nowness, sense of danger, fears of losing control) serve as hallmarks in the development and maintenance of PTSD and are a central focus in the treatment of the disorder. Despite their importance, no existing measure assesses for the relevant clinical features alongside intrusions. To address this gap, we aimed to develop and evaluate a brief intrusive memory questionnaire for clinical and research applications. A sample of treatment-seeking veterans (N = 185) were administered an item pool of intrusion questions together with measures of PTSD (PCL-5) and depression (PHQ-9). Intrusion items were subjected to tests of relative importance, which identified five items we termed the IMQ-5 (Intrusive Memory Questionnaire-5) that comprised a single factor, CFI (0.99), TLI (0.97), RMSEA (0.07, 90% CI [0.00, 0.14]), SRMR (0.03). The IMQ-5 evidenced greater convergent validity with the PCL-5 (r = .69) than the PHQ-9 (r = .51), and demonstrated an ability to distinguish probable PTSD from subthreshold symptoms (AUC = 0.83, 95% CI [0.74-0.93]). Implications of the findings and suggestions for future research are discussed.
... Both cognitive-relational theory (8) and the cognitive model of PTSD (9) emphasize the importance of subjective appraisal of a traumatic event when assessing the psychological impact of a trauma or stress. When a threat is perceived to be more severe than it actually is, one may experience increased psychological stress that could develop into PTSD. ...
... Especially in countries with collectivist cultures, people perceive socioeconomic status through social relations and social support, which has a more direct predictive effect on their mental health (52). The current conclusion is also closely related to the cognitive model of PTSD (9), in which the negative evaluation and memory of traumatic events have an impact on sustained PTSD. After a stressful event occurs, the focus is not on the event itself but on the negative evaluation of and sense of threat from the event. ...
Background/purpose
In December 2019, Wuhan, Hubei, China firstly reported the existence of the COVID-19 virus. It is crucial to prioritize the psychological well-being of citizens in lockdown cities and make more strides in the academic field of post-traumatic stress disorder (PTSD) to prepare for the post-pandemic era.
Methods
We took the cognitive-relational theory as our basis and collected Hubei province-level data ( N = 3,465) to examine the impact of perceived social status decline on the prevalence of PTSD symptoms, and checked the mediating effect of perceived vulnerability to disease (PVD) during the period of psychological adjustment.
Results
Using propensity score matching, we estimate the average treatment effect of perceived social status decline on PTSD level, and we robustly regress the two with weight adjustment generated in matching. We found that more decline in perceived social status is associated with a worse degree of PTSD symptoms, and confirmed PVD’s buffering role although the mediating effect was not as high as hypothesized.
Conclusion and implications
Our study confirmed the decisive role of subject social status in health prediction compared to traditional socioeconomic measures, which extends the cognitive-relational in examining socioeconomic status and contributes to the dialog on socioeconomic inequality. We also suggested providing more social support at the community level and enhancing individuals’ positive understanding to protect mental health.
... The framework of this intervention was modeled after psychoeducation paradigms used in previous research and found to be effective (e.g., anxiety sensitivityfocused psychoeducation intervention; Schmidt et al., 2014). The content of this intervention was derived from current theoretical models of PTSD and threat responding (Ehlers & Clark, 2000;Foa & Rothbaum, 1992;Löw et al., 2015;Resick et al., 2017). Throughout the psychoeducation program, vignettes are presented to clarify concepts and promote participant engagement. ...
... Individuals who experienced TI during their trauma may be particularly prone to avoid trauma-related stimuli (Bovin et al., 2008). Such avoidance can maintain posttraumatic stress symptoms and interfere with the individual's ability to collect evidence against maladaptive beliefs (Ehlers & Clark, 2000). Therefore, participants are presented with information about how behaviors may maintain negative thoughts and emotions as well as vignettes illustrating the use and potential benefits of behavioral experiments. ...
Tonic immobility (TI) is a defensive response that may occur during traumatic events. Although TI is adaptive in certain circumstances, it has been shown to contribute to increased trauma-related symptoms and poorer recovery. However, current frontline treatments for posttraumatic stress disorder (PTSD) have not focused significant attention on the experience of TI. Thus, the aim of this study was to develop and test the impact of a brief TI-focused psychoeducation (TIP) intervention on posttraumatic cognitions and PTSD symptoms relative to a health education control intervention. The sample included 46 adults with elevated PTSD symptoms who endorsed prior TI episodes. After providing informed consent, participants were randomly assigned to either the active or control intervention and completed self-report questionnaires including the tonic immobility questionnaire (TIQ-R), Life Events Checklist for DSM-5 (LEC-5), Posttraumatic Stress Checklist for DSM-5 (PCL-5), Posttraumatic Cognitions Inventory (PTCI), and Positive and Negative Affect Schedule (PANAS) at baseline, 1-week, and 1-month follow-up assessments. Results from linear mixed effects models indicated that participants in the TIP condition reported significantly larger reductions in posttraumatic cognitions and PTSD symptoms at 1-week, ds = 0.48 and 0.84, respectively, and 1-month, ds = 0.67 and 0.74. The findings suggest that TIP is a promising intervention that may be used to reduce posttraumatic cognitions and PTSD symptoms associated with TI. Given the ease of access, TIP could be used as a standalone intervention or as an add-on to existing evidence-based treatments for PTSD.
... Cognitive-behavioral models suggest that following a traumatic event, individuals may become hypervigilant to threats in the environment (i.e., epistemic hypervigilance as described by Fonagy & Campbell, 2021). Threatening appraisals of nonthreatening stimuli that were associated with the traumatic event may thus lead to this perceived sense of unsafety (Ehlers & Clark, 2000). For example, an individual who was assaulted in a public restroom may come to fear all public restrooms, even when there is no danger present. ...
... Thus, behavioral avoidance becomes more likely to occur in the future, which serves to maintain PTSD symptoms. Cognitive-behavioral models of trauma also focus on how the interplay of pre-existing characteristics, peritraumatic cognitive processes, subsequent appraisals, and coping styles maintain the bi-directional cycle of fear and avoidance (Ehlers & Clark, 2000). For example, there is a vast amount of research on different types of cognitive mediators of trauma and psychopathology (Aafjes-van Doorn et al., 2020). ...
Background:
In contrast to the vast clinical, theoretical, and empirical literature on the impact of trauma, relatively few studies have reviewed the trauma measures that researchers and clinicians can choose to use in their work. This scoping review aimed to catalog all trauma measures (trauma exposure and its subjective responses) that have been published in the peer-reviewed literature, developed for use with adult populations.
Method:
Through a systematic search of the literature and the screening of 19,631 abstracts, a total of 363 unique trauma measures were identified.
Result:
Most of these measures were developed for assessment purposes rather than for clinical screening or diagnostic purposes. Most of these measures are patient-self-report measures that assess trauma exposure in the patients' lifetime, or subsequent symptoms, particularly cognitive impairments.
Discussion:
Complications in the trauma literature are highlighted, including the use of very similar abbreviations of measures, substantial discrepancies regarding the definition of trauma, and the general assumption that a potentially traumatic event inevitably leads to traumatic distress rather than a path of resilience.
... Последующие концепции ПТСР формировались преимущественно в русле когнитивно-поведенческих моделей, которые хотя и признавали роль обусловленности страхом в этиологии ПТСР, но также уделяли значительное внимание организации памяти [27]. Например, в теории двойного представления постулировалось, что в результате повышенного возбуждения во время травмы воспоминания о ней кодируются преимущественно в сенсорных модальностях с фрагментированной и неорганизованной последовательностью, тем самым уменьшая вероятность адекватного встраивания этих воспоминаний в систему «автобиографической памяти» [28]. ...
Background : among the psychological and psychiatric consequences of life-threatening situations, the problem of post-traumatic stress disorder (PTSD) is invariably of leading importance. At the same time, diagnostic and therapeutic approaches to solving this problem have undergone significant changes over the past decades.
The aim of review is the analysis of scientific materials on the problems of PTSD with the use search systems, to highlight the evolution of views on the clinic, pathogenesis, approaches to the treatment of this disorder and to formulate promising directions for further research in this area.
Material and methods : a review of more than 60 scientific papers containing scientifically based information on the diagnostic and therapeutic and preventive aspects of PTSD was conducted using the resources of search engines, including PubMed and eLibrary, for the keywords “post-traumatic stress disorder”, “PTSD”. Results: at present, relatively weak progress in the field of clinical diagnostics is being noted, noticeably lagging behind the results of research in the field of neurophysiology of PTSD, primarily the molecular biology of operant conditioning and extinction of fear reactions, as a result of which this disease is still a diagnostic puzzle.
Conclusion : it is expedient to search for clearer, non-overlapping with other taxonomic units, clinical symptoms and signs with “PTSD pathognomonicity” on the basis of phenomenological and network approaches that allow to eliminate the limitations of polythetical categorization, whereas in genetic studies, on the contrary, the rejection of the methodology looks more promising “case/control” and the transition to the “binding” of the detected polymorphisms to the transnosological characteristics. It is necessary to develop effective methods for the prevention of stress-associated disorders in military personnel, in general, including programs to increase stress resistance, as well as domestic multimodal software and hardware complexes to optimize the treatment and prevention of PTSD.
