The role of alienation appraisals in mediating the relationship between trauma and posttraumatic stress

The first study tested the proposed mediating role of trauma appraisals between both childhood and cumulative trauma, and two markers of trauma-related distress; posttraumatic stress and depression. Mediation models were developed and tested with data collected from a sample of trauma-exposed, treatment receiving adults (N = 106). Trauma appraisals fully mediated relationships between childhood trauma and PTSD/depression however further analyses indicated alienation appraisals were the only significant mediator of these relationships. Subsequently we conducted a systematic review to explore the relationship between alienation appraisals and PTSD symptoms in trauma-exposed adults; the search returned found 470 studies, 9 of which met full inclusion criteria. A random effects meta-analysis for the relationship between alienation appraisals and PTSD symptoms showed a total effect size of r=.57, (Z=8.41, p<.001). Although a strong, positive relationship was found between alienation and PTSD symptoms, the mechanism of this relationship remained unclear.The second study explored alienation appraisals in student (n=100) and clinical samples (n=93), assessing whether alienation significantly mediated the relationship between cumulative trauma and trauma-related distress. It additionally explored whether alexithymia, social support, and loneliness also mediated the relationship between cumulative trauma and markers of trauma-related distress, clarifying the role of alienation. In the student sample, alienation (B = 1.27) fully mediated the relationship between cumulative trauma and posttraumatic stress. For the clinical sample, alienation appraisals (β = .53) were the only significant predictor of posttraumatic stress.Clinical assessment of alienation appraisals is recommended to inform psychological interventions for trauma survivors.