Recollection Of Trauma Research Articles

The Memory Wars Then and Now: The Contributions of Scott O. Lilienfeld

In this review, honoring Scott O. Lilienfeld, we reflect on key conflicts, controversies, and flash points in the so-called memory wars that have captured headlines, affected legislative action, and influenced civil suits and criminal trials. We trace the memory wars, beginning in the 1990s to the present. From the outset, the memory wars featured debates regarding repressed memories, recollections of trauma, and the hazards of memory recovery therapy, and these disagreements persist today in controversies concerning dissociative amnesia, beliefs about memory, suggestive psychotherapies, and the genesis of dissociative identity disorder (DID). We acknowledge Lilienfeld’s contributions, particularly to the sociocognitive model of DID, reviewed in the second half of the article, and to a recent transtheoretical framework that contrasts sharply with the posttraumatic view of DID. The memory wars greatly enhanced scientific understanding of memory, trauma, iatrogenic psychotherapies, and dissociative disorders. We conclude with suggestions for future research to deepen understanding of issues stimulated by the memory wars.

Fear Extinction Learning in Posttraumatic Stress Disorder.

Impairments in fear extinction processes have been implicated in the genesis and maintenance of debilitating psychopathologies, including Posttraumatic stress disorder(PTSD). PTSD, classified as a trauma- and stressor-related disorder, is characterized by four symptom clusters: intrusive recollections of trauma, avoidance of trauma-related stimuli, alterations in cognition and mood, and hyperarousal. One of the key pathological feature associated with the persistence of these symptoms is impaired fear extinction, as delineated in multiple studies employing Pavlovian fear-conditioning paradigms. These paradigms, comprising fear acquisition, extinction, extinction recall, and fear renewal phases, have illuminated the neurobiological substrates of PTSD. Dysfunctions in the neural circuits that mediate these fear learning and extinction processes can result in failure to extinguish fear responses and retain extinction memory, giving rise to enduring experience of fear and anxiety. The protective avoidance behaviors observed in individuals with PTSD further exacerbate intrusive symptoms and pose challenges to effective treatment strategies. A comprehensive analysis of fear conditioning and extinction processes, along with the underlying neurobiology, could significantly enhance our understanding of PTSD pathophysiology. This chapter delineates the role of fear extinction processes in PTSD, investigates the underlying neurobiological substrates, and underscores the therapeutic implications, while also identifying future research directions.

Recollection of childhood trauma changes according to the shift in individual attachment rather than psychiatric diagnosis

• Baseline scores of abuse and neglect predicts follow up scores. • Attachment changes is linked with recollection of abuse and neglect at follow-up. • Lower attachment anxiety is associated with more recollection of abuse and neglect. • Lower attachment anxiety and avoidance decrease recollection of abuse and neglect. Childhood trauma (CT) has been linked to the development of various mental disorders. While traumatic history cannot be reversed, the shift in its perception can have significant implications. This study investigates how changes in the severity of attachment insecurity, depression and social anxiety influence CT trauma recollection one year later. Individuals with major depressive disorder with or without comorbid anxiety as well as controls were included ( N = 76). Participants completed questionnaires on attachment, depression, social anxiety, and CT at baseline and one year later. Multivariable linear regressions were used to explore the associations. Baseline scores of emotional abuse, physical neglect, and sexual abuse were significant predictors of their respective follow up scores ( p <0.01). Interaction terms of the changes between two attachment dimensions were significantly associated with recollection of emotional abuse, physical neglect, and total trauma at follow-up. When attachment avoidance increased, a decrease in attachment anxiety was associated with increases in recollection of emotional abuse, physical neglect, and total trauma ( p <0.001). Decreases in both attachment anxiety and avoidance were significantly associated with a reduction in the recollection of emotional abuse, physical neglect, and total trauma ( p <0.001). Treatments used in each group was not collected and there was no corroboration with respect to accuracy of events reported on the CT. Our results suggest that improving both dimensions of attachment insecurity will influence the reappraisal of CT towards a less traumatic perception. This shift in the narrative is likely to promote resilience and recovery in patients with CT.

Baghdad Twist

Baghdad Twist

The Accuracy of Traumatic Memories in Posttraumatic Stress Disorder: A Review.

This review sought to investigate the accuracy of traumatic memories in persons with a diagnosis of posttraumatic stress disorder (PTSD). PubMed, PsycINFO, and Embase were searched for articles, and 11 studies were included. Three different methods of studying memory accuracy were identified in the included articles: coherence, change in recollection of trauma over time, and remembering details of trauma. Three studies found a deficiency in the accuracy of traumatic memory. Despite some inconsistencies, most of the studies concluded that the memory of trauma is as accurate in people with as in those without PTSD. The only recurring difference identified across studies was in recollection of trauma over time. The findings are of importance both clinically and for the legal system.

