Intrusive Cognitions Research Articles

The disruptive effects of pain on multitasking in a virtual errands task

Background and aimsPain is known to have a disruptive effect on cognitive performance, but prior studies have used highly constrained laboratory tasks that lack ecological validity. In everyday life people are required to complete more complex sets of tasks, prioritising task completion and recalling lists of tasks which need to be completed, and these tasks continue to be attempted during episodes or states of pain. The present study therefore examined the impact of thermal induced pain on a simulated errand task. MethodsFifty-five healthy adults (36 female) performed the Edinburgh Virtual Errands Task (EVET) either during a painful thermal sensation or with no concurrent pain. Participants also completed the Experience of Cognitive Intrusion of Pain (ECIP) questionnaire to measure their self-reported cognitive impact of pain in general life. ResultsParticipants who completed the EVET task in pain and who self-reported high intrusion of pain made significantly more errors than those who reported lower intrusion on the ECIP. ConclusionsFindings here support the growing literature that suggests that pain has a significant impact on cognitive performance. Furthermore, these findings support the developing literature suggesting that this relationship is complex when considering real world cognition, and that self-report on the ECIP relates well to performance on a task designed to reflect the complexities of everyday living. ImplicationsIf extrapolated to chronic pain populations, these data suggest that pain during complex multitasking performance may have a significant impact on the number of errors made. For people highly vulnerable to cognitive intrusion by pain, this may result in errors such as selecting the wrong location or item to perform tasks, or forgetting to perform these tasks at the correct time. If these findings are shown to extend to chronic pain populations then occupational support to manage complex task performance, using for example diaries/electronic reminders, may help to improve everyday abilities.

Intrusive Cognitive Content and Postdeployment Distress.

Although intrusive cognitions (ICs) are common posttrauma, little is known about trauma-related IC content, or associations between IC content and posttraumatic adjustment. A mixed-method cross-sectional approach was used in a secondary analysis of IC content and postdeployment distress. Participants were 1,521 U.S. Army soldiers 3-12 months postdeployment reporting their most distressing postdeployment ICs (mean number of ICs reported was 1.20). ICs were transcribed and content was categorized by 13 emergent themes. The most commonly reported ICs were of injury or death (48.2%) and combat (43.5%), and soldiers with probable posttraumatic stress disorder (PTSD; n = 187) were more likely to report the presence of these ICs, χ(2) s(1) = 35.27, ps < .001, φs < .16 than those without probable PTSD (n = 1,331). Other domains also emerged frequently, including ICs about friends (31.0%), family (15.8%), and leadership concerns (13.8%). IC content was a small, but significant correlate of distress after adjusting for combat exposure (ΔR(2) ≥ .02, ps ≤ .001). The presence of ICs of injury or death, combat, military sexual trauma, health, leadership, and family (βs > .06, ps < .02) were unique correlates of distress. Results suggested that ICs about a wide range of topics should be addressed in postdeployment interventions.

Obsessional and Eating Disorder-related Intrusive Thoughts: Differences and Similarities Within and Between Individuals Vulnerable to OCD or to EDs.

Unwanted intrusive cognitions constitute the normal variant of clinically significant intrusive cognitions found in disorders such as obsessive-compulsive disorder (OCD) and eating disorders (EDs). This study investigates whether individuals who are vulnerable to OCD or EDs experience more intrusions than people with no vulnerability to these disorders, and it examines the consequences of obsessional (OITs) and eating disorder (EDITs) intrusions in the same individuals, taking into account their susceptibility to OCD, EDs or neither of the two. From a sample of 922 participants, three groups were formed: risk of OCD (n = 92), risk of EDs (n = 41) and a no-risk group (n = 100). EDITs were more frequent than OITs in the two risk groups. Within-group comparisons showed that in the OCD-risk group, the OIT had more negative consequences (interference, emotional distress, dysfunctional appraisals and neutralizing strategies) than the EDIT, whereas in the ED-risk group, the OIT and the EDIT instigated similar negative consequences. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

Sleep in Schizophrenia: Exploring Subjective Experiences of Sleep Problems, and Implications for Treatment.

