Presentation by D Hett at the University of Birmingham IPV Conference 2/3/18

1. The Role of
Metacognition in
Trauma
Danielle Hett
PhD Researcher
dxh665@bham.ac.uk

2. • Over 70% of people worldwide are exposed to at
least one traumatic event within their lifetime
(Kessler et al., 2018)
Background
• Following trauma exposure, approximately 1.3 – 8.8% of people will go on to
develop a psychiatric disorder known as, post-traumatic stress disorder (PTSD)
(Atwoli, Stein, Koenen, & McLaughlin, 2015).
• However, PTSD risk varies significantly by trauma type

3. Background
• The Diagnostic and Statistical Manual for Mental
Disorders (DSM -5), definition of trauma requires
“actual or threatened death, serious injury or sexual
violence”
• Direct personal exposure
• Witnessing of trauma to others
• Indirect exposure (e.g., learning that trauma has occurred to a close friend/
family member)
• Repeated exposure to aversive details of trauma (e.g., police repeatedly exposed
to details of child abuse)

4. Background
Intrusion
Symptoms
Avoidance Negative
alterations in
mood &
cognition
Increased
Arousal
1+ 1+ 2+ 2+
-Intrusive
memories /
thoughts
-Nightmares
-Flashbacks
-Internal
reminders
(e.g., thoughts)
-External
reminders
(e.g., places,
people,
situations)
-Persistent
negative emotion
(e.g., shame,
guilt)
-Negative beliefs
about oneself
-Hypervigilance
-High startle
response
-Poor sleep

7. • Liu et al. (2017) found that traumas associated
with the highest risk of PTSD were:
• Rape (19%)
• Physical Abuse by a romantic partner (11.7%)
• Sexual assault other than rape (10.5%)
Background
• Traumas involving interpersonal violence are
associated with the highest risk of PTSD (Breslau &
Peterson, 2008; Kessler et al., 2018 ;Liu et al., 2017).

8. Background
• Around 1 in 3 women worldwide have experienced
physical and/or sexual violence by their intimate
partner (WHO, 2013)
• Within the UK, an estimated 1.9 million adults
aged 16—59 years experienced domestic abuse in
the last year (year ending march 2017) (ONS, 2017)

9. •Police
• Therapists / counsellors
•Nurses / Doctors
•Social workers
•Lawyers
• Vicarious trauma refers to indirect exposure to
a traumatic event through first-hand account or
narrative of that event
Vicarious Trauma (VT)

10. •Symptoms of VT resemble those of PTSD, and are
distressing and impairing for the individual
•Approximately 40-50% of “helping professionals”
develop vicarious trauma and/or high rates of
traumatic symptoms ( Mathieu, 2012)
Vicarious Trauma (VT)

11. Treatments for PTSD
NICE Guidelines recommend two
psychological therapies for the treatment of
PTSD:
•Trauma Focused Cognitive Behavioural
Therapy (CBT) (Ehlers & Clark)
•Eye Movement Desensitization and
Reprocessing (EMDR) (Shapiro)

12. •Most preventative strategies for vicarious trauma
for professionals include – peer support,
managerial supervision, psychoeducation on self-
care, warning signs etc.
Prevention of PTSD
•More research is needed on preventative/ early
intervention approaches for PTSD
•One novel approach to prevention, focuses on the
role of metacognition

13. Metacognition is broadly defined as thinking about
one’s own thoughts
THINKING
ABOUT
THINKING
What is Metacognition?

14. • Metacognition is how people relate to their
thoughts, rather than the content of their
thoughts
• There is now growing evidence for the role of
maladaptive metacognition in the development
of PTSD
• Like normal cognition we can have healthy and
unhealthy beliefs which will affect the way we
respond to stress – likewise with metacognition
What is Metacognition?

15. • Metamemory – a type of metacognition related to
how people assess the contents of their memory
• Positive beliefs: “I must try to remember all of the
details of the event so that I can understand why it
happened”
• Negative Beliefs: “gaps in my memory for the
event are preventing me from getting over it”
What is Metacognition?
• Metamemory beliefs have been found to predict and maintain PTSD symptoms
(Bennett & Wells, 2010)

16. Examples of Maladaptive
Metacognition in PTSD
“Worrying makes me more
prepared for the future” “Intrusions mean I am
losing my mind”
“My worrying is
dangerous for me”
“ I should be in control of
my thoughts at all times”

17. Takarangi, Smith, Strange, & Flowe (2016)
conducted a prospective longitudinal study (i.e., 12
weeks) to assess whether metacognition can
increase trauma suffers’ risk for developing and
maintaining PTSD
Results found that people who endorsed
maladaptive metacognition pre-trauma were
more likely to develop PTSD symptoms, following
a novel traumatic event
Maladaptive Metacognition &
PTSD

18. Trauma
Symptoms
Metacognitive
Beliefs
PTSD
Exit
Metacognitive Model of
PTSD
Wells, 2009, p. 129; Wells & Sembi 2004
Worry
Rumination
Thought Suppression
Avoidance

19. If so, how can we use this knowledge to
build new preventative interventions that
guard against the development of PTSD?
Current Research
PhD Research question: Does
maladaptive metacognition play a
causal role in PTSD???

20. •Developed a new computerised cognitive bias
modification training (CBM) protocol to target
maladaptive metacognition – to try and train people
to adopt healthy metacognitive beliefs.
•Based the training on the types of maladaptive
metacognition associated with PTSD according to
previous studies and the metacognitive model of
PTSD
•Healthy participants– (i.e., not individuals with PTSD)
Current Research

21. “Experiencing intrusive memories
shows that I am n – r m a l”
(resolved as normal )
“Gaps in my memory for a
negative event shows that I am a d
- u s t i n g ”
(resolved as adjusting )
“Worrying excessively about a
negative event is c o u - t e r p r o -
u c t i v e ”
(resolved as counterproductive )
CBM
Training

22. Retrospective (immediately after stress):
Prospective (prior to stress):
+
CBM
CBM
+
Measure:
- Metacognitive beliefs
- Analogue PTSD symptoms from
film-clip over time
Current
Research

23. Results: Retrospective Study (N
= 30)

24. Future Research
• Further experimental work is needed – test the efficacy of this training using
sexual violence trauma film clips
• Future work – is it effective using clinical samples?
• Primary prevention – i.e., prior to direct
trauma exposure in at risk groups (e.g., first
responders) and vicarious trauma (e.g.,
professionals working with traumatised victims)

25. Conclusions
• Maladaptive metacognitive beliefs linked to increased risk of PTSD
• Training around metacognition may be a useful tool in the prevention of
PTSD
• Initial findings indicate CBM to promote healthy metacognitive beliefs,
reduces symptoms
• Implications for those directly exposed to traumatic events, but also for
vicarious trauma

26. Thank you for listening,
any questions?
Danielle Hett
dxh665@bham.ac.uk
dhett20