Rational Emotive Behaviour Therapy (REBT: Ellis, 2001) represents the original cognitive behavioural therapy (eBT) model of psychopathology. Although there is much empirical support for the basic theory of REBT (see David, Lynn, & Ellis, 2010), the model has never been tested in the context of posttraumatic stress responses to adverse life events. The first empirical chapter of the thesis investigated the construct validity of the Attitudes and Belief Scale 2 (ABS-2: DiGiuseppe, Leaf, Exner, & Robin, 1988). This chapter employed traditional confirmatory factor analysis and confirmatory bifactor modelling to investigate the psychometric properties of the ABS-2. Results indicated that a bifactoral model conceptualisation was found to offer an adequate representation of the underlying factor structure of the scale. Based on these results, an abbreviated version of the ABS-2 with superior psychometric properties was thus constructed. In the second empirical chapter confirmatory bifactor modelling and composite reliability analysis were employed to investigate the psychometric properties of the Profile of Emotional Distress (PED: Opris & Macavei, 2007). The PED was designed to capture the qualitative distinction between dysfunctional emotions, as predicted by REBT theory. Results indicated that the PED does not capture the distinction between functional and dysfunctional negative emotions, however a bifactor model inclusive of a single general distress factor, and four method factors was found to be an acceptable fit of the data. The third empirical chapter utilised structural equation modelling to test the organisation of the irrational beliefs in the prediction of posttraumatic stress responses. A model consistent with the predictions of REBT theory was found to be a good fit of the data and explained a large percentage of variance in each symptom class of posttraumatic stress. The fourth empirical chapter provided the first piece of empirical evidence that generalised irrational beliefs impact upon posttraumatic stress symptoms via trauma-specific irrational beliefs; a frequently hypothesised relationship which had hitherto remained untested. Results of structural equation modelling offered support for this core hypothesis. Subsequently, the fifth empirical chapter investigated the impact of trauma-specific irrational beliefs in the prediction of reporting posttraumatic stress symptoms while controlling for a number of important sociodemographic factors. Binary logistic regression ~ .. ~ ... analysis was employed and found that three irrational belief process positively predicted belong to the strongly symptomatic group. Finally, the sixth empirical chapter employed sequential moderated multiple regression analysis to determine if rational beliefs could positively moderate the impact of irrational beliefs of posttraumatic stress symptoms. Rational beliefs were found to exert a negative, direct effect on posttraumatic stress symptoms, and to lessen the impact of irrational beliefs on posttraumatic stress responses.

Research has suggested that incidences of traumatic experience may cluster within the population, suggesting that individuals may suffer from similar, multiple experiences (Menard, 8andeen-Roche, & Chi lcoat, 2004). Also, differences in trauma type and exposure have been shown to exist between the sexes. Given that different traumatic experiences have consistently been shown to influence psychopathological disorders in both males and females (Kessler et al, 1995; Breslau & Wilcox, 2004; Breslau, Chilcoat, Kessler, & Davis, 1999; Tolin & Foa, 2006), the current thesis aimed to identify distinct groups of females and males within the population characterised by unique profiles of trauma hi story. The present research investigated exposure to traumatic events by adopting a 'person centred' latent class approach. Latent class analysis (LCA), multinomial logistic regression analysis, and confirmatory factor analysis (CFA) were utilised to test a series of hypotheses using data from The National Comorbidity Survey. In chapter two, three latent classes of traumatic exposure were identified for both sexes. For females a low risk class, a medium risk class and an interpersonal trauma class were identified; for males a low risk class, a situational trauma class and an interpersonal/violence class were identified. In chapter three multinomial logistic regression analyses were adopted to identify situational, environmental and clinical risk factors associated with each of the six trauma classes. Traumatised females and males had significantly high associations' with parental psychopathology variables, parental behaviour variables, domestic violence and household/loss factors. It appeared that pre-trauma risk factors were significantly related to latent class membership. In chapter four, multinomial logistic regress ion analyses were used to identify associations between each of the latent classes of trauma and a range of psychopathological disorders. Significant associations were found between the male and female trauma classes and all psychopathological disorders. Extremely high associations were evident for diagnoses of psychosis and PTSD. In chapter five confirmatory factor analyses were utilised to investigate the underlying symptom dimensions of PTSD in both sexes. In addition a multiple indicators and multiple causes (MIMIC) model was used to predict variation in the latent dimensions of the King, Leskin, King, and Weathers (1998) PTSD model using the six trauma classes. All trauma classes in each sex had significant associations with each of the symptom dimensions of PTSD. These findings add to the growing body of research supporting associations between diverse traumatic experiences and diverse psychological outcomes. It is recommended that, based on the current findings, clinicians and practitioners should demonstrate care and consideration when evaluating clients who present with trauma. Full trauma histories may afford better opportunities to deliver more successful and informed treatment interventions, while discrimination between the sexes in terms of trauma risk, occurrence and outcome may aid recovery and care