... Cognitive theories of PTSD suggest that negative trauma-related appraisal of oneself and the world (i.e., trauma centrality) maintains this syndrome (Ehlers & Clark, 2000;Robinaugh & McNally, 2011). It is thus concerning that students who report both resilience to PTSD and high trauma centrality behave similarly to those with clinically significant PTSD with regard to using trigger warnings. ...
Trigger warnings alert readers that upcoming themes may serve as trauma reminders. They have been proposed as an accommodation for individuals diagnosed with posttraumatic stress disorder (PTSD) in the context of higher education. Previous research has raised the concern that deploying and using trigger warnings can increase one’s sense of trauma centrality, which in turn impedes posttraumatic adjustment. The current study tests the hypothesis that trauma centrality moderates the relationship between self-reported PTSD symptoms and positive trigger warning attitudes, such that those reporting comparatively high centrality and high symptomatology are most receptive to trigger warnings. Participants (n = 161) were trauma-exposed undergraduates who completed measures of trigger warning attitudes, PTSD symptoms, and trauma centrality. Results showed a significant moderating effect. Participants reporting the greatest levels of PTSD severity reported the most receptivity to trigger warnings. For those reporting the highest levels of trauma centrality, we saw high levels of trigger warning acceptability, regardless of PTSD levels reported. Even those who were experiencing few symptoms, but nevertheless understood their trauma as highly central to their identity, were highly receptive to trigger warnings. The finding adds empirical data to the understanding of the relationship between PTSD symptoms and trigger warning attitudes. Results have implications for the use of trigger warnings for trauma survivors in the context of higher education, indicating more research on how to address trauma on campus in a trauma-sensitive and evidence-based way.
... Indeed, sexual assault may be the type of trauma associated with the most severe PTSD symptoms (e.g., Guina et al., 2018). PTSD is associated with physiological reactivity to reminders of the trauma and related avoidance of such triggers (APA, 2013;Ehlers & Clark, 2000). It is thus unsurprising that women with a history of sexual assault can often struggle with avoidance of sexual activities (Bird et al., 2021;Rosenthal et al., 2005) and intrusive sexual thoughts/ memories (Ching et al., 2020;Kelley et al., 2019). ...
Sexual Interest/Arousal Disorder (distressing, long-lasting impairments in sexual desire and/or arousal) is common in women, but few have access to efficacious psychotherapies, including cognitive-behavioral therapy (CBT) and mindfulness-based therapy (MBT). eSense, an online program meant to maximize treatment access, has been shown to be a feasible, satisfactory, and potentially efficacious intervention. However, subpopulations such as sexual assault survivors may find the program less usable or efficacious. The current study compared women with and without a history of sexual assault (SA) regarding their ability to use and benefit from eSense. Forty-four women (22 with a history of SA; M age = 34.20 years) used eSense (CBT or MBT) and completed validated self-report scales of sexual function, sexual distress, treatment satisfaction, and homework compliance. A history of SA did not predict differences in attrition or changes in clinical outcomes. Exploratory analyses suggested that women with a history of SA reported slightly higher difficulty completing homework assignments, but also slightly higher treatment satisfaction. These preliminary results suggest that eSense may be usable and helpful for women with a history of SA. We discuss ways to maximize the acceptability and efficacy of online programs for women with a history of SA.
... Researchers within the PTSD-field broadly agree that PTSDsymptoms are related to integration of the trauma memory into identity and life story, although it is disputed whether PTSD is related to lack of integration or over-integration (e.g., Ehlers & Clark, 2000;Foa et al., 1989;Horowitz, 1986;Rubin, Berntsen, & Bohni, 2008). Within the past decades, a mnemonic model of PTSD (Berntsen et al., 2003;Rubin, Berntsen, & Bohni, 2008) has gained empirical support. ...
... Thus, therapists may be required to modify conventional roles and clinical practices, such as appropriate self-disclosure and considering cultural gift-receiving, to build trust (Kinzie, 2001;Kirmayer, 2003;Savin & Martinez, 2006;Tseng et al., 2004). Evidence-based treatments which are considered efficacious for refugees with multiple traumas, include Narrative Exposure Therapy (NET), Eye Movement Desensitisation and Reprocessing (EMDR), imagery rescripting, cognitive therapy for PTSD and prolonged exposure therapy, depending on client preferences; however, EMDR is not deemed suitable for combat-related traumas (Ehlers & Clark, 2000;Elbert et al., 2022;Neuner et al., 2018;NICE Guidelines, 2018;Steel et al., 2023). A phased-based model of psychological intervention is recommended for trauma treatment, which comprises of (1) safety and stabilisation, (2) processing of traumatic memories and (3) re-integration into family and community (Herman, 1992;Patel et al., 2018;Robertson et al., 2013). ...
Objective:
Therapeutic boundaries are limits to appropriate behaviours within a therapist-client relationship (e.g. related to accepting gifts, self-disclosures, therapist neutrality and advocacy). Therapeutic boundary considerations are fundamental in the care of refugees and asylum seekers. Research on the experiences of therapists navigating such boundaries is sparse and warrants further exploration. The aim of this qualitative systematic review was to thematically synthesise literature regarding therapists' (psychologists, psychotherapists, counsellors) experiences of implementing flexible therapeutic boundaries with refugee and asylum seeker clients and determine how such applications have been helpful for therapeutic interventions.
Method:
Six databases were searched. Following full-text screening, 21 papers were included in the analysis. Boundary theory underpinned the analysis.
Results:
Three major themes were developed: (i) Changes to Therapeutic Practice & Therapeutic Intervention, (ii) Re-Conceptualisation of Therapy as 'Clinical Political' and Re-Conceptualisation of Therapist Identity and (iii) Careful Monitoring of Personal Boundaries-Not becoming 'Hardened' or 'Haunted'. Papers described how, when used in a reflective, considerate way, flexible therapeutic boundaries can strengthen the therapist-client alliance and positively impact therapeutic interventions. Many therapists acknowledged making conscious efforts to re-conceptualise therapeutic work with refugee and asylum seeker clients from advocacy standpoints. However, systemic constraints, and lack of guidance, made this difficult to navigate and contributed to therapist burn-out.
Conclusions:
Boundary considerations manifested as interpersonal, structural and cultural changes to practice. These have implications for clinical practice and developing guidelines on boundary practices with refugees and asylum seekers. Future research should explore promoting therapist well-being and training needs for therapists supporting this population.
... did or did not act, as well as characterological, such as thinking the event occurred because of "who I am" (Startup et al., 2007). Research suggests that posttraumatic cognitions contribute to the development, maintenance, and worsening of PTSD symptoms (Berntsen & Rubin, 2007;Dunmore et al., 1999;Ehlers & Clark, 2000;Kleim et al., 2013). Posttraumatic cognitions contribute to avoidance in particular, a common symptom of PTSD, which inadvertently reinforces negative views of the self and the world (Brown et al., 2019). ...
... This notion is prominent in several clinical theories of PTSD (e.g. Brewin et al., 1996;Ehlers & Clark, 2000;Foa et al., 1989;Janoff-Bulman, 1989;van der Kolk & Fisler, 1995) (see Dalgleish, 2004, for a review). Impaired traumatic memory is also one of the core Multiple studies (e.g. ...
The application of MDMA in conjunction with psychotherapy has in recent years seen a resurgence of clinical, scientific, and public interest in the treatment of posttraumatic stress disorder (PTSD). Clinical trials have shown promising safety and efficacy, but the mechanisms underlying this treatment form remain largely unestablished. This article explores recent preclinical and clinical evidence suggesting that the treatment's efficacy may be influenced by the mnemonic effects of MDMA. We review data on the effects of MDMA on fear extinction and fear reconsolidation and the utility of these processes for PTSD treatment. We corroborate our findings by incorporating research from cognitive psychology and psychopharmacology and offer recommendations for future research.
... One possibility is that trigger warnings increase anxiety and apprehension about upcoming content and therefore promote the avoidance of warned-of material. For instance, a trauma survivor may see a trigger warning relating to their traumatic experience and avoid the warned-of content the same way they would avoid other trauma-related stimuli (e.g., people, places, or objects associated with the original trauma; Ehlers & Clark, 2000). However, other research suggests that warnings might increase rather than decrease the attractiveness of content. ...
Trigger warnings, content warnings, or content notes are alerts about upcoming content that may contain themes related to past negative experiences. Advocates claim that warnings help people to emotionally prepare for or completely avoid distressing material. Critics argue that warnings both contribute to a culture of avoidance at odds with evidence-based treatment practices and instill fear about upcoming content. A body of psychological research has recently begun to empirically investigate these claims. We present the results of a meta-analysis of all empirical studies on the effects of these warnings. Overall, we found that warnings had no effect on affective responses to negative material or on educational outcomes. However, warnings reliably increased anticipatory affect. Findings on avoidance were mixed, suggesting either that warnings have no effect on engagement with material or that they increased engagement with negative material under specific circumstances. Limitations and implications for policy and therapeutic practice are discussed.
... That is, the individual appraises and cognitively processes an experience that requires potentially effortful accommodation into their existing knowledge. This is not dissimilar to the cognitive process that is theorised to occur in the cognitive model of posttraumatic stress disorder (PTSD; Ehlers & Clark, 2000) in which people have difficulty cognitively integrating (accommodating) a traumatic event within their existing knowledge. However, while awe may have a negative valence at times related to threat, as evidenced in the current review (e.g., Taylor & Uchida, 2019), it is apparent in the case of PTSD that the threat, real or perceived is central and prevailing, leading to distress and anxiety rather than awe. ...
