Model of severity of Post-traumatic Stress Disorder symptoms in teenagers based on alienation and temperament and character traits with the mediating role of metacognitive beliefs

Document Type : Original Article


1 PhD student in psychology, Faculty of Humanities, Islamic Azad University, Qom, Iran

2 Associate Professor, Department of Psychology, Faculty of Humanities, Islamic Azad University, Qom, Iran


Introduction: Post-traumatic stress disorder may be observed at any age, it is more common in teenagers due to accelerating factors. This study has aimed to provide a model of the severity of symptoms of post-traumatic stress disorder based on alienation and temperament and character traits with the mediating role of metacognitive beliefs in teenagers. This study aimed to present of a model of the severity of post-traumatic stress disorder symptoms based on alienation and temperament characteristics with the mediating role of metacognitive beliefs in teenagers.
Method: descriptive correlation and structural equation modeling was used in the study. The statistical population includes all secondary school students in the city of Qom who were in the academic year 2018-2019. 421 students (105 boys and 316 girls) were selected by the convenience sampling method and completed temperament and character inventory, alienation, metacognitive beliefs, and PTSD symptom severity. To analyze the data, a structural equation method was used with Imus software. Results: The results of the structural equation modeling showed that the measured model has a good fit with the conceptual model. The results of the model analysis showed that the direct effects of temperament and character and alienation and indirect effects with the mediation of metacognitive beliefs are significant on the severity of post-traumatic stress disorder symptoms (p<0.05). Metacognitive beliefs also had a direct and significant effect on the severity of PTSD symptoms (p<0.05). Conclusion: The findings from the study showed that the loss of social support affected by alienation leads to a decrease in individual psychological resistance in facing crises and incidents, as well as metacognitive beliefs via creating concern about hypervigilance and focused attention on oneself causes the severity of post-traumatic stress disorder symptoms. Thus, it is possible to point out the influence of temperament, and character, alienation, and metacognitive beliefs on the mental health of teenagers in families.


