Posttraumatic Appraisals Research Articles

Trauma appraisals and posttraumatic growth among survivors of sexual assault.

Trauma survivors often endorse some level of posttraumatic growth (PTG), referring to positive outcomes after trauma related to meaning-making and strengthened perceptions of the self. While extant research points to cognitive processes at the root of PTG, posttrauma cognitions such as shame, fear, and self-blame have thus far only been linked to negative outcomes of trauma exposure. The current study examines the association between posttrauma appraisals and PTG among victims of interpersonal violence. Findings will reveal whether appraisals directed toward the self (shame and self-blame), toward the world (anger and fear), or those directed toward relationships (betrayal and alienation) are most conducive to growth. A sample of 216 adult women aged 18-64 years were interviewed at baseline and 3, 6, and 9 months later as part of a larger study on social reactions received when disclosing sexual assault. As part of the interview battery, they were administered the Posttraumatic Growth Inventory (PTGI) and Trauma Appraisal Questionnaire. Posttrauma appraisals were used as time-invariant predictors of PTG (PTGI score) at each of the four time points. Posttrauma appraisals of betrayal were associated with initial PTG and alienation appraisals predicted increases in PTG over time. However, self-blame and shame did not predict PTG. Results suggest that a violation to one's views of interpersonal relationships, reflected in experiences of alienation and betrayal posttrauma, may be especially relevant for growth. As PTG reduces distress among trauma victims, this finding suggests targeting maladaptive interpersonal appraisals is an important intervention target. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Appraisals of Social Trauma and Their Role in the Development of Post-Traumatic Stress Disorder and Social Anxiety Disorder.

Cognitive theories of post-traumatic stress disorder (PTSD) feature appraisal of trauma as a critical factor in the development and maintenance of the disorder. Here we explored appraisals of social trauma (severe rejection or humiliation). Participants were outpatients with social anxiety disorder (SAD) and clinically significant PTSD symptoms (PTSS) after social trauma (n = 15); two clinical control groups of either SAD (n = 32) or obsessive-compulsive disorder (OCD; n = 13); and a control group with no diagnoses (n = 38). Measures included a clinical interview to assess social trauma and related open-ended appraisals and the Posttraumatic Cognitions Inventory (PTCI). Raters blind to group assignment performed content analyses of appraisals. Results showed that the PTSS group scored significantly higher than either clinical group on the PTCI SELF subscale. Only the SELF subscale predicted a diagnosis of both PTSS and SAD. All but one PTSS participant reported primarily negative beliefs about their social trauma, and the most common categories were flawed self and others are critical or cruel. Post-traumatic appraisals implicated in the course of PTSD are significant in how individuals respond to social trauma, with negative self-cognitions linked to both PTSS and SAD.

The nature of posttraumatic stress disorder in treatment-seeking first responders

ABSTRACT Background Approximately 10% of first responders report posttraumatic stress disorder (PTSD). Although reports within first responders suggest that they have distinct symptom presentations, there is a need to understand how the clinical profiles of first responders may differ from others seeking treatment for PTSD. Objective This study compared the PTSD symptom profiles of first responder and civilians seeking treatment for PTSD. Method Participants self-referred to the Traumatic Stress Clinic (University of New South Wales, Sydney) for enrolment in out-patient treatment trials for PTSD. Participants comprised people of mean age 41.72 years (SD = 10.71) who met DSM-IV criteria for PTSD. The sample was composed of 128 first responders and 182 civilians. Clinician-administered interviews of PTSD (Clinician-Administered PTSD Scale) and depression were conducted, as well as measures of self-report measures of depression, alcohol use, posttraumatic appraisals, and anger. Results First responders reported greater rates of dysphoric cluster of symptoms, including diminished interest, emotional numbing, and social detachment, and less psychological reactivity and avoidance of situations, than civilians with PTSD. Beyond PTSD symptoms, first responders also reported more severe levels of depression and suppressed anger. Conclusions These findings indicate that treatment-seeking first responders present with a distinct clinical profile that is characterized by dysphoric symptoms. These symptoms can predict poor treatment response and require specific attention in treating PTSD in first responders.

