Path analytic examination of a cognitive model of PTSD

Ehlers and Clark (2000) developed a cognitive model of posttraumatic stress disorder (PTSD) symptom maintenance which implicated the role of posttraumatic cognitions and aspects of the trauma memory in maintaining symptoms via an increased sense of current threat. The aim of the current study was to empirically test a variant of this model using path analysis. Participants in the current study were 514 undergraduates at a midwestern university who reported experiencing at least one traumatic event. Path analyses examined various models of the possible relationships between one’s posttraumatic cognitions and the centrality of the traumatic event to the sense of self (considered an aspect of memory integration) in predicting current level of PTSD symptoms. Results indicate that both event centrality and posttraumatic cognitions are unique and independent predictors of current symptom level. Overall, the results of this study support aspects of Ehlers and Clark’s cognitive model of PTSD; cognitive appraisals of the self and centrality of the event were highly related to levels of distress. However, the current study suggests that overly integrated trauma memories may lead to greater distress and not poorly integrated ones as suggested by Ehlers and Clark.     

A prospective study of appraisals in childhood posttraumatic stress disorder

This study investigated the predictors of posttraumatic stress disorder (PTSD) in children following a diagnosis of traumatic injury. Children (N=76) aged between 7 and 13 who were admitted to hospital following injury were assessed within a month of trauma for acute stress disorder (ASD), negative appraisals, as well as parental stress reactions. Children (N=62) were re-assessed 6-months later for PTSD and negative appraisals. The majority of the variance of chronic posttraumatic stress was accounted for by negative appraisals about future harm. This study supports cognitive models of PTSD, and suggests that younger children who exaggerate their vulnerability after trauma exposure are high risk for PTSD after trauma.     

Cross-sectional and prospective associations between cognitive appraisals and posttraumatic stress disorder symptoms following stroke

This study examined cross-sectional and prospective associations between cognitive appraisals and posttraumatic stress disorder (PTSD) symptoms following stroke. While in hospital, stroke patients (n=81) completed questionnaires assessing cognitive appraisals (i.e., negative cognitions about the self, negative cognitions about the world, and self-blame) and PTSD symptoms. PTSD symptoms were assessed again 3 months later when all patients had been discharged from hospital (n=70). Significant correlations were found between the time 1 measures of negative cognitions about the self and the world, but not self-blame, and the severity of PTSD symptoms measured at time 1 and at time 2. Regression analyses revealed that cognitive appraisals explained a significant amount of variance in the severity of PTSD symptoms at time 1, with negative cognitions about the self-emerging as a significant predictor. In contrast, time 1 cognitive appraisals were unable to explain additional variance in time 2 PTSD severity over and above that explained by time 1 PTSD severity. The findings therefore provide only weak support for Ehlers and Clark's cognitive model of PTSD.     

Maladaptive appraisals as a risk factor for posttraumatic stress: a study of trainee firefighters

This study tested the proposal that catastrophic appraisals are a risk factor for developing stress reactions after trauma. Trainee firefighters (N = 82) were assessed during training (and before trauma exposure), and 68 firefighters were subsequently reassessed 6 months after commencing firefighter duty (after trauma exposure). Initial assessment included the Clinician Administered PTSD Scale, the Traumatic Events Questionnaire, and the Posttraumatic Cognitions Inventory. The Clinician Administered PTSD Scale was again administered approximately 20 months after initial assessment and after trauma exposure. Posttraumatic stress at follow-up was predicted by pre*trauma catastrophic thinking (24% of variance). These findings accord with cognitive models predicting that a tendency to catastrophize about negative events is a risk factor for developing posttraumatic stress symptoms.     

