Background <p>Sexual trauma is highly prevalent, particularly in women, and is often associated with elevated posttraumatic stress disorder (PTSD) symptoms. While many survivors experience a natural reduction in PTSD symptoms over time, the mechanisms underlying these changes remain unclear. Cognitions, specifically trauma appraisals, play a key role in trauma recovery, though the longitudinal examination of changes in trauma appraisals and their impact on PTSD symptoms has been largely overlooked. This study aims to document the natural course of change in trauma appraisals (i.e., threat, challenge, centrality, self-blame, and self and life impact) over time and to examine directionality of the relationships between trauma appraisals and PTSD symptoms in the first &#xa0;three months after sexual trauma.</p> Methods <p>Women (<i>N</i> = 203) who experienced a sexual trauma in the past month were recruited via an online platform and completed questionnaires at three timepoints (baseline, 1-month, and 2-month follow-ups).</p> Results <p>The extent to which participants endorsed each appraisal (except for challenge), as well as PTSD symptoms, significantly decreased over time, with the steepest changes occurring soon after the trauma. Cross-lagged panel models revealed some bidirectional relationships between appraisals (threat, self-blame, centrality) and PTSD, while self and life impact exerted a solely-unidirectional&#xa0;influence on PTSD. In contrast, challenge appraisals remained stable over time and showed no significant longitudinal relationship with PTSD symptoms.</p> Conclusions <p>Findings underscore the critical role of timing and valence: threat and self and life impact appraisals most strongly influence PTSD symptoms early on, self-blame and centrality become more impactful two to three &#xa0;months later, and positive appraisals, such as challenge, remain stable and distinct in the early aftermath of trauma. These results highlight the need for stage-specific interventions, targeting threat and self and life impact appraisals in the acute aftermath of trauma and addressing self-blame and centrality as time progresses to mitigate long-term distress. Given the bidirectional nature of these relationships, interventions focused on targeting PTSD symptoms in the first month after experiencing sexual trauma are also warranted.</p>