Betrayal trauma, dissociative experiences, and posttrauma cognitions among women in a state shelter home

Context: There is a long history of interpersonal trauma in women, and the risk factors and mental health consequences have been well studied. Betrayal trauma (BT) theory by Freyd talks about the specific kind of trauma perpetrated by someone close to the victim, which may lead to increased dissociative responses. Recent research extends the theory to explain the role of posttrauma appraisals playing a mediating role in the development of psychopathological responses.Aim: The aim of this study was to explore trauma history, BT, and dissociative experiences among women in a Government Reception Centre.Setting: The sample included 30 women from the Reception Centre, Bangalore.Subjects and Methods: Data were obtained using a Sociodemographic Data Sheet, Brief BT Survey (revised), the Dissociative Experiences Scale, Posttrauma Cognitions Inventory and a visual analog scale for assessing psychological distress.Statistical Analysis Used: Descriptive statistics and nonparametric inferential statistics were used for quantitative analysis.Results: All the women in the sample had experienced BT directly or as witnesses. There was no significant difference in dissociation between high- and low-BT groups. The presence of negative cognitions toward oneself was associated with increased dissociative experiences. Negative cognitions toward self and depersonalization experiences were higher in the group with severe physical trauma than the group without.Conclusion: The article highlights the high prevalence of betrayal trauma, and risk for trauma-related psychopathology and revictimization that go unassessed in government shelter homes, while reiterating the need for a trauma-informed care approach to intervention.

Associations between relationship quality, social network resources, appraisals, coping, and posttraumatic stress disorder symptoms.

Objective: This study aimed to explore whether posttrauma cognitions and maladaptive coping strategies mediated the association between perceived social support (availability of social network and quality of specific relationships) and posttraumatic stress disorder (PTSD) symptoms. Method: A community sample of trauma survivors (N = 67, 84% female) completed self-report measures assessing relationship quality, perceived availability of social network support, PTSD symptoms, negative posttrauma appraisals and maladaptive coping strategies. Results: Posttrauma appraisals mediated the association between quality of relationships (support, conflict and depth) and PTSD symptoms, and between availability of social network support and PTSD symptoms. Further, there was an indirect pathway between social support (quality of relationship and availability of social network) and PTSD symptoms through negative cognitive appraisals and maladaptive coping strategies (serial mediation). Conclusions: Our results are consistent with theoretical predictions that socially supportive (support, depth and social network availability) and unsupportive (conflict) relationships are associated with PTSD, through cognitive appraisal and coping processes. Clinical implications for further integrating interpersonal support into cognitive therapies were discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A Longitudinal Examination of the Relationship between Trauma-Related Cognitive Factors and Internalising and Externalising Psychopathology in Physically Injured Children

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.

Shame and alienation related to child maltreatment: Links to symptoms across generations.

The current study investigated associations between appraisals of shame and alienation related to mothers' own experiences of child maltreatment and symptoms across generations-in mothers themselves as well as their toddler/preschool-aged children. Mothers who survived maltreatment (N = 113) with a child between the ages of 2 and 5 were recruited to participate in an online study on Maternal Coping, Attachment and Health. Mother participants completed a series of questionnaires, including those that asked about posttrauma appraisals of their own maltreatment experiences as well as their child's and their own mental health symptoms. When taking into account other posttrauma appraisals (e.g., fear, betrayal, anger, self-blame), maternal shame and alienation were both significantly associated with maternal trauma-related distress (a composite of anxiety, PTSD, dissociation, and depressive symptoms). Maternal shame was also significantly linked to child internalizing symptoms and externalizing symptoms. Lower levels of fear and higher levels of betrayal were associated with externalizing symptoms as well. Maternal trauma-related distress mediated the relationship between maternal shame and child externalizing symptoms, and partially mediated the relationship between shame and internalizing symptoms. This study is the first of its kind to examine the role of posttrauma appraisals among mother survivors of maltreatment as they relate to symptoms in their young children. Although additional research is necessary, findings suggest that mothers' posttrauma appraisals, such as shame, could be a relevant factor in the early social-emotional development of survivors' children. (PsycINFO Database Record

Development and Evaluation of the Thinking About Recovery Scale: Measure of Parent Posttraumatic Cognitions Following Children's Exposure to Trauma.

