Negative Trauma-related Cognitions Research Articles

Predicting Recovery Pathways in Jewish Ultra-Orthodox Intimate Partner Violence Survivors: A Structural Equation Modeling Approach.

Cultural and religious norms, as well as trauma-related cognitions and recovery actions, are known to impact the well-being of survivors of intimate partner violence (IPV). Although acknowledged as a key component, there is scant research on the recovery trajectories of women who have experienced IPV, in particular on survivors from collectivistic societies such as the Jewish Ultra-Orthodox (JUO) community in Israel. A mediation model examined the recovery process of 261 Israeli JUO survivors. In particular, it tested whether the normalization of violence and women's endorsement of Jewish religious norms that justify violence would be directly and negatively associated with women's well-being and positively associated with psychopathology. Additionally, it examined whether women's normalization of violence and support of religious norms would positively predict women's negative trauma-related cognitions. In turn, these cognitions were expected to negatively predict women's engagement in recovery actions, help-seeking behaviors, and faith-based responses but positively predict disengagement responses. The model further posited that women's engagement in steps toward recovery, help-seeking behaviors, and faith-based responses would positively predict women's well-being and negatively predict psychopathology. In contrast, women's disengagement responses would negatively predict women's well-being and positively predict their psychopathology. Bootstrap results indicated that supporting religious norms positively predicted women's trauma-related cognitions, which then negatively predicted women's recovery actions, help-seeking behaviors, and faith-based responses but positively predicted women's disengagement responses. Women's recovery actions and faith-based responses positively predicted women's well-being, while disengagement responses positively predicted women's psychopathology. Contrary to expectations, help-seeking behaviors positively predicted psychopathology.

Examining emotional processing theory and predictors of outcome in prolonged exposure for PTSD

Prolonged exposure (PE) is an empirically supported treatment for posttraumatic stress disorder (PTSD). The current study examined multiple facilitators and indicators of emotional processing to identify key predictors of outcome in PE using observational coding methods. Participants were 42 adults with PTSD who received PE. Video recordings of sessions were coded to capture negative emotion activation, negative and positive trauma-related cognitions, and cognitive rigidity. Two variables emerged as predictors of PTSD symptom improvement assessed via self-report, but not clinical interview: a greater decrease in negative trauma-related cognitions and lower average cognitive rigidity. Peak emotion activation, reductions in negative emotions, and increases in positive cognitions did not predict PTSD improvement (self-report or clinical interview). Findings contribute to growing evidence highlighting the importance of cognitive change as part of emotional processing and as a key ingredient of PE, beyond activation and reduction in negative emotions. Implications for evaluating emotional processing theory and for clinical practice are discussed.

Replication and longitudinal measurement invariance of the PTCI-9.

Inflexible negative trauma-related cognitions are a common consequence of trauma exposure and an important indicator of posttraumatic stress disorder. One common measure of trauma-related cognitions is the 36-item Posttraumatic Cognitions Inventory (PTCI; Foa et al., 1999). Recently, a nine-item abbreviated version was developed (PTCI-9; Wells et al., 2019), which may be a reliable alternative with improved model fit. The present study examined the latent factor structure of the PTCI and PTCI-9 in a sample of 185 treatment-seeking outpatients with traumatic stress symptoms to replicate and extend initial findings on the psychometric properties of the PTCI-9. Using confirmatory factor analysis, the correlated three-factor model of the PTCI-9 demonstrated excellent model fit at Time 1 and Time 2 (6 weeks later), as well as strong internal and test-retest reliability. It also exhibited configural, metric, and scalar invariance across time. The present study replicated previous findings that the PTCI-9 may be a psychometrically sound alternative for measuring trauma-related cognitions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Resilience predicts posttraumatic cognitions after a trauma reminder task and subsequent positive emotion induction among veterans with PTSD. Correction to Szabo et al. (2022).

