Pyszczynski 2011

Anxiety, Stress, & Coping
Vol. 24, No. 1, January 2011, 326
INVITED ARTICLE
Anxiety buffer disruption theory: a terror management account of
posttraumatic stress disorder
Tom Pyszczynskia and Pelin Kesebirb*
a
Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs, CO,
USA; bNational Institute of Science, Space and Security Centers, University of Colorado at
Downloaded by [Gebze Yuksek Teknoloji Enstitïsu ] at 23:39 25 December 2014
Colorado Springs, Colorado Springs, CO, USA

(Received 13 May 2010; final version received 18 August 2010)
We present anxiety buffer disruption theory (ABDT) and provide a review of

current evidence regarding the theory. ABDT is an application of terror
management theory to explain diverse reactions to traumatic events and the
onset and maintenance of posttraumatic stress disorder (PTSD). It posits that
PTSD results from a disruption in one’s anxiety-buffering mechanisms, which
normally provide protection against anxiety in general and death anxiety in
particular. The disruption of these mechanisms leaves the individual defenseless in
the face of overwhelming anxiety, which leads to the major symptom clusters of
PTSD: re-experiencing, hyper-arousal, and avoidance. According to ABDT,
because of the disruption in their anxiety-buffering mechanisms, individuals with
PTSD symptoms do not respond to mortality reminders in the defensive ways
that psychologically healthier individuals do. We review four sets of studies
conducted in four different cultures and with people who have experienced
different types of trauma, which reveal this atypical response pattern and lend
support to ABDT.
Keywords: terror management theory; PTSD; death anxiety; trauma
Anxiety buffer disruption theory (ABDT) builds on terror management theory

(Greenberg, Pyszczynski, & Solomon, 1986) to understand the processes through
which people respond to traumatic life experiences, and develop posttraumatic
stress disorder (PTSD). The central proposition of ABDT is that PTSD entails a
trauma-induced disruption in one’s anxiety-buffering mechanisms, which normally
serve to protect against overwhelming existential anxiety. Building on Janoff-
Bulman’s (1989, 1992) shattered assumptions theory, this disruption of the anxiety-
buffer functioning is posited to occur when traumatic life events undermine one’s
ability to maintain fundamental aspects of one’s cultural worldview that provide a
sense of safety and security in an otherwise frightening world. The breakdown of
anxiety-buffering mechanisms leads people to experience severe anxiety, which is
manifested in the three major symptom clusters of PTSD (American Psychiatric
Association [DSM-IV-TR], 2000). This article presents ABDT and reviews current
empirical evidence relevant to it. We will start with overviews of terror manage-
*Corresponding author. Email: kesebir@gmail.com

This article was invited by the editors of the journal (Aleksandra Luszczynska and Joachim
Stoeber).
ISSN 1061-5806 print/1477-2205 online
# 2010 Taylor & Francis
DOI: 10.1080/10615806.2010.517524
http://www.informaworld.com
4 T. Pyszczynski and P. Kesebir
ment theory and PTSD, present the basic tenets of ABDT, and then review
relevant empirical evidence.
Terror management theory

Terror management theory is a broad integrative theory highlighting the role that
knowledge of inevitable mortality plays in a diverse range of human behaviors
(Solomon, Greenberg, & Pyszczynski, 1991). It starts with the premise that humans,
unlike other animals, possess the cognitive capacity to realize and reflect on the fact
that they will cease to exist one day. Combined with the biologically rooted desire to
continue living, this knowledge is apt to create paralyzing terror. For psychological
well-being and effective functioning, it is imperative that people manage this

potential for terror. The sense of meaning and significance that manages this
potential for anxiety and provides existential well-being is provided by three
psychological components that together make up the anxiety-buffer system. These
components are: (1) cultural worldviews; (2) self-esteem; and (3) close personal
relationships.
Cultural worldviews are personally and culturally held assumptions and beliefs
about the nature of existence. Terror management theory posits that the need to
manage the potential for terror inherent in the knowledge of one’s mortality led early
humans to invent and support conceptions of reality, known as cultural worldviews,
which function to keep existential fears at bay. The potential for terror continues to
this day to motivate people to cling to their worldviews and live up to the standards
they prescribe. Cultural norms, moral values, and religious beliefs are among the key
constituents of cultural worldviews, which control anxiety by imbuing life with
meaning, structure, and purpose. Cultural worldviews are ultimately human
constructions and, as such, are fragile and vulnerable. Because there is no means
to definitively prove the correctness of one’s worldview, cultural worldviews must be
maintained through the process of social consensus. Others who share one’s
worldview increase faith in them and others who do not share them threaten this
faith. As a result, people typically enjoy people and ideas that reinforce their
worldviews and dislike those that challenge the validity of them.
In addition to providing meaning and structure to life, cultural worldviews make
it possible for individuals to attain value and self-esteem by living up to the standards
they prescribe. Thus, in addition to being certain of the correctness of one’s
worldview, management of existential anxiety also requires that people attain self-
esteem by believing that they are indeed meeting these standards. From the
perspective of terror management theory, cultural worldviews and self-esteem are
inextricably related and both are required for managing anxiety and maintaining
psychological equanimity.
Relationships with other people are the third component of the cultural anxiety
buffer. Even before a child is cognitively sophisticated enough to conceive of death,
entertain ideas about the nature of reality, or even have a concept of self, attachments
to primary caregivers function to control distress and fear. According to terror
management theory, these primary attachments, along with later ones to romantic
partners and close friends, work in concert with the person’s worldview and self-
esteem to provide protection against anxiety throughout the lifespan (for a thorough
discussion, see Mikulincer, Florian, & Hirschberger, 2004).
Anxiety, Stress, & Coping 5
Since terror management theory was first proposed, the role of cultural
worldviews, self-esteem, and attachment relationships in protecting against death
anxiety has been tested and supported in over 400 studies (Pyszczynski, Greenberg,
Solomon, & Koole, 2010). These studies, conducted in a diverse array of countries,
have consistently revealed that reminding people of their mortality activates the
anxiety-buffering system, thus intensifying desires to defend one’s cultural world-
view, attain self-esteem, and maintain and bolster close relationships (for a recent
meta-analysis on the effects of mortality reminders, please see Burke, Martens, &
Faucher, 2010). Reminders of death, for example, have been found to lead to harsher
punishment for those who transgress moral and cultural values (Rosenblatt,
Greenberg, Solomon, Pyszczynski, & Lyon, 1989); more favorable evaluations of
in-group members and less favorable evaluations of out-group members (Greenberg