Researchers have recently suggested that parent posttraumatic appraisals potentially contribute to the development of posttraumatic stress in both parents and children following children's exposure to trauma. However, a single-instrument, multidimensional measure of parent posttraumatic cognitions as they relate to their child's recovery has yet to be operationalized. This study described the development and evaluation of a parent-report questionnaire of parent posttraumatic cognitions, designed to be used after a child's exposure to trauma. We generated an initial pool of items in reference to existing theories and subjected this list to an iterative process of item writing and revision. Items were subjected to expert review to maximize construct validity. The 33-item Thinking About Recovery Scale (TARS), which measures three domains (My child has been permanently damaged; The world is dangerous for my child; Parents should always promote avoidance) demonstrated good internal consistency (Cronbach's α = .74-88) and convergent validity (r 2 range = .08-.40) when piloted in a sample of 116 parents of children who had been exposed to a serious accidental injury. The TARS augments the available literature by providing a brief measure of parent posttraumatic cognitions, an area which is currently understudied in childhood posttraumatic stress and could have broad clinical and research use.

Intergenerational Transmission of Trauma: Maternal Trauma-Related Cognitions and Toddler Symptoms.

The purpose of this study was to elucidate possible cognitive mechanisms involved in the intergenerational transmission of trauma from maltreatment-survivor mothers to their toddler/preschool-aged children. This study investigated whether maternal trauma-related cognitions-posttrauma appraisals and disorganized memory for maltreatment-were associated with higher levels of toddler internalizing and externalizing symptoms and more dysfunction in the mother-child relationship. A community sample of mothers with histories of maltreatment and a child between the ages of 2 and 5 years was recruited for a study on maternal attachment, coping, and health ( N = 113). Path analysis results showed that posttrauma appraisals and disorganized memory were significantly related to toddler internalizing symptoms, even with maternal trauma symptoms included in the model. Maternal posttrauma appraisals and disorganized memory were also linked to more dysfunction in the mother-child relationship. These findings provide preliminary evidence in support of maternal trauma-related cognitions as potential mechanisms for the intergenerational transmission of trauma.

PTSD symptoms and perception of cognitive problems: The roles of posttraumatic cognitions and trauma coping self-efficacy.

Posttraumatic stress disorder (PTSD) is associated with mild neurocognitive deficits, yet clients often complain of cognitive problems that exceed what their objective performance demonstrates. In addition, PTSD is associated with negative appraisals about the self, traumatic event, and one's ability to cope. This study examined posttraumatic cognitions as a moderator, and trauma coping self-efficacy as a mediator, of the relationship between PTSD symptoms and self-report of cognitive problems. A sample of 268 trauma-exposed adults completed the PTSD Checklist for DSM-5, the Posttraumatic Cognitions Inventory, the Trauma Coping Self-Efficacy Scale, the Cognitive Self-Report Questionnaire, and the Quality of Life Scale. Negative self-appraisals was a significant moderator in the relationship between PTSD symptoms and perception of cognitive problems (β = -.252, p = .001). In participants with high levels of negative posttraumatic cognitions, perception of cognitive problems was high regardless of PTSD symptom level. In a mediator analysis, there was a significant indirect effect of trauma coping self-efficacy (b = .125, 95% CI [.088, .172]). Finally, there was evidence of moderated mediation, such that trauma coping self-efficacy was a mediator only when posttraumatic cognitions were low or average. Results indicate that posttraumatic appraisals and coping self-efficacy play significant roles in perception of cognitive problems following trauma. Clinically, in patients for which there is a perception of cognitive impairment that is not borne out in neuropsychological testing, cognitive-behavioral therapy focused on altering negative self-perceptions and appraisals may be beneficial. (PsycINFO Database Record

