The role of cognitions and emotional processes in PTSD severity among young people seeking treatment for PTSD and substance use

Purpose Cognitive models emphasise trauma-related appraisals in relation to post-traumatic stress symptoms. Cognitive-emotional processes may also shape symptom presentation, yet these processes are rarely examined together. This study aims to address these gaps by examining the associations between overall and cluster-specific PTSD severity and the severity of trauma-related beliefs (i.e. negative post-traumatic cognitions about the self, others and the world) and transdiagnostic processes (perseverative thinking, emotion regulation and distress tolerance) in treatment-seeking youth. Design/methodology/approach Data were drawn from 55 adolescents and young adults (M age = 19.49, SD = 3.27; 38 female) enrolled in a randomised controlled trial evaluating an integrated treatment for co-occurring PTSD and substance use. Participants completed baseline assessments of trauma-related beliefs, perseverative thinking, distress tolerance, emotion regulation and PTSD symptom severity. Findings PTSD severity was strongly associated with the severity of trauma-related cognitions. Beliefs about a fragile self and perceptions of permanent disturbing change evidence the strongest associations with overall PTSD severity, and re-experiencing, negative cognitions/mood and hyperarousal. No variables were significantly associated with avoidance. Rumination, emotion regulation and distress tolerance were not significantly associated with PTSD severity once trauma-related cognitions were included in the models. These findings highlight associations between maladaptive trauma-related beliefs about the self and the world and PTSD severity. Originality/value To the best of the authors’ knowledge, this study is among the first to examine trauma-related cognitions and cognitive-emotional processes in youth with PTSD and substance use. It advances existing research by examining their associations with overall and cluster-specific PTSD severity and highlights the need to examine temporal and mediating pathways in future work.