The relationship between maladaptive appraisals and posttraumatic stress disorder: a meta-analysis.

Cognitive models of post-traumatic stress disorder (PTSD) suggest maladaptive appraisals play a central role in the aetiology of this disorder. The current meta-analysis sought to provide a comprehensive, quantitative examination of the relationship between maladaptive appraisals and PTSD. One-hundred and 35 studies met study inclusion criteria and were subject to random effects meta-analysis. A large effect size was found for the relationship between appraisals and PTSD (r = 0.53, 95% CI = 0.51-0.56, k = 147), albeit with significant heterogeneity. In studies using only the Posttraumatic Cognitions Inventory or Child Post-traumatic Cognitions Inventory, the effect size remained large (r = 0.56; k = 104). In adults, appraisals about the self had a large effect size (r = 0.61), appraisals about the world had a medium effect size (r = 0.46) and self-blame appraisals had a small effect size (r = 0.28). In child/adolescent studies, large effect sizes were found for both 'fragile person in a scary world' and 'permanent and disturbing change' appraisals (r = 0.54 and r = 0.60, respectively). The effect size remained large in prospective longitudinal studies up to one year after trauma. There was no moderation effect for civilian vs military populations, questionnaire vs interview measures of PTSD, single vs multiple trauma exposure, or intentional vs unintentional trauma. The main effect size estimate was robust to sensitivity analyses concerning statistics used, study quality and outliers. These findings are consistent with the strong role for maladaptive appraisals in the aetiology of PTSD proposed by cognitive models. In particular, the role of self-appraisals in adults was highlighted. Avenues for future research include more studies in child, multiple trauma and military populations and longer-term follow up studies

Psychometric Properties of the German Version of the Child Post-Traumatic Cognitions Inventory (CPTCI-GER)

Dysfunctional trauma-related cognitions are associated with posttraumatic stress disorder (PTSD). The psychometric properties of the German version of the Child Post-Traumatic Cognitions Inventory (CPTCI-GER) were assessed in a sample of 223 children and adolescents (7–16 years) with a history of different traumatic events. Confirmatory factor analyses supported the original two-factor structure—permanent and disturbing change (CPTCI-PC) and fragile person in a scary world (CPTCI-SW). The total scale and both subscales showed good internal consistency. Participants with PTSD had significantly more dysfunctional trauma-related cognitions than those without PTSD. Dysfunctional posttraumatic cognitions correlated significantly with posttraumatic stress symptoms (PTSS; r = .62), depression (r = .71), and anxiety (r = .67). The CPTCI-GER has good psychometric properties and may facilitate evaluation of treatments and further research on the function of trauma-related cognitions in children and adolescents. (Partial) correlations provide empirical support for the combined DSM-5 symptom cluster negative alterations in cognitions and mood

Changes in posttraumatic cognitions mediate the effects of trauma-focused therapy on paranoia

Abstract Background Evidence suggests that in individuals with psychosis, paranoia is reduced after trauma-focused therapy (TFT) aimed at co-morbid posttraumatic stress disorder (PTSD). Objective To identify mediators of the effect of TFT on paranoia. Method In a multicenter single-blind randomized controlled trial 155 outpatients in treatment for psychosis were allocated to 8 sessions Prolonged Exposure (PE; n=53), 8 sessions Eye Movement Desensitization and Reprocessing (EMDR) therapy (n=55), or a waiting-list condition (WL; n=47) for treatment of co-morbid PTSD. Measures were performed on (1) paranoia (GPTS); (2) DSM-IV-TR PTSD symptom clusters (CAPS-IV; i.e., intrusions, avoidance, and hyperarousal); (3) negative posttraumatic cognitions (PTCI; i.e., negative self posttraumatic cognitions, negative world posttraumatic cognitions and self-blame); (4) depression (BDI-II); and (5) cognitive biases (i.e., jumping to conclusion, attention to threat, belief inflexibility and external attribution), cognitive limitations (i.e., social cognition problems and subjective cognitive problems), and safety behaviors (DACOBS). Outcome in terms of symptoms of paranoia (1) and potential mediators (2-5) were evaluated at post-treatment, controlling for baseline scores. Results The effects of TFT on paranoia were primarily mediated by negative self and negative world posttraumatic cognitions, representing almost 70% of the total indirect effect. Safety behaviors and social cognition problems were involved in the second step mediational pathway models. Conclusions Targeting the cognitive dimension of PTSD in TFT in psychosis could be an effective way to influence paranoia, whereas addressing safety behaviors and social cognition problems might enhance the impact of TFT on paranoia

Veterans are not the only ones suffering from posttraumatic stress symptoms:what do we know about dependents’ secondary traumatic stress?

PURPOSE: Previous research has mainly focused on veterans’ mental health problems, especially on posttraumatic stress disorder (PTSD). Less is known about the impact that the veteran’s experienced potentially traumatic events (PTEs) might have on their significant others. Therefore, we reviewed the scientific literature to find out what is known about the prevalence of secondary traumatic stress (STS) in significant others of veterans. METHODS: We systematically searched Pubmed, PsycINFO, Embase, Cochrane Library and PILOTS for relevant articles. This search resulted in 3100 records from which we included 48 articles. RESULTS: Two studies that reported on parental PTSD did not find evidence that parents were affected by their offspring’s experience. Nine studies that reported on PTSD in mainly adult children of veterans found only scant evidence that children were affected by their parent’s experienced PTE. Twenty-seven studies investigated PTSD symptoms in partners of veterans. Here results varied largely between studies with PTSD rates between 0 and 51 %. CONCLUSIONS: Overall, we found the strongest evidence of STS in partners of help-seeking veterans with PTSD. The lack of clarity provided by the currently available evidence suggests a pressing need for further work to examine this subject in more detail

The world is a scary place? Investigating treatments and assessment for children after trauma

This dissertation provides new insights about treatments and assessment for children who experienced traumatic events. We investigated the comparative effectiveness of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR) by means of a randomized controlled trial (RCT). The results of this trial suggest that both treatments are effective and efficient. We did not find statistically significant between-group differences. The preparation of this RCT included the validation of an assessment tool for Posttraumatic Stress Disorder (PTSD) in children, the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA). We found that the Dutch version of this interview is valid and reliable. During our work on the RCT, DSM-5 criteria for PTSD became known. One major change was the inclusion of trauma-related cognitions in the criteria. Therefore two chapters of the dissertation focus on the effects of psychotherapy on trauma-related cognitions and the assessment of these cognitions in children. Meta-analytic results showed that trauma-focused therapy leads to the largest reduction of trauma-related cognitions. Our validation study of the Dutch version of the Child Posttraumatic Cognitions Inventory showed that this instrument is a valid questionnaire that can help to assess trauma-related cognitions in children