Understanding and Treating Unwanted Trauma Memories in Posttraumatic Stress Disorder

As in post-traumatic stress disorder (PTSD), intrusive memories (IMs) also play an important role in depression. Evidence about the comparative quality of IMs in PTSD and depression is limited and inconsistent. A total of 28 adults with PTSD, 29 with depression, and 30 controls identified intrusive and voluntary segments of narrative memories of key events. Self-report and language measures of memory quality were obtained. Depressed and PTSD participants reported higher frequency of IMs and higher IM-related interference than controls. IMs in PTSD participants were distinguished from depressed and control participants by higher self-rated distress, higher self-rated sensory quality, and a higher proportion of sensory words in the narrative. The depressed and control groups did not differ on IM quality. PTSD IM segments had more sensory content than voluntary segments and fewer temporal markers. The IM segments of the depressed and control groups had fewer temporal markers than the voluntary segments. Depression severity predicted fewer sensory words in the IM after considering peri-event dissociation and arousal but did not add to the prediction of other IM qualities. A strong sensory quality is a distinctive feature of IMs in PTSD but not in depression. Basic sensory processes contribute to the intrusiveness of remembering in PTSD but not in depression.

Interaction of noradrenaline and cortisol predicts negative intrusive memories in posttraumatic stress disorder

The purpose of this study was to examine factors predicting the development of posttraumatic stress symptoms after a traumatic event, the 1991 Oakland/Berkeley firestorm. The major predictive factors of interest were dissociative, anxiety, and loss of personal autonomy symptoms reported in the immediate aftermath of the fire; contact with the fire; and life stressors before and after the fire. Subjects were recruited from several sources so that they would vary in their extent of contact with the fire. Of 187 participants who completed self-report measures about their experiences in the aftermath of the firestorm, 154 completed a follow-up assessment. Of these 154 subjects, 97% completed the follow-up questionnaires 7-9 months after the fire. The questionnaires included measures of posttraumatic stress and life events since the fire. Dissociative and loss of personal autonomy symptoms experienced in the fire's immediate aftermath, as well as stressful life experiences occurring later, significantly predicted posttraumatic stress symptoms measured 7-9 months after the firestorm by a civilian version of the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder and the Impact of Event Scale. Dissociative symptoms more strongly predicted posttraumatic symptoms than did anxiety and loss of personal autonomy symptoms. Intrusive thinking differs from other kinds of posttraumatic symptoms in being related directly to the trauma and previous stressful life events. These findings suggest that dissociative symptoms experienced in the immediate aftermath of a traumatic experience and subsequent stressful experiences are indicative of risk for the later development of posttraumatic stress symptoms. Such measures may be useful as screening procedures for identifying those most likely to need clinical care to help them work through their reactions to the traumatic event and to subsequent stressful experiences.

Suicide is a major public health concern accounting for 800 000 deaths globally each year. Although there have been many advances in understanding suicide risk in recent decades, our ability to predict suicide is no better now than it was 50 years ago. There are many potential explanations for this lack of progress, but the absence, until recently, of comprehensive theoretical models that predict the emergence of suicidal ideation distinct from the transition between suicidal ideation and suicide attempts/suicide is key to this lack of progress. The current article presents the integrated motivational–volitional (IMV) model of suicidal behaviour, one such theoretical model. We propose that defeat and entrapment drive the emergence of suicidal ideation and that a group of factors, entitled volitional moderators (VMs), govern the transition from suicidal ideation to suicidal behaviour. According to the IMV model, VMs include access to the means of suicide, exposure to suicidal behaviour, capability for suicide (fearlessness about death and increased physical pain tolerance), planning, impulsivity, mental imagery and past suicidal behaviour. In this article, we describe the theoretical origins of the IMV model, the key premises underpinning the model, empirical tests of the model and future research directions.

Intrusive memories are a key symptom of Post-Traumatic Stress Disorder (PTSD). Brain Derived Neurotrophic Factor (BDNF) has been proposed as a possible mechanism influencing intrusive memories in PTSD given its role in synaptic plasticity and memory consolidation. The BDNF Val66Met polymorphism has been linked PTSD susceptibility and episodic memory disturbances however previous research outcomes have been variable, potentially due to a failure to control for important confounds such as sex, ethnicity, BMI, developmental stage and extent of previous trauma experiences. This study explored the relationship between the BDNF Val66Met genotype and emotional memory (intrusive memories and recall) in PTSD controlling for these factors in 276 participants: 53 with PTSD, 118 Trauma Exposed and 105 Controls. Key findings revealed the PTSD group experienced significantly more negative intrusions than Controls, and females more intrusions than males, however there were no group or sex differences in negative memory recall. When developmental stage of trauma was considered in a traumatised sub-sample, BDNF genotype significantly interacted with PTSD status, sex, and developmental trauma stage. This highlights the importance of controlling for sex and timing of trauma on BDNF expression in neurobiological PTSD research, however further research is needed to replicate these preliminary findings and investigate the specific epigenetic and neurobiological mechanisms involved.