Sleep dysfunction is a pervasive issue in schizophrenia and psychosis. Current knowledge is drawn almost exclusively from studies using quantitative research methodologies that include measures and tools developed in healthy population groups. Qualitative studies investigating the first-person perspectives of sleep problems are therefore important for designing better assessment and treatment tools to meet consumer needs. Focus groups were conducted to elicit detailed information regarding the personal experience of sleep problems, their antecedents and impact, in 14 individuals with schizophrenia-spectrum disorder who experienced insomnia during their illness. Thematic analysis was applied to examine the data and draw treatment implications for sleep management. Insomnia was ubiquitous and frequently co-occurred with other sleep difficulties (nightmares, sleep walking, acting out dreams, etc.) in this group. Discussions revealed themes common across insomnia populations (role of negative mood states and cognitive intrusions) and also new themes on factors contributing to sleep problems in schizophrenia: (1) beliefs that sleep problems cannot be changed; (2) trauma and adversity; (3) lifestyle choices and lack of motivation; and (4) medication side effects. Sleep problems also had profound impact on daytime dysfunctions and disability. The findings point to novel issues that may benefit from consideration in the treatment of sleep problems in schizophrenia. Unhelpful cognitions and behaviours about sleep can be addressed with psychological interventions, activity scheduling and motivational interviewing techniques. Seeking a first-person perspective is vital for identifying issues that will impact on treatment success and recovery.

The Limits of True Knowledge (Metaphysical and Topological Aspects)

The present article studies the correlation of true cognition not with the performance of certain cognitive or probative procedures by a subject, but with the processes occurring to the object of cognition. Therefore, the limits of truth coincide with the inexhaustible regularity or with nature in the antique, or Kant's interpretation. Opposite to science, art deals with principal singularity: its objects remain the objects of art as long as they cannot be confused with anything else. The present article considers some illegal cognitive intrusions, both leftwards from the limits of truth where the quantum objects (ensembles) are found, and rightwards, where the definiteness of the subject and the soul itself are determined.

The Experience of Cognitive Intrusion of Pain: scale development and validation.

Patients with chronic pain often report their cognition to be impaired by pain, and this observation has been supported by numerous studies measuring the effects of pain on cognitive task performance. Furthermore, cognitive intrusion by pain has been identified as one of 3 components of pain anxiety, alongside general distress and fear of pain. Although cognitive intrusion is a critical characteristic of pain, no specific measure designed to capture its effects exists. In 3 studies, we describe the initial development and validation of a new measure of pain interruption: the Experience of Cognitive Intrusion of Pain (ECIP) scale. In study 1, the ECIP scale was administered to a general population sample to assess its structure and construct validity. In study 2, the factor structure of the ECIP scale was confirmed in a large general population sample experiencing no pain, acute pain, or chronic pain. In study 3, we examined the predictive value of the ECIP scale in pain-related disability in fibromyalgia patients. The ECIP scale scores followed a normal distribution with good variance in a general population sample. The scale had high internal reliability and a clear 1-component structure. It differentiated between chronic pain and control groups, and it was a significant predictor of pain-related disability over and above pain intensity. Repairing attentional interruption from pain may become a novel target for pain management interventions, both pharmacologic and nonpharmacologic.

Involuntary cognitions in everyday life: exploration of type, quality, content, and function.

Psychological research into spontaneous or intrusive cognitions has typically focused on cognitions in one predefined domain, such as obsessional thoughts in OCD, intrusive memories in posttraumatic stress disorder and depression, or involuntary autobiographical memories and daydreaming in everyday life. Such studies have resulted in a wealth of knowledge about these specific cognitions. However, by focusing on a predefined type of cognition, other subtypes of cognition that may co-occur can be missed. In this exploratory study, we aimed to assess involuntary cognitions in everyday life without a pre-determined focus on any specific subtype of cognition. Seventy unselected undergraduate student participants were administered a questionnaire that assessed the presence of any involuntary cognitions in the past month, their quality, type, content, and potential function. In addition, participants provided self-descriptions and completed measures of psychopathology. Content analyses showed that involuntary cognitions were common, predominantly visual in nature, emotional, often about social relationships, and often related to a hypothetical function of emotional processing. About two-thirds of the cognitions that participants reported were memories. Non-memories included daydreams, imaginary worst case scenarios, imaginary future events, hypothetical reconstructions, and ruminations. Memories and non-memories were strikingly similar in their subjective experience of content and emotionality. Negative (but not positive) self-descriptions were associated with negative involuntary cognitions and psychopathology, suggesting a link between involuntary cognitions and the self. Overall, the findings suggest that people experience a wide variety of subtypes of involuntary cognitions in everyday life. Moreover, the specific subtype of involuntary cognition appears to be less important than its valence or content, at least to the subjective experience of the individual.