et al., 1990); more reckless driving behavior in those who derive self-esteem from
their driving ability (Taubman Ben-Ari, Florian, & Mikulincer, 1999); and increased
romantic commitment to one’s partner (Florian, Mikulincer, & Hirschberger, 2002).
In contrast, research shows that perceived threats to one’s worldview, self-esteem, or
personal relationships increase the accessibility of death-related thoughts, while
boosts to these psychological entities reduce it (e.g., Florian et al., 2002; Greenberg,
Arndt, Schimel, Pyszczynski, & Solomon, 2001; Harmon-Jones et al., 1997;
Schmeichel & Martens, 2005).
Over the past two decades, terror management theory has been applied to and
yielded insights regarding a broad range of psychological and societal phenomena,
from political ideology to objectification of women, from inferential biases to mental
illness, from fascination with fame to robotics (Greenberg, Solomon, & Arndt, 2008).
This literature, taken as a whole, shows that knowledge of mortality is a centrally
important motivating force for the human psyche and suggests that maintaining an
effectively functioning anxiety-buffer mechanism is essential for psychological well-
being. This proposition is consistent with the point made by some existential thinkers
that psychological disorders involve extreme, graceless, or inefficient ways of dealing
with death anxiety (Becker, 1971, 1973; Lifton, 1979; Yalom, 1980). For example,
cultural anthropologist Becker (1973) argued that man is an animal who fears death,
seeks self-perpetuation, and heroic transcendence of his fate and that mental illness
results from a failure in these death-transcendence goals. Psychiatrist Irvin Yalom
similarly noted: ‘‘Either because of extraordinary stress or because of an inadequacy of
available defensive strategies, the individual who enters the realm called ‘patienthood’
has found insufficient the universal modes of dealing with death fear and has been
driven to extreme modes of defense. These defensive maneuvers, often clumsy modes
of dealing with terror, constitute the presenting clinical picture’’ Yalom (1980, p. 111).
Research conducted in recent years provides preliminary empirical support for
the observation that psychological disorders entail mismanaged death anxiety (for a
review, see Arndt, Routledge, Cox, & Goldenberg, 2005). For example, reminders of
mortality have been shown to exacerbate phobic and compulsive symptoms in those
who suffer from these disorders (Strachan et al., 2007). Clinically diagnosed spider-
phobics spent less time looking at pictures of spiders presented on a computer
screen after mortality reminders, and they also rated the spiders in these pictures as
more dangerous and threatening. No such effect of mortality reminders was
observed among non-phobic participants. In a similar vein, following mortality
salience (MS), college students who scored high on a measure of contamination
obsession and compulsive hand-washing used more water to wash their hands after
they had been soiled with gooey electrode gel. Low obsessive-compulsive
participants’ hand-washing was unaffected by mortality reminders. This set of
studies shows that individuals with certain anxiety disorders exhibit increased
symptoms of these disorders after mortality reminders.
Other studies exploring the relationship between mismanaged death anxiety and
psychological difficulties have pointed to the role mortality awareness plays in
depression (Simon, Harmon-Jones, Greenberg, Solomon, & Pyszczynski, 1996) and
discomfort with the physicality of one’s body (e.g., Goldenberg, Arndt, Hart, &
Routledge, 2008; Goldenberg, Cox, Pyszczynski, Greenberg, & Solomon, 2002).
Finally neuroticism, which is characterized by an enduring tendency to experience
negative emotional states and is robustly associated with a wide array of

psychological disorders (Malouff, Thorsteinsson, & Schutte, 2005), has been shown
by terror management theory research to render it more difficult for the individual to
handle existential anxiety (e.g., Arndt & Solomon, 2003; Goldenberg, Pyszczynski,
McCoy, Greenberg, & Solomon, 1999; Goldenberg, Routledge, & Arndt, 2009).
ABDT posits that traumatic events that forcibly confront individuals with death
and challenge core assumptions of their worldviews sometimes lead to a disruption
of normal anxiety-buffer functioning, and that this disruption plays an important
role in the onset and maintenance of PTSD. Mild to moderate experiences of trauma
typically threaten these structures and therefore lead to more extreme attempts to
defend them. For example, although the 9/11 terrorist attacks were traumatic for
most Americans, the vast majority did not develop clinically significant PTSD in
response to them; rather, these attacks led to a variety of exaggerated reactions to
worldview threats (Pyszczynski, Solomon, & Greenberg, 2003). More severe
traumatic experiences, however, sometimes lead to a more complete breakdown of
these mechanisms, which leaves the person vulnerable to overwhelming terror,
leading to the symptom pattern of PTSD.
Posttraumatic stress disorder (PTSD) from the perspective of terror management

theory
PTSD is a severely debilitating anxiety disorder that results from exposure to a
traumatic event that involves actual or threatened death or injury, and produces
intense fear, helplessness, or horror (American Psychiatric Association [DSM-IV-
TR], 2000; also see Hathaway, Boals, & Banks, 2010). Although PTSD was first
formally classified as a disorder in 1980 in the DSM-III, versions of it were found in
the earliest edition of the DSM, published in 1952. The disorder was first recognized
in the context of military combat, which is evident in the terms such as battle fatigue,
shell shock, soldier’s heart, and combat neurosis used in the past to refer to PTSD
(Davidson & Foa, 1993; Keane, Marshall, & Taft, 2006). In addition to combat
trauma, the most commonly encountered precipitating events for PTSD are physical
and sexual assaults, natural or human-caused disasters, and motor vehicle accidents
(Norris, 1992).
According to DSM-IV-TR, PTSD is characterized by three clusters of symptoms:
re-experiencing, avoidance, and hyper-arousal. Individuals suffering from the
disorder persistently re-experience the original trauma through flashbacks, intrusive
thoughts and night terrors, and respond to these with intense negative psychological
and physiological reactions. Given these severe reactions, they deliberately try to
avoid places, persons, and things that would remind them of the trauma and
sometimes develop amnesia for important aspects of the traumatic event and attempt
to self-medicate with alcohol and other drugs. These avoidance attempts are
accompanied by a reduced ability to feel emotions (particularly those associated
with intimacy and tenderness), feelings of detachment from others, loss of interest in
previously enjoyed activities, and a sense of foreshortened future. Finally, PTSD-
afflicted individuals also display hyper-arousal, as manifested in exaggerated startle
responses, irritability, outbursts of anger, difficulty concentrating, and difficulty
falling or staying asleep. All in all, the person suffering from PTSD is flooded with
anxiety and struggles desperately to cope with this anxiety.
ABDT proposes that the overwhelming anxiety experienced by the PTSD-