La mémoire intrusive dans le trouble de stress post-traumatique : apport de la neuroimagerie

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Intrusive autobiographical memories of negative past events are a clinical feature common to post-traumatic stress disorder (PTSD) and depression. Recent investigations provide increasing evidence that shared cognitive processes are linked to the maintenance of intrusive memories in both conditions. Still absent from the existing literature, however, is a systematic examination of the basic content and defining characteristics of intrusive memories in depression. This study sought to: (i) outline the content and features of intrusive memories in depression, and (ii) investigate whether intrusion characteristics linked to the persistence of intrusive memories in PTSD are also characteristic of intrusive memories in depression. A sample of undergraduate students (n=250) were interviewed and assessed for the presence of an intrusive memory in the past week, and completed a battery of measures that indexed cognitive and affective responses to the memory. Consistent with prediction, intrusive memories contained high levels of sensory experience and were marked by a sense of “nowness”. In accord with studies with PTSD samples, sensory features accounted for unique variance in the prediction of depression severity, over and above that accounted for by intrusion frequency. This pattern of findings was replicated in a dysphoric (BDI-II≥12) sub-sample of participants. Our results underscore the value of drawing on theoretical conceptualisations and empirical findings from the post-traumatic stress literature to extend our understanding of intrusive memories in depression.

Posttraumatic stress disorder (PTSD) is characterized by vivid intrusive memories of the trauma. Among these, visual sensations of the trauma are most commonly reported. However, intrusions may involve other senses as well (e.g., acoustic, olfactory, or bodily sensations). It has been proposed that enhanced mental imagery may predispose individuals with traumatic experiences to intrusions and ultimately to PTSD. A total of 58 victims of interpersonal violence with current (n = 20), past (n = 19), and no lifetime PTSD (n = 19) as well as non-traumatized controls (n = 23) were assessed with the Vividness of Visual Imagery Questionnaire (VVIQ) and a modality-specific imagery questionnaire. Moreover, the sensory quality of the traumatic intrusions was assessed in traumatized participants. Participants with recovered PTSD displayed less overall mental imagery than the other three groups who were indistinguishable. No relation was found between the modality-specific mental imagery and the sensory quality of the intrusions. The impact of mental imagery on intrusive memories in PTSD is complex. Less mental imagery appears beneficial in the recovery process, but does not prevent the development of intrusive symptoms in the first place. Further investigation of perceptual and memory vividness as well imagery control (i.e., to sustain, modify, or terminate an image) also including trauma-related material may be important for trauma-specific interventions.

Intrusive memories are a hallmark symptom of posttraumatic stress disorder (PTSD). They reflect excessive and uncontrolled retrieval of the traumatic memory. Acute elevations of cortisol are known to impair the retrieval of already stored memory information. Thus, continuous cortisol administration might help in reducing intrusive memories in PTSD. Strong perceptual priming for neutral stimuli associated with a “traumatic” context has been shown to be one important learning mechanism that leads to intrusive memories. However, the memory modulating effects of cortisol have only been shown for explicit declarative memory processes. Thus, in our double blind, placebo controlled study we aimed to investigate whether cortisol influences perceptual priming of neutral stimuli that appeared in a “traumatic” context. Two groups of healthy volunteers (N = 160) watched either neutral or “traumatic” picture stories on a computer screen. Neutral objects were presented in between the pictures. Memory for these neutral objects was tested after 24 hours with a perceptual priming task and an explicit memory task. Prior to memory testing half of the participants in each group received 25 mg of cortisol, the other half received placebo. In the placebo group participants in the “traumatic” stories condition showed more perceptual priming for the neutral objects than participants in the neutral stories condition, indicating a strong perceptual priming effect for neutral stimuli presented in a “traumatic” context. In the cortisol group this effect was not present: Participants in the neutral stories and participants in the “traumatic” stories condition in the cortisol group showed comparable priming effects for the neutral objects. Our findings show that cortisol inhibits perceptual priming for neutral stimuli that appeared in a “traumatic” context. These findings indicate that cortisol influences PTSD-relevant memory processes and thus further support the idea that administration of cortisol might be an effective treatment strategy in reducing intrusive reexperiencing.