A prospective investigation of the role of cognitive factors in persistent posttraumatic stress disorder (PTSD) after physical or sexual assault

The effectiveness of psychological treatments for PTSD is likely to be enhanced by improved understanding of the factors involved in maintaining the disorder. Ehlers and Clark [A cognitive model of persistent posttraumatic stem disorder Behav. Res. Ther. 38 (2000) 319-345] recently proposed a cognitive model of maintenance. The current study aimed to investigate several cognitive factors highlighted in Ehlers and Clark's model using a prospective design. Fifty-seven victims of physical or sexual assault participated in the study. Cognitive factors were assessed within 4 months of assault and victims were followed-up 6 and 9 months after the assault. Cognitive variables which significantly predicted PTSD severity at both follow-ups were: cognitive processing style during assault (mental defeat, mental confusion, detachment); appraisal of assault sequelae (appraisal of symptoms, perceived negative responses of others, permanent change); negative beliefs about self and world; and maladaptive control strategies (avoidance/safety seeking). Relationships between early appraisals, control strategies, and processing styles and subsequent PTSD severity remained significant after statistically controlling for gender and perceived assault severity. These findings support the cognitive model of PTSD proposed by Ehlers and Clark and suggest that effective treatment will need to address these cognitive factors.     

Predictors of posttraumatic stress in children following injury: The influence of appraisals, heart rate, and morphine use

Prospective studies of posttraumatic stress disorder (PTSD) in children that investigate simultaneously both cognitive and biological or psychophysiological predictors are rare. The present research reports on the impact of cognitive factors (trauma-related appraisals) and biological indicators (heart rate, morphine use) in predicting PTSD and depression symptoms following single-incident trauma. Children and adolescents (N = 48) were assessed within 4 weeks of an injury that led to hospital treatment and followed up 6-months later. While morphine did not predict initial PTSD severity, it was associated with lower levels of PTSD at follow-up. Reductions in PTSD symptoms (change scores) between assessments were similarly associated with morphine dosage. Trauma-related appraisals also contributed to PTSD and depression symptom severity. While slightly different patterns of results were obtained depending on whether static or change scores were examined, as a whole the study adds to a growing literature that morphine has the potential to reduce PTSD symptoms severity. Likewise the relationship between unhelpful trauma appraisals and posttrauma psychopathology was replicated.     

Cognitive factors involved in the onset and maintenance of posttraumatic stress disorder (PTSD) after physical or sexual assault.

Cognitive factors hypothesised to influence the development and maintenance of PTSD were investigated. 92 assault victims completed questionnaires assessing a range of cognitive variables. Factors relating to onset of PTSD were investigated by comparing victims who did and who did not suffer PTSD. Factors relating to maintenance of PTSD were investigated by comparing victims who had recovered from PTSD with victims who had persistent PTSD. Cognitive factors associated with both onset and maintenance of PTSD were: appraisal of aspects of the assault itself (mental defeat, mental confusion, appraisal of emotions); appraisal of the sequelae of the assault (appraisal of symptoms, perceived negative responses of others, permanent change); dysfunctional strategies (avoidance/safety seeking) and global beliefs impacted by assault. Cognitive factors that were associated only with the onset of PTSD were: detachment during assault; failure to perceive positive responses from others and mental undoing. Relationships between the cognitive variables and PTSD remained significant when variations in perceived and objective assault severity were statistically controlled. The cognitive factors identified in the study may contribute to PTSD directly, by generating a sense of ongoing threat, or indirectly, by motivating cognitive and behavioural strategies that prevent recovery, or by affecting the nature of the traumatic memory.     

Posttraumatic stress disorder in the emergency room: exploration of a cognitive model

Ehlers and Clark (Behav. Res. Ther., 38 (2000) 319) recently proposed a cognitive model of posttraumatic stress disorder (PTSD). In this study, we examined two facets of this model, appraisal and peritraumatic dissociation, in the context of a hospital emergency room. Fifty-one emergency room personnel completed questionnaires measuring posttraumatic stress symptoms, interpretations of traumatic events experienced while working in the emergency room and subsequent intrusive recollections, and peritraumatic dissociation. Twelve percent of participants met formal diagnostic criteria for PTSD, and 20% met PTSD symptom criteria. As predicted, both negative appraisals of the trauma and of intrusive recollections were associated with increased PTSD severity. Although peritraumatic dissociation did not correlate with overall PTSD symptom severity, it was associated with the reexperiencing symptom cluster. Discussion focuses on the factors associated with PTSD in emergency room professionals and implications for intervention.     

