Abstract
Cognitive models of posttraumatic stress disorder (PTSD) highlight maladaptive posttrauma appraisals, trauma memory qualities, and coping strategies, such as rumination or thought suppression, as key processes that maintain PTSD symptoms. Anxiety, depression and externalising symptoms can also present in children in the aftermath of trauma, yet there has been little empirical investigation of the potential relevance of posttrauma cognitive processes for such difficulties. Here, we examined whether: a) acute maladaptive cognitive processes (specifically, maladaptive appraisals, memory qualities, and cognitive coping) were associated with symptoms of PTSD, internalising, and externalising at 1-month posttrauma (T1); and b) changes in these cognitive processes predicted symptom change at a follow-up assessment 6 months later (T2). We recruited 132 6–13 year old children and their parents from emergency departments following the child’s experience of an acute trauma. Children self-reported on their maladaptive appraisals, trauma-memory and cognitive coping strategies, along with symptoms of PTSD, anxiety and depression. Parents also rated children’s internalising and externalising symptoms. We found each cognitive process to be robustly associated with PTSD and non-PTSD internalising symptoms at T1, and change in each predicted change in symptoms to T2. Maladaptive appraisals and cognitive coping were unique predictors of children’s posttrauma internalising. Effects were partially retained even controlling for co-occurring PTSD symptoms. There was less evidence that trauma-specific cognitive processes were associated with externalising symptoms. Findings suggest aspects of cognitive models of PTSD are applicable to broader posttrauma psychopathology, and have implications for how we understand and target children’s posttrauma psychological adjustment.
Highlights
Following a young person’s experience of trauma, they are at risk of developing a range of poor mental health outcomes, of which the most widely studied is posttraumatic stress disorder (PTSD; Alisic et al 2014; Hiller et al 2017)
Meta-analytic reviews of the child and adolescent trauma literature have concluded that the use of thought suppression is moderately to strongly positively associated with PTSD symptoms (PTSS) severity (Trickey et al 2012), and that there is a strong association between maladaptive appraisals and PTSS (Mitchell et al 2017; Trickey et al 2012)
We examined whether cognitive processes would continue to be significantly associated with symptom outcomes, even after
Summary
Following a young person’s experience of trauma, they are at risk of developing a range of poor mental health outcomes, of which the most widely studied is posttraumatic stress disorder (PTSD; Alisic et al 2014; Hiller et al 2017). While relatively robust empirical evidence has identified key psychological mechanisms that contribute to the maintenance of chronic PTSS (e.g., Ehlers and Clark 2000; Trickey et al 2012), the role of these processes in relation to other posttrauma psychological outcomes has been little studied. Such investigation is important for understanding the extent to which targeting trauma-related psychological processes in intervention is likely to address other adverse mental health outcomes, beyond PTSD. Trauma-focused cognitive behavioural therapy (tf-CBT), the recommended first-line treatment for PTSD in children (Cohen et al 2000; Perrin et al 2000), targets the reduction of maladaptive appraisals, unhelpful coping strategies, and problematic memory qualities
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