ABSTRACTObjectiveThere has been an increasing interest in understanding what contributes to the development and what maintains posttraumatic stress disorder (PTSD). The cognitive model emphasizes that it is a disturbance of the autobiographical memory for the trauma, cognitive beliefs and maladaptive behaviour that maintain trauma symptoms. Interventions are based on cognitive restructuring and behaviour experiments to modify these beliefs. In contrast, the metacognitive model emphasizes that it is the metacognitive beliefs that give rise to the cognitive attentional syndrome (CAS) that maintain trauma symptoms. The focus of treatment is reducing CAS and working on metacognitive beliefs. The aim of this study was to explore the contribution of cognitions and metacognitive beliefs to trauma symptoms and investigate what predicts symptom burden in traumatized patients.MethodParticipants (N = 290) diagnosed with PTSD were included, and hierarchical multiple regression analyses were performed to explore if cognitions and metacognitive beliefs explained additional and independent variance in trauma symptoms while controlling for age and gender.ResultsBoth cognitions and metacognitive beliefs contributed independently and significantly to predicting trauma symptoms.ConclusionThe results provide further support for investigating what maintains trauma symptoms and what to target in treatment. This may have clinical implications for our theoretical and practical understanding of PTSD.