afflicted individuals ensues, at least in part, because the anxiety-buffering mechan-
isms that should protect them against these bouts of anxiety have been rendered
ineffective by the trauma. If such a buffering mechanism is indispensable for keeping
incapacitating anxiety at bay, as terror management theory suggests it is, in the case
of PTSD the mechanism has been severely disrupted, leaving the individual
defenseless in the face of intense fears and anxieties (see Figure 1 for a visual
depiction of ABDT). This collapse might be associated with a realization, on either
an implicit or explicit level, that nothing not faith in one’s worldview, not self-
esteem, not close relationships could effectively protect one from vulnerability and
mortality. In line with such an analysis, a meta-analysis reveals a small to medium
weighted effect size (r .26) for the strength of the relationship between perceived life
threat and PTSD (Ozer, Best, Lipsey, & Weiss, 2003). Other research has linked
perceived life threat to both the development of PTSD and the maintenance of PTSD
symptoms over time (Schnurr, Lunney, & Sengupta, 2004).
Our proposition that severe trauma is capable of shattering the individual’s
anxiety-buffering system resonates with humanistic psychotherapist Greening’s
(1997, p. 125) analysis of PTSD: ‘‘What happens when we are traumatized? In
addition to the physical, neurological, and emotional trauma, we experience a
fundamental assault on our right to live, on our personal sense of worth, and further,
on our sense that the world (including people) basically supports human life. Our
relationship with existence itself is shattered.’’ The shattering of one’s relationship
with existence, from an ABDT perspective, corresponds to the breakdown of the
protective mechanisms that had up to then allowed the individual to live in
existential equanimity. The end result of the powerful confrontation with one’s
vulnerability is that the protective anxiety-buffering system ceases to function
normally and the individual finds herself inundated by anxiety.
According to ABDT, while exposure to trauma can lead to a temporary strain on
the individual’s anxiety buffer, those who develop PTSD as the result of the trauma
experience a complete shattering of this system. Terror management theory posits
that the three crucial components of the individual anxiety-buffering system are
cultural worldviews, self-esteem, and close personal relationships. ABDT suggests
that exposure to trauma could lead to problems in these three domains. Those who
develop PTSD, in particular, should experience severe, incapacitating problems in
each of these domains. Both anecdotal evidence and correlational studies are
consistent with this hypothesis. Below, we review studies conducted with trauma-
exposed populations, among which some are suffering from PTSD.
Figure 1. Anxiety buffer disruption theory.
Disrupted faith in one’s cultural worldview

Cultural worldviews, according to terror management theory, assure the individual
that the world is a relatively meaningful, benevolent, and livable place. Several
theorists, most notably Janoff-Bulman (1989, 1992), have argued that a central aspect
of PTSD is the breakdown of the individual’s system of meaning and core
assumptions about the world (see also Herman, 1997; Horowitz, 1976; Kardiner &
Spiegel, 1947). These core assumptions (e.g., ‘‘people get what they deserve and
deserve what they get,’’ ‘‘the world is a safe and benevolent place’’) closely
correspond to what terror management theory refers to as cultural worldviews and
function to maintain illusions of invulnerability and indestructibility. Extreme
trauma can shatter these assumptions regarding the secure continuity of one’s
existence.
Janoff-Bulman (1992) likens the shattering of assumptions by traumatic events to
the emergence of new findings that lead to paradigm changes in science. When the
accumulation of anomalous research findings cannot be readily assimilated to

existent paradigms, a scientific crisis ensues and scientific revolutions result (Kuhn,
1962). Similarly, there are times for individuals when their guiding paradigms or
fundamental assumptions about the world are seriously challenged. These are times
of extreme trauma. People cannot easily assimilate the data of the traumatic
experience into existing meaning structures and intense psychological crisis is
induced. In the words of psychiatrist Lifton (1967, p. 256), who had worked with
survivors of the atomic bomb in Hiroshima, the experience of trauma involves ‘‘a
vast breakdown of faith in the larger human matrix supporting each individual life,
and therefore a loss of faith (or trust) in the structure of human existence.’’ These
accounts of PTSD are consistent with the ABDT proposition that exposure to
trauma can disrupt faith in one’s cherished worldviews and thus leave one vulnerable
to overwhelming anxiety.
Empirical data corroborate the view that exposure to trauma involves problems
within one’s meaning structures. Decreased perceptions of meaningfulness and
decreased belief in the benevolence of the world have been documented among
victims of diverse traumas including combat veterans (Dekel, Solomon, Elklit, &
Ginzburg, 2004), direct and indirect victims of crime (Denkers & Winkel, 1995),
accident survivors (Solomon, Iancu, & Tyano, 1997), survivors of torture and
detention in South Africa (Magwaza, 1999), and undergraduates who lost their
parents to a sudden death (Schwartzberg & Janoff-Bulman, 1991). These studies
indicate that traumatic events are capable of shattering one’s core assumptions about
existence. According to ABDT, the shattering of one’s worldview is so devastating
because of the role that it plays in managing existential fear.
Recently, Cann et al. (2010) developed Core Beliefs Inventory, which measures
the disruption of one’s assumptive world following a stressful or traumatic event.
Sample items include ‘‘because of the event, I seriously examined my beliefs about
the meaning of my life,’’ ‘‘because of the event, I seriously examined my beliefs about
my own value or worth as a person,’’ and ‘‘because of the event, I seriously examined
my beliefs about my relationships with other people.’’ Their studies, conducted with
undergraduate students who experienced significant stressful events in the last 30
days, revealed that scores on the Core Beliefs Inventory were negatively associated
with satisfaction with life. The study also used the Impact of Events Scale-Revised
(IES-R; Weiss & Marmar, 1997), which is a 22-item self-report measure of the three
major symptom clusters associated with PTSD (i.e., avoidance, intrusions, and hyper-
arousal). Substantial positive correlations were observed with scores on Core Beliefs
Inventory and each subscale of the IES-R, as well as the total IES-R score. The Core
Beliefs Inventory can be considered as an assessment of a person’s cultural worldview
following a traumatic event, and as such, these findings provide promising indirect
evidence for ABDT.
Disruptions in self-esteem
Terror management theory suggests that a sense of self-worth is an essential
component of the existential anxiety-buffering system. To the extent that PTSD is
associated with a breakdown in this system, PTSD-afflicted individuals would be
expected to exhibit decreased perceptions of self-worth. Consistent with this
proposition, Greening (1997, p. 125) observed that PTSD involves a loss of the
feeling that one is ‘‘a valued and viable part of the fabric of life.’’ Several studies lend
support to this idea. Dekel and colleagues (2004), for example, found that veterans
with past, present, or chronic PTSD symptoms report lower levels of self-esteem than
do veterans without PTSD. Veterans with PTSD also report more frequent
fluctuations in self-esteem compared to veterans without PTSD (Kashdan, Uswatte,
Steger, & Julian, 2006). Self-esteem has also been demonstrated to correlate
negatively with PTSD symptoms in a sample of low-income African-American
women with a history of intimate partner violence (Bradley, Schwartz, & Kaglow,
2005). It appears that the belief in one’s self-worth is considerably compromised in
individuals suffering from PTSD. According to the ABDT analysis, this renders them
particularly vulnerable in the face of anxiety, given that self-worth is an integral part
of the individual’s anxiety-buffering mechanism.
Disruptions in close personal relationships

