Cognitive paths from trauma to posttraumatic stress disorder: a prospective study of Ehlers and Clark's model in survivors of assaults or road traffic collisions

Abstract

BackgroundIndividual 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.MethodsParticipants (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.ResultsCognitive 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.ConclusionsThe 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.

Does broadening one's concept of trauma undermine resilience?

“…For example, people who believe that a stressor is likely to cause a chronic and relapsing emotional condition from which they will never recover may be especially unlikely to take steps enabling them to confront and overcome their distress following the experience. Indeed, trauma survivors who report negative appraisals about a traumatic event (e.g., mental defeat, mental confusion) are more likely to develop PTSD and to experience it more persistently (Dunmore, Clark, & Ehlers, 1999;Beierl, Böllinghaus, Clark, Glucksman, & Ehlers, 2019).…”

Psychological, addictive, and health behavior implications of the COVID-19 pandemic

“…Many constellations of interweaving risk and protective factors, learning histories, and life circumstances can affect how trauma histories and potentially traumatic experiences during the COVID-19 crisis can affect individual journeys of recovery. For example, more unbalanced, negative individual interpretations of the COVID-19 crisis and related changes in beliefs about oneself, others, or the world may have lasting deleterious effects (e.g., "I am damaged"; "People cannot be trusted"; "The world is dangerous and unsafe"; Beierl, Böllinghaus, Clark, Glucksman, & Ehlers, 2019;Bernardi & Jobson, 2019;Köhler, Goebel, & Pedersen, 2019;LoSavio, Dillon, & Resick, 2017;Scher, Suvak, & Resick, 2017). Similarly, avoidance of thoughts or emotions related to the COVID-19 crisis may increase the risk of developing PTSD symptoms and/or exacerbating or maintaining pre-existing trauma-related symptoms (e.g., Orcutt, Reffi, & Ellis, 2020, pp.…”

Investigating predictors of trauma induced data-driven processing and its impact on attention bias and free recall

“…Whilst this study focused more on information processing, attention and memory, other cognitive factors that are pertinent to predominant cognitive models should be considered alongside the current findings. In particular, negative trauma-related appraisals have recently shown to be a relevant predictor of persistent post-traumatic stress difficulties (Beierl et al, 2019). These findings suggest that trauma-related appraisals may be another key factor in the development of PTSD and should be integrated into further attentional bias research.…”