Obsessive-compulsive behaviours in specific situations: the relative influence of appraisals of control, responsibility and threat

Obsessive-compulsive disorder (OCD) is characterized by repeated and persistent attempts by the individual to control their thoughts and by taking action through rituals in order to prevent feared or personally distressing outcomes. While cognitive theories of OCD have generated supportive research findings and effective treatments, they have not considered broader control beliefs that may motivate aspects of OC-phenomenology. We have previously proposed that broader control beliefs, specifically desire for control and sense of control, may play a role in OC-symptoms (Moulding & Kyrios, 2006). In the present study, non-clinical participants (N=219) were presented with four hypothetical scenarios relevant to an OCD-checking concern, and using a manipulation paradigm, the relationship between control constructs and appraisals hypothesized to be relevant to OCD (threat, responsibility) was examined. Desire for control was moderately affected to responsibility and threat appraisals, while sense of control did not relate to these constructs. The relationship between aspects of OC-phenomenology and appraisals of control, responsibility and threat were also investigated. Higher desire for control predicted both affect and action, while a lower sense of control predicted higher distress and action, over-and-above appraisals of threat and responsibility. Control appraisals were particularly relevant to use of action, and to affect in the low responsibility situations. A possible interactive model of desire for control, threat and responsibility is discussed.     

青少年重复创伤暴露与创伤后应激障碍的关系:安全感与认知重评的中介作用

采用创伤暴露程度问卷、生活事件量表、安全感量表、情绪调节策略问卷和修订后的DSM-5的PTSD核查表对汶川地震8.5年后的1156名中学生进行调查,考察其重复创伤暴露、安全感和认知重评与PTSD之间的关系。结果发现,在控制初次地震暴露后,重复创伤暴露可以直接正向预测PTSD,也可以通过确定控制感和人际安全感分别间接地正向预测PTSD,还可以通过人际安全感经认知重评的多重中介作用来正向预测PTSD。不过,重复创伤暴露不能直接经过认知重评对PTSD发挥显著的预测作用,也不能通过确定控制感经认知重评来对PTSD发挥显著的多重间接预测作用。     

The impact of depression and PTSD symptom severity on trauma memory

Posttraumatic stress disorder (PTSD) and depression frequently co-occur following a traumatic event. Differences in the processing of autobiographical memory have been observed in both disorders in the form of overgeneralised memories and negative intrusive memories. The current study examined how symptoms of PTSD and depression influence the phenomenological characteristics of trauma memories. Undergraduate students who had experienced a traumatic event (n?=?696) completed questionnaires online including measures of PTSD and depressive symptom severity. They rated their trauma memory on several phenomenological characteristics using the Memory Experiences Questionnaire [Sutin, A. R., &; Robins, R. W. (2007). Phenomenology of autobiographical memories: The memory experiences questionnaire. Memory.]. Moderated multiple regression was used to examine how PTSD and depressive symptom severity related to each phenomenological characteristic. Symptoms of PTSD and depression were related separately and uniquely to the phenomenological characteristics of the trauma memory. PTSD severity predicted trauma memories that were more negative, contained higher sensory detail, and were more vivid. In contrast, depressive symptom severity predicted trauma memories that were less accessible and less coherent. These findings suggest that depressive and PTSD symptomatology affect traumatic memory differently and support a distinction between these two disorders.     

Cognitive abnormalities in post-traumatic stress disorder

Characteristically arising in response to overwhelmingly terrifying events, post-traumatic stress disorder (PTSD) is a disorder of memory: sufferers seemingly relive their trauma in the form of involuntary recollection. Prominent cognitive abnormalities, especially in memory functioning, have motivated research designed to elucidate the mediating mechanisms that produce PTSD symptoms, especially those involving involuntary recollection. Recent developments suggest a pathophysiological model of PTSD which includes hyporesponsive prefrontal cortical regions and/or a hyper-responsive amygdala. Other work has also identified above-average cognitive ability as a protective factor and below-average hippocampal volume as a vulnerability factor for PTSD among the trauma-exposed. These attempts to elucidate the mediating mechanisms of PTSD have been both cognitive and, more recently, cognitive-neuroscientific in emphasis.     