Main Subjects

  1. Gluck RL, Hartzell GE, Dixon HD, Michopoulos Jovanovic T, Ressler KJ, Bradley B, Gillespie ChF. Trauma exposure and Stress‑related Disorders in a large, Urban, PredominantlyAfrican‑American, Female Sample. Archives of Women’s Mental Health.2021;24(6):893-901
  2. World Health Organization.International Statistical Classification of Diseases and Related Health Problems. (11th Revision).2018.
  3. Munyandamutsa N, Nkubamugisha MP, Gex-Fabry M, Eytan A. Mental and Physical Health in Rwanda 14 Years after the Genocide. Soc Psychiat Psychiatr Epidemiol.2012; 47(11):1753–1756.
  4. V, Powers A, Stevens JS, Fani N, Carter S, Schwartz AC,
  5. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. United States: American Psychiatric Association. 2013.
  6. Barzilay R, Calkins ME, Moore TM, Wolf DH, Scott JC, Jones JD, Benton TD, Gur RC, Gur RE. Association Between traumatic Stress Load, Psychopathology, and Cognition in the Philadelphia Neuro Developmental Cohort. Psychological Medicine.2018; (49): 325-334.
  7. Dyregrov A, Yule W, Olff M. Children and Natural Disasters. European Journal of Psycho Traumatology.2018; (9): 9-11.
  8. James A, Wells A. Death Beliefs, Superstitious Beliefs and Health Anxiety. British Journal of Clinical Psychology. 2002; 41(1), 43–53.
  9. Melli G, Carraresi C, Poli A, Bailey R. The Role of Metacognitive Beliefs in Health Anxiety. Personality and Individual Differences.2016; (89): 80–85.
  10. Rhodes MG. Metacognition. Teaching of Psychology. 2019; 46(2), 168–175.
  11. Brinck I, Liljenfors R. The Developmental Origin of Metacognition. Infant Child Dev.2013; 22(1): 85-101.
  12. Myers SG, Wells A.Early Trauma, Negative Affect, and Anxious Attachment: the Role of Metacognition. Anxiety Stress Coping.2015; 28(6):634-49.
  13. Wells A, Matthews G. Attention and Emotion (Classic edition): A Clinical Perspective: Psychology Press; 2014.doi:10.4324/9781315747187
  14. Wells A. Metacognitive Therapy for Anxiety and Depression. New York, NY: Guilford press. 2009.
  15. Brown R, Wood A, Carter JD, Dymand LK. The Metacognitive Model of Posttraumatic Stress Disorder and Metacognitive Therapy for Post-traumatic Stress Disorder: A Systematic Review. Clin Psychol Psychother.2021; 1–16.
  16. Hosseini Ramaghani NA, Rezaei F, Sepahvandi MA, Gholamrezaei S, Mirderikvad F.The Mediating Role of the Metacognition, Time Perspectives and Experiential Avoidance on the Relationship Between Childhood Trauma and post-traumatic Stress Disorder Symptoms. European Journal of Psycho traumatology.2019; 10 (1), 1648173. [Persian].
  17. Wisco BE, Pineles SL, Shipherd JC, Marx BP. Attentional Interference by Threat and Post-traumatic Stress Disorder: The Role of Thought Control Strategies. Cognition & Emotion. 2013; 27(7), 1314–1325.
  18. Cacioppo J T, Patrick W. Loneliness: Human Nature and TheNeed for Social Connection. W. W. Norton & Company, New York. 2008.
  19. DePrince A, Chu AT, Pineda AS. Links Between Specific Posttrauma Appraisals and Three Forms of Trauma-Related Distress Psychological Trauma: Theory, Research, Practice, and Policy.2011; 3, 430–441
  20. McIlveen R, Curran D, Mitchell R, DePrince A, O’Donnell K, Hanna D. A Meta-Analytic Review of the Association Between Alienation Appraisals and Posttraumatic Stress Disorder Symptoms in Trauma -Exposed. Journal of Traumatic Stress. 2020; 33, 720–730
  21. Rayce SLB, Holstein BE, Kreiner S. Aspects of Alienation and Symptom load among Adolescents. Eur. J. Public Health. 2009; 19, 79–84.
  22. Walsh SD, Kolobov T, Simanovskaya O.What is it about Perceived Discrimination that can lead Immigrant Adolescents to Alcohol use and Delinquency? The Mediating Role of Feelings of Alienation. Subst. Use Misuse. 2019; 54, 65–77.
  23. Sprang G, Silman M. Posttraumatic Stress Disorder in Parents and Youth After Health-Related Disasters. Disaster Med. Public Health Prep.2013; 7.105–110.
  24. Mitchell R, Hanna D, Brennan K, Curran D, McDermott B, Ryan M, Dyer KF. Alienation Appraisals Mediate the Relationships Between Childhood Trauma and Multiple Markers of Posttraumatic Stress. Journal of Child & Adolescent Trauma.2020; 13(1): 11–19.
  25. Hebenstreit CL, Maguen S, Koo KH, DePrince AP, Latent Profiles of PTSD Symptoms in Women Exposed to Intimate Partner Violence. J. Affect. Disorder.2015; 180, 122–128.
  26. Srinivas T, DePrince AP, Chu AT.Links Between Posttrauma Appraisals and Trauma-Related Distress in Adolescent Females from the Child Welfare System. Child Abuse Negl.2015; 47. 14–23.
  27. Ehlers A, Clark DM, Dunmore E, Jaycox L, Meadows E, Foa EB. Predicting Response to Exposure Treatment in PTSD: the Role of Mental Defeat and Alienation. J. Trauma. Stress.1998; 11, 457–471.
  28. Cloninger CR, Svrakic DM, Pryzbeck TR. A Psychobiological Model of Temperament and Character. The Development of Psychiatry and its Complexity.1998; p. 1-16.
  29. Thomas KM, Hopwood CJ, Donnellan MB, Wright AG, Sanishlow CA, MCDevitt-Murphy ME, et al. Personality Heterogeneity in PTSD: Distinct Temperament and Interpersonal Typologies. Psychol Assess.2014; 26(1): 23-34.
  30. Sujung J, YoonaChansoo S, JunbHye-young AnbHyoung, RyulKangbTae-YounJun. Comprehensive Psychiatry.2009; 50(3): 226-231
  31. North CS, Abbacchi A, Cloninger CR. Personality and Posttraumatic Stress Disorder AmongDirectly Exposed Survivors of the Oklahoma City bombing. Comprehensive Psychiatry.2012; 53, 1–8.