Peritraumatic Neural Processing and Intrusive Memories: The Role of Lifetime Adversity

BackgroundPathological peritraumatic encoding is proposed as a proximal risk factor for the development of posttraumatic stress disorder (PTSD), with trauma-analog studies linking increased neural processing of trauma films to intrusive trauma recollections, a core symptom of PTSD. Cumulative lifetime adversity is proposed as a more distal risk factor, with research indicating a tipping point at about five events with regard to PTSD development following re-exposure to trauma. Thus, within a diathesis × stress framework, increased peritraumatic neural processing may constitute a specific risk factor for PTSD, particularly in individuals with several lifetime adversities. MethodsFifty-three healthy women watched highly aversive films depicting severe interpersonal violence versus neutral films during functional magnetic resonance imaging, and they reported involuntary recollections during subsequent days. Moderation analyses tested the interactive relationship between peritraumatic neural processing and lifetime adversity in predicting intrusion load, i.e., the total number of intrusions weighted for their average distress. ResultsIncreased processing of aversive versus neutral films in the amygdala, anterior insula, dorsal and rostral anterior cingulate cortices, and hippocampus predicted increased intrusion load only in participants reporting above five lifetime adversities; for participants reporting few to none, no such relationship was found. This interactive relationship explained ≤59% of variance. Conditioned stimuli preceding film viewing mirrored this pattern. ConclusionsPeritraumatic neural processing in multiple salience network regions and cumulative lifetime adversity interactively predicted PTSD-like symptomatology, representing a diathesis × stress framework that might guide identification of at-risk individuals and potential targets for symptom prevention after traumatic incidents.

Reduced Salience and Enhanced Central Executive Connectivity Following PTSD Treatment

Background In soldiers with posttraumatic stress disorder, symptom provocation was found to induce increased connectivity within the salience network, as measured by functional magnetic resonance imaging and global brain connectivity with global signal regression (GBCr). However, it is unknown whether these GBCr disturbances would normalize following effective posttraumatic stress disorder treatment. Methods Sixty-nine US Army soldiers with (n = 42) and without posttraumatic stress disorder (n = 27) completed functional magnetic resonance imaging at rest and during symptom provocation using subject-specific script imagery. Then, participants with posttraumatic stress disorder received six weeks (12 sessions) of group cognitive processing therapy or present-centered therapy. At week 8, all participants repeated the functional magnetic resonance imaging scans. The primary analysis used a region-of-interest approach to determine the effect of treatment on salience GBCr. A secondary analysis was conducted to explore the pattern of GBCr alterations posttreatment in posttraumatic stress disorder participants compared to controls. Results Over the treatment period, present-centered therapy significantly reduced salience GBCr (p = .02). Compared to controls, salience GBCr was high pretreatment (present-centered therapy, p = .01; cognitive processing therapy, p = .03) and normalized post-present-centered therapy (p = .53) but not postcognitive processing therapy (p = .006). Whole-brain secondary analysis found high GBCr within the central executive network in posttraumatic stress disorder participants compared to controls. Post hoc exploratory analyses showed significant increases in executive GBCr following cognitive processing therapy treatment (p = .01). Conclusion The results support previous models relating cognitive processing therapy to central executive network and enhanced cognitive control while unraveling a previously unknown neurobiological mechanism of present-centered therapy treatment, demonstrating treatment-specific reduction in salience connectivity during trauma recollection.

Altered default mode network connectivity in adolescents with post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is characterized by intrusions, re-experiencing, avoidance and hyperarousal. These symptoms might be linked to dysfunction in core neurocognitive networks subserving self-referential mental processing (default mode network, DMN), detection of salient stimuli (salience network, SN) and cognitive dysfunction (central executive network, CEN). Resting state studies in adolescent PTSD are scarce and findings are inconsistent, probably due to differences in patient symptom severity. Resting state brain activity was measured in 14 adolescents with severe PTSD and 24 age-matched controls. Seed-based connectivity analyses were used to examine connectivity between the DMN and the whole brain, including regions from other networks (SN and CEN). The relationships of network properties with symptom dimensions (severity, anxiety and depression) and episodic memory were also examined. Analyses revealed decreased within-DMN connectivity (between PCC and occipital cortex) in patients compared to controls. Furthermore, within-DMN connectivity (between PCC and hippocampus) correlated negatively with symptom dimensions (severity and anxiety), while increased connectivity (DMN-SN and DMN-CEN) correlated positively with episodic memory measures. These abnormal network properties found in adolescent PTSD corroborate those previously reported in adult PTSD. Decreased within-DMN connectivity and disrupted DMN-SN and DMN-CEN coupling could form the basis for intrusive trauma recollection and impaired episodic autobiographical recall in PTSD.

