the research sample consisted of 40 individuals with asd who referred to forensic medicine centers of mazandaran province and 40 individuals with war - related ptsd following displacement after iran - iraq war who referred to clinical centers of mazandaran province .
then , 40 individuals who had the experience of trauma but were not diagnosed as patients with acute stress disorder wereas normal individuals for the study . to ensure the correctness of psychiatrist 's diagnosis , the composite international diagnostic interview was utilized .
age over 25 years , minimum education level of grade 9 , being married , being informed , and voluntary consent were considered as the entrance criteria .
data were analyzed using multivariate analysis of variance ( manova ) and multivariate regression analysis .
instruments utilized for data collection were as follows : the composite international diagnostic interview ( cidi ) : the original version of cidi has been edited by world health organization ( 1997 ) . this interview is of good validity in diagnosing mental disorders . in terms of validity of cidi ,
the specificity for most psychiatric disorders is high ( over 0.85 ) , but the sensitivity for diagnoses is to some extent lower , especially for severe psychiatric disorders ( like schizophrenia ) .
the instrument 's reliability assessment through test - retest method showed that the reliability of diagnosis for most psychiatric disorders is within an acceptable range kappa over 0.4 ; however , for schizophrenia , this figure was smaller .
results obtained from the two diagnostic systems of dsm - iv and icd were similar to a large extent ( 20 ) .
stroop color - word test ( scwt ) : stroop test is a classic scale for attention processing and cognitive set shifting ability .
the test in its original form consists of four cards : word reading ( first card ) , color naming ( second card ) , reading words regardless of the color ( third card ) , and telling the color of words regardless of what is written ( forth card ) .
each card displays 25 stimuli ordered in 5 lines and 5 columns ( 21 ) .
the impact of event scale  revised ( ies - r ) : the impact of event scale  revised ( 7 ) has 22 items graded on a 5-point scale .
emmerik et al . came to a range of 0.76 to 0.84 for cronbach 's alpha coefficient of these scales ( 22 ) . in study of abdi , moradi&akramian ( 2008 ) ,
abolghasemi , bakhshian and narimani(2013 ) showed that the impact of event scale  revised was correlated with the thought control questionnaire ( r= 0.54 , p < 0.01 ) ( 24 ) .
posttraumatic cognitions questionnaire ( pcq ) : this questionnaire was developed by foa et al .
the posttraumatic cognitions questionnaire consists of 33 items to which the subjects should answer on a 7-point scale ranging from  fully disagree  ( 1 ) to  fully agree  ( 7 ) .
cronbach 's alpha coefficient for this test is 0.97 . in a study by louise field
, cronbach 's alpha coefficients for this test were reported as 0.83 , 0.83 , and 0.70 in subscales of negative self - appraisal , negative world appraisal , and self - blame respectively ( 15 ) . in study of abolghasemi , bakhshian and narimani(2013 ) cronbach 's alpha coefficient for this inventory was 0.96 .
bakhshian ( 2011 ) showed that this questionnaire was correlated with the thought control questionnaire ( r = 46 , p < 0.01 ) ( 24 ) .
first , individuals encountering damaging events who were diagnosed as having acute stress disorder ( in legal medical center of sari ) and posttraumatic stress disorder ( veterans of iran - iraq war ) were identified . at the next stage , to ensure the correctness of psychiatrist 's diagnosis , subjects were administered the composite international diagnostic interview for asd and ptsd . after diagnosis
the research sample consisted of 40 individuals with asd who referred to forensic medicine centers of mazandaran province and 40 individuals with war - related ptsd following displacement after iran - iraq war who referred to clinical centers of mazandaran province .
then , 40 individuals who had the experience of trauma but were not diagnosed as patients with acute stress disorder wereas normal individuals for the study . to ensure the correctness of psychiatrist 's diagnosis , the composite international diagnostic interview was utilized .
age over 25 years , minimum education level of grade 9 , being married , being informed , and voluntary consent were considered as the entrance criteria .
data were analyzed using multivariate analysis of variance ( manova ) and multivariate regression analysis .
instruments utilized for data collection were as follows : the composite international diagnostic interview ( cidi ) : the original version of cidi has been edited by world health organization ( 1997 ) . this interview is of good validity in diagnosing mental disorders . in terms of validity of cidi ,
the specificity for most psychiatric disorders is high ( over 0.85 ) , but the sensitivity for diagnoses is to some extent lower , especially for severe psychiatric disorders ( like schizophrenia ) .