  32. Mohseni Tabrizi A. Alienation. Journal of Social Sciences, Tehran University Publications.1991, 2, 2.
  33. Trickey D, Siddaway AP, Meiser-Stedman R, Serpell L, Field AP. A Meta-analysis of Risk Factors for Post-traumatic Stress Disorder in Children and Adolescents. Clinical Psychology Review.2012; 32(2): 122–138.
  34. DePrince AP, Huntjens RJC, Dorahy MJ.Alienation Appraisals Distinguish Adults Diagnosed With DID From PTSD. Psychological Trauma: Theory, Research, Practice, and Policy.2015; 7(6): 578–582.
  35. Kline RB. Principles and practice of structural equation modeling (3. Baskı). New York, NY: Guilford. 2011.
  36. Keane TM, Kolb LC, Kaloupek DG, Orr SP, Blanchard EB, Thomas RG, & et al. Utility of Psycho Physiological Measurement in the Diagnosis of Posttraumatic Stress Disorder: Results from a Department of Veterans Affairs Cooperative Study. Journal of Consulting and Clinical Psychology.1998; 66(6):914-23.
  37. Goodarzi MA. Reliability and validity of Posttraumatic Stress Disorder Mississippi Scale. Journal of Psychology.2003; 7(2):135-78.
  38. Kaviani H, Poor Naseh M. Validation of Temperament and Character Inventory (TCI) In Iranian Sample: Normative Data. Tehran Univ Med J. 2005:63(2):89-98.
  39. Ghaemifar H. The Study of Some Factors Affecting Vandalism with an Emphasis on Jahrom Urban Society [Dissertation]. Ahvaz, Shahid Chamran University. 2007.
  40. Wells A, Cartwright-Hatton SA. Form of the Metacognitions Questionnaire: Properties of the MCQ-30. Behaviour Research Therapy.2004; 42(4): 385-96.
  41. Mohammadkhani Sh, farjad M. The Relationship of the Metacognitive Beliefs and Thought Control. Journal of Clinical Psychology.2009; 1(3):35-51.
  42. Purewal R, Fisher PL.The contribution of Illness Perceptions and Metacognitive Beliefs to Anxiety and Depression in Adults with Diabetes. Diabetes Research and Clinical Practice. 2017;136:16–22
  43. Donnellan C, Al Banna M, Redha N, Al Sharoqi I, Al-Jishi A, Bakhiet M, & et al. Association Between metacognition and Mood Symptoms Poststroke. Journal of Geriatric Psychiatry and Neurology. 2016:29(4): 212–220.
  44. Fisher PL, Reilly J, Noble A. Metacognitive Beliefs and Illness Perceptions are Associated with Emotional Distress in People with Epilepsy. Epilepsy & Behaviour. 2018; 86:9–14.
  45. Fisher PL, McNicol K, Cherry MG, Young B, Smith E, Abbey G, & et al. The Association of Metacognitive Beliefs with Emotional Distress and Trauma Symptoms in Adolescent and Young Adult Survivors of Cancer. Journal of Psychosocial Oncology.2018; 36(5):545–556.
  46. Kollmann J, Gollwitzer M, Spada MM, Fernie BA.The Association Between metacognition and the Impact of Fibromyalgia in a German sample. Journal of Psychosomatic Research.2016; 83.1-9.
  47. Cook S, Salmon P, Dunn G, Holcombe C, Cornford P, Fisher P. The Association of Metacognitive Beliefs with Emotional Distress after Diagnosis of Cancer. Health Psychology.2015; 34(3):20–215.
  48. Sun X, So SHW, Zhu C, Leung PWL. Dysfunctional Meta-cognitive Beliefs across Psychopathology: A Meta-analytic Review. European Psychiatry.2016; 33(S1), s225–s225.
  49. Hagen R, Havnen A, Hjemdal O, Kennair LE O, Ryum T, Solem S. Protective and Vulnerability Factors in Self-esteem: The Role of Metacognitions, Brooding, and Resilience. Frontiers in Psychology.2020; 11.
  50. Capobianco L, Faija C, Husain Z, Wells A. Metacognitive Beliefs and their Relationship with Anxiety and Depression in Physical Illnesses: A Systematic Review. PloS One, 2020; 15(9), e0238457.
  51. Ogińska-Bulik N, Juczyński Z, Michalska P. The Mediating Role of Cognitive Trauma Processing in the Relationship Between empathy and Secondary Traumatic Stress Symptoms among Female Professionals Working with Victims of Violence. Journal of Interpersonal 2020; Violence, 0886260520976211.
  52. Bardeen JR, Fergus TA. Executive Control Deficits Potentiate the Effect of Maladaptive Metacognitive Beliefs on Posttraumatic Stress Symptoms. Frontiers in Psychology.2018; 9, 1898.
  53. Sharon A C, Salmon P, Dunn G, Holcombe CH, Cornford Ph, Fisher P. The Association of Metacognitive Beliefs with Emotional Distress after Diagnosis of Cancer.Health Psychol.2015;34(3): 207–215
  54. Yoon SJ, Jun CHS, Hye young An, Kang HR, Tae-Youn Jun. Patterns of Temperament and Character in Patients with Posttraumatic Stress Disorder and their Association with Symptom Severity. Comprehensive Psychiatry.2009; 50, 226-231.
  55. Kuroki T, Ishibashi H. Evidence for the Efficacy of Behavioral Activation against Depressive Disorder: A Literature Review. Seishin Shinkeigaku Zasshi.2015; 117(1):42-8
  56. Matsudaira T, Kitamura T. Personality Traits as Risk Factors of Depression and Anxiety among Japanese Student. Journal of Clinical Psychology.2006; 62(1): 97-109.
  57. Woodward MJ, Eddinger J, Henschel AV, Dodson TS, Tran HN, Beck JG. Social Support, Posttraumatic Cognitions, and PTSD: The Influence of Family, Friends, and a Close other in an Interpersonal and non-interpersonal Trauma Group. Journal of Anxiety Disorders.2015; 35, 60–67.
  58. Pancani L, Marinucci M, Aureli N, Riva P. Forced Social Isolation and Mental Health: A Study on 1006 Italians under COVID-19 lockdown. Front. Psychol.2020; 12:663799.