Perception of control and the development of PSTD symptoms have been negatively correlated (Kushner, Riggs, Foa, & Miller, 1993). Persons who view events as being out of their control are likely to show greater PTSD symptom intensity than are those who believe that they some control over the trauma event (Kushner, Riggs, Foa, & Miller, 1993). This supports the notion that survivors will view the environment differently after the trauma, consistent with their new assumptions and established beliefs about the world (Kushner, Riggs, Foa, & Miller, 1993).
Additionally, the pervasiveness of traumatic events occurring in the world, such as rape, violence, neglect, and hungers, may initially elevate subjective stress. However, if after an individual reorganizes self-beliefs about safety and personal control, the fear or horror is replaced by perceptions of powerlessness and hopelessness (Erwin, Newman, McMacklin, Morrissey, & Kaloupek, 2000). People pronounce beliefs and exercise controls to justify their opinions and maintain their comfort level (Carver & Harris, 2000). Perceptions of personal control relate to a person’s sense of emotional wellness (Carver & Harris, 2000).
Those persons with a sense of internal control have been found to have control over important outcomes in their lives relates positively to their activity level, mental acuity, sense of happiness, and responsiveness to stress. In addition, relinquishing personal control may also reduce stress and anxiety, particularly if it brings about a desired outcome (Carver & Harris, 2000). Cognitive control, a subcomponent of personal control, entails persons reframing their beliefs systems and developing behavioral patterns that conform to the new belief systems (Carver & Harris, 2000).
Cognitive control may include attribute, attitudes, unconscious processes, and expectations (Carver & Harris, 2000). Behavioral control is more activity oriented and is predicated on the person’s self-perceptions of efficacy, mortality, and cultural worldview (Arndt & Greenberg, 1999). Both cognitive and behavioral control are observed in self-esteem, which qualifies the patients for the protection afforded by the accepted worldview, acts as a buffer against anxiety-related defense mechanisms (Arndt & Greenberg, 1999).
Self-esteem, which qualifies the patient for the protection afforded by the accepted worldview, acts as a buffer against anxiety, mortality, and anxiety-related defense mechanisms (Arndt & Greenberg, 1999). Self-esteem levels are related to self-serving biases and the employment of defense mechanisms (Arndt & Greenberg, 1999). For example, those with low self-esteem are more likely to employ defense mechanism, while those with high self-esteem are less likely to employ defense mechanism and seek to control their environment (Arndt & Greenberg, 1999).
Perceived control beliefs have been suggested as a predictor of exposure therapy outcome (Swenson & Kennedy, 1995). In evaluating the beliefs and the symptoms for treatment, the reflection of PTSD symptoms as representing different phases of mental processing within the progression of the disorder needs to be considered (Kushner, Riggs, Foa, & Miller, 1992). Altering beliefs and instituting control through defense mechanisms may represent typical responses to trauma in the early stages of acknowledging the traumatic event (Overstreet & Braun, 2000).
Patients may inculcate beliefs and defense mechanisms to the extent that, in later stages of personal development and recovery, they may be seen as abnormal responses (Ajdukovic, 1998; Deary, Alistair, & Austin, 1998; Shalev, Bonne, & Eth, 1996). The patients may resist exposure treatment due to the control features associated with posttraumatic beliefs and perceived control beliefs they sustain through defense mechanisms (Shalev, Bonne, & Eth, 1996; Swenson & Kennedy, 1995).