Using a quasi-experimental design, we examined the association between trait resilience and state PTCs in veterans with PTSD (n = 47, Mage = 48.60, 91.8% male) at two points: following a written trauma narrative exposure (Time 1 [T1]), and following a subsequent positive distraction task (i.e., brief, positive video; Time 2 [T2]). After controlling for PTSD symptom severity and combat exposure, resilience was negatively associated with PTCs at T1 (ΔR2 = .19) and T2 (ΔR2 = .13). However, resilience was a poor predictor of change in PTCs from T1 to T2. We also examined the relationship between resilience and subtypes of PTCs: resilience was associated with negative views of the self (T1, ΔR2 = .24) but not negative views of the world or self-blame (T1, ΔR2s ≤ .07); these results were consistent at T2. Thus, resilience may attenuate negative trauma-related cognitions after trauma recall; however, this study was not designed to test causal pathways. Future research could examine whether resilience-building exercises reduce negative PTCs after trauma reminders among veterans. Additional research is needed to generalize to other trauma-exposed populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Resilience predicts posttraumatic cognitions after a trauma reminder task and subsequent positive emotion induction among veterans with PTSD.

Using a quasi-experimental design, we examined the association between trait resilience and state PTCs in veterans with PTSD (n = 47, Mage = 48.60, 91.8% male) at two points: following a written trauma narrative exposure (Time 1 [T1]), and following a subsequent positive distraction task (i.e., brief, positive video; Time 2 [T2]). After controlling for PTSD symptom severity and combat exposure, resilience was negatively associated with PTCs at T1 (ΔR2 = .19) and T2 (ΔR2 = .13). However, resilience was a poor predictor of change in PTCs from T1 to T2. We also examined the relationship between resilience and subtypes of PTCs: resilience was associated with negative views of the self (T1, ΔR2 = .24) but not negative views of the world or self-blame (T1, ΔR2s ≤ .07); these results were consistent at T2. Thus, resilience may attenuate negative trauma-related cognitions after trauma recall; however, this study was not designed to test causal pathways. Future research could examine whether resilience-building exercises reduce negative PTCs after trauma reminders among veterans. Additional research is needed to generalize to other trauma-exposed populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The role of social connectedness in buffering the effects of discrimination on post-trauma cognitions in forcibly displaced Muslims.

Among trauma-exposed, forcibly displaced Muslims, very little is known about how social connectedness, or perceived interpersonal connection and belonging, may alter the relationship between discrimination and negative posttraumatic cognitions. Discrimination may aggravate trauma psychopathology (Helms et al., 2010); however, social connectedness may buffer its negative effects (Juang & Alvarez, 2010). We examined whether higher religious and racial/ethnic discrimination would be associated with stronger negative posttraumatic cognitions and whether stronger social connectedness may adaptively buffer this relationship. Trauma exposed individuals (N = 99) who identified as Muslim and as a refugee, asylum seeker, or internally displaced person participated in the study. Measures of discrimination, social connection, and posttraumatic cognitions were completed. Higher discrimination was moderately associated with stronger negative trauma-related cognitions (r = .40, p < .001) and with lower social connectedness (r = -.32, p = .001). Social connectedness moderated the relationship between discrimination and posttraumatic cognitions, such that at lower levels of social connectedness there was a stronger relationship between discrimination and posttraumatic cognitions (-2SD: b = .32, -1SD: b = .23, M: b = .14), this was not present at higher levels of social connectedness. Connectedness to one's minority group may be an important protective factor by modulating the effects of discrimination on posttrauma adjustment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Help in hand after traumatic events: a randomized controlled trial in health care professionals on the efficacy, usability, and user satisfaction of a self-help app to reduce trauma-related symptoms

ABSTRACT Background: Despite the fact that many people are affected by trauma and suffer from posttraumatic stress symptoms (PTSS) there is a lack of easy-accessible interventions to self-manage these symptoms. Mobile apps may deliver low-intensity self-help to reduce trauma-related symptoms and empower individuals following trauma, such as high-risk professionals who are regularly exposed to potentially traumatic events. In this randomized controlled trial, we examined the efficacy, and evaluated the usability and user satisfaction of the app ‘SUPPORT Coach’ as a self-help tool to reduce trauma-related symptoms. Methods: Health care professionals (e.g. nurses, physicians, paramedics and ambulance drivers) completed an online screening on PTSS (T0). They were randomized when at least one PTSS was reported, either to the intervention (1 month unlimited access to SUPPORT Coach) or control condition (no access to SUPPORT Coach). Self-reported PTSS, negative trauma-related cognitions, psychological resilience, and social support were assessed online at baseline (T1), post-condition (T2), and 1 month follow-up (T3). Results: Of the 1175 participants screened, 287 (24.4%) indicated at least one posttraumatic stress symptom and were randomized. The majority of intervention condition participants (83%, n = 103) used SUPPORT Coach; they were slightly to moderately satisfied with the app. There was no significant group difference in change in PTSS and social support after one-month app usage. However, the intervention condition showed a greater decline in negative trauma-related cognitions at T2 and T3, and a larger increase in psychological resilience at T3 than the control condition. Conclusions: SUPPORT Coach without guidance could potentially provide easy-accessible self-help to diminish negative trauma-related cognitions, and strengthen resilience in coping with adversities. However, since the attrition rate was substantially higher in the intervention than in control condition, our findings should be interpreted with caution and warrant replication.

