Commentary: I thought I was going to die and the world is not safe-how to help children recover after trauma? Reflections on Meiser-Stedman et al. (2019).

Children all over the world experience exposure to trauma. Why do only some young people have significant traumatic stress symptoms in the days and weeks immediately post-trauma while others do not, and why do some youth then recover without treatment while others go on to suffer from persistent PTSD? This important question is examined in a comprehensive study by Meiser-Stedman et al., (2019). In a sample of single-event trauma exposed youth, they investigate the role cognitive processes may have in shaping early reactions and in maintaining post-traumatic stress symptoms (PTSS) over time. For the onset of PTSS, perceived threat and feeling overwhelmed and confused during the traumatic event was associated with significant PTSS. For the maintenance of PTSS, poorly elaborated, sensory-based memories, dissociation, rumination, and negative appraisals were associated with higher PTSS. The newly revised International Society for Traumatic Stress Studies' guidelines for the prevention and treatment of PTSS found no strong evidence to recommend any of the evaluated preventive or early intervention programs. This commentary highlights how understanding different trajectories for the onset and maintenance of post-traumatic stress may inform our development of prevention and early intervention strategies. Cognitive processes seem to play an important role in the development of PTSS but these may play out differently in youth exposed to single events and youth with interpersonal trauma experiences. Knowledge on memory processing, meaning making, the role of social support and maladaptive cognitions need to be implemented in systems of trauma-informed care.