علائم استرس پس از سانحه: تست های روابط با استراتژی ها و باورهای کنترل فکر به عنوان مدل پیش بینی فراشناختی
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|35668||2006||صفحه PDF||سفارش دهید||محاسبه نشده|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Personality and Individual Differences, Volume 40, Issue 1, January 2006, Pages 111–122
The present study aimed to assess the contribution of metacognitive beliefs and coping strategies characterised by worry to the persistence of stress symptoms in a student population. Following Wells’ (2000) metacognitive model of post-traumatic stress disorder (PTSD), it was hypothesized that worry and specific positive and negative metacognitive beliefs will be positively associated with stress symptoms. Furthermore, the association between specific positive metacognitive beliefs will be mediated by worry, whilst a direct relationship between negative metacognitions and stress symptoms was predicted. One-hundred and seventy-one students were assessed cross-sectionally. In accordance with predictions, thought control strategies of “worry”, and positive and negative metacognitions were positively associated with stress symptoms. Mediational path analyses provided support for the mediational predictions, but relationships depended on the symptom measure used. These results are discussed in relation to previous findings in the domain of PTSD and metacognition.
Since post-traumatic stress disorder (PTSD) was officially included as a diagnostic category in the third edition of the Diagnostic and Statistical Manual of mental disorders (DSM-III, 1980), several theoretical formulations have been put forward in order to explain the nature and course of its symptoms. Socio-cognitive models (Horowitz, 1973, Horowitz, 1976, Horowitz, 1979, Horowitz, 1986, Janoff-Bulman, 1985 and Janoff-Bulman, 1992) propose that persistent stress reactions, such as intrusions and arousal, result from ineffective attempts to integrate trauma-relevant information with pre-existing beliefs and assumptions about the self and the world, in general. This account is shared to an extent by information-processing theories (e.g. Foa, Steketee, & Rothbaum, 1989), but these models seek also to explain how trauma is represented in memory and why attempts to integrate it with prior knowledge end up in failure. In doing so, they present common arguments and also distinct features. Foa and Rothbaum (1998) stress that beliefs and assumptions about the self and the world are likely to impede successful integration of trauma with the memory network, only to the extent that these assumptions are rigid and extreme, in their nature. Likewise, Brewin, Dalgleish, and Joseph (1996) view the rigidity and extremeness of prior assumptions and beliefs as an important factor in trauma resolution. However, they conceive of trauma memory as consisting of two separate memory systems with distinct functions, rather than as a single associative network, as suggested by Foa et al. (1989). More recently, Ehlers and Clark (2000) also assigned an important role to beliefs that predate trauma, coping strategies, the quality of trauma memory, and individual appraisals of the event. They proposed that situational processing of the event with a focus on its sensory attributes impedes the integration of trauma with the rest of the person’s autobiographical memories, resulting in the formation of particularly strong associations in memory for trauma-related stimuli and responses. According to Ehlers and Clark (2000), this explains, at least partially, problematic intentional recall and re-experiencing phenomena in PTSD. Each of the theoretical approaches reviewed above assign an important role to memory in the development or maintenance of PTSD. A somewhat different information-processing account of the onset and persistence of post-stress reactions is represented by Wells’ (2000) metacognitive model (see also Wells and Matthews, 1994 and Wells and Sembi, 2004). This model does not emphasize the quality of memory for trauma, but emphasizes levels of processing and the influence of metacognition and coping strategies on normal emotional processing. According to Wells’ model symptoms of intrusive thoughts, arousal, and attentional orienting responses are normal in the aftermath of stress, providing an impetus for emotional processing. Emotional processing is the development of a program or plan for guiding thinking and behaviour in future encounters with threat. This process normally proceeds unimpeded and is associated with the running of simulations of dealing with threat, such as imagining dealing with trauma in different ways. The acquisition of a plan requires flexible control over cognition. However, this normal process is thwarted by the person’s coping strategies. In particular, the use of verbal worry/ruminative styles of coping, attempting to avoid/suppress thoughts of trauma, and coping by attentional strategies of threat monitoring are problematic. These strategies lead the person’s processing to be locked onto threat such that anxiety and a sense of danger persist. They also impair flexibility of processing required for developing an internal program. Thus, the individual strengthens internal programs for detecting danger/threat rather than allowing cognition to retune to the normal threat-free environment. These unhelpful styles of responding emerge from metacognitive beliefs. Examples of such beliefs