The relationship between negative trauma-related cognitions and psychosocial functioning in veterans with posttraumatic stress disorder and alcohol use disorder

Background: The comorbidity of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) is highly prevalent and associated with especially poor psychosocial functioning. Negative trauma-related cognitions are theoretically proposed to be associated with poor psychosocial functioning in PTSD, but few studies have examined the association between negative trauma-related cognitions and psychosocial functioning in PTSD/AUD. Evaluating this association may provide evidence of a potential treatment target for improving psychosocial functioning in PTSD/AUD. We hypothesized that negative trauma-related cognitions, including cognitions about the self, world, and self-blame, would be independently associated with poor psychosocial functioning in the following domains: vitality, psychosocial well-being, role limitations due to emotional distress, and social functioning. Methods: We examined the relationship between negative trauma-related cognitions and psychosocial functioning in 145 treatment-seeking veterans with PTSD/AUD using multiple linear regression analyses while controlling for PTSD and alcohol abuse and dependence severity. Results: Our hypotheses were partially supported. We found that negative trauma-related cognitions were uniquely associated with greater psychosocial functional impairment, independent of PTSD and alcohol abuse and dependence severity. Specifically, negative trauma-related cognitions about the self were associated with greater psychosocial functional impairment across all domains, cognitions about the world were associated with worse social functioning and psychological well-being, and self-blame was associated with impaired psychological well-being. Conclusions: Given that improvements in negative trauma-related cognitions are a mechanism of trauma-focused treatment, future studies should examine whether changes in negative trauma-related cognitions through trauma-focused treatment are associated with improved psychosocial functioning.

A gender-specific model of trauma and victimization in incarcerated women

ABSTRACT Trauma, victimization and risk factors associated with women’s pathways to crime have been widely discussed. The focus of this manuscript is on trauma and victimization’s role in the development of negative trauma related cognitions in the lives of incarcerated women. To improve post release adjustment it is imperative to understand how trauma experienced prior to incarceration [PIT-pre-incarceration trauma] and trauma associated with the prison environment [IBT-incarceration-based trauma] impedes incarcerated women’s ability to engage in future oriented behavior, such as gaining sustainable employment. A conceptual framework to examine, explain and theorize the effects of childhood and adulthood trauma experiences on post release adjustment of incarcerated women has been presented. This manuscript has been organized in two broad sections which aim to to review theoretical perspectives on the influence of PIT, specifically multiple traumatic events, on the development of negative trauma-related cognitions and the discontinuity of self; and (2) to propose a gender-specific conceptual model as a lens through which to critically examine the role of PIT in the lives of incarcerated women. The manuscript concludes with a discussion of how PIT, and IBT affects women’s Post-Release Adjustment. Implications for trauma-informed intervention with incarcerated women and gender-specific programming in criminal justice and community settings to provide a continuum of care are discussed.

The role of parental negative world assumptions in the intergenerational transmission of war trauma.

Among the most prevalent and adverse sequalae of traumatic experiences are negative world assumptions (WAs), which describe trauma-related negative cognitions regarding the self, the world, and others. Even though a wealth of studies has shown intrapersonal associations between negative WAs and posttraumatic stress symptoms (PTSS), there has been little research on how WAs may affect family systems. This study examined the intergenerational associations between parental WAs, paternal PTSS, and maternal secondary traumatic stress (STS) on adult-children's STS in veterans' families. It was hypothesized that negative paternal WAs would mediate the association between parental PTSS/STS and adult-children's STS. Three domains of WAs (benevolence of the world, meaningfulness of the world, and self-worth) and PTSS were prospectively assessed in 123 father-mother-offspring triads of former Israeli veterans of the 1973 Yom Kippur War, their wives and adult offspring. Data were collected in 2003, 2008, and 2014, and analyzed using triadic path modeling. Mothers' STS was associated with children's STS via negative maternal WAs on world benevolence. Fathers' PTSS was related to children's STS via fathers' WAs on world benevolence and self-worth. Moreover, fathers' WAs on world benevolence and self-worth mediated the intergenerational transmission of STS from mothers to offspring. No effects were found for meaningfulness WAs. Findings suggest that parental WAs related to world benevolence and paternal self-worth contribute to intergenerational trauma transmission. Clinical implications favor cognitive and systemic approaches to therapy that address negative benevolence and self-worth assumptions and involve the entire family system.