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Objectives: Posttraumatic stress disorder (PTSD) is a universal phenomenon, but evidence suggests psychological processes involved within its aetiology and maintenance have cultural variations. Leading PTSD models agree that autonomous appraisals are central to PTSD but give little consideration to the influence of culture. However research suggests individuals from cultures with primarily independent self-construals make more autonomous (e.g. control, responsibility) appraisals for everyday events. This could have significant implications for PTSD models. This study's objective was to assess cultural differences in everyday appraisals and provide a novel examination of cultural differences in appraisals of trauma. Design: A total of 90 participants (49 Independent, 41 Interdependent) were recruited from the community. A 2 (culture; Independent vs. Interdependent) x 2 (memory: everyday vs. trauma) mixed design was utilised. It was predicted that the Independent group would show elevated autonomous appraisals for the everyday memory. The trauma condition was exploratory. A correlational analysis of the relationship between appraisal patterns and PTSD symptoms was also conducted across cultures. It was hypothesised that a negative association would be observed between elevated PTSD symptoms and autonomous appraisals in Independent but not Interdependent cultures. Results: Cultural differences were reported for several appraisals themes, however methodological limitations prevented firm conclusions regarding control and responsibility appraisals. Cultural differences also emerged in the relationship between trauma appraisals and posttraumatic symptoms. Some unexpected relationships arose, but as anticipated, the Interdependent group's psychological well-being correlated with interpersonal appraisals rather than autonomous appraisals typical within Independent cultures. Conclusions: This study highlights the complex relationship between culture and PTSD. The central findings support claims that whilst PTSD is a universal phenomenon, the appraisal themes involved may not be. There is a clear need for further research to clarify these initial findings and where necessary develop culturally appropriate assessment measures, models and interventions for PTSD.

Surviving subarachnoid haemorrhage (SAH) patients' experience significantly reduced health-related quality of life (HRQoL) in both the short- and long-term, as well as mysterious symptoms of fatigue and sleep dysfunction. Patients’ family members and friends - who often act as their informal carers - can also experience psychosocial disability. The cause for these poor outcomes remains unknown. Traditional explanations focusing on the neurological sequelae associated with SAH or the characteristics of the illness are not satisfactory; nor are attempts to explain family members' difficulties on the basis of carer burden. The hypothesis which is tested in this thesis is that post-traumatic stress disorder (PTSD) may be abnormally high in both the SAH patient and 'significant other' (SO) population and that this may explain their outcomes. SAH patients are known to be at risk of suffering from PTSD, but it is unknown if this explains their outcome. In terms of patients' SOs, they are known to experience psychiatric symptoms and I suggest these could be caused by their development of PTSD, but this has never been examined. In Part One (Chapter 2-5), I focus on patients' outcomes. Before examining my PTSD hypothesis, I present a meta-analysis (Chapter 2) I conducted of studies which have tried to explain patients' outcome using neurological factors. I conducted the meta-analysis as a tendency for prior studies to be underpowered and use unreliable statistics could have meant that the actual importance of traditional factors was obscured. The results of my meta-analysis however did not support this possibility and instead showed traditional neurological variables did not explain patients' outcome. With this in mind, I then present a longitudinal study (Chapter 5) in which I examined one of the largest prospective series of SAH patients to establish PTS D's explanative importance. Using regression analyses, this study showed PTSD was the best predictor for patients' mental HRQoL - the domain most persistently impaired. It also helped predict patients' physical HRQoL. Moreover, PTSD was linked to sleep problems and may therefore cause fatigue. Crucially, to establish the cause of PTSD, logistic regression was performed. This showed that maladaptive stress coping strategies were the best predictor for PTSD development. In Part Two of the thesis (Chapter 6), I present my longitudinal study of one of the largest prospective samples of SOs. All SOs were assessed with a diagnostic PTSD measure and coping skills were assessed. An elevated incidence of PTSD was found in both the short- and long-term. Although SOs' PTSD did not impinge on the recovery of the SAH patients being cared for, given that it is important to ensure SOs continue caring, regression results are presented which show the cause of SOs' PTSD was (at least in the short- term) due to the use of maladaptive coping strategies. The overarching conclusion is that the elevated incidence of PTSD in SAH patients and SOs helps explain why they experience psychosocial disability. In the final part of the thesis (Chapter 8) the clinical and theoretical implications of this conclusion are considered, such as that teaching patients and their SOs more effective coping skills might prevent PTSD and psychosocial disability.