Motor vehicle evaluative criteria: Using unmet expectations as signals for dissonance

This study assesses whether motor vehicle consumers base their purchases on functional or symbolic needs. It also evaluates motor vehicle buyer’s level of importance attached to evaluative criteria and the extent to which they believe the purchased vehicle fulfils the evaluative criteria, in order to assess whether expectations have been met or not and hence, the potential for cognitive dissonance. Biographical correlates (race, marital status, age, education, occupation, income, gender) are evaluated and the influence of range of motor vehicle is also analysed. A sample of 200 brand new motor vehicle buyers was drawn using the stratified random sampling technique based on range of motor vehicle purchased, month of purchases, gender and age of the buyer. Only new motor vehicle buyers (within KwaZulu-Natal) who concluded their purchases in one major, reputable and leading motor vehicle manufacturing company and who owned the vehicle for a maximum period of seven months were considered, so as to avoid cognitive intrusion. The results indicate that consumer’ expectations were not met in terms of price, economy and performance yet these were buyers’ most highly rated evaluative criteria, thereby reflecting the potential for dissonance. Significant biographical correlates were noted in terms of race, age, occupation, income, gender and motor vehicle evaluative criteria. Whilst bottom and middle of the range motor vehicle consumers favour functional or utilitarian value, top of the range motor vehicle consumers aim to fulfil symbolic needs.

Stress and sleep reactivity: a prospective investigation of the stress-diathesis model of insomnia.

To prospectively assess sleep reactivity as a diathesis of insomnia, and to delineate the interaction between this diathesis and naturalistic stress in the development of insomnia among normal sleepers. Longitudinal. Community-based. 2,316 adults from the Evolution of Pathways to Insomnia Cohort (EPIC) with no history of insomnia or depression (46.8 ± 13.2 y; 60% female). None. Participants reported the number of stressful events they encountered at baseline (Time 1), as well as the level of cognitive intrusion they experienced in response to each stressor. Stressful events (OR = 1.13; P < 0.01) and stress-induced cognitive intrusion (OR = 1.61; P < 0.01) were significant predictors of risk for insomnia one year hence (Time 2). Intrusion mediated the effects of stressful events on risk for insomnia (P < 0.05). Trait sleep reactivity significantly increased risk for insomnia (OR = 1.78; P < 0.01). Further, sleep reactivity moderated the effects of stress-induced intrusion (P < 0.05), such that the risk for insomnia as a function of intrusion was significantly higher in individuals with high sleep reactivity. Trait sleep reactivity also constituted a significant risk for depression (OR = 1.67; P < 0.01) two years later (Time 3). Insomnia at Time 2 significantly mediated this effect (P < 0.05). This study suggests that premorbid sleep reactivity is a significant risk factor for incident insomnia, and that it triggers insomnia by exacerbating the effects of stress-induced intrusion. Sleep reactivity is also a precipitant of depression, as mediated by insomnia. These findings support the stress-diathesis model of insomnia, while highlighting sleep reactivity as an important diathesis. Drake CL, Pillai V, Roth T. Stress and sleep reactivity: a prospective investigation of the stress-diathesis model of insomnia.

Individual differences in resting heart rate variability and cognitive control in posttraumatic stress disorder.

Post-traumatic stress disorder (PTSD) is characterized by deficits in cognitive functioning, particularly cognitive control. Moreover, these deficits are thought to play a critical role in the etiology and maintenance of core PTSD symptoms such as intrusive thoughts and memories. However, the psychophysiological concomitants of cognitive control remain largely unexamined. In this article, we suggest that individual differences in heart rate variability (HRV), a physiological index of self-regulatory capacity, may underlie the association between cognitive control ability and intrusive cognitions in PTSD. We review evidence showing that individual differences in HRV at rest are related to prefrontal cortical activity and performance on a broad range of cognitive control tasks. We highlight the importance of inhibition as a mechanism by which HRV promotes successful cognitive control. In addition, we summarize recent research linking individual differences in HRV to performance on laboratory tasks that assess the ability to control unwanted memories and intrusive thoughts. We conclude by suggesting that future studies should examine the role of low HRV as a risk factor for developing PTSD.

