Journal article
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:
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Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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- Publisher copy:
- 10.1017/S0033291719002253
Authors
- Publisher:
- Cambridge University Press
- Journal:
- Psychological Medicine More from this journal
- Volume:
- 50
- Issue:
- 13
- Pages:
- 2172-2181
- Publication date:
- 2019-09-11
- Acceptance date:
- 2019-08-07
- DOI:
- ISSN:
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0033-2917
- Language:
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English
- Keywords:
- Pubs id:
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pubs:1039455
- UUID:
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uuid:9a079499-f232-40c0-ade3-6efd9bcfe9d9
- Local pid:
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pubs:1039455
- Source identifiers:
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1039455
- Deposit date:
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2019-08-07
Terms of use
- Copyright holder:
- Beierl et al
- Copyright date:
- 2019
- Rights statement:
- © The Author(s) 2019 This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
- Notes:
- This is an open access article distributed under the terms of the Creative Commons Attribution Licence
- Licence:
- CC Attribution (CC BY)
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