A network analysis of two conceptual approaches to the etiology of PTSD

Abstract

Two prominent conceptual models of PTSD are the cognitive model, used in the development of cognitive processing therapy (CPT; Resick & Schnicke, 1992), and the functional contextualist model, underlying acceptance and commitment therapy (ACT; Hayes, Strosahl, & Wilson, 1999). Despite the evidence supporting both models, they fundamentally differ in the constructs that are theorized to pose risk and maintenance for PTSD. Network analysis was used in the current study to examine the dynamic interactions among cognitive (relating to CPT) and functional contextualistic (relating to ACT) variables and PTSD symptoms. Specifically, for both the cognitive and functional contextualist models, a Gaussian graphical model and a directed acyclic graph were estimated, resulting in a total of four networks. A sample of 722 trauma-exposed adults were included in the final sample. Results from the cognitive networks highlighted the importance of maladaptive beliefs about threat, strong negative feelings, strong negative beliefs, feeling distant, startle, and hypervigilance in maintaining the co-occurrence of PTSD symptoms and maladaptive posttraumatic beliefs. Additionally, the cognitive networks revealed that PTSD symptoms are more likely to lead to posttraumatic beliefs, rather than the reverse direction being true. Results from the functional contextualist networks identified numerous associations amongst variables that may be particularly important, including associations between experiential avoidance and avoidance of trauma-related thoughts and memories, between risky behaviors and lack of contact with values, between cognitive fusion and strong negative beliefs, and among trouble concentrating, lack of present-moment awareness, and inaction. Findings from this study may help identify potentially important causal relationships that can be tested further with longitudinal research.