Post Traumatic Stress Disorder

Post Traumatic Stress Disorder

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Introduction
There has been a proliferation of interest in the development and nature of individual’s thinking patterns and processes following traumatic psychological exposure (Ehlers, Mayou, & Bryant, 1998). In particular, previous research has suggested that specific thinking styles and patterns preceding trauma predict a greater vulnerability and a poorer long-term prognosis of posttraumatic stress disorder (PTSD) (Dalgleish, 2004). Moreover, the literature has illustrated that adolescents can be predisposed to developing PTSD which develops as a result of either direct or indirect exposure to a trauma. For example, witnessing a trauma directly or learning about a specific traumatic event experienced by others (Finkelhor & Dziuba-Leatherman, 1994).

Previous research has highlighted that adolescents that have been exposed to a trauma and PTSD may also be more vulnerable to developing aggressive and antisocial behaviours (Falshaw, Browne & Hollin, 1996), alcohol and drug dependence, hypervigilance and impulsive misconduct (Lynam, Caspi, Moffitt, Wikström, Loeber & Novak, 2000). Erwin, Newman, McMackin, Morrissey and Kaloupek (2000) suggest that a reason for this is that early exposure to trauma can have severe impact on adolescent’s functioning in terms of their emotions, cognition and behaviour, poor self-regulation and information-processing. Adding to this, Tyson & Goodman, (1996) suggest that it is these deficits in functioning coupled with the individual’s inability to regulate emotions that predispose them to engaging in protective aggression and dangerous re-enactment behaviours as a way of dealing with their exposure to trauma.

The link between dysfunctional cognitions and PTSD has been widely explored by various researchers, and it has been suggested that a tight relationship exists between PTSD and antisocial behaviour in youths (Danckwerts & Leathem, 2003). However, little is yet known about the psychological mechanisms which underlie the relationship. This literature review will explore the underlying mechanisms which predict a greater vulnerability to the onset, development and maintenance of PTSD associated with young offenders. More specifically, depressive cognitions such as rumination and counterfactual thinking will be explored with reference to their link with PTSD.

Defining Rumination and Counterfactual Thinking
Individuals affected by PTSD often report symptoms of incessant ruminative thinking associated with a traumatic experience. The DSM-IV (American Psychiatric Association, 1994) does not however distinguish intrusive rumination and intrusive memories associated with the trauma in the development of PTSD. However, more recently various theoretical perspectives propose that the two are functionally distinct and should be regarded as separate entities (Ehlers & Clark, 2000; Joseph, Williams & Yule, 1997; Ehlers & Steil, 1997).

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This review will be refer to ‘rumination’ as repetitive and recurrent, negative thinking which is self-focused and reflects on past negative experiences (Michael, Halligan, Clark & Ehlers, 2007) and specifically focuses on their symptoms of distress and worrying about the meanings of their distress (Lyubomirsky, Caldwell, and Nolen-Hoeksema, 1991). Previously, rumination has been understood as a similar concept to worry. ‘Worry’ is commonly defined as repetitive, reoccurring, uncontrollable thoughts associated with negative life events (Borkovec, Ray, & Stober, 1998). Therefore the key difference is that ‘worry’ focuses on events which will take place in the future whereas rumination refers to events which have taken place in the past (Borkovec, Ray & Stober, 1998).

Set aside from rumination, counterfactual thinking is a term described by Leithy, Brown and Robbins (2006) referring to thinking about alternative outcomes. It is understood as the key psychological process underlying specific emotions such as disappointment, regret and disbelief (Kahneman & Miller, 1986) as well as both shame and guilt (Niedenthal, Tangney, & Gavanski, 1994). Psychological literature largely associates counterfactual thinking with negative affect as well as contributing to adaptive outcomes (Roese & Olson, 1997). Beside negative affect, counterfactual thinking has also been subcategorised into upward and downward counterfactuals associated with the direction of comparison to the actual event. Upward counterfactuals compare reality to a more desirable alternative world, for example, ‘if only I was driving slower, I could have avoided the crash’, whereas downward counterfactuals compare reality to a less desirable alternative world, for example, ‘if I hadn't been wearing my seat belt, I could have been killed’ (Markman, McMullen, Elizaga, & Mizoguchi, 2006).

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