Problems with close relationships are commonly documented sequelae of PTSD.
Individuals suffering from PTSD have significantly higher separation and divorce
rates; they experience more problems in raising their children, and also exhibit more
violence toward loved ones (Jordan et al., 1992; Riggs, Byrne, Weathers, & Litz,
1998). Research identifies PTSD-related emotional numbing, emotional/behavioral
withdrawal, and anger outbursts as particularly damaging to relationships (Galovski
& Lyons, 2004). The finding that perceived posttrauma social support is a strong
negative predictor of PTSD (Brewin, Andrews, & Valentine, 2000; Ozer et al., 2003)
suggests that to the extent the trauma-exposed individual is in a position to receive
and respond to the psychological and material support coming from close others,
these relationships perform their anxiety-buffering function and help to shield the
individual from severe PTSD.
This brief review indicates that posttraumatic distress, and specifically PTSD is
associated with problems in domains that according to terror management theory
should play a key role in protecting the individual from overwhelming anxiety. This
provides indirect support for the ABDT hypothesis that PTSD entails a disruption in
the functioning of anxiety-buffering mechanisms for the individual. We turn now to
studies that directly tested hypotheses derived from ABDT.
Evidence for anxiety buffer disruption theory (ABDT)

The central tenet of ABDT is that PTSD results when a person’s anxiety-buffering
system has been rendered ineffective as a result of a traumatic experience. If this is
the case, we would expect that individuals suffering from PTSD would not respond
to mortality reminders in the way that psychologically healthy individuals do. We
know from hundreds of terror management theory studies that people typically
respond to death reminders with reactions that function to boost aspects of their
anxiety-buffering system (for a review, see Greenberg et al., 2008). If PTSD-afflicted
individuals do not have an intact anxiety-buffering mechanism, they may not be able
to exhibit these defensive responses. For example, they should not engage in cultural
worldview defense or exhibit death thought suppression following reminders of
death, as people with intact anxiety buffers have been shown to do. Furthermore,
factors identified as predictors of PTSD, such as peritraumatic dissociation, coping
self-efficacy, or exposure to trauma would be expected to moderate the tendency to

show atypical responses to mortality reminders. Below, we present four sets of studies
conducted in four different cultures with different types of trauma that tested these
hypotheses and provide preliminary evidence for ABDT.
Evidence from Iran: earthquake survivors Study 1

The first test of ABDT was conducted with survivors of the 2005 Zarand earthquake
in southeast Iran (Abdollahi, Pyszczynski, Maxfield, & Luszczynska, in press). The
earthquake, measuring at 6.4 on the Richter scale, left more than 1500 people dead
and many more homeless. One month after the earthquake, the researchers
investigated the relationship between peritraumatic dissociation, which is a precursor

of PTSD, and the disruption of anxiety-buffering mechanisms.
Peritraumatic dissociation refers to unusual perceptions of time, space, and the
self that occur during or in the immediate aftermath of a traumatic event. Common
descriptions of dissociation include the experience of the event as unreal like a
dream or movie a sense that things were happening in slow motion, or that the
person felt disconnected from her own body. It has been argued that dissociation
enables the person to flee psychologically at a time when the traumatic experience
exceeds one’s coping capacities and physical escape is impossible (Gershuny &
Thayer, 1999; Herman, 1997). Yet this respite from terror is purchased at a high
price dissociation plays an integral role in the onset of dysfunction. Research
reveals peritraumatic dissociation to be one of the strongest predictors of PTSD, if
not the strongest (Brewin et al., 2000; Ozer et al., 2003).
From the perspective of ABDT, dissociation might represent a breaking point
where the traumatic experience fundamentally subverts the individual’s meaning
structures and shatters one’s existing relationship with existence, thereby leading to
the perception that what is happening is not real, or is not really happening to
oneself. These meaning structures (i.e., core assumptions and cultural worldview)
were partly responsible for sustaining an illusion of immunity from death. Hence, a
realization of their ineffectiveness might have brought about the breakdown of the
entire anxiety-buffering system, triggering full-blown PTSD. In line with this
analysis, Gershuny, Cloitre, and Otto (2003) found that the relation between
peritraumatic dissociation and PTSD severity was mediated by fears about death
and losing control experienced during the traumatic event. When these were
accounted for, the relationship between dissociation and PTSD disappeared
completely. Dissociative responses are therefore hypothesized to predict a disruption
of normal responses to MS among traumatized individuals.
In this first test of ABDT, peritraumatic dissociation was the independent
variable of interest instead of PTSD symptoms, because the study was conducted one
month after the trauma and not sufficient time had passed to allow a PTSD
diagnosis as per DSM-IV criteria. Increased worldview defense is a typical reaction
to mortality thoughts, as consistently documented by the terror management theory
literature (see Pyszczynski et al., 2010 for a review), and due to their relatively intact
anxiety-buffering mechanisms, low dissociators were expected to show this defensive
response. If dissociation entails a breakdown of normal anxiety-buffering function-
ing as ABDT argues it does, however, high dissociators should not engage in such
worldview defense. Abdollahi and colleagues also hypothesized that, consistent with
previous research with non-traumatized populations, low dissociators would not

show any emotional reaction to mortality thoughts. High dissociators, on the other
hand, were expected to display elevated negative and lowered positive affect in
response to thoughts of mortality, since their disrupted anxiety-management system
would not cushion the emotional impact of death thoughts.
Procedure
Within four weeks of the earthquake, the researchers held a screening session to
recruit participants either high or low in dissociation. Potential participants were
recruited from local universities and completed the Dissociative Experiences Scale II
(DES-II; Carlson & Putnam, 1993). Ninety high and 90 low dissociators were
recruited using criteria suggested by Groth-Marnat and Michel (2000). These
participants were randomly assigned to one of three conditions: MS, earthquake
salience, or dental pain, which served as a control condition. The manipulation in
each condition consisted of two open-ended questions. Participants in the MS
condition were asked to respond to the following questions: ‘‘Please, briefly describe
the emotions that the thought of your own death arouses in you’’ and ‘‘Jot down, as
specifically as you can, what you think will happen to you as you physically die.’’ In
the earthquake salience and control condition, participants responded to similarly
worded questions about the earthquake or dental pain, respectively.
Following the manipulation, participants completed the 20-item Positive and
Negative Affect Schedule (PANAS; Watson, Clark, & Tellegen, 1988) and a neutral
word search task to provide a delay and distraction. Terror management theory
research over the years has established that the effects of MS emerge most clearly
after some delay and distraction, when thoughts of death are still highly accessible
but not in focal consciousness (Arndt, Cook, & Routledge, 2004).
Finally, participants completed a measure of attitudes toward foreign aid that
was used to assess cultural worldview defense. This operationalization of the
dependent variable was based on the well-replicated terror management theory
finding that reminders of death increase negative attitudes toward out-group
members and foreigners (see Pyszczynski et al., 2010 for a review). Participants
responded on a Likert scale to 5 items assessing attitudes toward assistance offered
to Iran by foreign countries, such as ‘‘If foreigners (e.g., Westerners) help us in these
hard earthquake conditions, they won’t do it in a non-conditional way.’’ High scores
indicated more negative attitudes toward foreign aid, i.e., more worldview defense.
Results
The results revealed that participants with low levels of dissociation displayed the
expected worldview defense in response to both mortality and earthquake reminders.
In other words, they became more negative toward foreign aid when reminded of
these threatening events, compared to those with similarly low levels of dissociation
in the control condition. Among high dissociators, in contrast, mortality reminders
had no effect on attitudes toward foreign aid, and earthquake reminders had
significantly less effect than they did among low dissociators. These results were
consistent with the ABDT prediction: high dissociators could not mobilize the
worldview defense following mortality thoughts, presumably because of their