Awe is considered a transformational and multifaceted emotion. Vastness is the core cognitive appraisal associated with awe, which activates a need for cognitive accommodation. Increasingly, studies are evaluating awe’s dimensions including triggers, cognitive and emotional characteristics, and primarily beneficial outcomes. Additionally, numerous emotions have been conceptualised within a cognitive behavioural framework and cognitive behavioural models may be utilised to promote positive human qualities and experiences. Therefore, this paper outlines the results of a systematic review of the literature on awe from a cognitive behavioural perspective to propose a cognitive behavioural model. Databases searched included Psych Net, Science Direct, Scopus, Web of Science, PubMed, ProQuest, EBSCO, SAGE, JSTOR, Springer LINK, Taylor and Francis, and Wiley with the inclusion of peer reviewed articles. A total of 57 studies were identified. Triggers of awe were primarily related to nature and cognitive processes centred on vastness and the need for accommodation. A range of outcomes associated with awe were identified including increased well-being, spiritual growth, and pro-environmental intent. The key findings from this review informed a cognitive behavioural model of awe. Such a cognitive behavioural model may inform the cultivation of awe for individual, community, or environmental well-being and experience design. Future research is required to validate the proposed model, proposed pathways, and utility.
... The hypervigilance syndrome follows, with a mean score of 9.02. involves signs including trouble getting to sleep or staying asleep, agitation or irrational outbursts, difficulties focusing, and being too watchful or alert (Ehlers & Clark, 2000). ...
... In PTSD, return of fear even in safe contexts is of high clinical relevance, probably resulting from inadequate contextualization of the trauma memory (Ehlers & Clark, 2000). In line with this, patients with PTSD compared with trauma-exposed controls showed a stronger return of fear and lower activation of the vmPFC and hippocampus, as well as hyperactivity of the dACC during extinction recall in the safe extinction context (Milad et al., 2009). ...
Background:
There are phenomenological similarities between social anxiety disorder (SAD) and posttraumatic stress disorder, such as a provoking aversive event, posttraumatic stress symptoms (e.g. intrusions) in response to these events and deficient (context-dependent) fear conditioning processes. This study investigated the neural correlates of context-dependent extinction recall and fear renewal in SAD, specifically in patients with intrusions in response to an etiologically relevant aversive social event.
Methods:
During functional magnetic resonance imaging a two-day context-dependent fear conditioning paradigm was conducted in 54 patients with SAD and 54 healthy controls (HC). This included fear acquisition (context A) and extinction learning (context B) on one day, and extinction recall (context B) as well as fear renewal (contexts C and A) one day later. The main outcome measures were blood oxygen level-dependent responses in regions of interest and skin conductance responses.
Results:
Patients with SAD showed reduced differential conditioned amygdala activation during extinction recall in the safe extinction context and during fear renewal in the acquisition context compared to HC. Patients with clinically relevant intrusions moreover exhibited hypoactivation of the ventromedial prefrontal cortex (vmPFC) during extinction learning, extinction recall, and fear renewal in a novel context, while amygdala activation more strongly decreased during extinction learning and increased during fear renewal in the acquisition context compared with patients without intrusions.
Conclusions:
Our study provides first evidence that intrusions in SAD are associated with similar deficits in context-dependent regulation of conditioned fear via the vmPFC as previously demonstrated in posttraumatic stress disorder.
... Evidence showed that fear due to the ongoing threat perception plays an important role in the persistence of PTSD symptoms (e.g. Ehlers & Clark, 2000;Şalcioğlu et al., 2017). On the other hand, researches (Harman & Lee, 2010;Hathaway et al., 2010;Lee et al., 2001;Semb et al., 2011) show that self-conscious emotions such as guilt and shame, which emerge as a result of self-evaluation, also play a role in the persistence of PTSD. ...
z Travma sonrası stres belirtilerinin sürdürülmesinde önemli bir role sahip olduğu bilinen travma sonrası utanca ait bir ölçme aracının hem araştırma hem de klinik değerlendirme amacıyla kullanılabilmesi önemlidir. Bu araştırmanın amacı travma sonrası utancı ölçen Travma Sonrası Utanç Ölçeği'nin (TSUÖ; Øktadalen ve ark., 2014) cinsel travma yaşantısı olan kadın örnekleminde Türkçe psikometrik özelliklerinin değerlendirilmesidir. Araştırmaya cinsel travma yaşantısına sahip olan 18-55 yaş arasındaki 604 kadın katılmıştır. Katılımcıların yaş ortalaması 32.5'tir. (Ss=10.0). TSUÖ'nun Türkçe formunun yapı geçerliğini test etmek amacıyla doğrulayıcı faktör analizi (DFA) yapılmıştır. Elde edilen DFA değerlerine göre (RMSEA [root-mean-square error of approximation]= 0.07, S-RMR = 0.06, GFI = 0.99; IFI = 0.99; CFI = 0.99) TSUÖ'nun iki düzeyli iki boyutlu yapısının model uyumu kabul edilebilir olarak raporlanmıştır. Travma sonrası gelişen utancı içsel/ kınama, dışsal/ kınama, içsel/ duygusal-davranışsal, dışsal/ duygusal-davranışsal utanç boyutları ile değerlendiren TSUÖ toplam puanları ile korku kontrol kaybı (r= 0.64) ve travmatik stres belirtileri (r= 0.69) arasında pozitif yönde anlamlı ilişkiler bulunmuştur. Travma Sonrası Stres Bozukluğu tanısı alan katılımcıların almayan katılımcılara kıyasla TSUÖ puanları anlamlı düzeyde daha yüksek bulunmuştur (t (459.90) = 18.106, p< 0.01). TSUÖ'nün güvenirliği için Cronbach Alpha iç tutarlık katsayısı incelenmiştir. Faktörlere ait Cronbach Alpha iç tutarlık katsayısının 0.84 ile 0.92 arasında değiştiği, ölçeğin tamamına ait iç tutarlık katsayısının ise 0.97 olduğu görülmüştür. Bu bulgular ışığında TSUÖ'nün Türkçe formunun cinsel travma yaşantısı olan kadın örnekleminde geçerli ve güvenilir bir ölçme aracı olduğu görülmüştür. Anahtar Kelimeler: travma sonrası utanç, cinsel travma, travma sonrası stres bozukluğu Abstract Psychometric Properties of the Turkish Trauma Related Shame Scale in a Sample of Women with Sexual Trauma It is important to use a measurement tool for post-traumatic shame, which is known to have a crucial role in maintaining the symptoms of post-traumatic stress, both in research and in clinical evaluation. The purpose of this study is to evaluate the Turkish psychometric properties of the Post Traumatic Shame Scale (TRSI; Øktadalen et al., 2014), which measures post-traumatic shame, in a sample of women who have experienced sexual trauma. Six hundred four women between the ages of 18-55 who had a sexual trauma experience participated in the study. The mean age of the participants is 32.5. (Ss=10.0). Confirmatory factor analysis (CFA) was performed to test the construct validity of the Turkish version of the TRSI. The DFA values (RMSEA = 0.07, S-RMR = 0.06, GFI = 0.99; IFI = 0.99; CFI = 0.99) showed that the model fit of the two-level two-dimensional structure of the TRSI is excellent. The positive significant relationships were found between total scores of TRSI, which evaluate post-traumatic shame with internal/condemnation, external/condemnation, internal/emotional-behavioral, external/emotional-behavioral shame dimensions, and loss of fear control (r= 0.64) and traumatic stress symptoms (r= 0.69). Participants who diagnosed with PTSD had significantly higher PTSD scores than those who did not (t (459.90) = 18.106, p< 0.01). The Cronbach Alpha internal consistency coefficient was examined for the reliability of the TRSI. It is found that the Cronbach Alpha internal consistency coefficient of the factors varied between 0.84 and 0.92, the internal consistency coefficient of the whole scale was 0.97. In the light of these findings, it has been seen that the Turkish version of the TRSI is a valid and reliable measurement tool in the sample of women who have experienced sexual trauma.
... This can include facets of psychotherapy such as cognitive appraisal. Some prior work on cognitive models of PTSD suggests that when individuals (i.e., veterans) report maladaptive appraisals of the traumatic event, this may produce a sense of threat and exacerbate beliefs that one can no longer recognize signs of threat/danger and produce self-blame appraisals that correspond to the guilt cognitions (Ehlers and Clark, 2000). However, this may not be the case when treating veterans with heavy alcohol use or alcohol use disorder, as our results point to a greater focus on distress and guilt cognitions aspects of guilt. ...
