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Thought control strategies in acute stress disorder

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Abstract

Intrusive trauma-related thoughts and the means to manage them are a central dynamic in posttraumatic stress. Thought control strategies were investigated in survivors of motor vehicle accidents with either acute stress disorder (ASD; n=20) or no ASD (n=20). Participants completed the Acute Stress Disorder Interview, the Beck Depression Inventory, the Beck Anxiety Inventory, the Impact of Event Scale, and the Thought Control Questionnaire (TCQ) within four weeks of their accident. Although distraction, social control, and reappraisal were the most common strategies in both groups, ASD participants engaged in punishment and worry more than non-ASD participants. Worry and punishment were also strongly associated with severity of intrusive, avoidance, arousal, and depressive symptoms. Findings are discussed in terms of the role of cognitive strategies in resolving posttraumatic stress.

Introduction

Cognitive theories of posttraumatic stress postulate that this condition is maintained by repeated avoidance of intrusive thoughts and emotions associated with the trauma (Litz and Keane, 1989). This proposal holds that avoidance strategies prevent habituation to fear-related stimuli and impede modification of threat-based beliefs. Despite evidence that avoidance strategies are predictive of posttraumatic stress severity (Solomon et al., 1988; Bryant and Harvey, 1995), there has been little investigation of the cognitive strategies employed by traumatised populations to manage their intrusive thoughts.

Previous studies have investigated thought control strategies in non-clinical (Wells and Davies, 1994) and clinical (Amir et al., 1997) populations. Wells and Davies (1994)indexed five thought control strategies that they proposed are used to manage intrusive thoughts (distraction, social control, punishment, reappraisal, and worry) in a non-clinical sample, and found that self-punishment and worry were associated with psychopathology measures. This finding was supported by the finding of Amir et al. (1997)that worry and punishment correlated with obsessive–compulsive disorder (OCD) symptomatology and that OCD patients used these strategies more frequently than non-patients.

This study aimed to investigate thought control strategies in motor vehicle accident (MVA) survivors with either acute stress disorder (ASD) or no ASD. Previous work indicates that between 78% and 82% of MVA survivors who satisfy criteria for ASD still suffer posttraumatic stress disorder (PTSD) 6 months posttrauma (Bryant and Harvey, 1998; Harvey and Bryant, 1998). Intrusive symptoms are a core feature of ASD (Bryant and Harvey, 1997). The role of thought control strategies in ASD is indicated by evidence that attempted suppression of traumatic memories in ASD is associated with increased intrusions (Harvey and Bryant, in press). We predicted that ASD participants would report greater use of punishment and worry strategies than non-ASD participants, and that these strategies would be positively correlated with posttraumatic stress symptomatology.

Section snippets

Participants

Twenty ASD (6 males, 14 females) and 20 non-ASD (8 males, 12 females) participants were included in the study. Participants were recruited from successive admissions to a major hospital following a MVA. Diagnosis of ASD was assessed using the Acute Stress Disorder Interview (ASDI; Bryant et al., in press). This structured clinical interview is based on DSM-IV criteria, contains 19 dichotomously scored items that relate to ASD symptoms, and provides a total severity score indicative of acute

Participant characteristics

Table 1 presents participants' mean age, trauma-assessment interval, length of hospitalisation, BDI, BAI, IES-Intrusion, IES-Avoidance and ASS scores. Planned comparisons on these variables indicated that ASD and non-ASD participants did not differ in terms of age, trauma-assessment interval, or length of hospitalisation. As expected, ASD participants scored higher than non-ASD participants on the BDI, BAI, IES-Intrusion, IES-Avoidance, and ASS.

Thought control strategies

Table 1 also presents the mean total scores of the

Discussion

These findings accord with previous reports that self-punishment and worry are associated with controlling unwanted thoughts in non-clinical (Wells and Davies, 1994) and OCD samples (Amir et al., 1997). These data are also consistent with proposals that posttraumatic stress reactions are associated with cognitive avoidance (Litz and Keane, 1989) and with experimental findings that attempted suppression results in increased intrusions in ASD (Harvey and Bryant, in press). Notably, punishment and

References (15)

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