The role of negative cognitions, emotion regulation strategies, and attachment style in complex post‐traumatic stress disorder: Implications for new and existing therapies
Open accessAbstract
Objective: We set out to investigate the association between negative trauma‐related cognitions, emotional regulation strategies, and attachment style and complex post‐traumatic stress disorder ( CPTSD ). As the evidence regarding the treatment of CPTSD is emerging, investigating psychological factors that are associated with CPTSD can inform the adaptation or the development of effective interventions for CPTSD . Method: A cross‐sectional design was employed. Measures of CPTSD , negative trauma‐related cognitions, emotion regulation strategies, and attachment style were completed by a British clinical sample of trauma‐exposed patients ( N = 171). Logistic regression analysis was used to assess the predictive utility of these psychological factors on diagnosis of CPTSD as compared to PTSD . Results: It was found that the most important factor in the diagnosis of CPTSD was negative trauma‐related cognitions about the self, followed by attachment anxiety, and expressive suppression. Conclusions: Targeting negative thoughts and attachment representations while promoting skills acquisition in emotional regulation hold promise in the treatment of CPTSD . Further research is required on the development of appropriate models to treat CPTSD that tackle skills deficit in these areas. Practitioner points: Results suggest that cognitive‐behavioural interventions might be useful for the treatment of CPTSD . Targeting negative thoughts and attachment representations while promoting skills acquisition in emotional regulation hold promise in the treatment of CPTSD .
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In cPTSD, emotion dysregulation is characterized by trauma-related self-perceptions (e.g., guilt, shame, helplessness), fear of closeness in relationships, and numbing or suppression of emotional expression.
“In cPTSD, emotion dysregulation is characterized by trauma-related self-perceptions (e.g., guilt, shame, helplessness), fear of closeness in relationships, and numbing or suppression of emotional expression [88].”
From Complex PTSD and borderline personality disorder (2021) · cites this paper as [88]
The Discussion (page not available) identifies negative self-cognitions, attachment anxiety, and expressive suppression as correlates of cPTSD, and describes suppression as hiding or inhibiting emotional expression. But it describes attachment anxiety as fear of rejection or abandonment, not fear of closeness, and treats these as distinct constructs rather than all as features of emotion dysregulation. It does not establish emotional numbing. (LLM, conf=0.86)
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Cites
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“, guilt, shame, helplessness), fear of closeness in relationships, and numbing or suppression of emotional expression [88].”
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- Authors
- Karatzias, T., Shevlin, M., Hyland, P., Brewin, C. R., Cloitre, M., Bradley, A., Kitchiner, N. J., Jumbe, S., Bisson, J. I., & Roberts, N. P.
- Affiliations
- NHS Lothian (GB)
- University of Ulster (GB)
- National College of Ireland (IE)
- University College London (GB)
- Department of Psychiatry and Behavioral Sciences Stanford University Palo Alto CA USA
- Edinburgh Napier University (GB)
- Cardiff and Vale University Health Board (GB)
- Queen Mary University of London (GB)
- Cardiff University (GB)
- Corresponding author
- Karatzias, Thanos
- ORCID
- Venue
- British Journal of Clinical Psychology
- Publisher
- Wiley
- Published
- 2018-01-22
- Volume
- 57
- Issue
- 2
- Pages
- 177-185
- ISSN
- 0144-6657 (ISSN-L)
- 2044-8260
- OpenAlex
- W2785604790
- Cited by
- 91
- References
- 25
- Citations by year
- 2026: 12 · 2025: 15 · 2024: 9 · 2023: 9 · 2022: 16 · 2021: 11 · 2020: 8 · 2019: 9 · 2018: 2
- FWCI
- 8.80
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
- Maynooth University ePrints and eTheses Archive (Maynooth University) (acceptedVersion)
- NORMA (acceptedVersion)
- Edinburgh Napier Research Repository (Edinburgh Napier University) (submittedVersion, cc-by)
- UCL Discovery (University College London) (submittedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- Research Output (Edinburgh Napier University) (submittedVersion, cc-by)
- Ulster University Research Portal (Ulster University) (submittedVersion, other-oa)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- complex PTSD, emotion regulation strategies, attachment styles, attachment anxiety, expressive suppression, cognitive-behavioural intervention, trauma exposure, attachment representations
- MeSH terms
- Adolescent, Adult, Aged, Cognition, Cross-Sectional Studies, Emotions, Female, Humans, Male, Middle Aged, Stress Disorders, Post-Traumatic, Young Adult
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