include the belief that worrying and recyclic thinking about threat will improve one’s ability to cope and avoid danger. They also include beliefs that maintaining a sense of attentional readiness for threat-related stimuli will be beneficial, beliefs that thoughts must be controlled, and the belief that it is important to remember all aspects of the traumatic event. In addition, negative metacognitive beliefs about symptoms and thinking contribute to unhelpful patterns of self-directed attention and worry. For instance, the individual might believe that intrusive thoughts about trauma are a sign of mental instability and this contributes to anxiety and a sense of threat as the person catastrophically misinterpretes his/her reactions. Support for the metacognitive model comes from several studies. Based on the assumption that on-line coping strategies contribute to failures in emotional processing, Wells and Davies (1994) developed the Thought Control Questionnaire (TCQ), in order to assess individual differences in the use of strategies for controlling intrusive thoughts. TCQ measures five types of thought control: (i) distraction, (ii) social control, which refers to confiding in others about the content of intrusions, (iii) worry, (iv) self-punishment, and (v) reappraisal. Wells and Davies (1994) established that worry and punishment as strategies for controlling intrusive thoughts are positively associated with indices of vulnerability to stress and psychopathology. Reynolds and Wells (1999) examined the relationship between individual differences in thought control strategies and psychiatric symptoms in patients with DSM-IV major depression, and PTSD with or without concomitant symptoms of depression. Worry and punishment control strategies were negatively associated with recovery from major depression and PTSD, whereas social control, reappraisal, and distraction correlated positively with reduced levels of these symptoms. Other studies utilizing TCQ to examine the relationships among thought control strategies and stress symptoms also found that worry and punishment correlated positively with symptoms of acute stress disorder (ASD) in victims of motor vehicle accidents (Warda & Bryant, 1998), and civilian trauma (Guthrie & Bryant, 2000). In addition, social control was negatively associated with overall ASD severity (Guthrie & Bryant, 2000) and intrusive symptoms (Warda & Bryant, 1998). In a longitudinal study of PTSD, Holeva, Tarrier, and Wells (2001) established that strategies of worry measured soon after accidents significantly contributed to the later development of PTSD. In this study distraction and social control were found to have a buffering effect on the experience of persistent stress symptoms. The effects of worry appear not to be confined to use of worry to control thoughts. Wells and Papageorgiou (1995) showed that a brief period of worry after exposure to a stressor led to the incubation of intrusive images over the next three days. A similar effect was found by Butler, Wells, and Dewick (1992). The role of metacognitive beliefs has been explored using the Metacognition Questionnaire. But as yet this has not been used in exploring PTSD symptoms. Cartwright-Hatton and Wells (1997) developed the Metacognitions Questionnaire (MCQ) in order to assess metacognitive factors related to psychopathology. The questionnaire consists of 65-items loading on five distinct factors: (1) positive beliefs about worry, measuring the extent to which the person feels that worrying is helpful; (2) negative beliefs about worry concerning uncontrollability and danger, which assesses the extent to which the person thinks that worrying is overwhelming and dangerous; (3) cognitive confidence (assessing confidence in attention and memory); (4) negative beliefs concerning the consequences of not controlling one’s own thoughts; and finally (5) cognitive self-consciousness, measuring the tendency to monitor one’s own thoughts and focus attention inwards. Research done to date has shown that the MCQ factors are positively associated with obsessive–compulsive symptoms (Hermans, Martens, De Cort, Pieters, & Eelen, 2003), with pathological worry (Wells & Papageorgiou, 1998), and depression (Papageorgiou & Wells, 2003). The metacognitive model predicts that: (1) TCQ-worry should be positively associated with stress symptoms; (2) positive beliefs about worry should be positively associated with stress symptoms; (3) negative beliefs about worry concerning uncontrollability of thoughts and danger, as well as negative beliefs about need for control should both positively correlate with stress symptoms. The model also suggests that the nature of the relationship between each type of metacognitive beliefs and symptoms is different. In particular, (4) the relationship between positive beliefs about worry and symptoms should be mediated by TCQ-worry. However, (5) negative beliefs about worry concerning uncontrollability of thoughts and danger should have a direct relationship with symptoms independent of TCQ-worry as a coping strategy. The present study aimed to test these predictions and also to replicate earlier findings concerning the relationship between TCQ strategies and stress symptoms. Specifically, that strategies of worry and punishment will be positively associated with stress symptoms, while other TCQ subscales will not be correlated or will show negative correlations with such symptoms.