Victim–perpetrator dynamics through the lens of betrayal trauma theory

ABSTRACTInterpersonal trauma exposure is linked with a host of seemingly disparate outcomes for victims, such as psychological distress, post-trauma appraisals (e.g., alienation, shame), poor cognitive functioning, expectations of harm in relationships, and revictimization risk. The presence of interpersonal trauma alone may not fully explain this range of outcomes. The current paper applies Betrayal Trauma Theory (BTT), which was originally articulated two decades ago as a framework for understanding memory disruptions following interpersonal trauma, as a framework to understand the diverse outcomes that can occur when interpersonal trauma is perpetrated by a close other. Implications for clinical work and future research are considered.

Post-traumatic cognitions as a mediator of the relationship between sense of coherence and post-traumatic stress disorder after motor vehicle accidents

ObjectiveIndividuals who experience a motor vehicle accident (MVA) are at increased risk for psychological problems, particularly post-traumatic stress disorder (PTSD). Among a wide range of pre-trauma cognitions, the sense of coherence (SOC) is considered as a good predictor of effective post-traumatic adaptation. However, the mechanism underlying the relationship between this resilience factor and the intensity of PTSD so far has not been fully explored. There arises the question of whether SOC protects only from the development of PTSD symptoms in the early post-traumatic period, or also from further development of the symptoms over time. Furthermore, has SOC an impact on PTSD directly, or through a third explanatory variable? This longitudinal study offers a contribution to the discussion. In searching for a potential mediator, the model of trauma-related beliefs was taken into consideration. MethodData were drawn from 289 MVA survivors. The first measurement took place one to six months after the injury; the second was taken a year later. The mediation hypotheses were tested using structural equation modelling. The path analysis method was carried out using LISREL 8.72. ResultsA path analytic modelling approach showed that SOC predicted the subsequent intensity of PTSD over and above what could be predicted from the initial symptom levels; however, the relationship was mediated by negative post-traumatic cognitions. Among them, only negative cognitions about self played a statistically significant mediating role. ConclusionsOur findings highlight the inverse relationship between SOC and later PTSD symptoms, mediated by post-traumatic cognitions. The set of negative cognitions about self, strongly related to other post-traumatic appraisals, plays the most influential mediating role. This confirms the suggestion, found in the current literature, that negative cognitions about self may have some hierarchical preference that drives other belief systems. Moreover, our findings present SOC as a resilience factor that provides added value in predicting the long-term psychological outcomes of trauma. It protects against PTSD symptoms development and escalation over time through a specific cognitive mechanism. In consequence, changes in cognitions seem to constitute one of the basic mechanisms of the development and maintenance of PTSD symptoms. This fully supports the decision to include post-traumatic negative cognitions and alteration in mood in the diagnosis of PTSD in DSM-5.

The Impact of Appraisals and Context on Readiness to Leave a Relationship Following Intimate Partner Abuse.

The current longitudinal study examined the relative impact of symptoms and appraisals as well as contextual and demographic factors on women's subsequent readiness to leave a relationship following intimate partner abuse. An ethnically diverse sample of women (N = 177) completed measures assessing posttrauma appraisals, symptoms, dependence on the perpetrator, and abuse characteristics. One year later, women reported on their readiness to leave the relationship. Regression analyses revealed that readiness to leave was (a) positively predicted by fear appraisals, (b) negatively predicted by shame appraisals, and (c) significantly associated with additional contextual factors (i.e., dependence on the perpetrator, stalking behaviors).