Moderators and mediators of the relationship between stress and insomnia: stressor chronicity, cognitive intrusion, and coping.

To assess moderators, such as stressor chronicity, and mediators, including stress response in the form of cognitive intrusion and coping behavior, of the prospective association between naturalistic stress and incident insomnia. Longitudinal. Epidemiological. A community-based sample of good sleepers (n = 2,892) with no lifetime history of insomnia. None. Participants reported the number of stressful events they had encountered at baseline, as well as the perceived severity and chronicity of each event. Similarly, volitional stress responses such as coping, as well as more involuntary responses such as cognitive intrusion were assayed for each stressor. Follow-up assessment 1 y hence revealed an insomnia incidence rate of 9.1%. Stress exposure was a significant predictor of insomnia onset, such that the odds of developing insomnia increased by 19% for every additional stressor. Chronicity significantly moderated this relationship, such that the likelihood of developing insomnia as a result of stress exposure increased as a function of chronicity. Cognitive intrusion significantly mediated the association between stress exposure and insomnia. Finally, three specific coping behaviors also acted as mediators: behavioral disengagement, distraction, and substance use. Most studies characterize the relationship between stress exposure and insomnia as a simple dose-response phenomenon. However, our data suggest that certain stressor characteristics significantly moderate this association. Stress response in the form of cognitive intrusion and specific maladaptive coping behaviors mediate the effects of stress exposure. These findings highlight the need for a multidimensional approach to stress assessment in future research and clinical practice. Pillai V, Roth T, Mullins HM, Drake CL. Moderators and mediators of the relationship between stress and insomnia: stressor chronicity, cognitive intrusion, and coping.

Converting a Freudian analysis into a Jungian one: obsession, addiction, and an answer from Job.

In his analyses of obsessional patients, Sigmund Freud suggested that they suffered from intrusive cognitions and compulsive activities. Early psychoanalysts delineated the phenomenology of obsessionality, but did not differentiate what is currently termed obsessive-compulsive disorder from obsessional personality. However, it was widely recognized that the success of psychoanalysis with obsessional patients was limited due to rigid characterological defences and transference resistances. The present paper examines the case of a middle-aged obsessional academic who had been treated for nearly twenty years in a 'classical' Freudian psychoanalysis prior to entering Jungian analysis. It examines how persistent focus on Oedipal conflicts undesirably reinforced the transference resistance in this obsessional man, and suggests that focusing instead on diminishing the harshness of the super-ego via the therapeutic alliance, and fostering faith in the salutary aspects of unconscious processing has led to salutary results in this case. The biblical book of Job is adopted as ancient instruction in how to address the scrupulosity and addictive mental structuring of obsessionality in analysis.

CBT for OCD: habituation or cognitive shift?

AbstractCognitive Behavioural Therapy (CBT) including Exposure and Response Prevention (ERP) is recommended by NICE as the psychological treatment of choice for obsessive compulsive disorder (OCD). Twenty-five percent of OCD patients refuse ERP, and many psychologists advocate formulation-driven cognitive therapy, including ERP, as opposed to ERP alone. However, a recent meta-analysis suggested there is insufficient evidence to suggest ERP is improved by cognitive methods. This paper proposes to contribute to this debate by providing a detailed description of the treatment of a patient with intrusive cognitions of a sexual nature, who was treated successfully using behavioural experiments designed to test cognitions, rather than ERP. This is, arguably, the way in which most cognitive behavioural therapists would work with someone with OCD. However, this approach is not reflected in the literature at present. The authors report the patient's feedback that therapeutic change was brought about through cognitive shift, as a result of the formulation-driven behavioural experiments.

Intrusive Thoughts in Obsessive–Compulsive Disorder and Eating Disorder Patients: A Differential Analysis

The present study aims to compare the unwanted intrusions experienced by obsessive-compulsive (OCD) and eating disorder (ED) patients, their appraisals, and their control strategies and analyse which variables predict the intrusions' disruption and emotional disturbance in each group. Seventy-nine OCD and 177 ED patients completed two equivalent self-reports designed to assess OCD-related and ED-related intrusions, their dysfunctional appraisals, and associated control strategies. OCD and ED patients experienced intrusions with comparable frequency and emotional disturbance, but OCD patients experienced greater disruption. Differences appeared between groups on some appraisals and control strategies. Intolerance to uncertainty (OCD group) and thought importance (ED group) predicted their respective emotional disturbance and disruption. Additionally, control importance (OCD group) and thought-action fusion moral (OCD and ED groups) predicted their emotional disturbance. OCD and ED share the presence of intrusions; however, different variables explain why they are disruptive and emotionally disturbing. Cognitive intrusions require further investigation as a transdiagnostic variable.