disrupted anxiety-buffering mechanism.
The analysis of the effects of mortality reminders on negative and positive affect
yielded a complementary pattern. As in previous research with non-traumatized
populations, low dissociators’ affective states did not vary as a function of the
mortality or earthquake salience primes. However, this was not the case for high
dissociators, who reported significantly higher negative affect and lower positive
affect in the MS and earthquake salience conditions than in the control condition.
This initial test of ABDT supported the hypothesis that traumatized individuals
with high levels of dissociation do not respond to death reminders in the same
manner as individuals with low levels of dissociation. They do not deflect mortality
threats through symbolic worldview defense, and they exhibit disturbance in affect
after mortality thoughts, pointing to an ineffective anxiety-buffering mechanism.
These findings implicate dissociation as an important factor in the disruption of
normal anxiety-buffer functioning.
Evidence from Iran: earthquake survivors Study 2

To assess the long-term consequences of trauma, Abdollahi et al. (in press) conducted
a follow-up study with the same participants two years after the earthquake. It was
hypothesized that participants with high levels of PTSD symptoms would show signs
of disrupted anxiety-buffer functioning in the form of atypical worldview defense
following mortality reminders. The researchers also tested whether the disrupted
anxiety-buffer functioning mediated the relationship between dissociation observed
one month after the trauma and PTSD symptom severity two years later.
Procedure
One hundred and seventy-two participants (out of the original 180) took part in the
study. They were exposed to the same materials and experimental conditions as at
Time 1, in the same order. There were two additions to the original study: first,
besides attitudes toward foreign aid, attitudes toward a strict Islamic dress code for
women were also assessed as an additional measure of worldview defense.
Participants indicated on a Likert scale their agreement with five statements such
as ‘‘Those girls and women whose dress styles are non-Islamic and Western must be
banished from our country.’’ As a second addition to Study 1, participants’ level of
PTSD symptom severity was measured at the end of the study, using Part 3 of the
Scale (PDS; Foa, 1995). This scale asks participants to indicate how frequently
during the previous month they have experienced a variety of symptoms such as
‘‘Having upsetting thoughts or images about the traumatic event that came into your
head when you didn’t want them to.’’ Following guidelines suggested by Foa (1995),
participants were categorized as ‘‘low’’ or ‘‘high’’ in symptom severity.
Results
Participants low in PTSD symptom severity responded to the mortality and
earthquake primes with increased disapproval for foreign aid relative to participants
in the control condition. This pattern was identical to the one observed among low
dissociators in Study 1 and was parallel to findings from previous terror management
theory research with non-traumatized populations. Among participants with more
severe symptoms, on the other hand, the mortality prime led to significantly more
positive attitudes about foreign aid than those in the control condition. In other
words, participants with high PTSD symptom severity displayed the opposite of the
usual form of worldview defense and became more counter-cultural after mortality
reminders, evincing abnormal anxiety-buffer functioning. The findings on attitudes
toward Islamic dress code replicated these effects and showed that they extend to a
different type of worldview defense. Participants with severe symptoms in the
earthquake salience condition did not differ significantly from either the MS or
control conditions in their attitudes to foreign aid, but were significantly less
supportive of a strict Islamic dress code compared to the control condition.

The researchers also conducted mediation analyses to determine whether the
relationship between peritraumatic dissociation reported at Time 1 and PTSD
symptom severity at Time 2 was mediated by worldview defense. Consistent with
Baron and Kenny’s (1986) criteria, regression analyses revealed that dissociation at
Time 1 predicted symptom severity measured at Time 2; dissociation at Time 1
predicted worldview defense (i.e., attitudes toward foreign aid) at Time 1; and
worldview defense predicted PTSD symptoms at Time 2. After controlling for
worldview defense, the regression coefficient for the relationship between dissociation
and PTSD symptoms was significantly reduced, but dissociation remained a
significant predictor of symptom severity. This suggests that worldview defense at
Time 1 was a partial mediator of the relationship between dissociation at Time 1 and
PTSD symptom severity at Time 2. Analyses of the mediational effect of worldview
defense at Time 2 produced similar results, confirming the role of disrupted anxiety-
buffer functioning in mediating the relationship between dissociation and PTSD
symptom severity. These findings show that dissociation is involved in the break-
down of the anxiety-buffering mechanisms, which in turn predicts PTSD symptom
severity.
Overall, Studies 1 and 2 were encouraging in their support of ABDT. Subsequent
studies tested hypotheses from the theory in different cultures and with different
types of trauma.
Evidence from Poland: female victims of domestic abuse