Trauma-related guilt, or a belief that one should have felt, thought, or acted differently during a traumatic event in which someone’s life or physical integrity was threatened, has been consistently associated with mental health disorders such as posttraumatic stress disorder (PTSD). Theories of trauma-related guilt suggest that some avoidant coping behaviors, such as problematic alcohol use, are crucial pathways connecting trauma-related guilt to PTSD but have not been thoroughly investigated. The present study uses data from a longitudinal cohort of veterans to examine two models: the first assessed problematic alcohol use as a mechanism linking trauma-related guilt and PTSD. The second explored PTSD as a mechanism linking trauma-related guilt to problematic alcohol use. Results indicated that problematic alcohol use was a significant mechanism linking global guilt and guilt cognitions with PTSD. Further, results indicated that PTSD was a significant mechanism linking global guilt and distress with problematic alcohol use. Results of our study indicate that alcohol use is a key construct that has been overlooked in the trauma-related guilt literature, despite the high prevalence of cooccurring
PTSD and alcohol use (and alcohol use disorder). Targeting trauma-related guilt during integrated treatments for PTSD and alcohol use disorder may be particularly important for veterans.
... Numerous sophisticated insights have been developed on the role of narratives and storytelling for societies, including linguistics, psychology, anthropology, media studies, medicine, policy studies, and other disciplines [Lasswell 1933;Barthes 1975;Polkinghorne 1988Polkinghorne , 2004Ehlers and Clark 2000;Paschen and Ison 2014;Hillier et al. 2016]. This literature spans understandings of narrative as a foundational spatial-temporal "coordinate system," or cognitive sense-making structure that attributes causality and creates meaning out of complex or random experience [Polkinghorne 2004;Paschen and Ison 2014;Gamboa et al. 2016]; to understandings of narrative as a literary praxis that communicates in a particular way using plotlines and characters in story-form (see a summary by Veland et al. [2018]). ...
This chapter approaches time as a cultural construct that co-constitutes space and takes on scale, geometry, rhythm, and direction through societal narratives about change. Humans derive a foundational sense of security – ontological security – from telling stories that can remember, predict, and provide concepts to produce desired change. Across cultures, efforts to hypothesize, test, and verify causal processes have led to the emergence of a multiplicity of cultural narratives of time, each with their own distinct temporal-spatialities. The Australian Everywhen, the Mayan calendar, the geological timescale, Biblical time, and a multitude of such cosmological narratives each express a kind of large-scale coordinate system which people derive a sense of security from knowing the present and the conditions and trajectories along which change happens. In the multiple possible geometries of space-times across cultures, there is a need to understand that the scaling of time and space to navigate rapid and global processes of change happens within particular cultural narratives. In the meeting of diverse cultures under global change, there is a risk that one spatiotemporal narrative is imposed over others. Finding transformative pathways involves listening to, remembering, and developing new narratives for urgency.KeywordsNarrativeHuman geographyEnvironmentUrgencySustainabilityTransformationCultureOntologyScaleDiscourseIndigenousMathematics Subject Classification (MSC2020)Primary 86A08Secondary 70K50Physics Subject Headings (PhySH)Disciplines: Interdisciplinary Physics, Energy Science & TechnologyFacets: Environmental research, Geophysics, Atmospheric science, Earth’s atmosphere, Climate research, Global warmingJEL CodeQ56
... Therefore, it is theorized that PTSD development is partly explained by the inability to process an event at a verbal and symbolic level following PD. 25,59,60 It is important to note, however, that researchers have questioned the trauma fragmentation theory, as evidence to support this theory has been severely limited. 61 Rather than actual fragmented memories, empirical evidence suggested that the perception of fragmented trauma memories following PD during trauma may be associated with PTSD development. ...
Objective: Tonic immobility (TI) and peritraumatic dissociation (PD) are common peritraumatic reactions associated with psychopathology following trauma. The present study aimed to test whether TI and PD mediated the relationship between perceived threat during an episode of rocket shelling and subsequent posttraumatic stress symptoms. Methods: In a prospective study among 226 Israeli civilians, data were collected both during rocket shelling, between May 14, 2021, until ceasefire on May 21, 2021 (T1) and 1 to 2 months after ceasefire (T2). Measures included the Tonic Immobility Scale, Peritraumatic Dissociative Experiences Questionnaire, and PTSD Checklist for DSM-5. Four mediation models were applied for each posttraumatic stress symptom cluster. Results: Findings showed that a substantial proportion of participants had developed posttraumatic stress disorder (PTSD) symptoms at the time of follow-up (18.8%). Both TI and PD fully mediated the relationship between perceived threat and symptoms of intrusion, avoidance, and negative alterations in mood and cognition, but only PD mediated the relationship with alterations in arousal and reactivity. Conclusions: The present findings suggest that TI and PD may serve as mechanisms underlying the link between individuals' appraisals of threat during the peritraumatic phase and subsequent PTSD symptomatology. Future research should seek to replicate the present findings before any conclusions can be drawn. In particular, the association between PD and arousal and reactivity symptoms should be further explored, given that it might be multifaceted in nature.
... Measures of the study consisted of not only depressive rumination but also rumination about the earthquake (e.g., thoughts about "the moment the earthquake happened," "the people who were killed," and "what might have happened during the earthquake")-a type of "event-based rumination". Beyond depressive rumination, rumination in PTSD has been defined as repeated thoughts about a traumatic event, its consequences, and the retrospective possibilities of prevention [69,78]. More recent studies have also confirmed the manifestation of this type of event-based rumination subsequent to significant stressors and trauma and have confirmed its associations with not only symptoms of depression but also PTSD and ideas of reference [9,[79][80][81][82]. ...
Rumination and its related mental phenomena share associated impairments in cognition, such as executive functions and attentional processes across different clinical conditions (e.g., in psychotic disorders). In recent decades, however, the notion of rumination has been increasingly narrowed to the “self-focused” type in depressive disorders. A closer review of the literature shows that rumination may be construed as a broader process characterized by repetitive thoughts about certain mental contents that interfere with one’s daily activities, not only limited to those related to “self”. A further examination of the construct of rumination beyond the narrowly focused depressive rumination would help expand intervention opportunities for mental disorders in today’s context. We first review the development of the clinical construct of rumination with regard to its historical roots and its roles in psychopathology. This builds the foundation for the introduction of the “Flow Model of Rumination (FMR)”, which conceptualizes rumination as a disruption of a smooth flow of mental contents in conscious experience that depends on the coordinated interactions between intention, memory, affect, and external events. The conceptual review concludes with a discussion of the impact of rapid technological advances (such as smartphones) on rumination. Particularly in contemporary societies today, a broader consideration of rumination not only from a cognition viewpoint, but also incorporating a human–device interaction perspective, is necessitated. The implications of the FMR in contemporary mental health practice are discussed.
The COVID-19 pandemic was characterized as a continuous traumatic stressor and associated with high levels of posttraumatic stress disorder (PTSD). This study examines the associations between demographic factors, COVID-19-related factors (fear of COVID-19 and perceived stress), and PTSD, as well as the associations between PTSD and indices of mental health. The participants in the study were university students (n = 322) who completed the PTSD Checklist for the Diagnostic and Statistical Manual-5 (DSM-5), the Fear of COVID-19 Scale, the Perceived Stress Scale, short forms of the Beck Hopelessness Inventory, the Center for Epidemiological Studies Depression Scale, and the trait scale of the State-Trait Anxiety Inventory. We used multiple regression analyses to determine significant predictors of PTSD and mental health. The results revealed distinctive associations between PTSD symptom clusters and the study’s variables. Perceived stress and fear of COVID-19 emerged as the strongest predictors of all PTSD symptom clusters. Participants who tested positive for COVID-19 reported high levels of intrusive re-experiencing. Age predicted negative alterations in cognition, mood, and hyperarousal. Furthermore, negative alterations in cognition and mood were the most significant predictors of anxiety, depression, and hopelessness, while hyperarousal was a significant predictor of anxiety and depression. The findings suggest that the potential benefits of implementing a rapid assessment of mental health among students at the outset of a disease outbreak can facilitate targeted intervention efforts. In addition, interventions that enhance resilience and coping may serve a protective function in mental health outcomes. Given the central role of maladaptive cognitions in the persistence of PTSD, interventions that focus on enhancing adaptive appraisals may bolster students' capacity to cope with adversity.
Background
Mental imagery, or ‘seeing with the mind’s eye’ (Kosslyn et al . 2001), provokes strong emotional responses (Ji et al ., 2016). To date, there is a lack of data on the content and clinical characteristics (e.g. vividness, likelihood, emotional effects) of spontaneous mental images (MI) in people with bipolar disorder (BD) according to their thymic states.
Aim
The current study sought to assess the characteristics associated with the contents of MI in people with BD.
Method
Forty-two euthymic individuals diagnosed with BD (American Psychiatric Association, 2013) were asked to self-report their MI during depression, (hypo)mania and euthymia. Participants also rated levels of vividness, likelihood and emotional activation related to MI (i.e. valence, arousal, type of emotion).
Results
The contents of the MI revealed phenomenological aspects of BD. Different themes were associated with each thymic phase. In (hypo)mania and in euthymia, the mental images were assessed as being as vivid as probable ( p >.05). (Hypo)manic and euthymic-related MI activated more pleasure than displeasure ( p <.001) and were mainly associated with joy. In depression, MI were assessed as more vivid than likely ( p <.05). In depression, MI activated more displeasure than pleasure ( p <.0001) and induced mainly sadness.
Discussion
Overall, a congruence between the contents of images and the three thymic phases was found. The content of the MI was related to self-reported emotional effects that were congruent with the thymic phases concerned. The results add new clinical information for the use of imagery-based cognitive therapy in individuals with BD.
