A cognitive model of posttraumatic stress disorder

• Published in: Behaviour research and therapy Vol. 38; no. 4; pp. 319 - 345
• Main Authors: Ehlers, Anke, Clark, David M.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.04.2000; Elsevier Science; Elsevier Science Ltd
• Subjects: Adaptation, Psychological; Adult and adolescent clinical studies; Anxiety disorders. Neuroses; Association; Biological and medical sciences; Chronic Disease; Cognition & reasoning; Cognitions; Cognitive Behavioral Therapy; Cognitive behaviour therapy; Humans; Imagery (Psychotherapy); Medical sciences; Memory; Models, Psychological; Negativism; Post traumatic stress disorder; Posttraumatic stress disorder; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; PTSD; Stress Disorders, Post-Traumatic - psychology; Stress Disorders, Post-Traumatic - therapy; Stress, Psychological - psychology; Thinking; PTSD; Cognitive behaviour therapy; Posttraumatic stress disorder; Cognitions; Memory; Human; Theoretical model; Posttraumatic syndrome; Treatment; Anxiety disorder; Strategy; Cognition; Review; Cognitive style; Stress
• ISSN: 0005-7967; 1873-622X
• DOI: 10.1016/S0005-7967(99)00123-0

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 contextualisation, 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.