Do PTSD symptoms and trauma-related cognitions about the self constitute a vicious cycle? Evidence for both cognitive vulnerability and scarring models (original) (raw)
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The Relationship of PTSD to Negative Cognitions: A 17-Year Longitudinal Study
With the growing interest in the role of cognitions in PTSD, this prospective study examined the course and bi-directional relationship between post-trauma cognitions and symptoms of PTSD. A sample of Israeli combat veterans, including former prisoners of war, was assessed in 1991, and later followed up in 2003 and 2008. PTSD symptoms were measured at three time points. Cognitions concerning the self and the world were measured twice. Applying Autoregressive Cross-Lagged (ARCL) modeling strategy, initial PTSD symptoms predicted subsequent negative cognitions but not vice versa. In addition, repeated measures design revealed that individuals with chronic PTSD symptoms had relatively negative cognitions that further amplified with time. More specifically, increasingly negative cognitions were documented among ex-prisoners of war. The main findings suggest that negative cognitions are fueled by PTSD and that in chronic PTSD there is an amplification of pathogenic outcomes over time. Discussion of the findings is in the context of current cognitive models of PTSD.
Clinical Psychology Review, 2009
Current models of posttraumatic stress disorder (PTSD) represent significant advances in our understanding of psychological processes involved in the development and maintenance of PTSD. However, these models may be limited theoretically and clinically given they have not considered cultural differences in selfconstrual. Cultural differences in self-construal have been found to impact on, and in many cases govern, the very psychological processes implicated by the PTSD models. The objective of this paper is to discuss some of the current models of PTSD and their associated psychological processes that have links to the self. Second, the paper reviews the literature highlighting the impact of cultural differences in self-construal on these processes. The paper, then, uses these links to draw the PTSD models into the cultural sphere. A model, 'Threat to the Conceptual Self' model, is developed. This is a working model that accounts for these two bodies of literature and suggests how cultural differences in the conceptual self may play a role in the etiology and maintenance of PTSD. Finally, clinical implications are discussed.
Cognitive Therapy and Research, 2018
In light of revisions to the diagnostic classification and criteria of PTSD in the DSM-5 that underscore a range of negative self-related appraisals and emotions beyond fear/anxiety, the current study examined the relative associations of peritraumatic perceptions of fear/life threat and posttraumatic negative self-conscious appraisals and emotions (shame, guilt, negative beliefs about the self, self-blame) with specific PTSD symptom clusters: re-experiencing, avoidance, numbing, and hyperarousal. The sample included 257 female survivors of intimate partner violence. Structural equation modeling analyses revealed that peritraumatic perceptions of fear/life threat and posttraumatic negative self-conscious appraisals/emotions significantly correlated with each of the PTSD symptom clusters. Findings support the conceptualization of PTSD as involving concurrent fear-and self-related cognitive/emotional factors.
Perception Counts: The Relationships of Inner Perceptions of Trauma and PTSD Symptoms Across Time
Psychiatry, 2018
This study examined how inner perceptions that develop in the aftermath of exposure to trauma attenuate the association between posttraumatic symptoms across time and what the reciprocal relations between inner perceptions of trauma and posttraumatic symptoms are. The present article is based on two studies. The data in Study 1 are drawn from three waves of a longitudinal study of community-dwelling midlife adults and older adults residing in the south of Israel. In Wave 1, 339 participants were interviewed (mean age = 65.44, SD = 9.77). Of these participants, 170 and 132, respectively, participated in Waves 2 (one year later) and 3 (two years later). Posttraumatic stress symptoms were self-reported in all three waves. Inner perceptions of trauma were assessed with the Subjective Traumatic Outlook scale (STO) and Centrality of Event Scale (CES), administered at Wave 3. Study 2 is drawn from two waves of research of young adults. Wave 1 included 138 participants (mean age = 32.01, SD...