Imagery and Likelihood Cognitive Bias in Pain

Distressing intrusive images are frequently experienced by sufferers from chronic and acute pain. The images (Index images) are correlated with elevations in anxiety, threat, and a cognition that the imaged event might actually happen. The over-estimation that having a negative cognition about an adverse event will increase the probability of the negative event occurring--the likelihood bias--has been observed in a variety of psychological disorders. Preliminary research indicated this cognitive bias might occur in pain sufferers. To investigate the occurrence of a cognitive likelihood bias associated with imagery in acute and chronic pain sufferers, and to relate the postulated cognitive bias to psychological characteristics of participants, and four other important cognitive responses to their Index images. Fifty-nine pain sufferers completed a newly developed questionnaire (Image-Event-Fusion-pain: IEF-p) to assess cognitive likelihood bias in pain sufferers. The internal consistency, reliability, factor structure and validity of the scale were evaluated. Psychological measures to assess anxiety, depression, PTSD symptoms, and levels of mental defeat were administered. The IEF-p was found to be psychometrically robust with satisfactory test-retest reliability, good internal consistency, single factor structure and criterion validity. The IEF-p was significantly correlated with four key cognitive appraisals of the Index Images (responsibility, likelihood, premonition, and threat). Three of these correlations were independent of depression. High cognitive bias scores were significantly associated with elevated levels of anxiety symptoms, depression, PTSD symptoms, and mental defeat. Pain Index images were significantly associated with cognitive bias (IEF-p), increased threat levels, and raised estimate of the likelihood of imaged events actually occurring. The results indicate the prevalence of a cognitive bias associated with pain imagery cognitions, comparable to that established with intrusive cognitions in OCD, notably Thought-Action- Fusion.

The effects of prism adaptation on egocentric metric distance estimation.

The present experiment evaluated whether training involving throwing transferred to metric distance estimation (i.e., describing in feet and inches the distance between oneself and targets). In prior work, we found that metric estimation training negatively transferred to throwing. We explained our results in terms of cognitive intrusion. The present study tested that possibility by swapping our training and transfer tasks. During pretesting, participants verbally estimated the metric distances between themselves and targets, or they threw a beanbag to targets. During training, participants donned goggles that distorted their vision. While wearing the goggles, they threw a beanbag to targets. Half received feedback. During posttesting, participants removed the distorting goggles and completed the same task that they performed during pretesting. The results indicated that the distorting goggles degraded throwing at the beginning of training, visual feedback improved throwing during training, the effects of training with feedback persisted into the throwing posttest, and the effects of training with feedback did not transfer to the verbal metric estimation posttest. Training involving throwing was effective, but did not transfer to verbal metric distance estimation. This supports our argument that the negative transfer observed in our previous study stemmed from cognitive intrusion. The present experiment suggests that the creation of distance estimation training should begin with a careful analysis of the transfer task, and that distance estimation training programs should explicitly teach trainees that their training will not generalize to all distance estimation tasks.

Does sex moderate the relationship between anxiety and pain?

Objectives : Sex differences exist in the relationship between anxiety and pain, although findings are mixed. One reason could be because a number of anxiety measures have been used. Therefore, this study aimed to identify the core components within commonly used pain anxiety measures, and see whether these components are differentially related to sensation and pain thresholds in men and women. Design, main outcome measures : One hundred and eighty-nine healthy adults (119 female) completed the Fear of Pain Questionnaire, Pain Catastrophising Scale, Pain Anxiety Symptoms Scale, Anxiety Sensitivity Index-3 and the Depression Anxiety Stress Scale. Thermal sensation and pain thresholds, mechanical sensation and pressure pain thresholds were also collected. Results : A Principal Components Analysis of anxiety measures revealed three constructs: general distress, cognitive intrusion and fear of pain from injury/insult. Sex did not moderate the relationship between these anxiety constructs and sensation/pain thresholds. However, a significant main effect of sex was found to predict thermal pain thresholds. Conclusion : Preliminary indications suggest that pain anxiety dimensions can be reduced to three core constructs, and used to examine pain sensation. However, sex did not moderate this relationship. Further research is required to establish the extent and strength of sex differences in the relationship between anxiety and pain.