Cardiovascular and psychological responses to voluntary recall of trauma in posttraumatic stress disorder

ABSTRACTVoluntary recall of trauma is a key element in exposure-based psychotherapies and can trigger spontaneous dissociative responses such as flashbacks, depersonalisation, and derealisation. In order to examine the associations between cardiovascular and psychological responses to voluntary recollection of trauma, individuals with PTSD recalled a traumatic memory. Heart rate and heart rate variability were recorded continuously and the episodes when different forms of dissociation were experienced during the recall were identified. A significant increase in parasympathetic activity was found during trauma recall, with greater parasympathetic dominance being indicative of greater state depersonalisation/derealisation. Whereas overall decreases in heart rate during trauma recall were associated with increased fear and perceived threat, flashbacks were accompanied by short-term increases in heart rate. These findings demonstrate different types of cardiovascular responses associated with different psychological experiences during trauma recall. Future research directions were discussed.

Recalling a Devastating Tornado: Qualities of Child Recollections and Associations with Mental Health Symptoms.

Trauma recollections often contain trauma-related cognitive and emotional processing. Research examining indicators of such processing in children's trauma recollections and their association with mental health symptoms is limited. Fifty 8 to 12-year-old children provided two open-ended recollections about (1) challenging/"bad" things and (2) positive/ "good" things that happened to them 1-year post experiencing an EF-5 tornado. Children completed exposure and mental health symptom measures (PTSD, anxiety, depression). Transcripts were coded for indicators of processing: coherence, positive and negative emotion terms, and resolutions. Age, gender, SES, family tornado-related discussion frequency, verbal ability, tornado-specific psychotherapy receipt, and exposure were controlled. Coherence and positive emotion were positively associated and resolutions were negatively associated with mental health symptoms when children discussed the "bad" things. Children's processing and mental health symptoms were unrelated when children discussed the "good" things. The measured indicators of children's processing may reflect children's meaning-making efforts and have implications for adjustment.

Interview and recollection-based research with child disaster survivors: Participation-related changes in emotion and perceptions of participation.

Research suggests that some types of trauma research can be conducted safely with children ages 10 and older. The aim of this project was to learn more about potential risks or benefits of conducting research with younger children and with child disaster survivors, specifically about research that includes children providing trauma recollections. Fifty 8- to 12-year-old children who experienced a devastating tornado participated in an in-person interview that included both individual and joint (mother-child) recollections of their tornado experiences 1 year after exposure. These 50 children also rated 3 emotions at 3 time points and rated their perceptions (e.g., benefit and regret) of research post-participation. Children (N = 28) also participated in phone surveys 3 months later to assess persistent participation-related emotions and perceptions. Child reported that emotions worsened from pre- to during participation; however, reports of emotions returned to preparticipation levels post-participation and remained so at the 3-month follow-up. Sixty-four percent of children reported at least some participation benefit and no participation regret immediately postparticipation, as did 89.3% at the 3-month follow-up. Four percent of children reported some participation regret (no benefit) postparticipation, and 0% 3 months later. No children requested to stop participating, and none required postresearch connection with crisis services. Posttraumatic stress symptom severity, tornado exposure, and age were largely unrelated to child-reported emotions and perceptions of research. Results indicate that carefully planned and executed disaster-related research that includes children providing recollections can be conducted with preadolescents with little risk and some benefit.

Posttraumatic Growth in Trauma Recollections of 9/11 Survivors: A Narrative Approach

ABSTRACTThe relationship between posttraumatic growth (PTG) and adaptation is unclear. This study is the first to examine PTG in trauma narratives of survivors of the World Trade Center (WTC) attacks. Participants recalled their experiences 7 and 18 months post 9/11, and content analysis was conducted to detect PTG. Posttraumatic stress was also measured. PTG was commonly reported. Relating to others and positivity were frequent in the PTSD and non-PTSD group, although less frequent over time in the PTSD. Greater appreciation for life was reported by the non-PTSD group but relatively absent in the PTSD group. Women but not men reported relating to others across time. It appears that there are distinct profiles of growth implicated in distress and adaptation.

