Experiencing a potentially traumatizing event can be followed by long-lasting reactions for some, while others experience more transient distress. An extensive line of research has aimed to elucidate the factors that may contribute to persistent post-trauma distress. Cognitive models suggest that how one thinks about and interprets a potentially traumatizing event, and what consequences it may have for one’s life, affects the persistence of posttraumatic stress reactions. Two types of trauma-related thoughts that have been associated with posttraumatic stress reactions are maladaptive appraisals and counterfactual thinking. However, less is known about what factors are associated with reporting persistent trauma-related thoughts, and regarding the long-term relationship between different traumarelated thoughts and posttraumatic stress reactions.
The overarching aim of this thesis was to investigate long-term associations of maladaptive appraisals and posttraumatic stress reactions, and between the vividness and frequency of counterfactual thinking and posttraumatic stress reactions. Furthermore, this thesis considers what factors are associated with reporting elevated levels of maladaptive appraisals and a higher degree of the frequency and vividness of counterfactual thoughts about the traumatic event.
These aims were investigated utilizing data from two comprehensive longitudinal studies. First, longitudinal data from the open-cohort study on survivors of the terror attack at Utøya on July 22, 2011, were included. The survivors were mainly adolescents and young adults. Second, baseline data from a randomized controlled trial on the efficiency of trauma-focused cognitive behavioural therapy (TF-CBT) were included. The participants in the TF-CBT study were trauma-exposed children and adolescents referred to the child and adolescents’ mental-health services.
The results showed that maladaptive appraisals and counterfactual thoughts were reported almost a decade after the terror attack, which indicates that such thoughts may persist for years once established. We found that maladaptive appraisals were highly and significantly associated with posttraumatic stress reactions over time and across trauma-exposed samples. There were also indications that maladaptive appraisals may become more negative in the long term. Both the frequency and vividness of counterfactual thinking were uniquely and significantly related to the levels of posttraumatic stress reactions in the long term. Exposure to physical violence, multiple types of potentially traumatic events, and female gender were associated with elevated levels of maladaptive appraisals after the terror attack. However, these risk factors may not generalize across all trauma-exposed youth samples, as we found no significant associations between types of potentially traumatizing events, number of trauma types, age, or gender for the level of maladaptive appraisals in the clinical sample.
These findings indicate that maladaptive appraisals and counterfactual thoughts about the traumatic event may persist for years and be associated with posttraumatic stress reactions over time. Thus, it is important to target maladaptive appraisals to mitigate harm after traumatic experiences. Furthermore, there may be clinical potential in addressing counterfactual thoughts about the traumatic event. Longitudinal studies on the temporal relationship between counterfactual thoughts and posttraumatic stress reactions and studies examining how trauma-related thoughts occur in daily life could be important next steps.