Posttraumatic Stress Disorder 521
perceptions of trauma memory quality mediated the relationship between data- driven
processing and intrusive reexperiencing symptoms in 75 children who had an injury that
led to hospital treatment. In two analogue studies Halligan, Clark, and Ehlers (2002)
found that data- driven processing of a road accident videotape was associated with poor
subsequent intentional recall of the videotape, more disorganized memory, and that stu-
dents, who scored high on a trait data- driven processing questionnaire, reported more
memory disorganization and PTSD symptoms. However, memory disorganization may
not be as specific to PTSD as data- driven processing or lack of self- referential processing
(Ehring, Ehlers, & Glucksman, 2006). In other studies individuals with PTSD showed
significant forgetting of the 9/11 terrorist attacks across a 9-month interval (Qin et al.,
2003) and individuals with PTSD retrieve fewer specific autobiographical memories
(Sutherland & Bryant, 2008).
Evidence of memory impairment for traumatic events in PTSD is fairly robust.
Most studies have found enhanced explicit recall of trauma- related cues and a consis-
tent relationship has emerged between data- driven encoding of the trauma, a more frag-
mented or disorganized memory of the trauma, and PTSD reexperiencing symptoms.
However, it is possible that PTSD has negative effects on memory more generally. A
recent meta- analysis found a small to moderate association between PTSD and visual
memory impairment of episodic, emotionally neutral material (Brewin, Kleiner, Vaster-
ling, & Field, 2007). Moreover, Taylor (2006) concluded in his review that evidence for
fragmented trauma memories is inconsistent at best. Despite lingering questions about
the exact nature of poor memory in PTSD, there is considerable empirical evidence that
individuals with PTSD have a selective, enhanced memory for the trauma that appears
to be a contributor to the persistence of their symptomatology.
Clinician Guideline 12.17
Because individuals with PTSD have an enhanced, selective recall of trauma- related infor-
mation, an important part of cognitive therapy is improvement of conceptual processing
so that a more complete, organized adaptive memory of past traumatic experiences is con-
structed.Hypothesis 5
Individuals with persistent PTSD are more likely to misinterpret their trauma- related
intrusive thoughts and images in a negative, threatening manner than individuals without
persistent PTSD.
This hypothesis proposes that the conscious, deliberate appraisal of intrusive recol-
lections of the trauma in a negative or threatening manner is an important factor in the
persistence of PTSD (Ehlers & Clark, 2000). Two sources of information are relevant
to this hypothesis: (1) negative appraisals of the trauma, and (2) negative appraisals of
reexperiencing symptoms.
A number of studies based on self- report measures have shown that negative
appraisal of the trauma and its sequelae are more prominent in traumatized individuals
with PTSD. The PTCI has been used most often to assess negative appraisals of trauma