A prospective investigation of the role of cognitive factors in persistent posttraumatic stress disorder (PTSD) after physical or sexual assault
Abstract
The effectiveness of psychological treatments for PTSD is likely to be enhanced by improved understanding of the factors involved in maintaining the disorder. Ehlers and Clark [A cognitive model of persistent posttraumatic stem disorder Behav. Res. Ther. 38 (2000) 319-345] recently proposed a cognitive model of maintenance. The current study aimed to investigate several cognitive factors highlighted in Ehlers and Clark's model using a prospective design. Fifty-seven victims of physical or sexual assault participated in the study. Cognitive factors were assessed within 4 months of assault and victims were followed-up 6 and 9 months after the assault. Cognitive variables which significantly predicted PTSD severity at both follow-ups were: cognitive processing style during assault (mental defeat, mental confusion, detachment); appraisal of assault sequelae (appraisal of symptoms, perceived negative responses of others, permanent change); negative beliefs about self and world; and maladaptive control strategies (avoidance/safety seeking). Relationships between early appraisals, control strategies, and processing styles and subsequent PTSD severity remained significant after statistically controlling for gender and perceived assault severity. These findings support the cognitive model of PTSD proposed by Ehlers and Clark and suggest that effective treatment will need to address these cognitive factors.
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Mental defeat was assessed with the Mental Defeat Scale, with Cronbach's α = 0.90 in the present sample.
“Internal consistency in the present sample was high, Cronbach's α = 0.90.”
From Early Linguistic Markers of Trauma-Specific Processing Predict Post-trauma Adjustment (2018) · cites this paper as [41]
Catastrophic appraisals about the outcome of the event are strongly associated with later PTSD severity.
“catastrophic appraisals 50-52 about the outcome of the event being strongly associated with later PTSD severity.”
From Post‐traumatic stress disorder: a state‐of‐the‐art review of evidence and challenges (2019) · cites this paper as [50]
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- Authors
- Dunmore, E., Clark, D. M., & Ehlers, A.
- Affiliations
- University of Surrey (GB)
- University of Oxford (GB)
- Corresponding author
- Dunmore, Emma
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2001-09
- Volume
- 39
- Issue
- 9
- Pages
- 1063-1084
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W2122304133
- Cited by
- 640
- References
- 58
- Citations by year
- 2026: 14 · 2025: 18 · 2024: 11 · 2023: 28 · 2022: 22 · 2021: 19 · 2020: 35 · 2019: 28 · 2018: 30 · 2017: 29 · 2016: 22 · 2015: 63 · 2014: 23 · 2013: 38 · 2012: 22
- FWCI
- 18.68
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Wellcome Trust (069777)
- Medical Research Council
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- post-traumatic stress disorder, physical assault, sexual assault, cognitive processing styles, avoidance
- MeSH terms
- Adult, Cognition Disorders, Female, Humans, Male, Prospective Studies, Psychiatric Status Rating Scales, Psychological Tests, Surveys and Questionnaires, Rape, Severity of Illness Index, Stress Disorders, Post-Traumatic, Violence
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