A second set of data on ABDT was collected among female survivors of domestic
violence living in shelters in Central, Eastern, and Southern areas of Poland
(Luszczynska, Kesebir, Pyszczynski, & Benight, in press). The researchers investi-
gated the hypothesis that both PTSD diagnosis and variables that are strongly
predictive of PTSD, specifically high levels of peritraumatic dissociation (e.g., Ozer et
al., 2003) and low levels of coping self-efficacy (Benight & Bandura, 2004), would be
associated with atypical responses to mortality reminders. Thus, in addition to
attempting to replicate the findings for PTSD severity and dissociation documented
by Abdollahi et al. (in press), this study sought to determine if another predictor of
PTSD severity, coping self-efficacy, was associated with atypical anxiety-buffer
functioning. Coping self-efficacy refers to the perceived ability to manage posttrau-
matic recovery demands (Benight & Bandura, 2004), and is a reliable predictor of
longitudinal PTSD symptom levels (Luszczynska, Benight, & Cieslak, 2009).
Procedure
Eighty-nine Polish female survivors of domestic violence between the ages of 22 and
75 completed a paper-and-pencil questionnaire. At the beginning of the study, they
were randomly assigned to either the MS or control conditions. Those in the MS
condition completed a 12-item death anxiety questionnaire (Lonetto & Templer,
1986), which required them to respond with a ‘‘True’’ or ‘‘False’’ to questions such as
‘‘I am very much afraid to die’’ or ‘‘I often think about how short life really is.’’
Those in the control condition responded to similarly worded questions on dental
pain. Following the manipulation, participants completed PANAS (Watson et al.,
1988) and solved a simple crossword puzzle, serving as tasks of delay and distraction.
To assess cultural worldview defense in response to MS, this study employed the
Judgment of Moral Transgressions Scale (Florian & Mikulincer, 1997), which has
been frequently used in previous terror management theory research. The scale is
made up of short vignettes that describe some moral transgression, such as a burglar
destroying the life masterpiece of a sculptor or a doctor mixing up the records of two
patients and amputating the leg of the wrong patient. After reading these vignettes,
participants rated how severe the wrongdoing in the situation was and how severe the
punishment should be.
Next, participants were evaluated on the three potential moderators of the MS
effect: PTSD diagnosis, coping self-efficacy, and peritraumatic disassociation.
Tentative PTSD diagnoses were made with the PDS (Foa, Cashman, Jaycox, &
Perry, 1997). The PDS is a 49-item self-report measure assessing all the criteria for
PTSD specified in DSM-IV (i.e., Criteria AF). Coping self-efficacy was measured
using the 29-item Domestic Violence Coping Self-Efficacy Measure (DV-CSE;
Benight, Harding-Taylor, Midboe, & Durham, 2005). Participants indicated on a
scale from 0 (not capable at all) to 100 (totally capable) how capable they feel in
dealing with matters related to having been a victim of domestic violence, such as
‘‘managing my feelings of guilt and self-blame about the abuse’’ or ‘‘managing my
housing, food, clothes, and medical needs, since the assault.’’ Finally, peritraumatic
dissociation experienced by the participant was assessed using the self-report version
of the 10-item Peritraumatic Dissociative Experiences Questionnaire (PDEQ;
Marmar, Weiss, & Metzler, 1997).
Results
The data analysis yielded across-the-board support for the hypothesized moderating
roles of the three variables of interest on responses to mortality reminders. Regarding
the moderating role of PTSD diagnosis, it was found that, as expected, among
participants who did not meet PTSD diagnostic criteria (49.4% of the sample),
mortality reminders led to harsher evaluations of the moral transgressions compared
to the control condition. Among participants who did meet PTSD criteria, on the
other hand, MS led to significantly less severe judgments of the moral transgressions,
indicating an anomaly in their anxiety-buffer functioning. Regarding the moderating
role of peritraumatic dissociation, it was found that while participants with low levels
of peritraumatic dissociation became harsher toward moral transgressors in the MS
condition compared to the control condition, among participants with high levels of
peritraumatic dissociation, exposure to MS led to more lenient evaluations of the
moral transgressors. These findings replicated those obtained in the Iranian study
with earthquake survivors and provided additional evidence of the role of
peritraumatic dissociation in the disruption of anxiety-buffering functions. Regard-
ing self-efficacy, it was found that while participants with high levels of coping
self-efficacy reacted to mortality thoughts with harsher judgments of moral
transgressions compared to the control condition, a reverse pattern occurred among
participants with low coping self-efficacy beliefs. Within this group, MS led to
significantly more lenient judgments of moral transgressors compared to the control
condition.
Further analyses showed that PTSD diagnosis, peritraumatic dissociation, and
coping self-efficacy contribute unique variance in moderating the effect of MS. Each
of these variables accounted for unique variance that interacted with death reminders
to affect worldview defense. This set of results strongly supports the hypothesis that
PTSD and factors associated with PTSD moderate responses to mortality reminders.
As would be predicted by ABDT, individuals with a PTSD diagnosis, with high levels
of peritraumatic dissociation, and with low levels of coping self-efficacy displayed
disrupted anxiety-buffer functioning.
Evidence from Côte d’Ivoire: civil war survivors Study 1

Two studies conducted in the aftermath of the Côte d’Ivoire civil war (20022007)
yielded further support for ABDT by testing the disruption of anxiety-buffer
functioning in new ways (Chatard et al., in press).
The researchers first tested the hypothesis that persons with high levels of PTSD
symptoms would not show the typical suppression of death-related thoughts,
whereas persons with low PTSD symptom levels would. Terror management theory
literature reveals that initial suppression of death-related thoughts is a typical first
response to MS (e.g., Arndt, Greenberg, Solomon, Pyszczynski, & Simon, 1997). The
lack of such suppression in those with high PTSD symptom severity would thus
point to another type of malfunction in their anxiety-buffering system.
Procedure
One hundred and five university students from Abidjan, the largest city in Côte
d’Ivoire, participated in the study that was presented as a short opinion survey about
the civil war. They first completed a measure of PTSD symptom severity, the Post-
Traumatic Stress Checklist-Civilian Version (PCL-C; Weathers, Litz, Huska, &
Keane, 1994). The PCL-C consists of 17 items corresponding to the three PTSD
symptom clusters specified by DSM-IV (i.e., re-experiencing, avoidance, and
arousal), and participants indicated on a Likert scale how much they have suffered
from a particular symptom in the last month. Following this, they were randomly
assigned to a MS or a control condition. Those in the MS condition answered two
questions about death (‘‘Please, describe the emotions you feel when you think that
you may have been killed during the war,’’ and ‘‘Please, imagine and describe the way
you may have been killed during this war’’), and those in the control condition
responded to similarly worded questions about a difficult exam. Finally, participants’
accessibility of death-related thoughts was measured with a word-completion task
that was the French version of a measure commonly used in terror management
theory research (e.g., Greenberg, Pyszczynski, Solomon, Simon, & Breus, 1994).
Participants had to complete 25 word fragments, five of which could be completed
with either a death-related word or a neutral word (e.g., the fragment T O _ _ _ can
be completed as TOTAL/total or as TOMBE/grave). Death-thought accessibility
(DTA) was operationalized as the number of wordstems completed in death-related
ways.
Results
As hypothesized, participants with more PTSD symptoms displayed higher DTA in
the MS condition than in the control condition. Participants with fewer PTSD
symptoms exhibited a non-significant trend in the opposite direction, which is

consistent with previous terror management theory research in non-traumatized
populations. The atypical reaction observed among individuals with high PTSD
symptoms was further evidence that PTSD is associated with a disturbance in normal
anxiety-buffering functioning. Whereas previous ABDT studies focused on cultural
worldview defense as the expression of disrupted anxiety-buffering functioning in
PTSD-afflicted individuals, this study unveiled a different aspect of the disruption,
namely failure to suppress death-related thoughts as a first defense against mortality
reminders.
Evidence from Côte d’Ivoire: civil war survivors Study 2