Personality and Individual Differences, 2015
Objective: To investigate the extent to which negative posttraumatic cognitions predict, and so can be best located within, the DSM-5 (APA, 2013) individual symptom clusters of posttraumatic stress disorder (PTSD). Method: An online survey of traumatic experiences, featuring 528 adults. Results: Negative posttraumatic cognitions seem best placed within the Numbing/Detachment symptom cluster. Negative posttraumatic cognitions relating to the self predict higher levels of symptoms across the clusters. While negative cognitions relating to the world contributed to most symptom groups, self-blame cognitions did not. Conclusions: Our findings support the placement of posttraumatic cognitions as part of the Numbing/Detachment symptom cluster within the DSM-5 rather than the Intrusion, Avoidance and Hyperarousal clusters.
Psychological theories of posttraumatic stress disorder
Clinical psychology review, 2003
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Behavioural and Cognitive Psychotherapy, 2020
Background: Cognitive models of post-traumatic psychological adjustment have implicated both self-concept and self-appraisals in post-traumatic stress disorder (PTSD). Two studies investigated the relationship between self-concept and trauma-related self-appraisals, and whether culture influenced this relationship. Method: In Study 1, a student sample (Asian n = 41, British n = 34) who self-identified as having been through a trauma or extremely stressful event completed measures of self-concept, trauma-related self-appraisals and trauma-related distress. Study 2 extended this by asking Asian (n = 47) and British (n = 48) trauma survivors with and without PTSD to complete the same self measures as those administered in Study 1. Results: Study 1 found that overall for the British group, disruptions in self-concept (i.e. self-discrepancies and trauma-themed self-concept) correlated significantly with negative self, world and self-blame appraisals and depression. However, the same was not found in the Asian group. Study 2 found that pan-culturally those with PTSD had greater self-discrepancies and trauma-defined self-concept than those without PTSD. Additionally, pan-culturally, trauma-defined self-concept correlated significantly with negative self appraisals and depression; ideal self-discrepancies correlated significantly with negative self-appraisals across cultures and depression for the British group; while ought self-discrepancies correlated significantly with negative world appraisals for the Asian group and negative self and self-blame appraisals for the British. Lastly, negative self, world and self-blame appraisals correlated with symptoms of depression. Conclusions: Taken together, the findings relay the important associations between appraisals, self-concept and post-traumatic psychological adjustment.
Change in negative cognitions associated with PTSD predicts symptom reduction in prolonged exposure
Journal of Consulting and Clinical Psychology, 2014
The goal of the current study was to examine mechanisms of change in prolonged exposure (PE) therapy for posttraumatic stress disorder (PTSD). Emotional processing theory of PTSD proposes that disconfirmation of erroneous cognitions associated with PTSD is a central mechanism in PTSD symptom reduction; but to date, the causal relationship between change in pathological cognitions and change in PTSD severity has not been established. Method: Female sexual or nonsexual assault survivors (N ϭ 64) with a primary diagnosis of PTSD received 10 weekly sessions of PE. Self-reported PTSD symptoms, depression symptoms, and PTSD-related cognitions were assessed at pretreatment, each of the 10 PE treatment sessions, and posttreatment. Results: Lagged mixed-effect regression models indicated that session-to-session reductions in PTSD-related cognitions drove successive reductions in PTSD symptoms. By contrast, the reverse effect of PTSD symptom change on change in cognitions was smaller and did not reach statistical significance. Similarly, reductions in PTSD-related cognitions drove successive reductions in depression symptoms, whereas the reverse effect of depression symptoms on subsequent cognition change was smaller and not significant. Notably, the relationships between changes in cognitions and PTSD symptoms were stronger than the relationships between changes in cognitions and depression symptoms. Conclusions: To our knowledge, this is the 1st study to establish change in PTSD-related cognitions as a central mechanism of PE treatment. These findings are consistent with emotional processing theory and have important clinical implications for the effective implementation of PE.