PTSDTRATT_AOSNCT07908186
Trauma-Related Attributions in Trauma Treatment: An Observational Study
An observational study of PTSD, run by Reinier van Arkel at 1 site in Netherlands.
Trial summary
Post-traumatic stress disorder (PTSD) is characterized by persistent distress following exposure to traumatic events and is often maintained by maladaptive trauma-related cognitions. Read more about this study
- Who is it for?
- Ages 18 years and olderHealthy volunteers can take part
- Conditions the study is for
- PTSD
- How many people
- 112 participants
- Where
- 1 siteNetherlands
- Study dates
- 24 Aug 2023to 22 Oct 2026
- How long will I take part?
- 6 Months
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Study population: Individuals receiving outpatient trauma treatment
Who may be able to join
- Age ≥ 18
- Sufficient proficiency in Dutch
- History of traumatic exposure and current trauma-related symptoms
Who cannot join
- Incomplete questionnaire data
- Cognitive impairment preventing informed consent or questionnaire completion
Trial locations and contacts
1 site in 1 country.
Netherlands1 site
Reinier van Arkel, Psychotraumacentrum Zuid-Nederland
's-Hertogenbosch, North Brabant, 5211LJ
About this study
Official title: Trauma-Related Attributions in PTSD: Associations With Symptoms and Treatment Change
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.
Read the detailed description
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:
- Individuals with more severe PTSD symptoms will report more maladaptive trauma-related attributions, characterized by greater internal, stable, global, and uncontrollable attributions.
- Trauma-focused treatment will lead to significant reductions in maladaptive trauma-related attributions.
- Reductions in maladaptive attributions will be associated with decreases in PTSD symptom severity.
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.
- Conditions
- PTSD
- Keywords
- PTSD, Attribution, Treatment, Observational study
- Medical subject headings
- Stress Disorders, Post-Traumatic
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
| Study group | Role | What they receive |
|---|---|---|
| Clinical sample | Individuals receiving outpatient trauma treatment |
What is being measured
The primary outcome is the main question the study is designed to answer.
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.
Measured: Baseline (pre-treatment) and post-treatment (upon completion of trauma-focused treatment; approximately 3-6 months after baseline, depending on treatment duration).
Secondary outcomes (2)
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.
Measured: 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.
Measured: Baseline (pre-treatment) and post-treatment (upon completion of trauma-focused treatment; approximately 3-6 months after baseline, depending on treatment duration).
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted30 Oct 2026
- Study start24 Aug 2023
- Primary completion22 Oct 2026
- Study completion22 Oct 2026
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for PTSDStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 112 participants (actual)
- Target duration
- 6 Months
Sponsor and investigators
- Lead sponsor
- Reinier van Arkel
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07908186
- Sponsor's protocol ID
- ESCW-2023-062R2
- Acronym
- TRATT_AOS
- Status last verified
- Nov 2026
- First submitted
- 5 Oct 2026
- Last updated
- 3 Nov 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- 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.
Study at a glance
From the registry record, last updated by the sponsor on 3 Nov 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Trauma-Related Attributions in PTSD: Associations With Symptoms and Treatment Change
- ClinicalTrials.gov ID
- NCT07908186
- Acronym / sponsor ID
- TRATT_AOS / ESCW-2023-062R2
- Conditions
- PTSD
- Keywords
- PTSD, Attribution, Treatment, Observational study
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 112 participants (actual)
- Lead sponsor
- Reinier van ArkelUniversity, hospital or other
- Study start
- 24 Aug 2023 (actual)
- Primary completion
- 22 Oct 2026 (actual)
- Study completion
- 22 Oct 2026 (actual)
- First posted
- 30 Oct 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Detailed description
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:
- Individuals with more severe PTSD symptoms will report more maladaptive trauma-related attributions, characterized by greater internal, stable, global, and uncontrollable attributions.
- Trauma-focused treatment will lead to significant reductions in maladaptive trauma-related attributions.
- Reductions in maladaptive attributions will be associated with decreases in PTSD symptom severity.
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.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
- Target follow-up
- 6 Months
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Clinical sample | – | –Individuals receiving outpatient trauma treatment |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
- Study population
- Individuals receiving outpatient trauma treatment
Key inclusion criteria (3 listed)
- Age ≥ 18
- Sufficient proficiency in Dutch
- History of traumatic exposure and current trauma-related symptoms
Key exclusion criteria (2 listed)
- Incomplete questionnaire data
- Cognitive impairment preventing informed consent or questionnaire completion
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Change in PTSD Symptoms as Measured by the PCL-5
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 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.
2 secondary outcomes
Change in Trauma-Related Attributions
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)
Time frame: Baseline (pre-treatment) and post-treatment (upon completion of trauma-focused treatment; approximately 3-6 months after baseline, depending on treatment duration).
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 3 Nov 2026.
- Individual participant dataSharing planned: 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.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of PTSD, run by Reinier van Arkel at 1 site in Netherlands.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 3 Nov 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Netherlands. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Change in PTSD Symptoms as Measured by the PCL-5 (time frame: Baseline (pre-treatment) and post-treatment (upon completion of trauma-focused treatment; approximately 3-6 months after baseline, depending on treatment duration).). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 3 Nov 2026.