Introduction
Given the high rate of trauma exposure among children and adolescents, it is important to understand the risk factors for post-traumatic stress disorder (PTSD). Anxiety sensitivity has been implicated in multiple anxiety disorders, and an emerging evidence base has explored the relationship between this construct and PTSD. The present review investigated the size of the relationship between anxiety sensitivity and PTSD symptoms among children and adolescents exposed to trauma.
Method
A systematic search on multiple electronic databases (MEDLINE, PsycINFO, CINAHL and PTSDpubs) returned a total of 2916 records, among which six (n = 1331) met study inclusion criteria and were included in our random effects meta-analysis.
Results
Our results indicated a large effect size (r = .56, 95% CI = 0.47 − 0.64) for the relationship between anxiety sensitivity and PTSD symptoms; there was significant between-study heterogeneity.
Conclusion
This supported current cognitive models of anxiety and PTSD. Clinical implications, strengths and limitations of the review were discussed.
Post-traumatic stress disorder (PTSD) after traumatic birth can have a debilitating effect on parents already adapting to significant life changes during the post-partum period. Cognitive therapy for PTSD (CT-PTSD) is a highly effective psychological therapy for PTSD which is recommended in the NICE guidelines (National Institute for Health and Care Excellence, 2018) as a first-line intervention for PTSD. In this paper, we provide guidance on how to deliver CT-PTSD for birth-related trauma and baby loss and how to address common cognitive themes.
Key learning aims
(1) To recognise and understand the development of PTSD following childbirth and baby loss.
(2) To understand how Ehlers and Clark’s (2000) cognitive model of PTSD can be applied to post-partum PTSD.
(3) To be able to apply cognitive therapy for PTSD to patients with perinatal PTSD, including traumatic baby loss through miscarriage or birth.
(4) To discover common personal meanings associated with birth trauma and baby loss and the steps to update them.
Emotional future thinking serves important functions related to goal pursuit and emotion regulation but has been scantly studied in posttraumatic stress disorder (PTSD). The current study sought to characterize emotional future thinking in PTSD and to identify clinical and neurocognitive profiles associated with potential alterations in the level of detail in narratives of imagined future events. Fifty-eight, trauma-exposed, war-zone veterans, who were classified into current PTSD, past PTSD, and no-PTSD groups, were asked to vividly imagine future events in response to positive and negative cue words occurring in the near and distant future. These narratives were scored for internal (i.e., pertaining to the main event) and external (i.e., tangential to the main event) details. Participants also performed neurocognitive tasks of generative ability, working memory, and relational verbal memory. Linear mixed modeling revealed that the current and past PTSD groups generated fewer internal details than the no-PTSD group across positive and negative cue words and across temporal proximity. Partial least squares analysis revealed that symptom severity for all PTSD clusters was inversely associated with production of internal details, albeit with the association relatively weaker for intrusion symptoms. Among the neurocognitive tasks, only relational verbal memory was associated with production of internal details. These findings suggest, as predicted, that functional avoidance may underlie reduced detail generation but also point to potential additional mechanisms to be further investigated. That future event simulation remains overgeneral even when PTSD symptoms abate highlights the importance of addressing alterations in future thinking in this population.
The endeavour to comprehend why certain individuals develop posttraumatic stress disorder (PTSD) symptoms subsequent to experiencing traumatic events, while others do not, underscores the paramount importance of pretraumatic risk factors. This meta‐analysis summarises the extant results of studies assessing risk factors prior exposure and PTSD symptoms following an index event on the same participants. It includes 43 studies ( N = 19,239) yielding 174 effect sizes of pretraumatic risk factors categories such as demographic factors, cognitive factors, personality traits, coping styles, psychopathology, psychophysiological and environmental factors, which were examined using a three‐level meta‐analysis. Additionally, univariate random‐effects meta‐analyses were performed to separately investigate individual risk factors reported in more than one study. The findings revealed significant, small and medium associations for all categories, except for demographic factors and coping styles, also highlighting that certain individual risk factor domains (i.e. previous mental disorders, negative emotionality, sleep complaints and PTSD symptoms) represent the strongest predictors for PTSD symptoms after subsequent exposure. Several moderators were also investigated for individual risk factors. Future research could benefit from considering the interplay of pretraumatic risk factors to draw a more complex picture of the aetiology and underlying mechanisms of PTSD symptoms.
In a community sample of trauma‐exposed postpartum individuals ( N = 167; mean age = 30, 90% White; 61.7% completed bachelor's degree or higher) longitudinally completed self‐report measures on PTSD, depressive, and Obsessive‐compulsive disorder (OCD) symptoms (specifically checking, ordering, washing, and obsessing symptoms), preoccupation with intrusive postpartum thoughts/neutralising strategies, and trauma exposure at 4 and 12 weeks postpartum. PTSD symptoms were strongly associated with all OCD symptoms ( r = 0.32‐ 0.49, p < 0.001), preoccupation with postpartum‐specific intrusive thoughts ( r = 0.32−0.45, p < 0.001), and preoccupation with neutralising strategies ( r = 0.21−0.29, p < 0.05) at both time points. PTSD symptoms were also predictive of checking and obsessing symptoms. This study identified PTSD symptoms as a new correlate for preoccupation with postpartum‐specific intrusive thoughts and neutralising strategies in the postpartum period in a community sample. These findings add to the evidence suggesting a strong association between PTSD and OCD symptoms across the lifespan, including in non‐clinical samples. Future research should examine best practices to assess and treat a variety of postpartum psychopathology symptoms, not just depression.
PTSD symptomatology is known to be associated with executive dysfunction. Inhibitory control is a core component of executive functioning, and inhibitory skills are essential both for adequate functioning in everyday life and important in situations following trauma. The aim of the present study was to examine the relationship between trauma exposure, inhibitory control and PTSD symptomatology in adolescent survivors of the terror attack at Utøya, Norway on the 22nd of July, 2011. In this cross-sectional case-control study, 20 trauma exposed adolescents and 20 healthy controls matched in age and gender were compared on a neuropsychological test of cognitive inhibition (Color-Word Interference Test) and a self-report measure of inhibition ability (BRIEF-A). Our analyses revealed that the trauma exposed group differed significantly on the self-reported measure of inhibitory control compared to the control group, but there were no differences between groups on the objective measures of cognitive inhibition. Follow-up analyses with subgroups in the trauma exposed group based on PTSD symptomatology (PTSD + and PTSD-) and the control group revealed that the PTSD- group showed significantly better results than both the PTSD + and the control group on the measures of inhibitory control. Moreover, the follow-up analyses showed that the PTSD + group showed significantly poorer results from the other two groups on the measures of inhibitory control and self-reported inhibition. We conclude that impaired inhibitory control, measured both objectively and by self-reported questionnaire, is related to PTSD symptomatology. Findings suggest that inhibitory dysfunctions may be a vulnerability factor for the development of PTSD symptomatology in trauma exposed adolescents, and thus it seems that the ability to exhibit inhibitory control could be a possible resilience factor to prevent the development of PTSD symptoms.
This case study recounts an application of Ehlers and Clark’s (2000) cognitive model of post-traumatic stress disorder (PTSD) to post-intensive care unit (post-ICU) PTSD. An AB single case design was implemented. The referred patient, Rosalind (pseudonym), completed several psychometric measures prior to the commencement of therapy (establishing a baseline), as well as during and at the end of therapy. Idiosyncratic measures were also implemented to capture changes during specific phases of treatment. The importance of the therapeutic alliance, particularly in engendering a sense of safety, was highlighted. Findings support the use of cognitive therapy for PTSD (CT-PTSD) with an older adult, in the context of a coronavirus infectious disease (COVID-19)-related ICU admission. This case is also illustrative of the effectiveness of implementing CT-PTSD in the context of co–morbid difficulties and diagnoses of delirium, depression, and complicated grief.
Key learning aims
(1) To recognise the therapeutic value of CT-PTSD in addressing PTSD following a COVID-19 admission, in the context of complicated grief and delirium.
(2) To consider the importance of a strong therapeutic alliance when undertaking CT–PTSD.
(3) To understand the intersection of complicated grief and delirium in the context of ICU trauma.
(4) To consider the challenges in working with PTSD, whereby the target trauma (COVID–19 ICU admission) is linked with ongoing uncertainty and continuing indeterminate threat.
Morality concerns individuals in every society and is important for the normal functioning of the society. Individuals are guided by morality in daily activities and may engage in emotions such as moral anxiety when moral perceptions conflict with moral behaviours. This study provides a review of the factors that influence morality from both internal and external influences. The results indicated that external factors that influence morality include the upbringing environment, childhood experiences. The internal factors that influence morality mainly include the function of brain areas and mental disorders. On the base of the review of prior studies, this paper makes recommendations for future research and practice development. Future research should systematically compare the effects of innate and acquired factors. In addition, the link between the neural structure of the brain and morality beforehand needs to be further explored. More research methods from other research fields are yet to be newly applied in the field of moral sense research.
Introduction:
Each year an estimated 48 million people are bereaved by suicide internationally. Following traumatic events, experiencing intrusive mental imagery relating to the trauma is not uncommon. This phenomenological study aimed to explore the nature, experience and impact of intrusive mental imagery after suicide bereavement.
