Pink elephants and trauma recovery

Don’t think of a pink elephant.

It’s a classic example of how thought suppression works: counterproductively. You will think of a pink elephant. Wegner and colleagues have shown that it is very difficult to suppress a thought. If you try, it’s very likely that you will think about it more than if you don’t.

This problematic nature of mental control doesn’t apply to fancy experimental settings only. It is thought to play an important role in posttraumatic stress symptoms. Survivors who try harder to avoid thoughts about (or images of) a terrifying moment such as a car crash, are more prone to develop posttraumatic stress disorder (PTSD). Avoidance of trauma-related thoughts makes it more difficult to challenge unhelpful beliefs related to the trauma (see the cognitive model by Ehlers & Clark).

Recently, researchers have started to look at the role of thought suppression in children. The first studies show strong relations with posttraumatic stress symptoms  (see also the meta-analysis by Trickey et al that I recently discussed). Understanding which cognitive processes take place in the development of PTSD in children is essential for our design of helpful interventions.

However, for high-quality evidence we need high-quality measures. So far, the widely used White Bear Suppression Inventory (which doesn’t ask questions about white bears at all…) had not been validated in a sample of children. Therefore, Vincken and colleagues (2012) set out to do so. They conducted two studies – one in a sample of primary school children and one in a sample of young road traffic accident survivors – to test the factor structure, internal consistency, test-retest reliability, and content validity of the self-report measure.

The findings are promising: the measure showed a high internal consistency, some level of stability over time, a rather clear factor structure (one factor), and convergence with a measure for PTSD. Although I think that it’s difficult to confirm validity based on an association that is still subject to theoretical development and empirical testing. What would have happened if there wasn’t a relation with PTSD; would that show invalidity of the measure or invalidity of the hypothesis that thought suppression and PTSD are related in children? Nevertheless, we need to study the phenomenon of thought suppression in traumatized children and it will probably be by iteration that we will understand what happens. This study is a helpful step in that trajectory.


Vincken, M., Meesters, C., Engelhard, I., & Schouten, E. (2012). Psychometric qualities of the White Bear Suppression Inventory in a Dutch sample of children and adolescents Personality and Individual Differences, 52 (3), 301-305 DOI: 10.1016/j.paid.2011.10.023

Ehlers, A., & Clark, D. (2000). A cognitive model of posttraumatic stress disorder Behaviour Research and Therapy, 38 (4), 319-345 DOI: 10.1016/S0005-7967(99)00123-0

Wenzlaff, R., & Wegner, D. (2000). Thought Suppression Annual Review of Psychology, 51 (1), 59-91 DOI: 10.1146/annurev.psych.51.1.59

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