The previous sections have addressed attempts at relatively comprehensive models of PTSD. In this section, individual research findings and theoretical work are discussed. Some of these may fit into one or more model discussed in preceding sections, but each is represented in the literature as relatively independent. These concepts are important to be aware of because new research directions and a more complete picture of the etiological cognitive factors will necessarily involve addressing all the relevant research findings and theoretical work.
Researchers and theorists have argued that it is a general human need to predict the future and have a sense of control over events. In fact, researchers have shown many positive mental and physical health benefits to the perception of control, even if it is slightly illusory. We live in our world as if it is predictable and orderly. When this perception is violated or tested, we seek answers. The more out of control we perceive our world to be, the poorer our adjustment overall.
In addition to our need to predict our world, we have a need to maintain our sense of self-worth and self-esteem. Brewin (1989) and Steele (1988) indicate that one way we do this is by attempting to understand why events have occurred. Greenberg and colleagues (1993) feel that self-esteem serves a stress-buffering function. (For more on stress buffers, see Chapters 2 and 4.)
Abramson et al. (1989) derived hopelessness theory to help us understand what happens when this need is thwarted. When we perceive a stressor as long-lasting and wide ranging in its effects, this can lead to an orientation of hopelessness. This theory has its theoretical roots in Albert Bandura's (1997) work in learned helplessness, which states that in the face of uncontrollable stress, individuals tend to develop an orientation that leads to giving up.
How may we go about the process of regaining that feeling of control, predictability, and hope? It seems that utilizing blame is one such technique. Stephen Joseph (1999) identifies two types of blame that are implicated here: self-blame and other-blame.
In blaming ourselves, we engage in a process of finding the ways and means that lead to a particular situation, giving us a sense of control and a sense that had we engaged in other behaviors or made other choices, we could have prevented whatever it was that happened. This works for future events as well. We may say to ourselves such things as "Next time I wont . . ." or "If this ever happens again, I'll be sure to . . ." Keep in mind, however, that overusing the blaming-oneself method can put one at risk for depression and increase our focus on our perceived weaknesses rather than strengths. Intrusive and avoidant symptoms of PTSD have been theoretically connected to self-blame and shame. Shame may lead to avoidance coping, such as denial or social distancing. Guilt may lead to problem-seeking reparative action, which is typically a positive attempt at coping. However, when direct reparation is not possible, trauma stimuli may linger in active memory and be more easily activated involuntarily, leading to the experience of intrusiveness.
Conversely, blaming other people may contribute to our sense of powerless-ness because we placed the perceived control over the event's occurrence in the hands of another person or persons. Although ironically we may be preserving our self-esteem by blaming others, we paradoxically increase our sense that the cause was out of our personal control. Research and clinical experience suggest that a balance between blaming oneself and blaming others is preferable.
Similar to self-blame versus other-blame, the concept of locus of control (Rotter, 1966) refers to the belief that control over events can be attributed internally ("I am in control") or externally ("Control resides outside or externally to me"). Research with combat veterans has shown poorer overall adjustment in individuals with a more external locus of control orientation, indicating that a belief in one's own sense of control is a more adaptive and positive orientation to events.
Attention deficits that result from trauma exposure were discussed in Chapter 3. However, in addition to the effects of trauma, attention deficits have been implicated in the etiology and maintenance of PTSD symptomology. Research has continued to show that trauma victims have an attentional bias toward trauma-related information.
According to Buckley, Blanchard, and Neill (2000), in PTSD, attentional resources are allocated toward threatening stimuli. Research, done with the broad class of Anxiety Disorders and not PTSD specifically, have led some to believe that Anxiety Disorder patients process negative information more quickly than positive or neutral information. They also do this faster than nonanxiety-disordered patients.
Research using a well-known technique called the Stroop Task has consistently shown that PTSD sufferers are poised and biased toward the perception of trauma-relevant information. The Stroop Task measures how much attention resources are being reserved or allocated to trauma-related information. This is done by measuring how much trauma-related information interferes with the processing of neutral information. Generally, findings show that when trauma-related information is presented simultaneously with neutral information, the processing of neutral information is slower as a consequence of the interference.
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