Understanding the relationship between posttraumatic stress disorder and trauma cognitions: The impact of thought control strategies Shira A. Bennett a, * , J. Gayle Beck a , Joshua D. Clapp b a The University of Memphis, Department of Psychology, 202 Psychology Building, Memphis TN 38152, USA b University at Buffalo – SUNY, Department of Psychology, Park Hall, Buffalo NY 14260, USA article info Article history: Received 19 November 2008 Received in revised form 10 July 2009 Accepted 22 July 2009 Keywords: Posttraumatic stress disorder Dysfunctional cognitions Thought control strategies abstract Several models of PTSD suggest that dysfunctional beliefs play an important role in the maintenance of PTSD. This study examined whether thought control strategies intermediated in the relationship between PTSD and dysfunctional cognitions. It was hypothesized that PTSD would be positively asso- ciated with dysfunctional cognitions and that negative thought control strategies (worry and self- punishment) would partially account for this relationship. These maladaptive strategies were predicted to be associated with increased levels of PTSD and more trauma-related beliefs. Additionally, it was predicted that positive thought control strategies (social control and reappraisal) would be associated with decreased levels of PTSD and fewer trauma-related beliefs. Finally, because the literature supports distraction as both an adaptive and a maladaptive thought control strategy, no a priori hypothesis was made. Results support worry and self-punishment as maladaptive intervening variables in the associa- tion between PTSD and dysfunctional cognitions, resulting in greater levels of PTSD and trauma cogni- tions. Social control and distraction emerged as adaptive strategies, resulting in lower levels of PTSD and trauma cognitions, while reappraisal showed no relationship with PTSD severity. Although the results are cross-sectional, continued focus on the effects of thought control strategies as meditational maintenance variables over time appears warranted. Ó 2009 Elsevier Ltd. All rights reserved. A central focus in the literature on posttraumatic stress disorder (PTSD) has been identifying factors that contribute to the devel- opment and maintenance of posttrauma symptoms (Ozer, Best, Lipsey, & Weiss, 2003). Although much attention has been paid to factors that increase risk for the development of PTSD, research is beginning to examine factors that help to maintain symptomotol- ogy. Resick and Schnicke (1992) highlighted the importance of identifying negative cognitions that may contribute to the persis- tent nature of PTSD. Related research has examined individual efforts to manage these dysfunctional cognitions (Reynolds & Wells, 1999) with emphasis on the role that thought control strategies play in maintaining posttrauma problems. The aim of the present study is to examine whether specific thought control strategies intervene in the relationship between PTSD symptoms and negative posttrauma cognitions. A number of theoretical models have emphasized the impor- tance of cognitions in the psychopathology of PTSD. Resick and Schnicke (1993) highlight the significance of dysfunctional cogni- tions associated with the traumatic event. These authors suggest that the failure to cognitively process the trauma leads to both PTSD symptoms and to distorted beliefs regarding the event; these beliefs in turn foster PTSD in a positive feed-forward system (Resick & Schnicke, 1993). Likewise, according to Foa and Rothbaum (1998), negative schemas about the self (e.g., ‘‘I am incompetent and cannot handle stress’’) and the world (e.g., ‘‘The world is a dangerous place’’) interfere with the integration of traumatic material and further perpetuate PTSD (Foa & Rothbaum, 1998). Similarly, Ehlers and Clark (2000) discuss the role of maladaptive cognitions leading to a sense of current threat. They emphasize negative appraisals and dysfunctional beliefs about the trauma as prominent maintaining factors for PTSD. Although each of these models highlights some- what different cognitive factors that contribute to posttrauma symptoms, each model emphasizes the salient role of maladaptive cognitions as a maintenance factor in PTSD. Numerous studies have examined the relationship between PTSD and negative cognitions, with particular attention to whether dysfunctional cognitions play a role in the persistence of PTSD symptoms. Ali and Dunmore (2002) assessed the role of negative beliefs in physical and sexual assault victims. The sample was divided into a no assault group (n ¼ 72), a persistent PTSD group (n ¼ 57), and a no PTSD group (n ¼ 43), and administered a ques- tionnaire to assess post-assault cognitions. Results indicated that * Corresponding author. Tel.: þ1 901 678 2914; fax: þ1 901 678 2579. E-mail address: sbnnett1@memphis.edu (S.A. Bennett). Contents lists available at ScienceDirect Behaviour Research and Therapy journal homepage: www.elsevier.com/locate/brat 0005-7967/$ – see front matter Ó 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.brat.2009.07.015 Behaviour Research and Therapy 47 (2009) 1018–1023