Links between posttrauma appraisals and trauma-related distress in adolescent females from the child welfare system

Research on predictors of trauma-related distress in youth has tended to focus on trauma exposure and individual difference characteristics. This study extends previous research by examining the role of posttrauma appraisals in predicting trauma-related distress in a sample of female adolescents with current or prior involvement in the child welfare system and a history of maltreatment. Participants’ posttrauma appraisals accounted for unique variance in trauma-related distress, above and beyond key trauma exposure and individual difference variables. Further, posttrauma appraisals of alienation accounted for unique variance in posttraumatic stress, dissociation, and depression symptom severity, and posttrauma appraisals of shame accounted for unique variance in posttraumatic stress symptom severity. These results suggest that posttrauma appraisals may represent an important predictor of trauma-related distress for youth with current or prior involvement in the child welfare system. They also replicate findings in youth and adult literature on interpersonal trauma, lending further support to the existence of specific pathways between certain appraisals and various forms of trauma-related distress. We discuss the implications of our study for trauma-informed practice within the child welfare system.

Links between the police response and women's psychological outcomes following intimate partner violence.

Virtually no research considers the psychological impact of institutional support for survivors of intimate partner violence (IPV). This study sought to fill this gap by examining associations between one component of institutional support--the police response--and posttraumatic stress disorder (PTSD) symptom severity and posttrauma appraisals (i.e., anger, fear, and self-blame) in a diverse sample of female IPV survivors (N = 236). Results indicated that a more negative police response, as operationalized by women's unmet expectations in relation to the police, was significantly associated with greater PTSD symptom severity in a very conservative test that involved controlling for personal resources and social support. Police response was not significantly associated with the tested posttrauma appraisals. Implications for policy and practice will be discussed. This study advances understanding of the psychological impact of the police response--one key component of institutional support.

Trauma-related guilt and posttraumatic stress among journalists

This study explored the psychological impact of exposure to work-related trauma among journalists. It was hypothesised that positive associations would exist between (a) exposure and PTSD symptoms, (b) exposure and guilt cognitions, and (c) guilt cognitions and PTSD symptoms, and that the relationship between exposure and PTSD symptoms would be mediated by guilt cognitions. The sample consisted of 50 journalists (response rate = 15%), who had recently been exposed to work-related trauma. They were predominantly male, aged 40 years or older, well-educated, and most had worked in journalism for at least 15 years. Participants completed an online questionnaire that explored their work-related experiences of trauma, PTSD symptoms, and trauma-related guilt cognitions. The findings showed that higher levels of exposure to work-related trauma were significantly associated with higher levels of PTSD symptoms (r = .36) and trauma-related guilt cognitions (r = .29). Guilt cognitions were significantly and positively independently associated with PTSD symptoms (r = .12) and were consistent with partial mediation of relationship between exposure to work-related trauma and PTSD symptoms. This study provides greater insight into the psychological processing of work-related traumatic events among journalists and emphasizes the importance of posttrauma appraisals of guilt regarding their experiences.

Links between specific posttrauma appraisals and three forms of trauma-related distress.

Several categories of posttrauma appraisals (e.g., fear, shame, self-blame) have been associated with different forms of trauma-related distress (e.g., posttraumatic stress disorder [PTSD], depression symptoms). In this paper, we extend previous research to consider two appraisal categories that have received little attention to date: alienation and betrayal. Alienation may be important following interpersonal traumas that disrupt one’s connection to self and others. Betrayal trauma theory points to the importance of betrayal in motivating responses to interpersonal traumas, though little research has directly examined appraisals of betrayal. With three separate samples of adults (one undergraduate; two community-based), we examined the relative contributions of six distinct appraisal categories (alienation, anger, betrayal, fear, shame, and self-blame) to three forms of trauma-related distress (PTSD, dissociation, and depression symptoms). Participants’ posttrauma appraisals accounted for variance in trauma-related distress above and beyond characteristics of the trauma itself. Further, specific appraisal categories accounted for unique variance in different forms of trauma-related distress. Across samples, alienation was significantly related to all three distress types, suggesting that appraisals of disconnection from the self and others are common across trauma-related distress responses. Several distress-appraisal patterns were replicated across samples, including links between self-blame and depression; shame and PTSD; and betrayal and dissociation. Betrayal-dissociation links have important implications for betrayal trauma theory. The results point to the importance of understanding specific appraisal processes associated with different forms of trauma-related distress.

