Problem 3
1. discuss ehler and clarks cognitive theory
2. what are the main psychological processes in ptsd
3. what are the emotional processing theory and dual representation theory
Brewin and Holmes – psychological theories of post-traumatic stress disorder
Psychological processes and PTSD
Memory
- one feature of PTSD: changes in memory functioning
- patients have difficulties retrieving autobiographical memories of particular events
- there is a bias to recall trauma-related material more intensely
o there are contradictory patterns:
o in some studies, high levels of emotions are associated with more vivid and
long-lasting memories
o in others, they are associated with vague memories that lack detail and are
error prone
- DSM5: PTSD is characterized with high-frequency, distressing, intrusive memories
and forgetting the details of the event
- another feature of memory in PTSD: reliving experiences, flashbacks of trauma
o compared to memory, flashbacks have sensory detail (vivid images, sounds or
other sensations)
o reflected in distortion, traumatic events seem to be happening in the present
o reliving episodes occur by getting triggered involuntarily by specific reminders
- other memory processes:
o individual differences in working memory capacity are related to the ability to
prevent unwanted material from intruding and negatively affecting you
o greater working memory capacity better at suppressing unwanted
thoughts
Attention
- attentional bias is important in PTSD but studies don’t have evidence showing that
the effects are unique to PTSD
- evidence whether PTSD is associates with deficits in sustained attention is
inconsistent
Dissociation
- dissociation is defined as a temporary breakdown in our continuous, interrelated
processes of perceiving the world
- symptoms seen in trauma involve emotional numbing, derealization,
depersonalization and out-of-body experiences
- these symptoms are related to the severity of the trauma, fear of death and feeling
helpless
- dissociation is linked to decrease in heart rate and reflect a defensive response
related to immobilization (freezing)
- peri-traumatic dissociation: when the symptoms occur in the course of a traumatic
experience, good predictor of PTSD
, Cognitive-affective reactions
- criteria of PTSD in DSM5: experiencing intense fear, helplessness or horror at the
time of trauma
- there’s a strong relationship between these reactions and risk of developing PTSD
- another state: mental defeat -> the perceived loss of autonomy and giving up efforts
to retain your identity
- feelings of guilt, shame, sadness, betrayal, humiliation and anger accompany PTSD
caused by the cognitive appraisal of the cause, responsibility and implications of
trauma
- anger predicts slower recovery from PTSD
- being abused as a child makes victims more likely to experience shame
Beliefs
- traumatic events wreck people’s beliefs and assumptions
- increase in negative beliefs about the self, others and world is seen in PTSD victims
- potential of trust to get destroyed and lead to feeling betrayed
- negative beliefs don’t occur during trauma but represents the outcome of appraisal
processes that happen after the danger is gone
- negative interpretations of symptoms predict slower recovery
- if beliefs occur peri-traumatically, they could trigger reexperienced trauma memories
Cognitive coping strategies
- attempting to suppress unwanted thoughts and avoidance of intrusive thoughts are
unhelpful and fail to return more strongly afterwards
- rumination and increase use of safety behavior as coping mechanisms are also
associated with increased risk of PTSD
Social support
- negative social environment is a predictor of PTSD
- negative appraisal of others support attempts also predicts PTSD 6-9 months later
- negative social support is more prevalent for women and this relationship is stronger
- social support has the strongest effect size as a risk factor for PTSD (compared to
many other factors)
Recent Theories
Emotional processing theory by Foa
- takes account of accumulation of knowledge
- elaborate the relationship between PTSD and knowledge available prior to trauma,
during trauma and after trauma
o people with rigid views are more vulnerable to PTSD
o rigid positive views about being competent and world being safe gets
contradicted by the event
o rigid negative views of being incompetent and the world being dangerous
gets confirmed by event
- negative appraisals of responses and behaviors worsen perceptions of incompetence
- these appraisals relate to events at the time of trauma, symptoms seen afterwards,
disruption of daily life, responses of others etc.
