A cognitive action theory of post-traumatic stress disorder

Abstract

Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder characterized in part by such phenomena as intrusive memories, flashbacks, numbing of affect, memory and attentional impairment, hyperalartness, and adjustment difficulties. In this paper we describe a new theoretical approach to understanding PTSD in combat veterans that has implications for understanding PTSD resulting from other life-threatening situations, and for understanding other anxiety disorders and ordinary cognitive processes. Previous approaches to understanding PTSD have derived from associative learning theory, from a reinterpretation of psychodynamic theory, or from general notions of information processing. The perspective presented in this paper integrates these previous approaches and elaborates them into a hierarchical network view of cognition and action. According to this view, emotion, action, and memory all flow from the processing of information by specific mental network structures. The symptoms of PTSD are derived from structures that were acquired during combat because they were then adaptive in promoting the soldier's survival, but now lead to actions that are inappropriate for the civilian environment. The presence of these structures continues to produce difficulties for some individuals. Such occurs because they are particularly susceptible to a vicious-cycle positive feedback loop in which mild evidence of threat activates threat-response structures that bias the individual to interpret ambiguous evidence as threatening. This, then, further raises the threat arousal, further activates the threat-response structures, and so forth. The implications of this view for the treatment of PTSD and other anxiety disorders are discussed.