Predictors of dropout from a randomized clinical trial of cognitive processing therapy for female veterans with military sexual trauma-related PTSD

Many veterans do not complete evidence-based treatments (EBTs) for posttraumatic stress disorder (PTSD). Veterans with military sexual trauma (MST)-related PTSD were shown to have higher than average rates of dropout from PTSD treatment in a national study of EBT implementation. Although predictors of dropout from EBTs have been identified, these factors are largely unmodifiable (e.g., age, service era). The purpose of the present study was to identify dynamic psychosocial predictors of dropout among female veterans from cognitive processing therapy (CPT). Data were utilized from 56 female veterans who participated in a randomized clinical trial investigating the effectiveness of CPT for MST-related PTSD. Dropout was defined continuously (i.e., number of sessions attended) and dichotomously (i.e., attending six or more sessions). Potential predictors included sociodemographic factors, psychotherapist fidelity, PTSD-related service connection, psychiatric symptom severity (i.e., PTSD, depression), trauma-related negative cognitions (about self, self-blame, world), and treatment expectations. Higher trauma-related negative cognitions about self-blame and lower trauma-related negative cognitions about self were protective against dropout. The current study generated testable hypotheses for further research on dynamic predictors of dropout from CPT in female veterans with MST-related PTSD. With replication, results may assist with identifying pre-treatment strategies to reduce dropout in this clinical population.

The Association Between Negative Trauma-Related Cognitions and Pain-Related Functional Status Among Veterans With Posttraumatic Stress Disorder and Alcohol Use Disorder.

Among veterans with posttraumatic stress disorder (PTSD), alcohol use disorders (AUDs) are highly prevalent. Furthermore, PTSD frequently co-occurs with chronic pain (CP), and CP is associated with an increased risk of AUD. Pain-related beliefs and appraisals are significantly associated with poorer pain-related functional status, yet few studies have examined negative trauma-related cognitions and their impact on pain-related functional disability in veterans with co-occurring PTSD and AUD. Accordingly, we examined the association between negative trauma-related cognitions and pain severity and pain disability in 137 veterans seeking treatment for PTSD and AUD. Using hierarchical multiple linear regression, we found that higher levels of negative trauma-related cognitions (e.g., "I am completely incompetent") were associated with a higher level of pain severity, after controlling for PTSD symptom severity and frequency of alcohol use, total R2 = .07, ΔR2 = .06. Additionally, as hypothesized, we found that higher levels of negative trauma-related cognitions were associated with higher levels of pain disability, after controlling for PTSD symptom severity, frequency of alcohol use, and pain severity, total R2 = .46, ΔR2 = .03. Given that negative trauma-related cognitions contributed to pain severity and pain disability, even when controlling for PTSD severity and frequency of alcohol use, future studies should explore the potential impact of interventions that address negative trauma-related cognitions (e.g., prolonged exposure or cognitive processing therapy) on pain severity and disability.

They Are Coming Home: The Effect of Trauma-Related Cognitions on Vocational Readiness of Incarcerated Women.

The prevalence of trauma in the lives of incarcerated women has been well-documented. Yet, few studies have included trauma-related cognitions, a common response to interpersonal trauma, in their analyses. The purpose of this study was to examine the relationship between trauma (pre-incarceration trauma [PIT] and incarceration-based trauma [IBT]), trauma-related cognitions [TRC] (i.e., Total; Self, Blame, and World), posttraumatic stress disorder (PTSD) severity, and vocational readiness-motivation (VR-M) in a random sample of incarcerated women in three prison facilities. A cross-sectional research design was employed using a stratified random sampling procedure. The stratum was housing security levels 1 to 4. The study was conducted in three prisons located in the midwestern region of the United States. Self-administered questionnaires measured PIT, IBT, TRC, PTSD, and VR-M. The study sample included (N = 250) female inmates: 152 White (60.8%), 50 Black (20.4%), 18 Biracial (7.3%), 13 Native American/Pacific Islander (5.3%), and 12 Latina (4.8%) females. The average age of participants was 36.2, and 82.4% were mothers. A key finding in this study was that TRC-Total was best predicted by trauma associated with the prison environment (IBT) and PTSD severity. Our findings indicated that for Black and Latina women, higher levels of trauma-related cognitions about "self" were predictive of a lower potential for vocational readiness in the area of motivation. Future examination of trauma's effect on the development of negative trauma-related cognitions about self (e.g., self as incompetent) has the potential to inform prison mental health practice and the development of clinical interventions to decrease trauma-related cognitions about self for incarcerated women with multiple trauma experiences.

