Maladaptive Post-traumatic Cognitions in Interpersonally Traumatized Adolescents with Post-traumatic Stress Disorder: An Analysis of “Stuck-Points”
This study investigated maladaptive post-traumatic cognitions, so-called “stuck-points”, from forty-three adolescent survivors of interpersonal traumatization. Thematic content and relationships between stuck-points and trauma characteristics as well as symptom severity were analyzed. Guilt, esteem and trust were the most frequently named themes. Physical abuse was related to stuck-points in the categories trust and control, sexual abuse was related to the categories safety and guilt. Penetration, female sex, an older age at trauma onset and a closer relationship to the perpetrator were related to the category guilt. Injuries through physical violence were related to the category trust. Physical violence and a longer duration of the index trauma were related to a higher number of stuck-points overall. Last, a higher number of stuck-points in the category trust was related to higher post-traumatic stress disorder symptom severity. Therapists should pay attention to these different themes in order to provide the best possible treatment for each patient individually.
KeywordsCognitive processing therapy Cognition Interpersonal violence Adolescents
This study was funded by DLR with the support code: 01KR1204A
Compliance with Ethical Standards
Conflict of interest
Janina Botsford, Maja Steinbrink, Eline Rimane, Rita Rosner, Regina Steil and Babette Renneberg declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
Informed consent was obtained from all individual participants included in the study.
This article does not contain any studies with animals performed by any of the authors.
- Ackerman, P. T., Newton, J. E., McPherson, W., Jones, J. G., & Dykman, R. A. (1998). Prevalence of post traumatic stress disorder and other psychiatric diagnoses in three groups of abused children (sexual, physical, and both). Child Abuse & Neglect, 22(8), 759–774. https://doi.org/10.1016/S0145-2134(98)00062-3.CrossRefGoogle Scholar
- American Psychological Association. (2001). Understanding child sexual abuse: Education, prevention, and recovery. Retrieved March, 9, 2005 from https://urldefense.proofpoint.com/v2/url?u=http-3A__www.apa.org_pi_families_resources_understanding-2Dchild-2Dabuse.aspx&d=DwIDaQ&c=vh6FgFnduejNhPPD0fl_yRaSfZy8CWbWnIf4XJhSqx8&r=cijxKIUfIjh6xB35XSxKelnSNfz2185wGO_qFr-DFH8&m=hdom8PoRDgMUoD2Oz7TISd0FxZagxX3PjizWZmqLMQk&s=pJ815JE_bBunb4mCdgGsjj6T1SG-Iaqc5NlKpJLpijg&e=.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.Google Scholar
- Beck, A. T., Steer, R. A., & Brown, G. K. (1996). BDI-II: Manual (2nd edn.). San Antonio, TX: Pearson PsychCorp.Google Scholar
- Chemtob, C. M., Roitblat, H. L., Hamada, R. S., Muraoka, M. Y., Carlson, J. G., & Bauer, G. B. (1999). Compelled attention: the effects of viewing trauma-related stimuli on concurrent task performance in posttraumatic stress disorder. Journal of Traumatic Stress, 12(2), 309–326. https://doi.org/10.1023/A:1024728626505.CrossRefPubMedGoogle Scholar
- Dunmore, E., Clark, D. M., & Ehlers, A. (1999). Cognitive factors involved in the onset and maintenance of posttraumatic stress disorder (PTSD) after physical or sexual assault. Behaviour Research and Therapy, 37(9), 809–829. https://doi.org/10.1016/S0005-7967(98)00181-8.CrossRefPubMedGoogle Scholar
- Elhai, J. D., Layne, C. M., Steinberg, A. M., Brymer, M. J., Briggs, E. C., Ostrowski, S. A., & Pynoos, R. S. (2013). Psychometric properties of the UCLA PTSD reaction index. part II: Investigating factor structure findings in a national clinic-referred youth sample. Journal of Traumatic Stress, 26(1), 10–18. https://doi.org/10.1002/jts.21755.CrossRefPubMedGoogle Scholar
- Janoff-Bulman, R. (1992). Shattered assumptions: Toward a new psychology of trauma. New York: Free PressGoogle Scholar
- Kadushin, A., Martin, J. A., & McGloin, J. (1981). Child abuse—An interactional event. New York: Columbia University Press.Google Scholar
- Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617–627. https://doi.org/10.1001/archpsyc.62.6.617.CrossRefPubMedPubMedCentralGoogle Scholar
- König, J. (2012). Therapeutische praxis. In von Julia König Posttraumatische Belastungsstörung: Ein Manual zur Cognitive Processing Therapy. Göttingen: Hogrefe.Google Scholar
- Kühner, C., Bürger, C., Keller, F., & Hautzinger, M. (2007). Reliabilität und Validität des revidierten Beck-Depressionsinventars (BDI-II). Befunde aus deutschsprachigen Stichproben [Reliability and validity of the Revised Beck Depression Inventory (BDI-II). Results from German samples]. Der Nervenarzt, 78(6), 651–656. https://doi.org/10.1007/s00115-006-2098-7.CrossRefPubMedGoogle Scholar
- Matulis, S., Resick, P. A., Rosner, R., & Steil, R. (2014). Developmentally adapted cognitive processing therapy for adolescents suffering from posttraumatic stress disorder after childhood sexual or physical abuse: A pilot study. Clinical Child and Family Psychology Review, 17(2), 173–190. https://doi.org/10.1007/s10567-013-0156-9.CrossRefPubMedGoogle Scholar
- McLaughlin, K. A., Koenen, K. C., Hill, E. D., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2013). Trauma exposure and posttraumatic stress disorder in a national sample of adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 52(8), 815–830. https://doi.org/10.1016/j.jaac.2013.05.011.CrossRefGoogle Scholar
- Mechanic, M. B., & Resick, P. A. (1993, October). The personal beliefs and reactions scale: Assessing rape-related cognitive schemata. In Annual Meeting of the International Society for Traumatic Stress Studies, San Antonio, TX.Google Scholar
- Owens, G. P., Chard, K. M., & Ann Cox, T. (2008). The relationship between maladaptive cognitions, anger expression, and posttraumatic stress disorder among veterans in residential treatment. Journal of Aggression, Maltreatment & Trauma, 17(4), 439–452. https://doi.org/10.1080/10926770802473908.CrossRefGoogle Scholar
- Rabenau, C. (2014). Stuckpoints (Hängepunkte) und deren Zusammenhang mit der Art und dem Schweregrad traumatischer Erfahrungen im Jugendalter.Google Scholar
- Resick, P. A., Galovski, T. E., Uhlmansiek, M. O., Scher, C. D., Clum, G. A., & Young-Xu, Y. (2008). A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence. Journal of Consulting and Clinical Psychology, 76(2), 243–258. https://doi.org/10.1037/0022-006X.76.2.243.CrossRefPubMedPubMedCentralGoogle Scholar
- Resick, P. A., Monson, C. M., & Chard, K. M. (2014). Cognitive processing therapy: Veteran/military version: Therapist’s manual. Washington, DC: Department of Veterans Affairs.Google Scholar
- Resick, P. A., Nishith, P., Weaver, T. L., Astin, M. C., & Feuer, C. A. (2002). A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. Journal of Consulting and Clinical Psychology, 70(4), 867–879.CrossRefPubMedPubMedCentralGoogle Scholar
- Resick, P. A., & Schnicke, M. (1993). Cognitive processing therapy for rape victims: A treatment manual (Vol. 4). Newbury Park: Sage Publications.Google Scholar
- Rosner, R., König, H.-H., Neuner, F., Schmidt, U., & Steil, R. (2014). Developmentally adapted cognitive processing therapy for adolescents and young adults with PTSD symptoms after physical and sexual abuse: Study protocol for a randomized controlled trial. Trials, 15, 195. https://doi.org/10.1186/1745-6215-15-195.CrossRefPubMedPubMedCentralGoogle Scholar
- Steil, R., & Füchsel, G. (2006). IBS-KJ Interviews zu Belastungsstörungen bei Kindern und Jugendlichen: Diagnostik der akuten und posttraumatischen Belastungsstörung. Manual, Testmappe komplett. Göttingen u. a.: Hogrefe Verl. f. Psychologie.Google Scholar
- Vaile Wright, C., Collinsworth, L. L., & Fitzgerald, L. F. (2010). Why did this happen to me? Cognitive schema disruption and posttraumatic stress disorder in victims of sexual trauma. Journal of Interpersonal Violence, 25(10), 1801–1814. https://doi.org/10.1177/0886260509354500.CrossRefPubMedGoogle Scholar