The association between negative cognitions and previous exposure to traumatic events to PTSD symptoms level following a subsequent traumatic event

Introduction

Traumatic events that threaten our physical and mental health are an integral part of our world. Many people develop post-traumatic distress manifested by posttraumatic symptoms, but most do not fully develop the syndrome (Irish et al., 2008). People differ in the intensity of the symptoms, which raises questions regarding the factors associated with these differences. Most studies show that a traumatic event leaves the individual with weaker coping resources, making them more vulnerable and at a greater risk of developing post-traumatic symptoms when dealing with subsequent traumatic events. Therefore, exposure to multiple previous traumatic events increases the risk of PTSD invoked by a current traumatic event. Furthermore, reports indicate that previous interpersonal traumatic events involving a malicious perpetrator- a person who consciously intends to harm another human being (eg rape, robbery, etc.)- increase the vulnerability in the next event compared to previous traumatic events of other types (such as natural disasters or disease). Many researchers discussed the implications of childhood trauma on an individual's vulnerability to develop PTSD symptoms in a subsequent event in adulthood. However, their conclusions are divided.

Another factor which is associated with both traumatic events and the development of post-traumatic symptoms is world assumptions. These are the basic cognitions, schemas held by the individual about the world and the self. This set of cognitions develops over time and serves as the basis for decision-making, behaviors, function effectively and adaptation to different interactions (Ehlers & Steil, 1995; Janoff-Bulman, 1989). Studies have shown that traumatic events are related to negative cognitions, especially when it comes to interpersonal traumatic events. Also, there is as association between negative cognitions and severity of PTSD symptoms.

The aim of this study was to examine the integrated contribution of the factors described above, i. e., characteristics of previous traumatic events and negative cognitions, in order to predict the severity of PTSD symptoms developed as a result of a traumatic event at present.

Hypotheses

The hypotheses were made under the assumption model in which negative cognitions will mediate the relationship between previous traumatic events and PTSD symptoms severity following a current event. It was hypothesized there is an association between the characteristics of the previous traumatic events (number of previous events, their type and the age at which they occurred) to the severity of PTSD symptoms reported following a current traumatic event. A second hypothesis claimed there is a link between negative cognitions and severity of PTSD symptoms. The third hypothesis argued that participants who have experienced interpersonal trauma will be more prone to holding negative cognitions compared to participants who have experienced non-interpersonal traumas. Finally, under the last hypothesis, negative cognitions mediate the association between repeated exposure to previous traumatic events to the severity of PTSD symptoms following a current traumatic event.

Method

The present study was based on an existing database from the research of Shalev and Freedman, collected between 2003-2007 among trauma victims who arrived at "Hadassah"

Hospital’s ER (Shalev et al., 2011; Shalev et al., 2012). The current study is based on 735 subjects from this database that in a telephone interview, conducted after their release from the hospital, reported symptoms of acute stress disorder (ASD) or distress. They were subsequently summoned to a clinical interview. Most participants arrived in the ER as a result of an MVA and the others due to terrorist attacks, work accidents or other events. The study variables were measured using a clinical interview to diagnose post-traumatic symptoms (CAPS), a questionnaire to identify previous traumatic events (SLESQ), a questionnaire to examine posttraumatic cognitions (PTCI) and a socio-demographic questionnaire. The analysis was done using t-tests, Pearson's correlations, one-way ANOVA, multiple regression and process procedure model 4.

Results

The results confirm the hypothesis that there is a link between negative cognitions and reporting of  more severe post-traumatic symptoms following the current traumatic event. It has also confirmed the hypothesis that participants who previously experienced an interpersonal traumatic event will hold more negative cognitions compared to participants who previously experienced a non-interpersonal traumatic event. However, the first hypothesis concerning the relationship between the characteristics of previous traumatic events to the severity of PTSD symptoms after a current traumatic event was not supported. The mediation hypothesis which examined the overall model has been validated and found that negative cognitions mediate the relationship between previous traumatic events and the severity of PTSD symptoms after a current traumatic event.

Conclusions

The findings confirm previous studies and reinforce the significance of negative cognitions when dealing with traumatic events. The study contributes to existing theoretical knowledge suggesting that negative cognitions mediate between previous traumatic events and the development of PTSD symptoms following a subsequent trauma. In practice, using this information will allow more efficient identification of patients at high risk of developing post-traumatic symptoms and that may suffer from PTSD over time. This will assist in offering them the required psychological assistance.