the instrument 's reliability assessment through test - retest method showed that the reliability of diagnosis for most psychiatric disorders is within an acceptable range kappa over 0.4 ; however , for schizophrenia , this figure was smaller .
results obtained from the two diagnostic systems of dsm - iv and icd were similar to a large extent ( 20 ) .
stroop color - word test ( scwt ) : stroop test is a classic scale for attention processing and cognitive set shifting ability .
the test in its original form consists of four cards : word reading ( first card ) , color naming ( second card ) , reading words regardless of the color ( third card ) , and telling the color of words regardless of what is written ( forth card ) .
each card displays 25 stimuli ordered in 5 lines and 5 columns ( 21 ) .
the impact of event scale  revised ( ies - r ) : the impact of event scale  revised ( 7 ) has 22 items graded on a 5-point scale .
emmerik et al . came to a range of 0.76 to 0.84 for cronbach 's alpha coefficient of these scales ( 22 ) . in study of abdi , moradi&akramian ( 2008 ) ,
abolghasemi , bakhshian and narimani(2013 ) showed that the impact of event scale  revised was correlated with the thought control questionnaire ( r= 0.54 , p < 0.01 ) ( 24 ) .
posttraumatic cognitions questionnaire ( pcq ) : this questionnaire was developed by foa et al . ( 1999 ) to assess thoughts and ideas associated with trauma ( 16 ) .
the posttraumatic cognitions questionnaire consists of 33 items to which the subjects should answer on a 7-point scale ranging from  fully disagree  ( 1 ) to  fully agree  ( 7 ) .
cronbach 's alpha coefficient for this test is 0.97 . in a study by louise field
, cronbach 's alpha coefficients for this test were reported as 0.83 , 0.83 , and 0.70 in subscales of negative self - appraisal , negative world appraisal , and self - blame respectively ( 15 ) . in study of abolghasemi , bakhshian and narimani(2013 ) cronbach 's alpha coefficient for this inventory was 0.96 .
bakhshian ( 2011 ) showed that this questionnaire was correlated with the thought control questionnaire ( r = 46 , p < 0.01 ) ( 24 ) .
first , individuals encountering damaging events who were diagnosed as having acute stress disorder ( in legal medical center of sari ) and posttraumatic stress disorder ( veterans of iran - iraq war ) were identified . at the next stage , to ensure the correctness of psychiatrist 's diagnosis , subjects were administered the composite international diagnostic interview for asd and ptsd . after diagnosis
in asd group , 57.5% of subjects were male and 42.5% were female ; in ptsd group , 62.5% of the subjects were male and 37.5% were female ; and in normal group , 50% of the subjects were male and 50% were female .
educational status of the subjects in asd group was as follows : 10% with grade 9 certificate , 37.5% with high school diploma , 25% with technician 's degree , and 7.5% with a bachelor 's degree and higher .
the mean age of the subjects was 45.20 ( sd = 9.29 ) for the ptsd group , 37.05 ( sd = 7.67 ) for the asd group , and 39.60 ( sd = 7.73 ) for the normal group with a range of 25 - 40 years .
as table 1 indicates , manova test results revealed a significant difference between individuals with asd and those with ptsd considering at least one of the dependent variables ( wilks lambda = 0.748 , f = 30.39 , p = 0.001 ) .
significant differences among the mean response inhibition scores ( f = 82.82 ) and negative self - appraisal ( f = 230.98 ) in three groups of asd , ptsd , and normal ( p < 0.001 ) .
there were also significant differences among the mean scores obtained for the constituents of and self - blame(f = 22.46 ) and post - trauma symptoms ( f = 264.45 ) in the three groups of subjects ( p < 0.001 ) . 
 
comparing mean of response inhibition and cognitive appraisal scores in patients with asd and ptsd , and normal subjects acute stress disorder(asd ) posttraumatic stress disorder ( ptsd ) as observed in table 2 , the results of lsd test on comparison of the mean response time scores in stroop test show that the mean response time in patients with asd is significantly more than that of those with ptsd , and so it is about those with asd compared to normal subjects , and about those with ptsd compared to normal subjects ( p < 0.01 ) .
also , it is revealed that the mean scores for the number of errors ( stroop cards ) in patients with asd are significantly more compared to patients with ptsd , and it is the same for patients with asd compared to normal subjects and for patients with ptsd compared to normal subjects ( p < 0.01 ) .
