The cognitive path to trauma recovery: examining the role of posttrauma cognitions in the maintenance of PTSD and the facilitation of trauma recovery for survivors of interpersonal violence

  • Sharelle L Smith

Student thesis: Doctoral Thesis

Abstract

Exposure to interpersonal violence has been identified as a global humanitarian crisis, with more than 520,000 people killed each year by an intimate partner or family member (Sethi &Butchart, 2017). The long-term economic, social, physical, and psychological impacts of nonfatal interpersonal violence have been identified as major health and welfare issues, resulting in significant morbidity and mortality for the Australian and global communities (Australian Bureau of Statistics [ABS], 2019; Centres for Disease Control and Prevention,1993; Sethi & Butchart, 2017; Webster, 2016). The experience of mental illness, including Posttraumatic Stress Disorder (PTSD), has been identified as the greatest current contributor to the disease burden following exposure to interpersonal violence (ABS, 2019; Brady et al.,2000; Breslau et al., 1991; Jordan et al., 2010; Kessler et al., 1995; Resnick et al., 1997;Resnick et al., 1993; Schnurr & Jankowski, 1999).

Recovery has been identified as the primary goal for survivors’ following interpersonal violence exposure however, Trauma Recovery is not universally experienced and many survivors continue to exhibit PTSD symptomatology following trauma exposure. Extensive clinical and empirical evidence demonstrates that post trauma cognitions play an important role in the development and maintenance of PTSD for survivors of interpersonal trauma (Brewin & Holmes, 2003; Ehlers & Clark, 2000; Foa et al., 1992; Foa & McLean,2016; Held et al., 2019; Kubany et al., 1996; Kubany & Watson, 2002). Whilst these posttrauma cognitions have been theorised to impair Trauma Recovery, the relationship between posttrauma cognitions and Trauma Recovery remains unaddressed in empirical research.

The overarching aim of this program of research was to enhance our understanding of Trauma Recovery following exposure to interpersonal violence, through the development of an evidence-based model and psychometrically sound means of measuring Trauma Recovery. To achieve this aim, this program of research was designed to explore the posttrauma cognitions associated with interpersonal trauma exposure and to obtain empirical support for the Trauma Cognition Model, the Cognitive Model of Trauma Recovery, and the Trauma Recovery Measure. To achieve these outcomes, a mixed methodological approach was adopted with four sequential studies completed between 2018 and 2020. Study one was designed to identify the modifiable posttrauma cognitions that maintain PTSD symptom expression following the experience of intimate partner violence (IPV). The outcomes from study one identified the unique and significant contribution of Shame, Blame, and Negative Self cognitions on PTSD symptom expression for female survivors of male perpetrated IPV. The posttrauma cognitions of Shame, Blame, and Negative Self were identified to independently predict the experience of clinically significant PTSD symptomatology following exposure to IPV.

Study two sought to extend the outcomes from study one, through an evaluation of the Trauma Cognition Model (TCM). The TCM proposes that the presence and severity of the posttrauma cognitions of Shame, Blame, and Negative Self predict the experience of clinically significant PTSD symptomatology for survivors of interpersonal trauma. The results obtained within study two demonstrated the TCM and the three posttrauma cognitions of Shame, Blame, and Negative Self to independently predict PTSD symptom expression for a diverse population of interpersonal trauma survivors. The TCM was also demonstrated to differentiate between individuals exposed to non-personal versus interpersonal forms of trauma. These outcomes highlighted the unique psychopathology and needs of interpersonal trauma survivors and the significant role of Shame, Blame, and Negative Self cognitions in the maintenance of PTSD symptom expression for a diverse population of interpersonal trauma survivors.

The findings from studies one and two informed the development of the Trauma Recovery Measure (TRM). The TRM was developed as a positive, strengths-based instrument to measure Trauma Recovery following exposure to interpersonal violence. Study three describes the development and psychometric evaluation of the TRM. Findings from study three revealed the TRM to have an acceptable factor structure, adequate overall model fit, and acceptable reliability and validity for a population of interpersonal trauma survivors. These results provide preliminary evidence for the TRM as a psychometrically sound measure of Trauma Recovery for interpersonal trauma survivors.

Study four incorporated the outcomes from previous studies within this program of research to develop and evaluate the Cognitive Model of Trauma Recovery (CMTR). The CMTR proposes that recovery from interpersonal trauma is achieved through the development, reinforcement, and gradual attainment of three specific positive cognitions related to the individuals’ sense of intrapersonal safety, security, and self-identity. The results obtained in study four demonstrated the cognitions of Validation, Liberation, and Positive Self to have a significant negative relationship to trauma-related psychopathology for survivors of interpersonal trauma. The CMTR was demonstrated to differentiate between individuals exposed to non-personal versus interpersonal forms of trauma. These outcomes highlighted the unique and significant role of the Validation, Liberation, and Positive Self cognitions for the mitigation of PTSD symptomatology and the facilitation of Trauma Recovery for a diverse population of interpersonal trauma survivors.

This program of research provides a unique and important contribution to the field of traumatology through the attainment of empirical support for the TCM and CMTR. These models identify the significant contribution of specific posttrauma cognitions in the maintenance of PTSD symptomatology and the facilitation of Trauma Recovery for a diverse population of interpersonal trauma survivors. The empirical evidence presented within this program of research provides preliminary evidence indicating that application of the TCM and CMTR within clinical settings would facilitate Trauma Recovery through the targeted intervention and modification of posttrauma cognitions. Additionally, the TRM provides a psychometrically sound means of assessment of these cognitions and the survivors Trauma Recovery journey. Overall, the outcomes obtained within this program of research provide empirical support for the CMTR, the TRM, and the utilisation of a positive, strengths-based approach to the assessment and treatment of Trauma Recovery.
Date of Award9 Feb 2022
Original languageEnglish
SupervisorAileen Pidgeon (Supervisor) & Peta Stapleton (Supervisor)

Cite this

'