Exploring the Relationship Between Alienation Appraisals, Trauma, Posttraumatic Stress, and Depression

Clinical Impact Statement Alienation appraisals are an important predictor of posttraumatic distress in student and clinical samples. Alexithymia, social support, and loneliness do not appear to better explain the role of alienation in posttraumatic stress. However, alienation appraisals, alongside the weaker predictors of social support and loneliness, are important factors to consider in trauma survivors with depression. Alienation makes an independent contribution to the prediction of posttraumatic distress, unique from loneliness, social support, and alexithymia. Recommended clinical treatments include sensitive cognitive restructuring of alienation appraisals and fostering a strong therapeutic alliance. Objective: Cognitive models posit negative trauma appraisals as maintaining symptoms of posttraumatic stress disorder. Recent research has demonstrated that alienation appraisals (feeling disconnected from the self and others) are salient in trauma-related distress. Studies show that alienation appraisals fully mediated the relationship between trauma exposure and symptoms of posttraumatic stress disorder (PTSD) in trauma-exposed adults. This study explored alienation appraisals in student and clinical samples, assessing whether alienation significantly mediated the relationship between cumulative trauma and trauma-related distress. It also 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. Method: Mediation and hierarchical regression models were tested with questionnaire data from a student sample (N = 100) and clinical sample of trauma-exposed treatment-seeking adults (N = 93). Results: In the student sample, alienation (B = 1.27) fully mediated the relationship between cumulative trauma and posttraumatic stress, but not depression. When alexithymia, social support, and loneliness were entered as parallel mediators, only alienation appraisals (B = 1.03) significantly mediated the relationship between cumulative trauma and posttraumatic stress. For the clinical sample, alienation appraisals (beta = .53) were the only significant predictor of posttraumatic stress, while alienation appraisals (beta = .75) and, to a lesser extent, social support (beta = .19) and loneliness (beta = .30) significantly predicted depression. Conclusions: Alienation was a salient predictor of posttraumatic distress. Clinical assessment of alienation appraisals is recommended to inform psychological interventions for trauma survivors.