Did I turn off the stove? Good inhibitory control can protect from influences of repeated checking

Background and objectivesObsessive-compulsive disorder (OCD) is an anxiety disorder characterized by compulsions aimed at reducing anxiety associated with intrusive cognitions. However, compulsive behaviors such as repeated checking were found to increase rather than decrease uncertainty related to obsessive thoughts (e.g., whether the gas stove was turned off). Some recent studies illustrate that OCD patients and their family members have inhibitory deficits, often demonstrated by the stop-signal task. The current study aims to investigate relations between inhibitory control and effects of repeated checking. MethodsFifty-five healthy participants carried out a stop-signal task followed by a repeated-checking task. Additionally, participants were asked to complete self-report questionnaires measuring OCD, anxiety and depression symptoms. ResultsConfirming our hypothesis, participants with poor inhibitory capabilities demonstrated greater uncertainty and memory distrust as a consequence of repeated checking than participants with good inhibitory control. LimitationsOur findings concern an initial investigation on a sample of healthy participants and should be replicated and extended to clinical populations. ConclusionsThese results suggest that deficits in inhibitory control may underlie cognitive vulnerability in OCD. An updated model integrating neuropsychological findings with current OCD models is suggested.

The impact of witnessing athletic injury: A qualitative examination of vicarious trauma in artistic gymnastics

We explored how athletes respond and cope after witnessing athletic injury in others participating in the same sport. Participants were eight competitive female artistic gymnasts aged 21–25 years. In the previous 3 years, participants had witnessed a serious athletic injury of another gymnast that had required hospital treatment. Participants took part in semi-structured interviews in which they were asked to discuss their experiences of witnessing injury, including descriptions of the injury's occurrence. Data were analysed using hierarchical content analysis. Following acute reactions to witnessing injury, participants reported experiencing intrusive cognitions and engaged in avoidance coping strategies. Participants reported gradually engaging in more approach coping strategies which served to lower their perceptions of vulnerability to injury. Despite the complex nature of trauma, suggestions may be made to assist applied sport psychologists working with athletes who have witnessed athletic injury.

Observed Social Support Behaviors and Cancer-Related Cognitive Processing in Couples Coping with Head and Neck Cancer (HNC)

Abstract Given the disfiguring and debilitating nature of HNC and its treatment, patients and their spouses are at risk of experiencing trauma symptoms including cognitive intrusion and avoidance which may exacerbate psychological distress. Even though the Social Cognitive Processing Model (SCPM) posits that social support facilitates adaptive cognitive processing, recent literature has pointed to harmful effects of received support. Most studies use self-report measures of perceived as opposed to actual received support focusing on the patient as the recipient of support. In reality, the support process is reciprocal and interdependent involving both receiving and providing support in both patients and spouses. Further, self-reports of cognitive processing are susceptible to self-presentation and defensive biases. The purpose of this research was to examine the association between actual observed support behaviors and cognitive intrusion and avoidance in 60 newly diagnosed HNC patients (87% male) and their spouses using a multi-method approach. As part of an ongoing longitudinal study, couples completed baseline questionnaires including an explicit measure of cognitive intrusion and avoidance (IES), completed a problem-solving discussion task in the laboratory immediately followed by an implicit assessment of cognitive intrusion (cancer Stroop task (CST)). We used the Social Support Interaction Coding System (SSICS) to code the video-recorded discussions. Dyadic analyses using multi-level modeling revealed that when patients and spouses received more (compared to less) positive support behaviors, they demonstrated slower reaction times (RT) on the CST (p &amp;lt; .01) indicating greater cognitive intrusion. The results were similar using the self-report method (IES; p &amp;lt; .05). No role differences (patients vs. spouses) were found. The current findings map on to recent literature suggesting that receiving support may be initially distressing in the acute phase of the traumatic event as it may elicit negative emotional responses, which are yet necessary to facilitate successful long-term adjustment. Thus, our next step in this ongoing longitudinal study is to examine long-term consequences of these findings as they will reveal clinical implications.