The relationship between maladaptive appraisals and posttraumatic stress disorder : a meta-analysis

• Main Author: Gomez De La Cuesta, Georgina
• Published: University of East Anglia 2017
• Subjects: 610
• Online Access: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.732485

Background: Cognitive models of posttraumatic stress disorder (PTSD) suggest maladaptive appraisals about the self, the world and one’s symptoms in the aftermath of trauma play a causal role in the aetiology of PTSD (e.g. Ehlers & Clark, 2000). The current meta-analysis aims to provide a thorough, quantitative examination of the relationship between maladaptive appraisals and PTSD. Methods: A systematic search of relevant databases was conducted. Effect sizes and study characteristics were extracted from eligible studies and 20 per cent double coded for inter-rater reliability. A series of random-effects meta-analyses using Hedge’s (1985) method were performed. Subgroup analyses, sensitivity analyses and assessment of publication bias were examined. Results Background Cognitive models of posttraumatic stress disorder (PTSD) suggest maladaptive appraisals about the self, the world and one’s symptoms in the aftermath of trauma play a causal role in the aetiology of PTSD (e.g. Ehlers & Clark, 2000). The current meta-analysis aims to provide a thorough, quantitative examination of the relationship between maladaptive appraisals and PTSD. Methods A systematic search of relevant databases was conducted. Effect sizes and study characteristics were extracted from eligible studies and 20 per cent double coded for inter-rater reliability. A series of random-effects meta-analyses using Hedge’s (1985) method were performed. Subgroup analyses, sensitivity analyses and assessment of publication bias were examined. Results: Background Cognitive models of posttraumatic stress disorder (PTSD) suggest maladaptive appraisals about the self, the world and one’s symptoms in the aftermath of trauma play a causal role in the aetiology of PTSD (e.g. Ehlers & Clark, 2000). The current meta-analysis aims to provide a thorough, quantitative examination of the relationship between maladaptive appraisals and PTSD. Methods A systematic search of relevant databases was conducted. Effect sizes and study characteristics were extracted from eligible studies and 20 per cent double coded for inter-rater reliability. A series of random-effects meta-analyses using Hedge’s (1985) method were performed. Subgroup analyses, sensitivity analyses and assessment of publication bias were examined. Results Results showed a large effect size in the overall meta-analysis (r = 0.53, 95% CI = 0.51-0.56, k = 147). In studies using only the Posttraumatic Cognitions Inventory or Child Posttraumatic Cognitions Inventory, the effect size remained large (r = 0.56; 95% CI = 0.53-0.59, k = 104). In adults, maladaptive appraisals about the self had a very large effect size (r = 0.61, 95% CI = 0.57-0.64, k = 66), maladaptive appraisals about the world had a medium effect size (r = 0.45, 95% CI = 0.41-0.49, k = 62) and self-blame appraisals had a small-medium effect size (r = 0.28, 95% CI = 0.24-0.33, k = 59). In child/adolescent studies, there was no difference in effect size between appraisals of being a fragile person in a scary world or appraisals of permanent change (r = 0.53, 95% CI = 0.43-0.62 and r = 0.59, 95% CI = 0.48-0.67, respectively, k = 12). The effect size of the relationship between maladaptive appraisals and PTSD symptoms reduced at 12 months following trauma (2-4 months: r = 0.53, k = 9; 6 months: r = 0.53, k = 13; 12 months: r = 0.32, k = 3). All results were robust to sensitivity analyses and there was no evidence of publication bias. Discussion: Findings underline the importance of maladaptive appraisals in the aetiology of PTSD and highlight the role of self appraisals in adults. Avenues for future research include more studies in child, multiple trauma and military populations and longer term follow up studies.