1. discuss ehler and clarks cognitive theory
2. what are the main psychological processes in ptsd
3. what are the emotional processing theory and dual representation theory
Brewin and Holmes – psychological theories of post-traumatic stress disorder
Psychological processes and PTSD
Memory
- one feature of PTSD: changes in memory functioning
- patients have difficulties retrieving autobiographical memories of particular events
- there is a bias to recall trauma-related material more intensely
o there are contradictory patterns:
o in some studies, high levels of emotions are associated with more vivid and
long-lasting memories
o in others, they are associated with vague memories that lack detail and are
error prone
- DSM5: PTSD is characterized with high-frequency, distressing, intrusive memories
and forgetting the details of the event
- another feature of memory in PTSD: reliving experiences, flashbacks of trauma
o compared to memory, flashbacks have sensory detail (vivid images, sounds or
other sensations)
o reflected in distortion, traumatic events seem to be happening in the present
o reliving episodes occur by getting triggered involuntarily by specific reminders
- other memory processes:
o individual differences in working memory capacity are related to the ability to
prevent unwanted material from intruding and negatively affecting you
o greater working memory capacity better at suppressing unwanted
thoughts
Attention
- attentional bias is important in PTSD but studies don’t have evidence showing that
the effects are unique to PTSD
- evidence whether PTSD is associates with deficits in sustained attention is
inconsistent
Dissociation
- dissociation is defined as a temporary breakdown in our continuous, interrelated
processes of perceiving the world
- symptoms seen in trauma involve emotional numbing, derealization,
depersonalization and out-of-body experiences
- these symptoms are related to the severity of the trauma, fear of death and feeling
helpless
- dissociation is linked to decrease in heart rate and reflect a defensive response
related to immobilization (freezing)
- peri-traumatic dissociation: when the symptoms occur in the course of a traumatic
experience, good predictor of PTSD
, Cognitive-affective reactions
- criteria of PTSD in DSM5: experiencing intense fear, helplessness or horror at the
time of trauma
- there’s a strong relationship between these reactions and risk of developing PTSD
- another state: mental defeat -> the perceived loss of autonomy and giving up efforts
to retain your identity
- feelings of guilt, shame, sadness, betrayal, humiliation and anger accompany PTSD
caused by the cognitive appraisal of the cause, responsibility and implications of
trauma
- anger predicts slower recovery from PTSD
- being abused as a child makes victims more likely to experience shame
Beliefs
- traumatic events wreck people’s beliefs and assumptions
- increase in negative beliefs about the self, others and world is seen in PTSD victims
- potential of trust to get destroyed and lead to feeling betrayed
- negative beliefs don’t occur during trauma but represents the outcome of appraisal
processes that happen after the danger is gone
- negative interpretations of symptoms predict slower recovery
- if beliefs occur peri-traumatically, they could trigger reexperienced trauma memories
Cognitive coping strategies
- attempting to suppress unwanted thoughts and avoidance of intrusive thoughts are
unhelpful and fail to return more strongly afterwards
- rumination and increase use of safety behavior as coping mechanisms are also
associated with increased risk of PTSD
Social support
- negative social environment is a predictor of PTSD
- negative appraisal of others support attempts also predicts PTSD 6-9 months later
- negative social support is more prevalent for women and this relationship is stronger
- social support has the strongest effect size as a risk factor for PTSD (compared to
many other factors)
Recent Theories
Emotional processing theory by Foa
- takes account of accumulation of knowledge
- elaborate the relationship between PTSD and knowledge available prior to trauma,
during trauma and after trauma
o people with rigid views are more vulnerable to PTSD
o rigid positive views about being competent and world being safe gets
contradicted by the event
o rigid negative views of being incompetent and the world being dangerous
gets confirmed by event
- negative appraisals of responses and behaviors worsen perceptions of incompetence
- these appraisals relate to events at the time of trauma, symptoms seen afterwards,
disruption of daily life, responses of others etc.