Adaptive Disclosure: An Open Trial of a Novel Exposure-Based Intervention for Service Members With Combat-Related Psychological Stress Injuries

We evaluated the preliminary effectiveness of a novel intervention that was developed to address combat stress injuries in active-duty military personnel. Adaptive disclosure (AD) is relatively brief to accommodate the busy schedules of active-duty service members while training for future deployments. Further, AD takes into account unique aspects of the phenomenology of military service in war in order to address difficulties such as moral injury and traumatic loss that may not receive adequate and explicit attention by conventional treatments that primarily address fear-inducing life-threatening experiences and sequelae. In this program development and evaluation open trial, 44 marines received AD while in garrison. It was well tolerated and, despite the brief treatment duration, promoted significant reductions in PTSD, depression, negative posttraumatic appraisals, and was also associated with increases in posttraumatic growth.

Maladaptive cognitive appraisals mediate the evolution of posttraumatic stress reactions: A 6-month follow-up of child and adolescent assault and motor vehicle accident survivors.

A prospective longitudinal follow-up study (n = 59) of child and adolescent survivors of physical assaults and motor vehicle accidents assessed whether cognitive processes predicted posttraumatic stress symptomatology (PTSS) at 6 months posttrauma in this age group. In particular, the study assessed whether maladaptive posttraumatic appraisals mediated the relationship between initial and later posttraumatic stress. Self-report measures of PTSS, maladaptive appraisals, and other cognitive processes, as well as structured interviews assessing for acute stress disorder and posttraumatic stress disorder (PTSD), were completed at 2-4 weeks and 6 months posttrauma. PTSS and PTSD at 6 months were associated with maladaptive appraisals and other cognitive processes but not demographic or objective trauma severity variables. Only maladaptive appraisals were found to associate with PTSS/PTSD after partialing out initial symptoms/diagnosis and to mediate between initial and later PTSS. It was argued that, on this basis, maladaptive appraisals are involved in the development and maintenance of PTSS over time, whereas other cognitive processes (e.g., subjective threat, memory processes) may have an effect only in the acute phase. The implications of this study for the treatment of PTSS in youths are discussed.

The psychological consequences of combat exposure: The importance of appraisals and post‐traumatic stress disorder symptomatology in the occurrence of delusional‐like ideas

The aim of the current study is to explore the association between combat experience and the occurrence of delusional-like beliefs. It is hypothesized that negative post-trauma appraisals and positive beliefs about paranoia will be associated with vulnerability to delusional ideas and that veterans who meet criteria for post-traumatic stress disorder (PTSD) will be more likely to hold delusional-like ideas. A small-scale survey design was employed in order to ensure that detailed information was gathered concerning battle exposure. Forty-one British war veterans completed questionnaires relating to combat experience, delusional ideation, beliefs about paranoia, appraisals of combat trauma and PTSD symptomatology. Negative post-trauma cognitions and positive and negative beliefs about paranoia were associated with increased predisposition to delusional beliefs; however, the severity of combat experience was not. It was also found that veterans who met criteria for PTSD were more likely to hold delusional-like ideas compared with those who did not. Furthermore, the PTSD group held more negative post-trauma cognitions and more positive beliefs about paranoia. These findings suggest that PTSD symptoms may confer vulnerability to delusional beliefs and that this may be mediated by negative appraisals about the self, the world and dysfunctional beliefs about paranoia. However, it is possible that psychotic-like phenomena confer vulnerability to PTSD. The implications of these findings are discussed.