An observational study in PTSD, sponsored by Reinier van Arkel. Completed at 1 site in Netherlands. Open to participants aged 18 Years and older, including healthy volunteers. Per ClinicalTrials.gov, last updated 2026-11-03.
Sponsored by Reinier van Arkel · Observational
Post-traumatic stress disorder (PTSD) is characterized by persistent distress following exposure to traumatic events and is often maintained by maladaptive trauma-related cognitions. Trauma-related attributions, such as perceiving traumatic experiences as caused by internal, stable, global, or uncontrollable factors, have been associated with greater PTSD symptom severity. However, limited research has examined how these attributions change following trauma-focused treatment in individuals with PTSD.
This study aims to investigate the relationship between trauma-related attributions and PTSD symptom severity among adult outpatient patients with chronic PTSD and to examine changes in maladaptive attributions following trauma-focused treatment. Trauma-related attributions and PTSD symptoms will be assessed before and after treatment. It is hypothesized that greater PTSD symptom severity will be associated with more maladaptive trauma-related attributions and that trauma-focused treatment will be associated with reductions in both PTSD symptoms and maladaptive attributional patterns.
Background Post-traumatic stress disorder (PTSD) is a debilitating mental health condition that may develop following exposure to traumatic events. Although many individuals recover naturally, a substantial proportion experience persistent symptoms that significantly impair psychological, social, and occupational functioning. Cognitive models of PTSD suggest that maladaptive interpretations and beliefs about traumatic experiences play a central role in the maintenance of symptoms.
One cognitive factor of particular relevance is trauma-related attribution style. Trauma-related attributions refer to the explanations individuals give for the causes and consequences of traumatic events. Individuals with PTSD often demonstrate maladaptive attributional patterns, including attributing traumatic experiences to internal causes (self-blame), perceiving causes as stable over time, viewing consequences as globally affecting many areas of life, and believing outcomes are uncontrollable. These attributional styles may contribute to persistent feelings of helplessness, guilt, shame, and ongoing threat, thereby maintaining PTSD symptoms.
Trauma-focused psychological treatments, such as Eye Movement Desensitization and Reprocessing (EMDR) and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), aim not only to reduce symptom severity but also to modify maladaptive trauma-related cognitions. While substantial evidence supports the effectiveness of trauma-focused treatments in reducing PTSD symptoms, less is known about how trauma-related attributions change during treatment and how these changes relate to symptom improvement.
Study Objectives The primary objective of this study is to examine the relationship between trauma-related attributions and PTSD symptom severity in adult outpatient patients with PTSD. A secondary objective is to investigate changes in trauma-related attribution styles following trauma-focused treatment and to determine whether these changes are associated with reductions in PTSD symptoms.
The study hypothesizes that:
Study Design This study uses a pre-post observational design in a clinical outpatient sample receiving routine trauma-focused treatment. Participants will be assessed before the start of treatment and again following completion of treatment.
Participants Eligible participants are adult outpatient patients meeting DSM-5 criteria for PTSD. Patients with severe comorbid psychiatric disorders that would interfere with participation, active substance dependence, or other conditions preventing valid assessment will be excluded.
Procedures and Measures Participants will complete standardized assessments of PTSD symptom severity and trauma-related attributions at baseline and post-treatment. PTSD symptoms will be measured using a validated PTSD assessment instrument. Trauma-related attributions will be assessed using a validated measure of attributional style focusing on internality, stability, globality, and perceived controllability of trauma-related causes and consequences.
Participants will receive trauma-focused treatment according to standard clinical practice, including evidence-based interventions such as EMDR therapy and/or Trauma-Focused Cognitive Behavioral Therapy.
Outcome Analyses Changes in PTSD symptoms and trauma-related attributions from pre-treatment to post-treatment will be examined using appropriate within-subject statistical analyses. Associations between trauma-related attributions and PTSD symptom severity will be evaluated through correlational and regression analyses. Particular attention will be paid to the role of internal, stable, global, and uncontrollable attributions as potential cognitive correlates of chronic PTSD and treatment-related recovery.
Expected Significance By examining both the presence and change of trauma-related attributions in a clinical sample with PTSD, this study seeks to advance understanding of cognitive mechanisms underlying PTSD maintenance and recovery. The findings may contribute to the optimization of trauma-focused interventions by clarifying the importance of targeting maladaptive attributional patterns during treatment and may ultimately support improved treatment outcomes for individuals suffering from PTSD.
2,682 studies on the registry are indexed under Stress Disorders, Post-Traumatic; 601 are open to participants now.
This study's enrollment of 112 is below the median of 150 across 371 observational studies indexed under Stress Disorders, Post-Traumatic.
Browse Stress Disorders, Post-Traumatic studies →Reinier van Arkel is the lead sponsor of 3 studies on the registry; none are open to participants now.
Counted across the registry records on this site, refreshed daily.
Individuals receiving outpatient trauma treatment
Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
Exclusion Criteria
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Informed consent
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Individuals receiving outpatient trauma treatment
Change in PTSD Symptoms as Measured by the PCL-5
Change in total score on the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5). Scores range from 0 to 80, with higher scores indicating greater PTSD symptom severity. The primary outcome is the difference between baseline and post-treatment scores.
Time frame: Baseline (pre-treatment) and post-treatment (upon completion of trauma-focused treatment; approximately 3-6 months after baseline, depending on treatment duration).
Change in Trauma-Related Attributions
Change in maladaptive trauma-related attributions, including internal, stable, global, and uncontrollable attributions, as assessed using a validated attribution measure.
Time frame: Baseline (pre-treatment) and post-treatment (upon completion of trauma-focused treatment; approximately 3-6 months after baseline, depending on treatment duration).
Change in Posttraumatic Trauma-Related Cognitions (PTCI Total Score)
Posttraumatic trauma-related cognitions will be assessed using the Posttraumatic Cognitions Inventory (PTCI). The PTCI measures maladaptive trauma-related beliefs across domains including negative cognitions about the self, negative cognitions about the world, and self-blame. Higher scores indicate more negative and dysfunctional trauma-related cognitions. The secondary outcome is the change in total PTCI score from pre-treatment to post-treatment.
Time frame: Baseline (pre-treatment) and post-treatment (upon completion of trauma-focused treatment; approximately 3-6 months after baseline, depending on treatment duration).
Plan to share: No — The individual participant data (IPD) collected in this study will not be shared. The dataset contains sensitive clinical information related to trauma exposure and trauma-related symptoms, and full de-identification cannot be guaranteed without compromising data integrity. Sharing such data may pose privacy risks to participants, particularly those in the clinical sample receiving specialized trauma treatment.
No publications or documents are linked to this record.
From the registry record's own update history. This site started tracking changes on Sep 25, 2026; for anything earlier, see the record history on ClinicalTrials.gov ↗
This study is completed, as verified in Nov 2026. You cannot join it, but the record below documents what was studied.
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Stress Disorders, Post-Traumatic →
Reinier van Arkel