Metacognition, memory disorganisation and post-traumatic stress symptoms

Most theoretical models of posttraumatic stress disorder (PTSD) assign an important role to the trauma memory. In particular, trauma memories are proposed to be disorganised and fragmented in those with PTSD (Foa & Riggs, 1993; Ehlers & Clark, 2000). According to these models, the nature of the trauma memory maintains symptoms and consequently needs to be addressed in treatment. The evidence for the role of memory disorganisation in maintaining PTSD symptoms, however,·is inconclusive. An alternative proposal is that, rather than the trauma memory itself, it is the individual's beliefs about the trauma memory (Le. meta-memory) that are important in the maintenance of posttraumatic stress symptoms. This proposal is asserted by the metacognitive model of PTSD (Wells, 2000), where an individual's metacognitive beliefs following a traumatic event motivate them to engage in dysfunctional responses, such as rumination and worry as a thought control strategy. Such responses consequently prevent the normal, adaptive emotional processing of the trauma that is required for symptoms to subside. Empirical evidence supports the role of metacognitive beliefs and maladaptive responses in the maintenance of PTSD. The potential role of meta-memory, however, has not been adequately studied. .The current study aimed to compare the relative importance of memory disorganisation and beliefs about the trauma memory (meta-memory) in the prediction of posttraumatic stress symptoms. Analyses were also conducted to determine whether additional factors considered important in the metacognitive model would contribute further to the prediction ofPTSD. A sample of 95 student nurses and midwives narrated their memory of the most distressing placement related event they had experienced. A number of questionnaires were also administered, including a measure of beliefs about the trauma memory, which was devised for the current study (the Beliefs about Memory Questionnaire, BAMQ). The reliability and validity of the BAMQ gained preliminary support. Beliefs about the trauma memory, but not memory disorganisation within the trauma narrative, predicted a significant proportion of the variance in posttraumatic stress symptoms after control variables were accounted for. Furthermore, consistent with the metacognitive model of PTSD, the use of rumination was found to mediate the relationship between both positive beliefs about the need for a complete memory of the trauma and negative beliefs about the meaning of gaps in the trauma memory and PTSD symptoms. The interpretation of the findings is limited by the student sample. The study, therefore, needs to be replicated with a clinical population. The findings, however, provide preliminary support for the role of meta-memory in the maintenance of posttraumatic stress symptoms. No evidence to support the role of memory disorganisation in PTSD was found. Consequently, altering the structure of the trauma memory in the treatment of PTSD, for example through exposure therapy, may not be necessary.EThOS - Electronic Theses Online ServiceGBUnited Kingdo