A cognitive model of posttraumatic stress disorder.
Posttraumatic stress disorder (PTSD) is a common reaction to traumatic events. Many people recover in the ensuing months, but in a significant subgroup the symptoms persist, often for years. A cognitive model of persistence of PTSD is proposed. It is suggested that PTSD becomes persistent when individuals process the trauma in a way that leads to a sense of serious, current threat. The sense of threat arises as a consequence of: (1) excessively negative appraisals of the trauma and/or its sequelae and (2) a disturbance of autobiographical memory characterised by poor elaboration and contextualization, strong associative memory and strong perceptual priming. Change in the negative appraisals and the trauma memory are prevented by a series of problematic behavioural and cognitive strategies. The model is consistent with the main clinical features of PTSD, helps explain several apparently puzzling phenomena and provides a framework for treatment by identifying three key targets for change. Recent studies have provided preliminary support for several aspects of the model.
Ehlers
A
A
Department of Psychiatry, University of Oxford, Warneford Hospital, UK. anke.ehlers@psych.ox.ac.uk
Clark
D M
DM
D000223:Adaptation, Psychological; D001244:Association; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy; D006801:Humans; D019018:Imagery, Psychotherapy; D008568:Memory; D008960:Models, Psychological; D009341:Negativism; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology* / Q000628:therapy; D013315:Stress, Psychological / Q000523:psychology*; D013850:Thinking