Psychological correlates of PTSD symptoms following stroke

This study assessed associations between a number of demographic, medical and psychological risk factors and post-traumatic stress disorder (PTSD) symptoms following stroke. Individuals (N = 102) who had experienced a stroke within the previous year participated in the study. Participants completed questionnaires containing measures of PTSD symptoms and a range of psychological risk factors (i.e., anxiety, depression, negative affect, dissociation, cognitive appraisals). Regression analyses revealed the variables under consideration were able to explain large proportions of the variance in the number (R(2) = .54, p < 0.001) and severity (R(2) = .58, p < 0.001) of PTSD symptoms. Number of strokes, negative affect and cognitive appraisals emerged as significant predictors of both the number and severity of PTSD symptoms. The present findings suggest that a significant proportion of stroke patients may benefit from the detection and treatment of PTSD symptoms.     

Passion and emotions: The mediating role of cognitive appraisals

Research reveals that harmonious passion leads to more positive emotions than obsessive passion, whereas the opposite result is true with respect to negative emotions. The purpose of this research was to evaluate the role of cognitive appraisals as mediators of the passion-emotion relationships. In Study 1, 227 participants engaged in different sports completed an online questionnaire about their passion for their specific sport, as well as cognitive appraisals and emotions generally experienced during an important game of their sport. Results of a structural equation modeling analysis and an indirect effect test showed that harmonious passion was linked to positive emotions through the mediating role of challenge appraisals, and that obsessive passion was linked to negative emotions through the mediating role of threat appraisals. In Study 2, 194 athletes completed questionnaires before and after a competitive game and focused on cognitive appraisals and emotions experienced during the game. Results of analyses conducted separately in the victory and defeat conditions based on game outcomes supported the model found in Study 1 in the case of defeat for both types of passion, and in the case of victory for harmonious passion only. Obsessive passion was not linked to threat appraisals among victorious athletes. These results suggest that both types of passion trigger different cognitive appraisals that lead to corresponding emotions. Future research is needed to replicate these findings and to better understand the role of passion and cognitive appraisals in emotions experienced in the realm of sports.     

Inducing and modulating intrusive emotional memories: a review of the trauma film paradigm

Highly affect-laden memory intrusions are a feature of several psychological disorders with intrusive images of trauma especially associated with post-traumatic stress disorder (PTSD). The trauma film paradigm provides a prospective experimental tool for investigating analogue peri-traumatic cognitive mechanisms underlying intrusion development. We review several historical papers and some more recent key studies that have used the trauma film paradigm. A heuristic diagram is presented, designed to simplify predictions about analogue peri-traumatic processing and intrusion development, which can also be related to the processing elements of recent cognitive models of PTSD. Results show intrusions can be induced in the laboratory and their frequency amplified/attenuated in line with predictions. Successful manipulations include competing task type (visuospatial vs. verbal) and use of a cognitive coping strategy. Studies show that spontaneous peri-traumatic dissociation also affects intrusion frequency although attempts to manipulate dissociation have failed. It is hoped that further use of this paradigm may lead to prophylactic training for at risk groups and an improved understanding of intrusions across psychopathologies.     

Emotion-specific and emotion-non-specific components of posttraumatic stress disorder (PTSD): implications for a taxonomy of related psychopathology

Many cognitive theories of posttraumatic stress disorder (PTSD), including our own SPAARS model, propose that one basis of the disorder is the cognitive system's persistent failure to resolve discrepancies between trauma-related information and the content of pre-existing mental representations, such as schemas. This leads to the characteristic PTSD symptom pattern of re-experiencing and avoidance of trauma-related material. Furthermore, the nature of this unresolved discrepancy revolves around appraisals of threat and the corresponding emotion profile in PTSD is therefore predominantly intense fear and anxiety. This paper argues that this general framework can be extended to discrepancies around other appraisal dimensions such as loss, and consequently to other emotions such as sadness. A localized taxonomy is therefore proposed comprising emotional disorders that resemble PTSD in their basic patterns of re-experiencing and avoidance symptoms--what we call their 'emotion-non-specific component'--but that differ from PTSD in terms of the core emotions involved--what we call their 'emotion-specific component'. The clinical and nosological implications of this argument are discussed.     