In a second study, Chatard and colleagues (in press) tested whether reminders of
death would increase reports of trauma symptoms among those afflicted with PTSD.
According to ABDT, the disruption in anxiety-buffer functioning renders people
defenseless against anxiety-provoking thoughts about death and the traumatic event.
This lack of protection is considered to be partly responsible for the symptoms of
PTSD. It follows that thoughts about the possibility of death and the traumatic event
should lead to an exacerbation of PTSD symptoms. This effect, however, was only
expected for those who were vulnerable to the disorder.
Based on the literature showing the link between extent of exposure to
traumatic event and PTSD severity, exposure to trauma was treated as a predictor
of vulnerability to PTSD. A geographical criterion was used to classify participants
as low and high in exposure to trauma. Participants who lived in Bouaké, where
armed confrontations were common at the onset of the war were categorized as
‘‘high exposure,’’ whereas participants who lived in Abidjan were categorized as
low exposure. The validity of this criterion was confirmed by the finding that
participants from Bouaké reported much more exposure to violence during the civil
war. It was hypothesized that participants with more direct exposure to the civil
war would report more severe PTSD symptoms following mortality reminders,
since their disrupted anxiety-buffer systems would be unable to shield them from
the anxiety-inducing thoughts about death and their traumatic experience.
Procedure
One hundred and ninety-seven students of the University of Abidjan participated
in the study. The researchers only selected participants who lived in Abidjan (low
war exposure) or in Bouaké (high war exposure) at the time of the war onset. The
design was a 2 (war exposure: high vs. low)2 (experimental condition: MS vs.
control) between groups factorial. In the MS condition, participants were asked
five questions about the possibility of death during the civil war, which were
responded to with a yes or no (e.g., ‘‘Do you think that you may have been killed
during this war?’’). Participants were also asked two open-ended questions
modeled after previous terror management theory research (e.g., ‘‘Please, describe
the emotions you feel when thinking that you may have been killed during the
war’’). In the control condition, participants were asked five closed-ended
questions about their student life (e.g., ‘‘Have you already repeated a year at
the University in the past?’’), and two open-ended questions (e.g., ‘‘Please describe
the emotions you feel when you think about your student life’’). PTSD symptom
severity was assessed with PCL-C as in the previous study, which this time served
as the dependent variable.
Results
As expected, high war-exposure participants reported higher PTSD symptoms in the
MS than in the control condition. In contrast, participants less exposed to war
tended to report lower PTSD symptoms in the MS than in the control condition,
although this difference did not reach significance. The study supported the notion
that more extreme war exposure was associated with greater disruption of the
anxiety-buffering system, thus leading high war-exposure participants to report
higher PTSD symptoms in the MS condition than in the control condition. This
study revealed exposure to trauma as an additional moderator of disrupted responses
to MS in addition to peritraumatic dissociation and coping self-efficacy.
Overall, the Côte d’Ivoire data extended the generality of the disrupted anxiety-
buffer functioning among PTSD-afflicted persons and lent further support to the
theory.
Evidence from the USA: college students exposed to trauma Study 1

The last set of studies testing ABDT came from the USA. In two studies conducted
with undergraduate students at a university in the Northeast, Edmondson (2009)
provided further data in support of the theory.
The first study tested the hypothesis that participants with clinically significant
trauma symptoms would not display an immediate suppression of death thoughts
after mortality reminders. This hypothesis, as in Study 1 from Côte d’Ivoire, was
based on the terror management theory finding that overt reminders of death lead to
a decrease in the accessibility of death thoughts in those with properly functioning
anxiety-buffers. The lack of this defense in those with clinical trauma symptoms
would indicate a compromised anxiety-buffer.
Procedure
Four hundred and forty-seven students participated in the study. At the beginning of
the study participants were randomly assigned to one of three experimental
conditions. These were MS, trauma salience, and the control condition (our
discussion will focus on the MS and control conditions only). Those in the MS
condition answered the two open-ended questions frequently used in terror
management theory research to induce mortality thoughts (i.e., ‘‘Please briefly
describe the emotions that the thought of your own death arouses in you,’’ and ‘‘Jot
down, as specifically as you can, what you think will happen to you as you physically
die and once you are physically dead’’). In the control condition parallel questions
were presented, with ‘‘dental pain’’ substituting for death.
Following this, participants were randomly assigned to a ‘‘delay’’ or ‘‘no delay’’
condition. They were asked to either solve two puzzles serving as a delay task before
completing the measure of DTA, or were immediately presented with the DTA
measure. The DTA measure, as in Study 1 from Côte d’Ivoire, was the number of
death-related words participants generated in a word-completion task (e.g., COFF_ _

could be completed as COFFEE or COFFIN).
Finally, participants completed the PCL-C, which assessed the severity of trauma
symptoms related to the most distressing event they have experienced. Based on their
PCL-C scores, participants were categorized into low, medium, or high symptom
severity groups. The high trauma symptom group included only participants who
scored above the suggested cut off point for PTSD diagnosis.
Results
The results revealed that, immediately following reminders of mortality, participants
with both moderate and high levels of trauma symptoms exhibited elevated DTA,
whereas participants with negligible symptoms showed no such increase, consistent
with findings from non-traumatized persons in previous research (Arndt et al., 1997).
Furthermore, there was a doseresponse effect, such that the high-symptom group
showed greater DTA than the medium-symptom group. After a delay following the
reminder of mortality, however, DTA did not differ as a function of high or low
trauma symptoms. This pattern of results suggests that individuals with significant
trauma symptomatology do not show the suppression of death-related thoughts
immediately after being primed with the topic of death that is typically found in non-
traumatized persons in previous research and was found in participants in this study
with low levels of PTSD symptoms.
Evidence from the USA: college students exposed to trauma Study 2

Study 2 tested the hypothesis that, unlike non-traumatized individuals in previous
terror management theory studies, participants with clinically significant trauma
symptoms would not display worldview defense, even if they have highly accessible
death thoughts. Edmondson also tested the hypothesis that an experimentally
manipulated self-esteem boost would not help those with severe PTSD symptoms to
suppress their death thoughts.
Procedure
Two hundred and ninety university students participated in the study. At the
beginning of the study, participants completed a personality test and were given false
feedback regarding their personality as part of a self-esteem manipulation. This self-
esteem manipulation was identical to the ones used in prior studies of the influence
of self-esteem boosts on terror management effects (e.g., Greenberg et al., 1992).
Participants were randomly assigned to receive either neutral or positive bogus
feedback in the form of a paragraph describing their personality, prospects for the
future, and psycho-social adjustment relative to others. Next, participants were
assigned to either a MS or dental pain condition and responded to the same two
open-ended questions as in Study 1. Immediately following the MS manipulation,
DTA was measured using the same word-completion task as in Study 1.
To assess worldview defense, the study used two vignettes adapted from the
Moral Transgressions Scale (Florian & Mikulincer, 1997). These vignettes described
transgressions motivated by anti-American sentiment, such as college students
burning an American flag in protest of American foreign policy. As in the Polish