Methods:
Semi-structured interview transcripts with 18 adults bereaved by the suicide of a close contact were analysed using thematic analysis to explore patterns and themes within the data, with particular consideration of the content of images, how people experience and relate to the imagery, and the impact that the imagery has on the bereaved.
Results:
Thematic analysis identified common characteristics in the experience of intrusive mental imagery following suicide loss, summarised under two main themes capturing: 1) the descriptive characteristics and 2) the emotional experience of intrusive mental imagery following suicide loss. The majority of participants found the experience of intrusive imagery distressing, but most also described positive aspects, including help in making sense of the death and retaining memories of the deceased.
Conclusion:
Findings inform our understanding of the distressing experience of intrusive imagery after suicide loss, also revealing perceived value in processing the death.
Background:
Caring for a young person with anorexia nervosa (AN) has been associated with psychological distress and found to be a traumatic experience. This can have an impact on patient and family outcomes.
Objective:
This study aimed to investigate whether self-blame cognitions contribute to post-traumatic stress disorder (PTSD) symptoms in parents of young people with AN.
Methods:
A cross-sectional design was used. One hundred and twenty-three parents of young people with AN completed a range of questionnaires assessing self-blame cognitions and PTSD symptoms.
Results:
Overall, levels of self-blame cognitions were significantly higher in those experiencing higher levels of PTSD symptoms compared to low levels. Additionally, levels of self-blame cognitions significantly predicted PTSD symptoms over and above demographic factors and illness severity, accounting for 22% of unique variance in PTSD symptoms.
Conclusions:
The findings suggest that negative appraisals regarding self-blame for their child's eating disorder contributed to the potential maintenance of PTSD symptoms. Parents presenting with thoughts of self-blame would benefit from further support to reduce these feelings and, subsequently, reduce carer distress.
Post-traumatic stress disorder is a clinical and social reality. There is a high prevalence of combined substance abuse in patients with PTSD. It also points to the medical and social difficulties in providing care for this group of patients. This article discusses topical issues of PTSD comorbidity and substance abuse. Substance abuse alters and significantly aggravates the clinical presentation of PTSD. A significant role of psychological factors, including premorbid personality traits, in the formation of addictive behavior is demonstrated in this article. Current data from neurobiological research are considered. The increased rate of PTSD diagnosis, including patients with comorbid substance abuse, as well as the high level of combined medical and social problems, reflect the significance and relevance of this problem.
A number of Western evidence-based trauma-focused interventions including EMDR, cognitive behavior therapy, and narrative exposure therapy for patients with post-traumatic stress disorder have been found to be effective in refugees. Results with respect to cognitive therapy with refugees are limited. Narrative exposure therapy has been found to be the most effective. There is a clear need of studies comparing the effectiveness of narrative exposure therapy delivered by trained refugee lay counselors versus narrative exposure therapy delivered by expert mental health workers. Post-traumatic stress disorder in refugees can be treated with cognitive behavior therapy through the Internet. Internet treatment of refugees consisting of ten sessions was equally effective in reducing post-traumatic stress as those reported for Western samples using the same treatment protocol. There is some evidence that refugee patients who suffer from post-traumatic stress disorder and severe comorbid depression benefit less from psychotherapy for post-traumatic stress disorder.KeywordsPost-traumatic stress disorderEMDRCognitive behavior therapyNarrative exposureInternet-based therapyComorbid depressionLay health workers
This case study presents the delivery of brief cognitive-behavioural therapy (CBT) for health anxiety, in the context of older age. Elements of standard CBT for health anxiety and psychoeducation techniques were employed. A collaborative case formulation adapted for older clients, comprising two models were developed and used as a roadmap for intervention. Psychometric assessment was conducted across six-time points alongside a narrative assessment of the client’s mental health needs. A detailed description of the case is presented, including an outline of the treatment and set of interventions employed, informed by the formulation. This case study calls for a nuanced understanding of health anxiety and highlights the importance of considering trauma and individualised approaches in clinical practice.
Objective
Mind-body exercise (MBE) interventions, such as yoga, are increasingly recognised as an adjunct treatment for trauma-related mental disorders but less is known about their efficacy as a preventative intervention. We aimed to systematically review if, and what type of, MBE interventions are effective at preventing the development of post-traumatic stress disorder (PTSD) or acute stress disorder (ASD) in trauma-exposed populations.
Design
Systematic review and meta-analysis.
Methods
A systematic search of MEDLINE, PsycINFO, EMBASE and CENTRAL databases was conducted to identify controlled trials of MBE interventions aimed at preventing the development of PTSD or ASD in high-risk populations. Risk of bias was assessed using the revised Cochrane risk-of-bias and ROBINS-I tools. Pooled effect sizes using Hedges’ g and 95% CIs were calculated using random effects modelling for the main meta-analysis and planned subgroup and sensitivity analyses.
Results
Six studies (N analysed=399) were included in the final meta-analysis. Overall, there was a small effect for MBE interventions in preventing the development of PTSD ( g=− 0.25, 95% CI −0.56 to 0.06) among those with previous or ongoing exposure to trauma. Although a prespecified subgroup analyses comparing the different types of MBE intervention were conducted, meaningful conclusions could not be drawn due to the small number of studies. None of the included studies assessed ASD symptoms.
Conclusion
Limited evidence was found for MBE interventions in reducing PTSD symptomology in the short term. Findings must be interpreted with caution due to the small number of studies and possible publication bias.
PROSPERO registration number
CRD42020180375
Poor integration and landmark views make opposing claims regarding the relationship between post-traumatic stress symptoms and trauma memory integration. This study tested these approaches using an event cluster paradigm. In total, 126 participants (Nptsd = 61; Nnon-ptsd = 65) remembered memories from the same story as trauma, positive and neutral memories and reported whether each memory was directly retrieved or generated. Moreover, the retrieval time (RT) was recorded. Finally, the participants completed the Centrality of Event Scale (CES) and Post-traumatic Stress Disorder Symptom Scale-Self Report (PSS-SR). The results demonstrated that participants with post-traumatic stress disorder (PTSD) recalled their clusters of memories more slowly and less directly than those without PTSD. However, the CES predicted PTSD severity more strongly than RT and retrieval strategy. These results suggest that traumatic memories are more disorganised but perceived as more central in PTSD.
Defines posttraumatic stress disorder (PSD), which has been used to circumscribe the varied symptoms reported by combatants, and briefly presents a conditioning model for the development of PSD. The model explains PSD as a combination of high-order conditioning and stimulus generalization. The benchmark symptoms for a diagnosis of PSD are (1) intrusive thoughts regarding the traumatic event, (2) vivid recollections of the traumatic event wherein the individual reports that he/she feels that the trauma is actually reoccurring, and (3) terrifying nightmares that contain specific details of the event. A previous study by the authors (unpublished) is reported in which several symptoms were assessed by evaluating Ss' performance on cognitive and behavioral tasks and by questionnaires selected for their relationship to specific symptoms to the disorder. Responses of PSD veterans on these tasks were compared to those of well-adjusted Vietnam combat veterans without PSD. Results show that performance on 5 of the 6 tasks was effective in distinguishing Vietnam veterans with PSD from those who were well adjusted: PSD Ss demonstrated increased physiological arousal; motoric agitation; intrusive, combat-related cognitions when exposed to cues resembling the original traumatic event; poor concentration; and poor performance on emotion identification. (26 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In this article we propose mechanisms that govern the processing of emotional information, particularly those involved in fear reduction. Emotions are viewed as represented by information structures in memory, and anxiety is thought to occur when an information structure that serves as program to escape or avoid danger is activated. Emotional processing is defined as the modification of memory structures that underlie emotions. It is argued that some form of exposure to feared situations is common to many psychotherapies for anxiety, and that confrontation with feared objects or situations is an effective treatment. Physiological activation and habituation within and across exposure sessions are cited as indicators of emotional processing, and variables that influence activation and habituation of fear responses are examined. These variables and the indicators are analyzed to yield an account of what information must be integrated for emotional processing of a fear structure. The elements of such a structure are viewed as cognitive representations of the stimulus characteristic of the fear situation, the individual's responses in it, and aspects of its meaning for the individual. Treatment failures are interpreted with respect to the interference of cognitive defenses, autonomic arousal, mood state, and erroneous ideation with reformation of targeted fear structures. Applications of the concepts advanced here to therapeutic practice and to the broader study of psychopathology are discussed.
Intrusive recollections are very common immediately after traumatic events and are considered necessary aspects of emotional processing. However, if these intrusive recollections persist over a long time, they are linked to long-term psychiatric disorder, especially Posttraumatic Stress Disorder (PTSD). This paper discusses the need to investigate factors involved in the maintenance of intrusive traumatic recollections. It is suggested that the idiosyncratic meaning of the intrusive recollections predicts the distress caused by them, and the degree to which the individual engages in strategies to control the intrusions. These control strategies maintain the intrusive recollections by preventing a change in the meaning of the trauma and of the traumatic memories. It is further suggested that what is needed is a comprehensive assessment of the processes that prevent change in meaning, going beyond the assessment of avoidance. In particular, safety behaviours, dissociation and numbing, suppression of memories and thoughts about trauma, rumination, activation of other emotions such as anger and guilt and corresponding cognitions, and selective information processing (attentional and memory biases) may be involved in the maintenance of intrusive recollections. Preliminary data supporting these suggestions from studies of individuals involved in road traffic accidents and survivors of child sexual abuse are described.