Trauma-Related Negative Cognitions Mediate the Relationship Between Avoidant Personality Beliefs and Impeded Response to Psychotherapy for PTSD

ABSTRACTThere is strong research evidence for the association of personality pathology and posttraumatic stress disorder (PTSD), as well as trauma-related negative cognitions (TRNC) and PTSD symptoms. However, the relationship between personality pathology and TRNC in the context of PTSD is mostly unknown. In the present study, we aimed to examine whether avoidant and borderline personality beliefs (PB, indicator of personality pathology) could predict therapy outcome in PTSD, and whether the relationship between PB and therapy outcome could be mediated by TRNC. Sixty patients with PTSD were assessed for PB, TRNC and PTSD symptoms at baseline, and for PTSD symptoms at the termination of Prolonged Exposure Therapy. Baseline avoidant PB predicted significant variance in PTSD symptoms at termination over and above baseline PTSD symptoms (16% reduction in treatment effect per SD on avoidant PB). Moreover, TRNC at baseline fully mediated the relationships between baseline avoidant PB and PTSD symptoms at termination. This is the first study to show that avoidant PB predicts treatment response in PTSD, and that patients with avoidant beliefs are more vulnerable to have TRNC, which are associated with impeded therapy response. Our results highlight the importance of targeting both dysfunctional PB and TRNC in PTSD interventions.

Predictors of Unbearability, Unlovability, and Unsolvability in Veterans With Military-Sexual-Trauma-Related Posttraumatic Stress Disorder.

Military sexual trauma (MST) and posttraumatic stress disorder (PTSD) both increase risk for suicidal self-directed violence (SDV). Suicide cognitions (i.e., unbearability, unlovability, and unsolvability) are strong predictors of future suicidal SDV. The present study investigated potential predictors of unbearability, unlovability, and unsolvability in veterans with MST-related PTSD. Suicide cognitions, depression, PTSD, quality of life, trauma-related negative cognitions, physical health functioning, mental health functioning, and childhood sexual assault were assessed in 12 male and 103 female veterans with MST-related PTSD. Higher depression scores, greater trauma-related negative cognitions about self, and poorer physical health functioning predicted increased unbearability scores. Greater trauma-related negative cognitions about self and self-blame, higher level of education, and higher depression scores predicted increased unlovability scores. Higher depression scores and greater trauma-related negative cognitions about self predicted increased unsolvability scores. In veterans with MST-related PTSD who express unbearability, unlovability, and unsolvability, assessing and addressing depression, trauma-related negative cognitions about self and self-blame, and physical health functioning may be an important step in reducing SDV.

A Single-Arm Meta-Analysis of Cognitive Processing Therapy in Addressing Trauma-Related Negative Cognitions

ABSTRACTCognitive Processing Therapy (CPT) is a first-line treatment for posttraumatic stress disorder designed to address cognitive “stuck points” connected to a patient’s trauma-related negative cognitions (NCs). Although CPT has well-established efficacy, the ability of CPT to address NCs remains understudied. The purpose of this study was to conduct a single-arm meta-analysis to determine the overall effect of CPT in attenuating NCs pre- to posttreatment across multiple clinical trials. A review of the existing literature was performed with only peer-reviewed clinical trials included in the meta-analysis. Nine studies with data from 583 participants were entered into the meta-analysis. CPT was found to have a large effect size in reducing NCs from pre- to posttreatment. Findings are limited by the single-arm nature of analyses and heterogeneity in included trial methodology (e.g., gender, trauma type, civilian versus veteran).

