The Role of Causal Attributions in Maintenance and Recovery of Trauma-Related Symptoms: A Systematic Review

This systematic review examines the role of causal attributions in the maintenance and recovery of PTSD symptoms. Causal attributions, which include dimensions such as locus (internal vs. external), controllability (controllable vs. uncontrollable), and stability (stable vs. unstable), as well as locus of control, learned helplessness, and self-blame, are crucial in understanding the cognitive processes that contribute to PTSD. The review followed PRISMA guidelines and included longitudinal empirical studies on the association between causal attributions and PTSD symptoms over time. A total of 13 articles were included in the review. Attributions were categorised as pertaining to 'locus', 'control', and 'consistency'. The findings indicate that maladaptive attributions, whether related to locus, control, or consistency, contribute to the persistence and severity of PTSD symptoms. For attributions regarding the origin of the traumatic event, an external locus of control with another person, as well as internal characterological self-blame, appeared to be maladaptive. In addition, for attributions regarding experiences during the traumatic event, low levels of experienced control, control options that were not (sufficiently) exercised, and high levels of perceived consistency appeared to be maladaptive. The review offers a nuanced and a comprehensive framework that enhances our understanding of how individuals perceive and interpret traumatic events, by recognising that attributions are complementary rather than mutually exclusive. This independency approach acknowledges the complexity of human cognition and highlights the importance of addressing deeply anchored maladaptive attributions in therapeutic interventions.