Cognitive processing therapy (CPT) was developed to treat the symptoms of posttraumatic stress disorder (PTSD) in rape victims. CPT is based on an information processing theory of PTSD and includes education, exposure, and cognitive components. Nineteen sexual assault survivors received CPT, which consists of 12 weekly sessions in a group format. They were assessed at pretreatment, posttreatment, and 3- and 6-month follow-up. CPT subjects were compared with a 20-subject comparison sample, drawn from the same pool who waited for group therapy for at least 12 weeks. CPT subjects improved significantly from pre- to posttreatment on both PTSD and depression measures and maintained their improvement for 6 months. The comparison sample did not change from the pre- to the posttreatment assessment sessions.
This study examines the usefulness of the Trauma Symptom Checklist (TSC-40) in measuring the long-term sequelae of sexual abuse. In a national survey of 2,963 professional women, the TSC-40 was found to be reliable and to display predictive validity with regard to childhood sexual victimization. Women who reported a sexual abuse history scored significantly higher than did women with no history of abuse on each of the six subscales and on the overall TSC-40 score. Various aspects of childhood victimization were associated with the subscale scores, with the Sexual Abuse Trauma Index and Dissociation subscales being more sensitive to the specific components of the abuse.
We present proposed changes to the dissociative disorders section of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders and review the concept of pathological and nonpathological dissociation, including empirical findings on the relations between trauma and dissociative phenomenology and between dissociation and hypnosis. The most important proposals include the creation of two new diagnostic entities, brief reactive dissociative disorder and transient dissociative disturbance, and the readoption of the criterion of amnesia for a multiple personality disorder diagnosis. We conclude that further work on dissociative processes will provide an important link between clinical and experimental approaches to human cognition, emotion, and personality.
Explicit measures of human memory, such as recall or recognition, reflect conscious recollection of the past. Implicit tests of retention measure transfer (or priming) from past experience on tasks that do not require conscious recollection of recent experiences for their performance. The article reviews research on the relation between explicit and implicit memory. The evidence points to substantial differences between standard explicit and implicit tests, because many variables create dissociations between these tests. For example, although pictures are remembered better than words on explicit tests, words produce more priming than do pictures on several implicit tests. These dissociations may implicate different memory systems that subserve distinct memorial functions, but the present argument is that many dissociations can be understood by appealing to general principles that apply to both explicit and implicit tests. Phenomena studied under the rubric of implicit memory may have important implications in many other fields, including social cognition, problem solving, and cognitive development.
In this article we propose mechanisms that govern the processing of emotional information, particularly those involved in fear reduction. Emotions are viewed as represented by information structures in memory, and anxiety is thought to occur when an information structure that serves as program to escape or avoid danger is activated. Emotional processing is defined as the modification of memory structures that underlie emotions. It is argued that some form of exposure to feared situations is common to many psychotherapies for anxiety, and that confrontation with feared objects or situations is an effective treatment. Physiological activation and habituation within and across exposure sessions are cited as indicators of emotional processing, and variables that influence activation and habituation of fear responses are examined. These variables and the indicators are analyzed to yield an account of what information must be integrated for emotional processing of a fear structure. The elements of such a structure are viewed as cognitive representations of the stimulus characteristic of the fear situation, the individual’s responses in it, and aspects of its meaning for the individual. Treatment failures are interpreted with respect to the interference of cognitive defenses, autonomic arousal, mood state, and erroneous ideation with reformation of targeted fear structures. Applications of the concepts advanced here to therapeutic practice and to the broader study of psychopathology are discussed.
Data were obtained on the general population epidemiology of DSM-III-R posttraumatic stress disorder (PTSD), including information on estimated life-time prevalence, the kinds of traumas most often associated with PTSD, sociodemographic correlates, the comorbidity of PTSD with other lifetime psychiatric disorders, and the duration of an index episode.
Modified versions of the DSM-III-R PTSD module from the Diagnostic Interview Schedule and of the Composite International Diagnostic Interview were administered to a representative national sample of 5877 persons aged 15 to 54 years in the part II subsample of the National Comorbidity Survey.
The estimated lifetime prevalence of PTSD is 7.8%. Prevalence is elevated among women and the previously married. The traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women. Posttraumatic stress disorder is strongly comorbid with other lifetime DSM-III-R disorders. Survival analysis shows that more than one third of people with an index episode of PTSD fail to recover even after many years.
Posttraumatic stress disorder is more prevalent than previously believed, and is often persistent. Progress in estimating age-at-onset distributions, cohort effects, and the conditional probabilities of PTSD from different types of trauma will require future epidemiologic studies to assess PTSD for all lifetime traumas rather than for only a small number of retrospectively reported "most serious" traumas.
In a cross-validated mediational model, the authors examined characteristics of memories formed in response to rape and other intense unpleasant and pleasant experiences. Data were responses to a mailed survey of women medical center and university employees. Measurement models of memory and symptom factors and a structural model with pathways among cognitive appraisal, emotional valence, memory characteristics, and health outcomes were developed in Sample 1 (N = 1,307) and confirmed in Sample 2 (N = 2,142). Rape had substantial direct effects on 2 memory factors (Clarity and Affect) and indirect effects through the construal of victimization. Rape was associated with memories described as more emotionally intense but less clear and coherent and less often thought of or talked about. Most effects on physical symptoms were nonsignificant. Implications of findings for neurohormonal and multiple representation models of emotional memory and to cognitive avoidance are discussed.
Review of book: Recovered Memories and False Memories by Martin A. Conway, New York: Oxford University Press, 1997, 301 pp. Reviewed by C. Brooks Brenneis.
Anxiety disorders are characterised by distorted beliefs about the dangerousness of certain situations and/or internal stimuli. Why do such beliefs persist? Six processes (safety-seeking behaviours, attentional deployment, spontaneous imagery, emotional reasoning, memory processes and the nature of the threat representation) that could maintain anxiety-related negative beliefs are outlined and their empirical status is reviewed. Ways in which knowledge about maintenance processes has been used to develop focussed cognitive therapy programmes are described and evaluations of the effectiveness of such programmes are summarized. Finally, ways of identifying the effective ingredients in cognitive therapy programmes are discussed.
Summary The main and the latest trends in the world and in Cuba regarding Posttraumatic Stress Disorder in female victims of rape, as well as the social factors that determine the general facts all over the nation and particularly in Pinar del Rio were analyzed using the historical method.
A patient with selective bilateral damage to the amygdala did not acquire conditioned autonomic responses to visual or auditory stimuli but did acquire the declarative facts about which visual or auditory stimuli were paired with the unconditioned stimulus. By contrast, a patient with selective bilateral damage to the hippocampus failed to acquire the facts but did acquire the conditioning. Finally, a patient with bilateral damage to both amygdala and hippocampal formation acquired neither the conditioning nor the facts. These findings demonstrate a double dissociation of conditioning and declarative knowledge relative to the human amygdala and hippocampus.
This chapter explores a question critical to the remainder of the chapters in the title: ‘what are memories?’ It discusses recovered memories and false memories, outlines the recovered memory debate and research into the area, before summarizing the content of the remaining chapters.
Posttraumatic stress disorder (PTSD) is an illness of considerable prevalence, often characterized by high morbidity, treatment resistance, and a chronic course. The core symptoms of PTSD include persistent reexperiencing of the traumatic event, avoidance of stimuli associated with the trauma, and autonomic hyperarousal. We propose several neurobiologic mechanisms that may account for these primary symptoms of PTSD. Preclinical investigations of the effects of stress on learning and memory processes suggest that fear conditioning, behavioral sensitization, and a failure of extinction may be important in the persistence and reexperiencing of traumatic memories and stressor sensitivity. The pathophysiology of PTSD may involve dysfunction of several brain structures, particularly the amygdala, locus coeruleus, and hippocampus, as well as noradrenergic, dopamine, opiate, and corticotropinreleasing factor neurochemical systems. Acutely, severe psychological trauma results in the parallel activation of these systems, producing an array of adaptive behavioral and physiologic responses necessary for survival. In PTSD, however
This chapter explores the nature of confession and inhibition. Conversely, not confiding significant experiences is associated with increased disease rates, ruminations, and other difficulties. This pattern of findings has helped in developing a useful theory of active inhibition that shares many of the assumptions of learning theory, psychodynamic models, and more recent cognitive perspectives. The chapter examines the nature of confession per se. The chapter focuses on the physiological and psychological effects of confronting or actively avoiding past traumatic experiences. Based on a number of laboratory and field studies, it is clear that requiring people to write or talk about traumas is associated with both immediate and long-term health benefits. The chapter presents a formal theory of active inhibition. The links among the theory and Freud, animal learning, and cognitive perspectives are discussed in the chapter. The chapter describes the reexamination of catharsis, the development and breakdown of the self, and the role of psychosomatics in social psychology.