Negative affect varying in motivational intensity influences scope of memory

Emotions influence cognitive processes involved in memory. While some research has suggested that cognitive scope is determined by affective valence, recent models of emotion–cognition interactions suggest that motivational intensity, rather than valence, influences these processes. The present research was designed to clarify how negative affects differing in motivational intensity impact memory for centrally or peripherally presented information. Experiments 1 & 2 found that, relative to a neutral condition, high intensity negative affect (anger) enhances memory for centrally presented information. Experiment 3 replicated this effect using another high intensity negative affect (threat). Experiment 4 extended this by finding that, relative to a neutral condition, low intensity negative affect (sadness) enhanced memory for peripherally presented information. Finally, in Experiment 5, the effects of sadness and threat on scope of memory were directly compared, finding that threat narrowed scope of memory, while sadness broadened scope of memory. Together, these results provide additional support for the motivational dimensional model of cognitive scope, in that high intensity emotions narrow cognitive scope, while low intensity emotions broaden cognitive scope.     

A memory-based model of posttraumatic stress disorder: evaluating basic assumptions underlying the PTSD diagnosis

In the mnemonic model of posttraumatic stress disorder (PTSD), the current memory of a negative event, not the event itself, determines symptoms. The model is an alternative to the current event-based etiology of PTSD represented in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000). The model accounts for important and reliable findings that are often inconsistent with the current diagnostic view and that have been neglected by theoretical accounts of the disorder, including the following observations. The diagnosis needs objective information about the trauma and peritraumatic emotions but uses retrospective memory reports that can have substantial biases. Negative events and emotions that do not satisfy the current diagnostic criteria for a trauma can be followed by symptoms that would otherwise qualify for PTSD. Predisposing factors that affect the current memory have large effects on symptoms. The inability-to-recall-an-important-aspect-of-the-trauma symptom does not correlate with other symptoms. Loss or enhancement of the trauma memory affects PTSD symptoms in predictable ways. Special mechanisms that apply only to traumatic memories are not needed, increasing parsimony and the knowledge that can be applied to understanding PTSD.     

Relation of positive memory recall count and accessibility with post-trauma mental health

ABSTRACT

Positive memory encoding and retrieval deficits have an empirical relation with several post-trauma outcomes. Drawing from the Contractor et al. model, we examined relations between positive memory characteristics and post-trauma mental health indicators. A trauma-exposed community sample of 203 participants (M_age?=?35.40 years; 61.10% female) was recruited via Amazon's Mechanical Turk. Participants completed measures of posttraumatic stress disorder (PTSD; PTSD Checklist for DSM-5), depression (Patient Health Questionnaire-9), posttraumatic cognitions (Posttraumatic Cognitions Inventory), affect (Positive and Negative Affect Schedule), count/number of recalled specific positive memories (Autobiographical Memory Test) and accessibility of a specific positive memory (i.e., subjective ease of recalling details of a memory; Memory Experiences Questionnaire-Short Form). Linear regression results indicated that PTSD intrusion severity, PTSD negative alterations in cognitions and mood (NACM) severity, PTSD alterations in arousal and reactivity (AAR) severity, self-blame, and positive affect significantly and negatively predicted the count of specific positive memories. Further, PTSD NACM severity, PTSD AAR severity, negative cognitions about the self, and negative affect significantly and negatively predicted accessibility of a specific positive memory. Thus, count/accessibility of specific positive memories was associated with several post-trauma mental health indicators; this highlights the relevance and potential impact of integrating positive memories into trauma treatment.