522 TREATMENT OF SPECIFIC ANXIETY DISORDERS
and its consequences (Foa, Ehlers, et al., 1999). In these studies perceptions that the
trauma had a more negative effect on the self and more pervasive and enduring negative
consequences correlated with severity of PTSD symptoms as well as specific symptoms
such as severity of intrusions and extent of avoidance (e.g., Ehring et al., 2006; Laposa
& Alden, 2003; Steil & Ehlers, 2000).
In addition negative appraisal of intrusive memories and other reexperiencing
symptoms is more evident in traumatized individuals with PTSD and is positively cor-
related with PTSD symptom severity (Dunmore et al., 1999; Halligan et al., 2003; Steil
& Ehlers, 2000). Moreover, negative appraisal of initial intrusive symptoms predicts
persistence and severity of PTSD symptoms at 6- and 9-month follow-up (e.g., Dunmore
et al., 2001; Halligan et al., 2003). These findings, then, are consistent with Hypothesis
5 and indicate that an explicit negative evaluation of trauma- related consequences, espe-
cially intrusive reexperiencing symptoms, plays an important role in the persistence of
PTSD symptoms. However, this research is limited by an overreliance on retrospective
self- report questionnaires. Future studies should consider expanding the assessment of
appraisals beyond self- report questionnaires toward adopting more “online” and exper-
imentally based methods of inquiry.
Clinician Guideline 12.18
Negative, maladaptive cognitions and beliefs about PTSD, especially trauma- related intru-
sions and their symptoms, is a major focus in cognitive therapy given the importance of
explicit negative symptom appraisal in the persistence of PTSD.Hypothesis 6
Maladaptive cognitive strategies like thought suppression, rumination, and dissociation will
be significantly more prevalent in those with persistent PTSD compared with their non-PTSD
counterparts.
Like other cognitive theories (e.g., Ehlers & Clark, 2000), the current cognitive
model posits that presence of deliberate, effortful but maladaptive cognitive strategies
like thought suppression, rumination, and dissociation are key contributors to the per-
sistence of PTSD. These strategies are intended to prevent or terminate intrusive recol-
lections and other reminders of the trauma. Although they may momentarily appear
effective, in the long term they contribute to a heightened sense of anxiety and increased
salience of trauma- related intrusions.
It is well known that individuals with PTSD engage in more peritraumatic dissocia-
tion than non-PTSD or recovered trauma survivors, and persistent dissociation is asso-
ciated with the development of PTSD (Halligan et al., 2003; Ozer et al., 2003). How-
ever, it may that ongoing or persistent dissociation is more germane to chronic PTSD
than state dissociation at the time of trauma (Ehring et al., 2006). In addition there is
evidence that individuals with PTSD engage in ruminative thinking about the trauma
and its consequences. Taylor (2006) noted that rumination in PTSD involves repeat-
edly asking oneself questions about why the trauma happened, whether it could have
been prevented, and self-blame. Various studies have found that rumination is positively