study described earlier, participants read each vignette and rated how severe the
offense was and how heavily the transgressor should be punished. Finally,
participants completed the PTSD Checklist-Civilian, as in Study 1, to assess the
presence and severity of their trauma symptoms.
Results
The results replicated the finding from Study 1 that MS led to elevated immediate
DTA among those with medium or high trauma symptoms, but not those with low/
no trauma symptoms. Furthermore, as in previous ABDT studies, participants with
significant trauma symptoms did not engage in cultural worldview defense in the MS
condition, despite the increased accessibility of death thoughts. And importantly, the
study showed that the self-esteem boost manipulation did not attenuate the
immediate DTA increase observed in the medium and high trauma symptom groups
following mortality reminders. This latter finding suggests that persons with high
levels of PTSD symptom severity are not able to use boosts to self-esteem to fend off
death-related thought in the way that persons with intact anxiety-buffers do
(Harmon-Jones et al., 1997).
The two studies conducted in the USA replicated and extended the findings
observed in other countries and provided further evidence in support of ABDT.
Conclusion
In this paper, we presented ABDT, which is an extension of terror management
theory to the problem of psychological trauma. ABDT posits that PTSD results
from a disruption in normal anxiety-buffering mechanisms, and that PTSD
symptoms reflect a failure of the anxiety-buffering mechanism to protect the
individual against overwhelming anxiety. Though ABDT is a recently proposed
theory, a substantial literature has already emerged supporting it. We have provided
a detailed review of the extant studies that have tested hypotheses from the theory.
These studies, conducted with hundreds of people from diverse cultures and with
diverse experiences of trauma, are encouraging in their support for the theory. These
studies consistently show that traumatized individuals with PTSD and vulnerability
factors for PTSD do not display typical terror management responses in the face of
mortality thoughts.
The Iranian studies reveal that the disruption of anxiety-buffer functioning

mediates the relationship between dissociation and PTSD, thus implicating
dissociation as playing a role in this breakdown and suggesting a mechanism to
explain the oft-observed relationship between dissociation and this disorder (Ozer
et al., 2003). The Ivory Coast study reveals that extent of exposure to trauma
moderates the effect of mortality reminders on reports of PTSD symptoms. Extent of
exposure to trauma is a well-recognized correlate of PTSD, and ABDT would
suggest that this is partly because greater traumatic exposure is more likely to result
in the disruption of one’s anxiety-buffering mechanisms. While the buffer can be
powerful enough to absorb a minor trauma, it becomes more likely with increasing
traumatic exposure that the buffer will not be able to thwart the attack and will be
crushed. Another variable that moderates atypical responses to mortality reminders,

as identified by the Polish study, is coping self-efficacy. Coping self-efficacy is
associated with better posttraumatic responses; and from an ABDT perspective, this
is partly because coping self-efficacy refers to the perceived strength of the
individual’s anxiety-buffering mechanisms. Individuals with higher coping self-
efficacy beliefs exhibit greater trust in their ability to defend themselves against
the anxiety characterizing the aftermath of trauma, and this, in a self-fulfilling
fashion, would help with the restructuring of one’s anxiety-buffering mechanisms.
Though the ABDT accounts of the moderating roles of dissociation, extent of
exposure to trauma, and coping self-efficacy are in need of further testing, we find
the preliminary results reported here very heartening.
PTSD is a complex disorder, and several distinct causal mechanisms, from
bottom-up, biogenetic ones to top-down, psychological ones, are indisputably
involved in its etiology. ABDT thus does not claim that the breakdown of the
anxiety-buffering system provides a complete explanation of all PTSD-related
processes. Rather, we suggest that ABDT provides a new and viable framework for
conceptualizing and integrating many of the psychological processes involved in the
onset, maintenance, and treatment of PTSD. As such, it is a theory that aims to
complement currently influential theories of PTSD. Since ABDT builds on a large
literature in social psychology, a variety of testable hypotheses can be generated
regarding the mechanisms that produce specific trauma-related symptoms and the
processes through which these symptoms can be reduced. Thus, the theory has
potential to provide a new perspective for thinking about responses to trauma to
inform new approaches to treatment for PTSD and related problems.
ABDT is still in its infancy and there are many questions that will need to be
addressed by future research. A fundamental question is why some traumatized
individuals develop PTSD whereas others do not. If it is the case that some anxiety-
buffers are stronger or more flexible to begin with, what are the features of such
buffers? Are some worldviews and some sources of self-esteem more resistant to
breakdown than others? Longitudinal studies could shed light on these questions,
which would be an important contribution to attempts to prevent and treat the
disorder. A related question is why and how some individuals experience
posttraumatic growth as a response to trauma (Calhoun & Tedeschi, 1999) and
what kind of changes their anxiety-buffering mechanisms undergo in this process.
PTSD is a disorder with far-reaching, devastating consequences. The risk of
suicide associated with PTSD exceeds that of any other anxiety disorder (Galovski &
Lyons, 2004) and those with PTSD are more likely to divorce, report trouble raising
their children, engage in intimate partner aggression, experience physical health

problems, become involved with the legal system, earn less, and change jobs
frequently (Keane et al., 2006). Given that the ongoing problems of war, terrorism,
natural disaster, and other forms of violence are unlikely to end soon, the importance
of efforts to prevent and heal PTSD is apparent, and we believe that ABDT has
significant potential to contribute to these efforts.
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Anxiety, Stress, & Coping

Vol. 24, No. 1, January 2011, 326

Colorado Springs, Colorado Springs, CO, USA

We present anxiety buffer disruption theory (ABDT) and provide a review of

Anxiety buffer disruption theory (ABDT) builds on terror management theory

*Corresponding author. Email: kesebir@gmail.com

Terror management theory

well-being and effective functioning, it is imperative that people manage this

in-group members and less favorable evaluations of out-group members (Greenberg

negative emotional states and is robustly associated with a wide array of

Posttraumatic stress disorder (PTSD) from the perspective of terror management

ABDT proposes that the overwhelming anxiety experienced by the PTSD-

Figure 1. Anxiety buffer disruption theory.

Disrupted faith in one’s cultural worldview

accumulation of anomalous research findings cannot be readily assimilated to

of the individual’s anxiety-buffering mechanism.

Disruptions in close personal relationships

Evidence for anxiety buffer disruption theory (ABDT)

self-efficacy, or exposure to trauma would be expected to moderate the tendency to

Evidence from Iran: earthquake survivors Study 1

investigated the relationship between peritraumatic dissociation, which is a precursor

previous research with non-traumatized populations, low dissociators would not

worldview defense following mortality thoughts, presumably because of their

Evidence from Iran: earthquake survivors Study 2

supportive of a strict Islamic dress code compared to the control condition.

Evidence from Poland: female victims of domestic abuse

Evidence from Côte d’Ivoire: civil war survivors Study 1

symptoms exhibited a non-significant trend in the opposite direction, which is

Evidence from Côte d’Ivoire: civil war survivors Study 2

Evidence from the USA: college students exposed to trauma Study 1

death-related words participants generated in a word-completion task (e.g., COFF_ _

Evidence from the USA: college students exposed to trauma Study 2

burning an American flag in protest of American foreign policy. As in the Polish

The Iranian studies reveal that the disruption of anxiety-buffer functioning

crushed. Another variable that moderates atypical responses to mortality reminders,

their children, engage in intimate partner aggression, experience physical health

mortality salience as predictors of severity of post-traumatic symptoms. Psychological

traumatic events on different demographic groups. Journal of Consulting and Clinical

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