Abstract
Individual differences in cognitive responses to trauma may represent modifiable risk factors that could allow early identification, targeted early treatment and possibly prevention of chronic posttraumatic stress disorder (PTSD). Ehlers and Clark's cognitive model of PTSD suggests that negative appraisals, disjointed trauma memories, and unhelpful coping strategies maintain PTSD. These are thought to be influenced by cognitive processing during trauma. The aim of this study was to test this model prospectively with path analyses. Participants (N = 828) were recruited from an emergency department following injury in a violent assault or road traffic collision and 700 participated in the 6-month assessments. Cognitive processing was assessed shortly after the event, negative appraisals, disjointed memories, and unhelpful coping strategies at 1 month, persistent PTSD symptom severity at 6 months, and early PTSD symptom severity at 2 weeks. Cognitive variables, with trauma type and gender, explained 52% of the variance in PTSD symptom severity at 6 months. Including early symptom severity in the model did not explain more variance (53%). Early PTSD symptom severity, with trauma type and gender, only predicted 40%. Negative appraisals and disjointed memories predicted persistent symptom severity both directly and indirectly via unhelpful strategies. Peritraumatic processing predicted persistent symptom severity mainly indirectly. The effects of trauma type and gender were fully mediated by the cognitive factors. The results are consistent with theoretically derived predictions and support cognitive factors as indicators of risk for chronic PTSD and as a target for the treatment and prevention of PTSD.
Highlights
Most people are exposed to one or more traumatic events during their life time (Benjet et al, 2016; Kessler et al, 2017), only a minority develop posttraumatic stress disorder (PTSD), of whom nearly half recover without treatment during the following months (Morina et al, 2014)
Recruitment method neither influenced persistent PTSD symptom severity 6 months post-trauma, b = −0.05, β = −0.02, p = 0.41, nor did it moderate the prediction of persistent symptom severity by peritraumatic processing, b = 0.01, β = 0.003, p = 0.92
The difference in persistent PTSD symptom severity between men and women was greater for assault than road traffic collision (RTC) survivors, padj = 0.005
Summary
Most people are exposed to one or more traumatic events during their life time (Benjet et al, 2016; Kessler et al, 2017), only a minority develop PTSD, of whom nearly half recover without treatment during the following months (Morina et al, 2014). Ehlers and Clark’s (2000) model of PTSD (see Fig. 1) was developed to explain why some people do not recover after trauma and to identify maintaining factors that can be modified in treatment. Ehlers and Clark’s cognitive model of PTSD suggests that negative appraisals, disjointed trauma memories, and unhelpful coping strategies maintain PTSD. These are thought to be influenced by cognitive processing during trauma. Cognitive processing was assessed shortly after the event, negative appraisals, disjointed memories, and unhelpful coping strategies at 1 month, persistent PTSD symptom severity at 6 months, and early PTSD symptom severity at 2 weeks. Negative appraisals and disjointed memories predicted persistent symptom severity both directly and indirectly via unhelpful strategies.
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