moreover , the mean cognitive appraisal is significantly more in patients with asd than in patients with ptsd and normal subjects , and similarly , it is significantly more in patients with ptsd compared to normal subjects ( p < 0.001 ) . to determine the role of each variable , response time , number of errors , and cognitive appraisal were analyzed as predictive variables , and post - trauma symptoms
were analyzed as criterion variable in regression equation.the observed f value in the table is significant and 61.4% of the variance of asd symptoms is explained by the variables of response time , number of errors , and cognitive appraisal ( adjusted r2 = 0.745 , f= 42.25 , p < 0.001 ) .
considering beta values , response time (  = 0.706 ) , number of errors (  = 0.159 ) , and cognitive appraisal ( = 0.730 ) can significantly predict the changes relevant to post trauma symptoms in subjects with ptsd ( table 3 ) .
also , 86.3% of the variance in the symptoms of acute stress disorder is explained by the variables of response time , number of errors , and cognitive appraisal ( adjusted r2 = 0.376 , f= 39.71 , p < 0.001 ) .
considering beta values , response time (  = 0.409 ) and cognitive appraisal ( = 0.503 ) can significantly predict the changes related to post - trauma symptoms in subjects with asd ( table 3 ) . 
 
mean of response inhibition and cognitive appraisal scores in subjects with asd , ptsd , and normal individuals with lsd test acute stress disorder(asd ) posttraumatic stress disorder ( ptsd ) , normal(n ) regression results for predictor of post trauma symptoms in ptsd and asd acute stress disorder ( asd ) posttraumatic stress disorder(ptsd )
results showed that the mean of response inhibition(response time and error rate ) scores is significantly higher in patients with asd compared to patients with ptsd ; similarly , it is higher in both groups of patients compared to the normal group ( p < 0.01 ) .
the mentioned studies showed that individuals with ptsd have longer reaction times in responding to stroop test compared to normal people .
it can be said that when an intrusive thought occurs , it is associated with emotional disturbance , physiological arousal , and interference in concentration or task completion which can last for a long time .
therefore , the presence of intrusive thoughts causes interference in concentration which entails occurrence of more errors and longer reaction time ( 25 ) .
cognitive theories emphasize that manifestations of negative emotions , like anxiety , cause attentional biases in information processing which results in occupation of the individual 's mind and response to the perceived danger ( 26 ) .
thus , belief system of the individual or cognitive schemata may be an important predisposing factor in developing posttraumatic disorders . specifically , the occurrence of intrusive and unacceptable thoughts is part of normal experience , but individuals who develop posttraumatic disorders have inflexible beliefs about personal meaning of these thoughts and their catastrophic implication .
occupation of the mind with such beliefs and thoughts causes interference in individual 's concentration , and this entails psychomotor retardation which is followed by increased number of errors and longer time responding to tasks .
therefore , it seems that the presence of bothering and intrusive thoughts produces interference in the process of individual 's attention and concentration on tasks ; and the effort to cope with these thoughts causes occupation of the mind and influences the individual 's responding to the tasks .
thus , individuals act more slowly in responding to the tasks and display more errors . to explain the obtained results
, it can be said that individuals with acute stress disorder who are in a closer time interval to the traumatic event experience more frequent and intense disturbance and intrusive thoughts .
results also showed that the mean of impaired cognitive appraisal scores(negative self - appraisal , negative world appraisal and self - blame ) are significantly higher in asd patients compared to ptsd persons , and this is also the case with the two groups of patients compared to normal individuals .
this result suggests that although both groups of patients have impaired cognitive appraisals , the problem is more serious in patients with asd .
's ( 15 ) studies , which showed that individuals have more negative cognitive self - appraisals after traumatic events .
recent cognitive theories ( 13 ) state that negative appraisal of an event and its consequences leads to the development of a sense of ongoing threat which causes the disorder to remain .
negative self - appraisals following trauma can focus on durable negative interpretations about oneself ( e.g. i will never improve ) . according to ehlers & clark 's model of posttraumatic disorders ,
these negative appraisals determine individual 's emotional response to the trauma and base cognitive and behavioral strategies ( e.g. thought suppression , behavioral avoidance form fearful situations , social seclusion , etc ) which later on contribute to maintenance of disorder . despite the discrepancies observed in the results ,
there is a consensus that self - opinion , specifically negative self - appraisal , has important roles in development and maintenance of posttraumatic reactions , and that such a negative self - view may have a central role in hindering one 's natural health improvement following traumatic events .
they believe that one of the sources of one 's intense and constant fear is the appraisals they make of the trauma and/or its sequels based on their own traits .