Rumination has been shown to play a part in post-traumatic stress disorder (PTSD), but its relation to the intrusions characteristic of PTSD has mainly been investigated experimentally. This proof-of-concept case study explored the occurrence, personal experiences, and possible relation between rumination and intrusions in two PTSD patients in their daily living using a mixed method approach. A novel wearable self-tracking instrument was employed which provided fine-grained temporal resolution of observation data and could eliminate recall bias. Furthermore, quantitative and qualitative data were collected on participants’ symptoms, rumination and experiences of using the self-tracking instrument. First, without distinguishing between the two phenomena, the participants tracked both for a week. After receiving psychoeducational training for distinguishing between rumination and intrusions, the differentiated phenomena were tracked for a week. Both participants reported being subjectively able to distinguish between rumination and intrusions and made observations with high adherence during the project. Data hinted at a possible temporal relation between the phenomena in line with theories posing rumination as a maladaptive coping strategy as well as an exacerbator of PTSD symptoms. However, relations to mood were inconclusive. Furthermore, by using the self-tracking instrument, participants gained a heightened awareness of the characteristics of rumination and intrusions and contextual cues for occurrence, as well as a greater sense of momentary agency. Results reveal promising prospects in using the wearable self-tracking instrument for further investigation of the relation between rumination and intrusions in the lived lives of PTSD patients, as well as potential for incorporating this method in clinical treatment. Key learning aims (1) Self-tracking with the One Button Tracker is a novel symptom registration method, particularly suited for use in psychotherapeutic treatment and research. (2) Rumination and intrusions appear to the participants as distinct cognitive phenomena and treatment targets in PTSD. (3) Registering rumination and intrusions in real-time could reveal important temporal relations between them and the contexts in which they occur. (4) The data obtained with this self-tracking method can potentially be used as a tool in, and for the further development of psychotherapy for PTSD.

Most people have experienced distressing events that they would rather forget. Although memories of such events become less intrusive with time for the majority of people, those with posttraumatic stress disorder (PTSD) are afflicted by vivid, recurrent memories of their trauma. Often triggered by reminders in the daily environment, these memories can cause severe distress and impairment. We propose that difficulties with intrusive memories in PTSD arise in part from a deficit in engaging inhibitory control to suppress episodic retrieval. We tested this hypothesis by adapting the think/no-think paradigm to investigate voluntary memory suppression of aversive scenes cued by naturalistic reminders. Retrieval suppression was compromised significantly in PTSD patients, compared with trauma-exposed control participants. Furthermore, patients with the largest deficits in suppression-induced forgetting were also those with the most severe PTSD symptoms. These results raise the possibility that prefrontal mechanisms supporting inhibitory control over memory are impaired in PTSD.

Intrusive memories hijack consciousness and their control may lead to forgetting. However, the contribution of reflexive attention to qualifying a memory signal as interfering is unknown. We used machine learning to decode the brain's electrical activity and pinpoint the otherwise hidden emergence of intrusive memories reported during a memory suppression task. Importantly, the algorithm was trained on an independent attentional model of visual activity, mimicking either the abrupt and interfering appearance of visual scenes into conscious awareness or their deliberate exploration. Intrusion of memories into conscious awareness were decoded above chance. The decoding accuracy increased when the algorithm was trained using a model of reflexive attention. Conscious detection of intrusive activity decoded from the brain signal was central to the future silencing of suppressed memories and laterforgetting. Unwanted memories require the reflexive orienting of attention and access to consciousness to be suppressed effectively by inhibitory control.

Brief Form of the Social Phobia and Anxiety Inventory (SPAI-B) for Adolescents

Memory for odors that are associated with intense emotional experiences is often strongly engraved. Odors are claimed to be more closely connected to affect than other sensory experiences. They can serve as potent contextual cues for memory formation and emotional conditioning and can also serve as cues for olfactory flashbacks. Though trauma-related smells have long been noted by clinicians to be precipitants of traumatic memories in patients with posttraumatic stress disorder (PTSD), very few reports have been published that document this. We review olfactory memories and olfactory flashbacks by presenting 3 cases that illustrate the role of olfaction in PTSD. In these cases olfaction is either a precipitant of PTSD symptoms or an important component of reexperiencing. In PTSD, seemingly nonspecific cues have the potential to precipitate traumatic memories with strong emotional components. These conditioned responses in PTSD are hypothesized to be mediated by specific brain areas, i.e., amygdala, hippocampus, and orbitofrontal cortex. Questions about smells as a traumatic reminder should be part of the routine assessment of intrusive memories in PTSD. In addition, smells may have the potential to provide cues to exposure situations in therapy or to facilitate de novo conditioning.