Horizontal Palatal Root Fracture in a Vital Upper First Premolar

Root fractures in non–root-filled teeth occur mostly in maxillary incisors because of trauma. Horizontal root fractures in posterior teeth are rare. This case report describes a horizontal fracture of the palatal root of an upper first premolar in which the pulp was vital. The patient had no symptoms and had no initial recollection of trauma. The dentition showed signs of bruxing and occlusal erosion. Cone-beam computed tomographic imaging identified the affected root. The literature revealed only 2 previous examples of horizontal root fractures in posterior teeth in which pulps remained vital. The possible roles of trauma and bruxing in the etiology are evaluated. A tooth with a fractured root may remain vital and symptomless. The etiology of the fracture can be difficult to establish in posterior teeth. Cone-beam computed tomographic imaging can be invaluable in identifying the fractured root. Pulp sensibility testing is critical before intervention.

Intrusive trauma recollections is associated with impairment of interference inhibition and psychomotor speed in PTSD

BackgroundIntrusive cognitions that enter consciousness involuntarily are prominent symptoms of posttraumatic stress disorder (PTSD). The present study aimed to identify neuropsychological mechanisms involved. MethodFifty PTSD outpatients and 50 healthy controls were tested using Finger Tapping, Simple and Choice Reaction Times and Stroop Tasks, to measure motor, psychomotor speed, response selection, and interference inhibition ability respectively. ResultsPTSD patients performed poorly in all tests, presumably owing to their generalized slowness of information processing and motor reaction. Psychomotor speed was a predictor of slowness and high error rate during the Stroop. Impaired inhibition, as measured by the interference index of the Stroop task, explained 9.7% of the predicated variance in frequency of re-experiencing PTSD symptoms and 23.5% of the predicated variance in augmentation of the interference response time. ConclusionImpaired interference control may be related to internal (re-experiencing) and external (sensory) stimuli that leads to cognitive deficits in PTSD patients.

Cortisol and PTSD Symptoms Among Male and Female High-Exposure 9/11 Survivors

Only a few studies have examined cortisol response to trauma-related stressors in relation to posttraumatic stress disorder (PTSD). We followed a sample of high-exposure survivors of the attacks on September 11, 2001 (9/11; 32 men and 29 women) and examined their cortisol response after recalling the escape from the attack, 7 and 18 months post-9/11. PTSD symptoms and saliva cortisol levels were assessed before and after trauma recollection. Hierarchical regression analyses revealed that PTSD symptoms and male sex predicted increased cortisol response following recollections. For men, elevated cortisol was associated with greater severity of reexperiencing symptoms (p < .001) and lower severity of avoidance symptoms (p < .001). For women, recall-induced cortisol was minimal and unrelated to PTSD symptoms (p = .164 and p = .331, respectively). These findings suggest that augmented cortisol response to trauma-related stressors may be evident in men reporting symptoms of PTSD. Thus, as cortisol abnormalities related to PTSD symptoms appear sex-specific, future research on mechanisms of sex differences in response to trauma is warranted.

Spontaneous brain activity in combat related PTSD

Posttraumatic stress disorder (PTSD) is a prevalent psychiatric disorder, especially in combat veterans. Existing functional neuroimaging studies have provided important insights into the neural mechanisms of PTSD using various experimental paradigms involving trauma recollection or other forms of emotion provocation. However it is not clear whether the abnormal brain activity is specific to the mental processes related to the experimental tasks or reflects general patterns across different brain states. Thus, studying intrinsic spontaneous brain activity without the influence of external tasks may provide valuable alternative perspectives to further understand the neural characteristics of PTSD. The present study evaluated the magnitudes of spontaneous brain activity of male US veterans with or without PTSD, with the two groups matched on age, gender, and ethnicity. Amplitudes of low frequency fluctuation (ALFF), a data driven analysis method, were calculated on each voxel of the resting state fMRI data to measure the magnitudes of spontaneous brain activity. Results revealed that PTSD subjects showed increased spontaneous activity in the amygdala, ventral anterior cingulate cortex, insula, and orbital frontal cortex, as well as decreased spontaneous activity in the precuneus, dorsal lateral prefrontal cortex and thalamus. Within the PTSD group, larger magnitudes of spontaneous activity in the thalamus, precuneus and dorsal lateral prefrontal cortex were associated with lower re-experiencing symptoms. Comparing our results with previous functional neuroimaging findings, increased activity of the amygdala and anterior insula and decreased activity of the thalamus are consistent patterns across emotion provocation states and the resting state.

Post disaster resilience: Racially different correlates of depression symptoms among hurricane Katrina-Rita volunteers.

