Cognitive Etiology of PTSD: Appraisals

Travis DixonAbnormal Psychology, Cognitive Psychology, Post-Traumatic Stress Disorder

Headache girl. High blood pressure concept. Vector illustration.

Updated July 2020

You can prepare for Paper 2 – Abnormal Psychology – by getting ready to answer any question from just the “Etiologies of abnormal psychology” topic. If you are using this strategy, you need to make sure you can explain biological, cognitive and sociocultural etiologies. 

Etiology – Cognitive appraisals (and re-appraisals)

Cognitive Appraisal: In the context of PTSD, cognitive appraisal refers to how someone thinks about their traumatic experience, its consequences and/or other events following it (e.g. reminders or “triggers.”). Appraisal includes a person assessing how threatening something is, how it will affect them and whether or not they have the resources to cope with it.

A negative cognitive appraisal, for example, could be a War Veteran experiencing “survivor’s guilt.” Their survival is the consequence of the trauma and they are thinking about it in a negative way – they shouldn’t have survived when others died (guilt is a common  factor that has been linked with developing PTSD after experiencing trauma).


How a soldier appraises his experiences in war can affect the likelihood of developing PTSD. Appraisal means assessing the effect of the trauma on the individual and also if they can cope with it. For example, a soldier might not feel like they can cope with the memories and the effects of the war, which is a negative appraisal and can increase chances of getting PTSD.

Negative cognitive appraisals can explain symptoms associated with avoidance because the appraisal will increase the person’s feelings of stress and negative emotions, so they may want to avoid people and places in an effort to avoid having these negative feelings. This could also be why depression is often diagnosed alongside PTSD.

Ehler and Clark’s cognitive model of PTSD (2000): According to this model, “PTSD becomes persistent when individuals process the trauma in a way that leads to a sense of serious, current threat.” (Ehler’s and Clark, 2000). This sense of threat occurs because of two factors: (1) negative appraisals of the trauma and its effects on the person, and (2) effects on memory, including those related to fear conditioning (associative memory) – e.g. the participant develops a conditioned fear response which increases their sense of threat. This is important as it has significant implications in how we can treat PTSD.

Key Study

Download all the teaching resources you need for a great unit on PTSD.

Cognitive appraisal as a predictor of PTSD (Hitchcock et al. 2015): This study is similar to many others in that it investigated correlations between negative appraisals after experiencing a traumatic event and the development of PTSD symptoms. Their participants were children aged 7-17 years who were admitted to hospital because they had experienced a one-off traumatic event (e.g. car accident, injury, house fire, etc.) Their symptoms of PTSD were measured within one month of the trauma and again after six months using the “Clinically Administered PTSD Scale (CAPS) (modified for children). The kids’ negative appraisals were measured using a 25-item self-report questionnaire called the “Child Posttraumatic Cognitions Inventory (CPTCI). The results showed that there was a moderate but statistically significant correlation between negative appraisals and PTSD symptom severity after six months (0.31, p<0.001). This is one example of a simple study that shows how appraisals can increase the chances of developing PTSD after experiencing trauma.

The interaction of biology and cognition…

Check out this blog post for a biological etiology of PTSD

Cognition and biology are inextricably linked because we can’t have cognitive processes without activity in the brain. Therefore, it’s important to look at how brain abnormalities and cognition may interact in the explanation of PTSD symptoms. The ventromedial prefrontal cortex (vmPFC) and the anterior cingulate cortex (ACC) are two areas that are associated with cognitive appraisal and cognitive reappraisal (the ability to readjust an initial appraisal of an emotional stimuli). This could have a top-down effect on the amygdala: positive appraisals (and reappraisals) can reduce the activity in the amygdala, and thus reduce the stress response. However, negative reappraisals (or simply negative appraisals) can increase activity in the amygdala. Therefore, if someone has low volume or activity in their vmPFC or ACC, it could explain the symptoms of PTSD associated with increased anxiety and arousal because the vmPFC is responsible for cognitive reappraisal and can reduce the activity of the amygdala, which can reduce the stress response. Without the area of this part of the brain, cognitive reappraisal might not be effective (or might not happen) so the activity in the amygdala remains high which also maintains high anxiety and arousal levels.


Reduced activity and volume in the vmPFC is a common finding in people with PTSD. This could be because this brain abnormality affects the ability to cognitively reappraise emotional stimuli in a more positive way, which will mean the stress response will stay elevated, resulting in symptoms like increased anxiety and arousal.

Cognitive reappraisal and top-down processing of the vmPFC and amygdala activation (Urry et al., 2006): In this study, 19 participants (without PTSD) were exposed to a range of emotional stimuli that were flashed on a screen while they were in an fMRI machine. They were asked to cognitively reappraise the stimuli by either increasing, decreasing or attending. They could “increase” by imaging the scene happening to someone they loved, “decrease” by imagining it wasn’t real or “attend” by simply focusing on the details of the image. The results showed a negative correlation between vmPFC and amygdala activation – the higher the vmPFC activity, the lower the amygdala activation. This could explain the common finding of hypofunction and reduced volume in the vmPFC in patients with PTSD.

Critical Thinking Considerations:

  • This study was conducted on health participants who did not have PTSD. How could this affect the validity of these findings?
  • The cognitive appraisals performed in this experiment were done in an fMRI. Is this another factor that affects generalizability? For example, are there reasons why it might be more difficult to perform these same appraisals in real-life scenarios?
  • How could the findings from these studies be applied to help reduce the chances of developing PTSD?

Exam Tips:

  • When writing about biology or cognition, first establish the specific factor/s that you are explaining and the relevant research. Only explain the interaction of factors later in your essay after you have made the basic links first.
  • Use the explanations as counter-arguments for one another. This will show your depth of understanding.
  • You may be asked about biological, cognitive and/or sociocultural etiologies of one or more disorders.
  • The material in the next section can also be used to explain cognitive, and biological explanations.
  • Drawing diagrams to help represent complex interactions is a good way to clarify and support your explanations in essays.