518 TREATMENT OF SPECIFIC ANXIETY DISORDERS
Hypothesis 2
Negative beliefs about a vulnerable self, a dangerous world, the threatening effects of trauma,
and the adverse consequences of PTSD symptoms are more characteristic of individuals with
persistent PTSD than traumatized victims without persistent PTSD.
There are two ways that dysfunctional beliefs in PTSD can be investigated. At the
most basic level, cross- sectional studies have compared endorsement of negative beliefs
following trauma exposure in PTSD versus non-PTSD groups. However, one can also
examine the issue longitudinally and ask whether trauma has had a greater negative
impact on the core beliefs of individuals with PTSD. This latter question is more dif-
ficult to answer but is probably more germane to the cognitive model.
A number of cross- sectional studies have compared endorsement of dysfunctional
beliefs using self- report questionnaires. Dunmore and colleagues found that negative
beliefs about the effects of the trauma were significantly higher in the PTSD group com-
pared to non-PTSD individuals and were related to PTSD severity at 6- and 9-month
follow-up (Dunmore et al., 1999, 2001). Belief that future assaults are less likely was
associated with lower distress in female sexual assault survivors assessed 2 weeks, 2
months, 6 months, and 12 months after the assault (Frazier, 2003). In a study of 124
New York municipal workers 6 months after the 9/11 terrorist attacks, beliefs reflect-
ing increased expectation of future terrorist attacks and lost confidence in oneself were
associated with greater PTSD symptoms (Piotrkowski & Brannen, 2002).
The Posttraumatic Cognitions Inventory (PTCI), which was developed to assess
appraisals of trauma and its sequelae, contain many items that actually assess more
enduring negative beliefs (e.g., “People can’t be trusted,” “If I think about the event, I
will not be able to handle it,” “The world is a dangerous place”). Traumatized individu-
als with PTSD score significantly higher on the PTCI than individuals without PTSD
(Foa, Ehlers, Clark, Tolin, & Orsillo, 1999), although less consistent results have been
obtained for the Self-Blame subscale (Startup, Makgekgenene, & Webster, 2007). Also
elevated scores on Negative Cognitions about the Self and the World subscales but not
PTCI Self-Blame were significantly correlated with PTSD symptoms assessed 3 months
after the initial assessment (Field, Norman, & Barton, 2008). In a group of firefighter
trainees, Bryant and Guthrie (2007) found that negative self- appraisals (i.e., PTCI Self
subscale) during training predicted severity of posttraumatic stress after at least 3 years
of active duty that involved multiple exposure to trauma. In addition to evidence that
presence of pretrauma dysfunctional beliefs (e.g., negative self- appraisals) predicts ten-
dency to develop PTSD after trauma exposure, optimistic pretrauma beliefs might buf-
fer the effects of trauma (see Taylor, 2006, for discussion). On the other hand, Dunmore
et al. (2001) found that change in negative beliefs due to trauma exposure was not a
significant predictor of PTSD symptom severity (Dunmore et al., 2001).
Overall there is consistent evidence that individuals with PTSD hold negative beliefs
about a vulnerable self, a dangerous world, and the threat of future trauma. The theme
of continuing threat and a vulnerable self appear to capture the essence of the negative
schematic organization in PTSD. Negative beliefs about the self may be a particularly
potent predictor of subsequent posttrauma symptoms. However, it is not entirely clear
whether these maladaptive beliefs reflect enduring pretrauma schemas or a change in
perspective brought about by trauma exposure.