A Meta‐Analytic Review of the Association Between Alienation Appraisals and Posttraumatic Stress Disorder Symptoms in Trauma‐Exposed Adults

Abstract

Ehlers and Clark's (2000) cognitive model of posttraumatic stress disorder (PTSD) highlights the importance of negative appraisals in maintaining posttraumatic stress. Recent research suggests that alienation appraisals, defined as feeling disconnected from the self and others, mediate the association between traumatic experiences and subsequent PTSD symptoms. To our knowledge, no systematic review has yet explored the relation between alienation appraisals and PTSD symptoms in trauma-exposed adults, despite the important clinical implications posed by this association. A systematic search of the SCOPUS, Web of Science, PsycInfo, MEDLINE, CINAHL Plus, and PILOTS databases resulted in 470 studies, nine of which met full inclusion criteria. Studies were quality-assessed for risk of bias using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD) quality assessment tool. A random-effects meta-analysis for the association between alienation appraisals and PTSD symptoms showed a large total effect size, r = .57, 95% CI [.46, .66], z = 8.41, p < .001. This large effect suggests that as alienation appraisals increase, PTSD symptoms increase. Although a strong positive association was found between alienation and PTSD symptoms, the mechanism of this association remains unclear. Limitations of the research included significant heterogeneity across studies and the fact that data were correlational. Future research to explore why alienation appraisals are significant in posttraumatic stress may further help to inform therapeutic approaches to targeting alienation appraisals in trauma survivors. Recommendations are made for the clinical assessment of alienation appraisals when exploring the impact of the traumatic experience on the survivor. Exposure to traumatic events is common; however, most people who witness or experience traumatic events do not develop posttraumatic stress disorder (PTSD; Schnurr, Friedman, & Bernardy, 2002). A large-scale survey of 2,953 adults in the United States found that although 89.7% of the sample had been exposed to a traumatic event, only 8.3% of the sample met the diagnostic criteria for PTSD per the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; Kilpatrick et al., 2013).

Examining bidirectional associations between perceived social support and psychological symptoms in the context of stressful event exposure: a prospective, longitudinal study

“…Among others, depressive and PTS symptoms are associated with problems in social cognition, that is the identification, perception and interpretation of socially relevant information [28,67]. Moreover, individuals with depressive [27,68,69] and PTS symptoms [69][70][71][72] report more distressing social emotions and associated maladaptive social cognitions. These feelings and cognitions relate, for example, to shame, guilt, social alienation and revenge [68][69][70][71][72].…”

“…Moreover, individuals with depressive [27,68,69] and PTS symptoms [69][70][71][72] report more distressing social emotions and associated maladaptive social cognitions. These feelings and cognitions relate, for example, to shame, guilt, social alienation and revenge [68][69][70][71][72]. On a behavioral level, individuals with depressive and PTS symptoms report problems regarding emotional self-disclosure [73,74] and show decreased reward-oriented social behavior [75,76].…”

Reproductive justice in the time of COVID-19: a systematic review of the indirect impacts of COVID-19 on sexual and reproductive health

“…Total scores range from 0 to 42, with higher scores indicating higher quality research. Scores were converted into a percentage, and those scoring > 60% were rated as high-quality studies, whereas those scoring ≤ 60% were rated as lower quality studies [ 31 ]. TM and AK independently reviewed and rated each study for risk of bias.…”

“… Quality Assessment Tool for Studies with Diverse Designs [ 29 ] Item 1: Explicit theoretical framework Item 2: Statement of aims/objectives in main report Item 3: Clear description of research setting Item 4: Evidence of sample size considered in terms of analysis Item 5: Representative sample of target group of a reasonable size Item 6: Description of procedure for data collection Item 7: Rationale for choice of data collection tool(s) Item 8: Detailed recruitment data Item 9: Statistical assessment of reliability and validity of measurement tool(s) (Quantitative studies only)* Item 10: Fit between research question and method of data collection (Quantitative studies only)* Item 11: Fit between research question and format and content of data collection tool e.g., interview schedule (Qualitative studies only)* Item 12: Fit between research question and method of analysis Item 13: Good justification for analytic method selected Item 14: Assessment of reliability of analytic process (Qualitative studies only)* Item 15: Evidence of user involvement in design Item 16: Strengths and limitations critically discussed Scores: 0 = not at all; 1 = very slightly; 2 = moderately; 3 = complete Total scores > 60% = High quality; scores ≤ 60% = Low quality [ 31 ] …”

The role of trauma, psychological therapy, and trauma appraisals in predicting posttraumatic growth.

“…Much of the research into the cognitive mechanisms behind posttraumatic stress (PTS) have focused on negative appraisals more generally (Keshet et al, 2019). However, there is an emerging body of research highlighting the value in examining specific appraisals in relation to PTS (McIlveen et al, 2020), specifically in developing theoretical and clinical knowledge. The PTG literature is following a similar trajectory, with much of the attention focusing on comparisons between positive and negative posttraumatic cognitions (Arikan et al, 2016).…”