Negative thoughts and mood

What are negative thoughts and mood in PTSD?

For a diagnosis of PTSD, there needs to be at least two “negative alterations in cognitions and mood”. These include negative thoughts or feelings that began or worsened after the trauma, an inability to recall key features of the trauma, overly negative thoughts and assumptions about oneself or the world, exaggerated blame of self or others for causing the trauma, negative affect (e.g., fear, horror, anger, guilt, or shame), decreased interest in activities, feeling isolated, and difficulty experiencing positive affect.

What is the evidence for negative thoughts and mood in PTSD?

Moderate to high quality evidence found a strong relationship between increased dysfunctional appraisals of the trauma and increased PTSD symptoms in children and adolescents. Increased shame was related to increased PTSD symptoms in adults. There was also a relationship between increased symptoms and increased guilt, particularly feelings of wrongdoing and self-blame. In veterans, poor mental health in general, poor social functioning, more substance use and more aggression were related to more emotional numbing. However, more treatment initiation and better treatment retention were also related to more emotional numbing in veterans.

Moderate to low quality evidence found decreased reward functioning in people with PTSD, being a reflection of an inability to feel pleasure. There was less anticipation and approach reward functioning, and also decreased hedonic responses.

Moderate to low quality evidence finds five clusters of items relating to negative alterations in cognition and mood. These are;

Decreased interest items

I lost interest in activities which used to mean a lot to me. I lost interest in my usual activities. I lost interest in free time activities that used to be important to me. I lost interest in social activities. I lost interest in activities that I used to enjoy.

Detachment items

I felt distant or cut off from people. No one, not even my family, understood how I felt.

Restricted affect items

I was not able to feel normal emotions. It seemed as if I have no feelings. I felt emotionally numb. I felt unemotional about everything. I was unable to have loving feelings for people who are close to me.

Foreshortened future items

I felt as if my plans for the future would not come true. I felt that I had no future. Making long term plans seemed meaningless to me. I felt as if I don’t have a future. I felt as if my future would somehow be cut short.

Guilt items

I felt guilty. I felt ashamed of the traumatic events that happened to me. I blamed myself. I felt guilt over things I did around the time of the event. I felt guilty for having survived.

August 2021

Image: ©2014 Igor Stevanovic –

Last updated at: 9:55 pm, 7th October 2021
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