Reductions in self-blame cognitions predict PTSD improvements with cognitive processing therapy for military sexual trauma-related PTSD

Reductions in trauma-related negative cognitions during Cognitive Processing Therapy (CPT) are theorized to precede posttraumatic stress disorder (PTSD) symptom reduction. This mechanism of change has not been validated for veterans with military sexual trauma-related PTSD. Using data from a previously published randomized clinical trial (n = 32), changes in trauma-related negative cognitions about self, self-blame, and the world were entered as predictors of change in PTSD symptoms for cross-lagged panel analyses. From baseline to 6-months posttreatment, only changes in self-blame predicted and temporally preceded changes in PTSD symptoms, highlighting a potential mechanism of change in CPT for military sexual trauma-related PTSD.

The role of negative cognitions, emotion regulation strategies, and attachment style in complex post-traumatic stress disorder: Implications for new and existing therapies.

We set out to investigate the association between negative trauma-related cognitions, emotional regulation strategies, and attachment style and complex post-traumatic stress disorder (CPTSD). As the evidence regarding the treatment of CPTSD is emerging, investigating psychological factors that are associated with CPTSD can inform the adaptation or the development of effective interventions for CPTSD. A cross-sectional design was employed. Measures of CPTSD, negative trauma-related cognitions, emotion regulation strategies, and attachment style were completed by a British clinical sample of trauma-exposed patients (N=171). Logistic regression analysis was used to assess the predictive utility of these psychological factors on diagnosis of CPTSD as compared to PTSD. It was found that the most important factor in the diagnosis of CPTSD was negative trauma-related cognitions about the self, followed by attachment anxiety, and expressive suppression. Targeting negative thoughts and attachment representations while promoting skills acquisition in emotional regulation hold promise in the treatment of CPTSD. Further research is required on the development of appropriate models to treat CPTSD that tackle skills deficit in these areas. Results suggest that cognitive-behavioural interventions might be useful for the treatment of CPTSD. Targeting negative thoughts and attachment representations while promoting skills acquisition in emotional regulation hold promise in the treatment of CPTSD.

A preliminary examination of the role of psychotherapist fidelity on outcomes of cognitive processing therapy during an RCT for military sexual trauma-related PTSD

While cognitive processing therapy (CPT) is an effective evidence-based treatment for many veterans with military-related post-traumatic stress disorder (PTSD), not all veterans experience therapeutic benefit. To account for the discrepancy in outcomes, researchers have investigated patient- and research design-related factors; however, therapist factors (e.g. fidelity) have received less attention. The present study is a preliminary examination of the effect of psychotherapists’ fidelity during CPT on clinical outcomes during a randomized clinical trial (RCT) for military sexual trauma-related PTSD. PTSD symptoms, trauma-related negative cognitions (NCs), and depression symptoms were assessed for 72 participants at baseline, and 1-week, 2-month, 4-month, and 6-month posttreatment. Of the four CPT therapists, two were found to have significantly poorer (i.e. “below average”) treatment fidelity scores compared to the other two therapists who had “good” treatment fidelity scores. To examine possible therapist effects on outcomes, hierarchical linear modeling was utilized with therapist fidelity entered as a Level 2 predictor. Participants treated by a therapist with “good” treatment fidelity experienced significantly greater reductions in PTSD symptoms, NCs, and depression symptoms than patients treated by a therapist with “below average” treatment fidelity. Our preliminary findings highlight the importance of monitoring, maintaining, and reporting fidelity in psychotherapy treatment RCTs.

Metacognitive capacity predicts severity of trauma-related dysfunctional cognitions in adults with posttraumatic stress disorder

Deficits in metacognition have been proposed as a barrier to adaptive responding to trauma. However, little is known about how different aspects of metacognitive capacity relate to responses to trauma and whether their potential link to such responses is independent of the overall level of psychopathology. To explore both issues, negative trauma-related cognitions about the self, the world, and self-blame, as measured by the Posttraumatic Cognitions Inventory (PTCI), were correlated with concurrent measures of depression, posttraumatic stress disorder symptoms, and two forms of metacognition; the Metacognitions questionnaire (MCQ-30), which focuses on specific thoughts, and the Metacognition Assessment Scale Abbreviated (MAS-A) which focuses on the degree to which persons can form complex representations of self and other. Participants were 51 veterans of the wars in Iraq and Afghanistan who had a PTSD diagnosis primarily involving a combat-related index trauma. Correlations revealed that being younger and more depressed were linked with greater levels of negative cognitions about self and the world. Lower levels of self-reflectivity on the MAS-A and higher levels of cognitive self-consciousness on the MCQ-30 were uniquely related to greater levels of self-blame even after controlling for age, level of depression, and PTSD. Implications for research and treatment are discussed.