negative appraisal of the trauma consists of negative appraisal of emotions appeared during a shocking event and negative appraisal of feelings and activities occurred during a shocking event , negative perception of others responses , and perception of a permanent change in the life after the accident ( 26 ) . in the present research , the significance of self - blame deference in the groups under study may be a reflection of variant nature of traumatic events that the individuals under study have experienced . in traumas like heart attack
that the individual 's life style , e.g. physical activity , diet , smoking , and alcohol consumption , plays an important role in the creation of trauma or in road accidents that the individual plays a role in its happening , they blame themselves more following the trauma ( 13 ) .
however , in traumas like war that the individual has no part in its occurrence , the amount of self - blame is smaller . since the acute stress disorder group in this study included individuals who were selected to be studied following road accidents , intrusion , rape , and violence , and the ptsd group included war veterans
results of showed that response inhibition and cognitive appraisal explain 86.3% of the variance symptoms in ptsd .
this result indicates that response inhibition and cognitive appraisal significantly predict changes associated with ptsd symptoms in the persons involved ( p < 0.01 ) .
ehlers & clark ( 13 ) suggest that negative cognitions probably lead to different cognitive - behavioral coping strategies and end up developing or intensifying ptsd symptoms .
these strategies can contribute to the development and maintenance of ptsd symptoms by directly producing ptsd symptoms , preventing negative appraisals of trauma and its sequels from alteration , and preventing the nature of incidental memory from alteration ( 13 ) .
research evidence also shows that thought suppression and selective attention are maladaptive cognitive strategies that directly predict the symptoms of ptsd ( 26 ) .
in addition , a number of studies have reported the power of these dysfunctional coping strategies to predict symptoms of ptsd ( 26 , 27 ) .
also , results revealed that variables of response inhibition and cognitive appraisal explain 61.4% of the variance of symptoms in asd patients .
this result indicates that response inhibition and cognitive appraisal significantly predict changes associated with the symptoms of acute stress disorder in the persons involved ( p < 0.01 ) .
research evidence ( 28 , 29 , 30 ) suggests that the experience of traumatic event is in contrast with individual 's previous schemata , and the disruption of individual 's beliefs about the self and the world leads to the development of acute stress symptoms .
this evidence predicts that experience of traumatic event leads the individual to challenge with one or more constant beliefs .
consequently , the individual 's system of integrated and intact self would be under pressure and disturbed resulting in acute stress symptoms .
the oldness of stroop color - word test may have affected the results of this study .
the cross - sectional study design restricts our understanding of the relationships between the variables .
furthermore , longitudinal designs in particular would be able to determine the role of response inhibition and cognitive appraisal on the subsequent development of psychopathology .
collecting data on the basis of self - report scales can bring about the distortion of information because of unconscious defenses , bias in responding , and personal introducing styles .
conducting the research with adult groups restricts the generalizability of the results to different age groups .
moreover , it is recommended that tools which are not self - reporting be applied to collect the research data .
these results have important implications for pathology , prevention , and treatment for ptsd patients .
these directions may provide important information about the influence of these variables on individual 's perceptions and evaluations of inappropriate behaviors and symptoms which may inform our conceptualization and treatment of psychopathology .
to sum , the results of this study showed that response inhibition and cognitive appraisal is significantly higher in patients with asd than in patients with ptsd . also , the research results indicated that response inhibition and cognitive appraisal significantly predict changes associated with ptsd symptoms in the persons involved ( p < 0.01 ) . in conclusion ,
 objectivethe purpose of the present study was to compare response inhibition and cognitive appraisal in clients with acute stress disorder , clients with posttraumatic stress disorder , and normal individuals.methodthis was a comparative study . 
 the sample consisted of 40 clients with acute stress disorder , 40 patients with posttraumatic stress disorder , and 40 normal individuals from mazandaran province selected through convenience sampling method . 
 data were collected using composite international diagnostic interview , stroop color - word test , posttraumatic cognitions inventory , and the impact of event scale.resultsresults showed that individuals with acute stress disorder are less able to inhibit inappropriate responses and have more impaired cognitive appraisals compared to those with posttraumatic stress disorder . 
 moreover , results showed that response inhibition and cognitive appraisal explain 75% of the variance in posttraumatic stress disorder symptoms and 38% of the variance in posttraumatic stress disorder symptoms.conclusionthe findings suggest that response inhibition and cognitive appraisal are two variables that influence the severity of posttraumatic stress disorder and acute stress disorder symptoms . 
 also , these results have important implications for pathology , prevention , and treatment of posttraumatic stress disorder and acute stress disorder . 
Material and Methods
Participants
Measures
Procedure
Result
Discussion
Limitations
Conclusion