A longitudinal investigation of the relationships among PTSD symptoms and various cognitive biases in children and adolescents

BACKGROUND: This study aimed to investigate the prospective associations among cognitive biases, including negative appraisals, attention to threat, belief inflexibility, and jumping to conclusions, and to examine bidirectional relationships between PTSD symptoms and these biases. METHOD: A total of 1,549 trauma-exposed children and adolescents (52.6% male; mean age = 13.66 years, SD = 1.24) were surveyed at baseline and one-year follow-up using self-report questionnaires. Cross-lagged models were used to examine significant associations via path analysis. RESULTS: Negative appraisals, attention to threat and PTSD symptoms prospectively predicted and were predicted by one another. No significant prospective links were found among attention to threat, belief inflexibility, and jumping to conclusions, although these variables showed strong concurrent correlations. Additionally, baseline PTSD symptoms and negative appraisals were associated with increased belief inflexibility at follow-up. CONCLUSIONS: Our findings reveal a vicious circle involving negative appraisals, attention to threat and PTSD symptoms in trauma-exposed children and adolescents. These cognitive biases play a critical role in the development and maintenance of PTSD. Interventions combining multiple forms of cognitive bias modification may enhance PTSD treatment and prevention.