Background:
Data were obtained on the general population epidemiology of DSM-III-R posttraumatic stress disorder (PTSD), including information on estimated lifetime prevalence, the kinds of traumas most often associated with PTSD, sociodemographic correlates, the comorbidity of PTSD with other lifetime psychiatric disorders, and the duration of an index episode.Methods:
Modified versions of the DSM-III-R PTSD module from the Diagnostic Interview Schedule and of the Composite International Diagnostic Interview were administered to a representative national sample of 5877 persons aged 15 to 54 years in the part II subsample of the National Comorbidity Survey.Results:
The estimated lifetime prevalence of PTSD is 7.8%. Prevalence is elevated among women and the previously married. The traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women. Posttraumatic stress disorder is strongly comorbid with other lifetime DSM-III-R disorders. Survival analysis shows that more than one third of people with an index episode of PTSD fail to recover even after many years.Conclusions:
Posttraumatic stress disorder is more prevalent than previously believed, and is often persistent. Progress in estimating age-at-onset distributions, cohort effects, and the conditional probabilities of PTSD from different types of trauma will require future epidemiologic studies to assess PTSD for all lifetime traumas rather than for only a small number of retrospectively reported "most serious" traumas.
A cognitive theory of posttraumatic stress disorder (PTSD) is proposed that assumes traumas experienced after early childhood give rise to 2 sorts of memory, 1 verbally accessible and 1 automatically accessible through appropriate situational cues. These different types of memory are used to explain the complex phenomenology of PTSD, including the experiences of reliving the traumatic event and of emotionally processing the trauma. The theory considers 3 possible outcomes of the emotional processing of trauma, successful completion, chronic processing, and premature inhibition of processing We discuss the implications of the theory for research design, clinical practice, and resolving contradictions in the empirical data.
Current thinking about Pavlovian conditioning differs substantially from that of 20 years ago. Yet the changes that have taken place remain poorly appreciated by psychologists generally. Traditional descriptions of conditioning as the acquired ability of one stimulus to evoke the original response to another because of their pairing are shown to be inadequate. They fail to characterize adequately the circumstances producing learning, the content of that learning, or the manner in which that learning influences performance. Instead, conditioning is now described as the learning of relations among events so as to allow the organism to represent its environment. Within this framework, the study of Pavlovian conditioning continues to be an intellectually active area, full of new discoveries and information relevant to other areas of psychology.
This paper reviews the evidence for the existence of a complex form of post-traumatic disorder in survivors of prolonged, repeated trauma. This syndrome is currently under consideration for inclusion in DSM-IV under the name of DESNOS (Disorders of Extreme Stress Not Otherwise Specified). The current diagnostic formulation of PTSD derives primarily from observations of survivors of relatively circumscribed traumatic events. This formulation fails to capture the protean sequelae of prolonged, repeated trauma. In contrast to a single traumatic event, prolonged, repeated trauma can occur only where the victim is in a state of captivity, under the control of the perpetrator. The psychological impact of subordination to coercive control has many common features, whether it occurs within the public sphere of politics or within the private sphere of sexual and domestic relations.
provide a detailed review of the literature on the psychobiology of traumatic stress response syndromes and discuss the treatment implications of recent findings in this area / after a brief discussion of four primary features of trauma—incomprehensibility, disrupted attachment, traumatic bonding, and inescapability—the authors review three animal models for PTSD [posttraumatic stress disorder]: inescapable stress, forced isolation, and disruption of attachments in nonhuman primates / [reviews] the role of endogenous opioids in trauma responses and the psychobiology of reliving and reenactment (PsycINFO Database Record (c) 2012 APA, all rights reserved)
highlight recent progress made in studies of the neurobiology of dissociative states, memory dysfunction, and hyperarousal in posttraumatic stress disorder (PTSD) patients / review and begin to integrate recent studies of PTSD patients, other patient populations, healthy Ss, and preclinical research / highlight the potential prognostic and therapeutic significance of recent research findings [on] the neurobiology of dissociative states and memory disturbance in PTSD (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Integrates findings from the fields of cognitive science, child development, and trauma to address basic questions about posttraumatic stress disorder (PTSD). Mechanisms of divided attention and emotional flooding during traumatic experiences may explain classic memory (ME) findings in PTSD: psychogenic amnesia in the setting of hyperarousal, startle response, intrusive images, and avoidance behaviors. Cognitive research shows that blocked focal attention leads to impaired explicit processing but intact implicit recall. The hippocampal formation is crucial for explicit ME processing, involving a subsequent consolidation process that is postulated to make MEs permanent in the cortex. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
From the perspective of memory researchers, there are 3 broad areas in which questions need to be posed about the state of evidence relevant to the recovered memories debate. The 1st set of questions concerns the issue of 'forgetting.' The 2nd set of questions concerns the issue of 'distortion.' The 3rd set of questions concerns the relation between recovered memories of actual abuse and illusory memories of abuse.
In this chapter, we examine evidence that pertains to each set of questions. For each set, we summarize briefly the state of knowledge regarding memories of childhood sexual abuse. We also broaden the frame of analysis to consider relevant evidence from other areas of research, including clinical observations of traumatic memory as well as current cognitive psychology and cognitive neuroscience. Our goals are twofold. The first is to provide our own assessment of the state of the evidence in the recovered memories debate. Here, we emphasize that answers to the various questions we have posed need not all point toward the same side of the debate. For instance, it is perfectly possible to conclude, as we do, that illusory memories of abuse exist yet at the same time concede that some traumatic experiences can be forgotten and later recovered. The 2nd goal is to seek guidance and direction for future research from current work on remembering and forgetting. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Cognitive models have linked individual differences in the appraisal of traumatic events and their sequelae to the persistence of post-traumatic stress disorder (PTSD). A pilot study investigated this proposal with victims of assault. Eleven assault victims suffering from persistent PTSD and 9 victims who had recovered from PTSD were interviewed retrospectively and compared on potentially relevant cognitive factors. Groups were comparable in terms of characteristics of the assault, gender, age, and initial PTSD severity. Participants with persistent PTSD were less likely than those who had recovered to have engaged in mental planning during the assault and more likely to have experienced mental defeat, and to indicate negative appraisals of their actions during the assault, of others' reactions after the assault, and of their initial PTSD symptoms. They were also more likely to indicate global negative beliefs concerning their perception of themselves, their world or their future. These cognitive factors may maintain PTSD symptoms either directly or by motivating the individual to engage in behaviour that prevents change.
This study examined feelings of anger among female victims of crime and the relation of anger to the development of post-traumatic stress disorder (PTSD). One hundred and sixteen women who had been victims of sexual or nonsexual criminal assaults were compared to a matched comparison group of 50 nonvictimized women on measures of anger and anger expression. Results indicate that victims were angrier than nonvictims. The level of anger was related to various aspects of the assault, such as the use of a weapon and the victim's response to the attack. In addition, the results indicate that elevated anger is positively related to the development of PTSD. Results are discussed in relation to a cognitive/behavioral conceptualization of PTSD.
In this study we examined the relationship between posttrauma pathology and the level of articulation (complexity) in rape narratives recounted by victims shortly after the assault. Degree of articulation was operationalized as the reading level of the narratives as determined by a computer program. Shortly after the trauma, reading level was correlated with severity of anxiety but not with posttraumatic stress disorder (PTSD) symptoms. Degree of the narrative articulation shortly after the trauma, however, was related to severity of later PTSD. These results are consistent with the hypothesis that the less developed trauma narratives hinder recovery from trauma.
Not all patients with posttraumatic stress disorder benefit from exposure treatment. The present paper describes two cognitive dimensions that are related to inferior response to exposure in rape victims. First, individuals whose memories during reliving of the trauma reflected mental defeat or the absence of mental planning showed little improvement. Second, inferior outcome was correlated with an overall feeling of alienation or permanent change following the trauma. These results are based on blind ratings of transcripts of exposure treatment sessions from 10 women with good outcome and 10 women with inferior outcome. Patients in the two groups were matched for initial symptom severity and were comparable in many aspects of the assault. Patients who experienced mental defeat, alienation, or permanent change may require cognitive restructuring in addition to exposure.
This paper presents a coding system developed to explore changes in narratives of rape during therapy for posttraumatic stress disorder (PTSD) involving repeated reliving and recounting of the trauma. Relationships between narrative categories hypothesized to be affected by the treatment and treatment outcome were also examined. As hypothesized, narrative length increased from pre- to post-treatment, percentage of actions and dialogue decreased and percentage of thoughts and feelings increased, particularly thoughts reflecting attempts to organize the trauma memory. Also as expected, increase in organized thoughts was correlated negatively with depression. While indices of fragmentation did not significantly decrease during therapy, the hypothesized correlation between decrease in fragmentation and reduction in trauma-related symptoms was detected.
Post-traumatic stress disorder (PTSD) and related psychopathology were examined in 95 female rape victims beginning soon after the assault (mean=12.64 days). Subjects were assessed weekly for 12 weeks. Ninety-four percent of women met symptomatic criteria for PTSD at Assessment 1, decreasing to 65% at Assessment 4 (mean=35 days postassault), and 47% at Assessment 12 (mean=94 days postassault). PTSD and related psychopathology decreased sharply between Assessments 1 and 4 for all women. Women whose PTSD persisted throughout the 3-month study did not show improvement after the fourth assessment; women who did not meet criteria for PTSD 3 months postassault showed steady improvement over time. This pattern was evidenced even after initial PTSD severity was statistically controlled. Moreover, PTSD status at 3 months postassault could be predicted with a high degree of accuracy by two brief self-report measures administered at the first assessment. The implications of the present findings and directions for future research are discussed.