The present analyses examined the differential risks of and protective factors against depressive symptoms of African American and Non-Hispanic White American student volunteers, respectively after Hurricanes Katrina and Rita (H-KR). A total sample of 554 student volunteers were recruited from mental health professional programs at five universities located in the Deep South, namely areas severely impacted by H-KR during fall semester 2005. The response rate was 91% (n = 505). African American respondents (n = 299) and Non-Hispanic White Americans (n = 206) completed the survey questionnaires. Respondents retrospectively provided information on peritraumatic emotional reactions and previous trauma that were recalled by H-KR and H-KR stressors. African American respondents reported higher levels of depressive symptoms (65.2%) than their Non-Hispanic White counterparts (34.8%). Hierarchical regression analyses revealed that disaster related stressors affected African Americans (p < 0.001), but not Non-Hispanic Whites. However, African Americans who experienced peritraumatic positive emotions had lower depression levels. Lower rates of recollection of prior traumas during H-KR were reported by African American respondents, whereas previous trauma recollections predicted symptoms among Non-Hispanic White Americans (p < 0.05). Exhibiting more optimism had lower depression levels among Non-Hispanic White Americans. Peritraumatic negative emotion was the only shared risk for depressive symptoms of both groups. Findings underscore racially different levels of depressive symptoms that may contribute to varying degrees of resilience among student volunteers. Future research and practice may address these racial differences by understanding the risk factors for depressive symptoms to develop appropriate interventions for racial groups, and cultivating the protective factors that contribute to resilience from traumatic experiences.

Trauma reactivation under the influence of propranolol: an examination of clinical predictors

BackgroundIn two recent studies conducted by our group, a treatment combining propranolol with a brief reactivation session subsequently reduced posttraumatic stress disorder (PTSD) symptom severity and diagnosis, as well as reducing psychophysiological responses during trauma-related script-driven imagery. One likely explanation for those results is that memory reconsolidation was blocked by propranolol.ObjectiveWe explored the influence of various predictors on treatment outcome (i.e., PTSD severity), and whether the treated individuals improved in other important domains of functioning associated with PTSD.MethodThirty-three patients with longstanding PTSD participated in a 6-week open-label trial consisting of actively recalling one's trauma under the influence of propranolol, once a week.ResultsTreated patients reported a better quality of life, less comorbid depressive symptoms, less negative emotions in their daily life and during trauma recollections. Women were also found to improve more than men. Type of trauma (childhood vs. adulthood), time elapsed since trauma, borderline personality traits, depressive symptoms severity, Axis I comorbidity, and age did not influence treatment outcome.ConclusionThese results must await publication of a randomized-controlled trial to further delineate effectiveness with this novel treatment approach.For the abstract or full text in other languages, please see Supplementary files under Reading Toolsonline

Culture and the Anxiety Disorders: Recommendations for DSM-V

Background: The anxiety disorders specified in the fourth edition, text revision, of The Diagnostic and Statistical Manual (DSM-IV-TR) are identified universally in human societies, and also show substantial cultural particularities in prevalence and symptomatology. Possible explanations for the observed epidemiological variability include lack of measurement equivalence, true differences in prevalence, and limited validity or precision of diagnostic criteria. One central question is whether, through inadvertent “over-specification” of disorders, the post-DSM-III nosology has missed related but somewhat different presentations of the same disorder because they do not exactly fit specified criteria sets. This review canvases the mental health literature for evidence of cross-cultural limitations in DSM-IV-TR anxiety disorder criteria. Methods: Searches were conducted of the mental health literature, particularly since 1994, regarding cultural or race/ethnicity-related factors that might limit the universal...

Positive traits versus previous trauma: racially different correlates with PTSD symptoms among hurricane katrina‐rita volunteers

AbstractThis study compared risks and protective factors for acquiring symptoms of posttraumatic stress disorder (PTSD) between African‐American (n=299) and European‐American (n=206) student volunteers 3 months after Hurricanes Katrina and Rita (H‐KR). Respondents retrospectively provided information on peritraumatic emotional reactions and previous trauma that were recalled by H‐KR and H‐KR stressors. African‐American respondents reported higher levels of symptoms and higher rates of recollection of prior traumas during H‐KR than their European‐American counterparts. Hierarchical regression analyses found that previous trauma recollections predicted symptoms among European Americans but not among African Americans. Disaster‐related stressors, however, affected African Americans more than European Americans. Though negative emotions had negative outcomes for both groups, positive emotions and hope served as protective factors for African Americans. © 2011 Wiley Periodicals, Inc.