The role of avoidance in PTSD symptom maintenance

Open Access
Parker-Guilbert, Kelly Sage
Graduate Program:
Doctor of Philosophy
Document Type:
Date of Defense:
June 16, 2015
Committee Members:
  • Amy Dyanna Marshall, Dissertation Advisor
  • Amy Dyanna Marshall, Committee Chair
  • Michelle Gayle Newman, Committee Member
  • Jose Angel Soto, Committee Member
  • Peter Cm Molenaar, Special Member
  • posttraumatic stress disorder
  • trauma
  • maintenance of psychopathology
Theories of posttraumatic stress disorder (PTSD) generally agree that, among the symptom clusters of the disorder, the avoidance cluster is central to the maintenance of PTSD. This assumption has not been adequately tested, however, leaving the empirical evidence mixed in regard to how the symptom clusters of PTSD function together. The major limitations of the prior literature include not using true PTSD samples and largely using cross-sectional research designs. Additionally, the most well-designed study to test this question (Schell, Marshall, & Jaycox, 2004) does not support the accepted theory, furthering the need to adequately test the role of avoidance in maintaining PTSD symptoms. In the current study, I used cross-lagged models to examine how the various PTSD symptom clusters predicted each other over six weeks in a clinical, chronic PTSD sample. Results indicated that reexperiencing and avoidance are both central to PTSD maintenance, challenging widely accepted views that avoidance is the central maintaining factor of the disorder. Thus, PTSD may be more accurately conceptualized in terms of a biphasic reexperiencing-avoidance maintenance cycle. Further, treatment of PTSD may benefit from a greater focus on decreasing reexperiencing symptoms.