Processing Of Trauma Memories Research Articles

Hippocampal Trauma Memory Processing Conveying Susceptibility to Traumatic Stress

While the majority of the population is ever exposed to a traumatic event during their lifetime, only a fraction develops posttraumatic stress disorder (PTSD). Disrupted trauma memory processing has been proposed as a core factor underlying PTSD symptomatology. We used transgenic Targeted-Recombination-in-Active-Populations (TRAP) mice to investigate potential alterations in trauma-related hippocampal memory engrams associated with the development of PTSD-like symptomatology. Mice were exposed to a stress-enhanced fear learning paradigm, in which prior exposure to a stressor affects the learning of a subsequent fearful event (contextual fear conditioning using foot shocks), during which neuronal activity was labeled. One week later, mice were behaviorally phenotyped to identify mice resilient and susceptible to developing PTSD-like symptomatology. Three weeks post-learning, mice were re-exposed to the conditioning context to induce remote fear memory recall, and associated hippocampal neuronal activity was assessed. While no differences in the size of the hippocampal neuronal ensemble activated during fear learning were observed between groups, susceptible mice displayed a smaller ensemble activated upon remote fear memory recall in the ventral CA1, higher regional hippocampal parvalbuminneuronal density and a relatively lower activity of parvalbumininterneurons upon recall. Investigation of potential epigenetic regulators of the engram revealed rather generic (rather than engram-specific) differences between groups, with susceptible mice displaying lower hippocampal histone deacetylase 2 expression, and higher methylation and hydroxymethylation levels. These finding implicate variation in epigenetic regulation within the hippocampus, as well as reduced regional hippocampal activity during remote fear memory recall in interindividual differences in susceptibility to traumatic stress.

A pharmacological challenge paradigm to assess neural signatures of script-elicited acute dissociation in women with post-traumatic stress disorder.

There is limited experimentally controlled neuroimaging research available that could explain how dissociative states occur and which neurobiological changes are involved in acute post-traumatic dissociation. To test the causal hypothesis that acute dissociation is triggered bottom-up by a selective noradrenergic-mediated increase in amygdala activation during the processing of autobiographical trauma memories. Women with post-traumatic stress disorder (n = 47) and a history of interpersonal childhood trauma underwent a within-participant, placebo-controlled pharmacological challenge paradigm (4.0 mg reboxetine versus placebo) employing script-driven imagery (traumatic versus neutral autobiographical memory recall). Script-elicited brain activation patterns (measured via functional magnetic resonance imagery) were analysed by means of whole-brain analyses and a pre-registered region of interest (i.e. amygdala). Self-reported acute dissociation increased significantly during trauma (versus neutral) recall but did not differ between pharmacological conditions. The pharmacological manipulation was also unsuccessful in eliciting increased amygdala activation following script-driven imagery in the reboxetine (versus placebo) condition. In the reboxetine condition, trauma retrieval resulted in similar activation patterns as in the placebo condition (e.g. elevated brain activation in the middle occipital gyrus and supramarginal gyrus), albeit with different peaks. Current (null) findings cast doubt on the suggested role of the amygdala in subserving dissociative processing of trauma memories. Alternative pharmacological manipulation approaches (e.g. ketamine) and analysis techniques (e.g. event-related independent component analysis) might provide better insight into the spatiotemporal dynamics and network shifts involved in dissociative experiences and autobiographical trauma memory recall.

Compassionate Recovery and Neurological Empowerment (CRANE): A trauma focused pilot intervention for women in prison with complex needs who engage in self-harm

The high prevalence of interpersonal trauma for women in custody is well known. The mental health sequelae of such experiences can include lifelong patterns of harmful behaviour directed towards both onself and others. Responding effectively to such concerns has presented a considerable challenge to prison services. Based on our clinical experience we proposed CRANE (Compassionate Recovery and Neurological Empowerment) as an integrative approach to treating ‘prolific’ and acute acts of self-harm and suicidal ideation as symptoms associated with interpersonal trauma. CRANE draws on compassion focused therapy (CFT), and other trauma focused approaches, to promote participant recovery and stability. This is reflected in CRANE’s four integrated strands, which include body centred trauma psychoeducation, trauma memory processing and a strengths-based approach to developing positive connections to self and others. This practice paper outlines these strands along with clinical illustrations from a pilot delivery and direction to theory, to help consider the benefits and challenges participants faced during the course of this intervention.

Sleep disorder symptoms and massed delivery of prolonged exposure for posttraumatic stress disorder: Nodding off but not missing out.

The impact of disrupted sleep on the effectiveness of prolonged exposure (PE) therapy for posttraumatic stress disorder (PTSD) is not well understood. Researchers have suggested that comorbid sleep disorders contribute to nonresponse by impairing therapeutic mechanisms such as emotional processing of trauma memories and extinction in cued fear conditioning. Several studies indicate daytime sleepiness, insomnia, and nightmares are correlated with PTSD symptom severity. However, a recent randomized controlled trial found that these sleep disorder symptoms did not affect PTSD symptom change over the course of massed PE (i.e., daily sessions across 2 weeks). The current study used an ecologically valid clinical sample to examine whether daytime sleepiness, insomnia, and nightmares interfere with the slope of symptom change in massed PE. Results indicate that all 3 sleep disorder symptoms correlate with PTSD symptom severity on the first day of treatment but were not associated with symptom change. These findings are consistent with the expectation that the daily structure of massed PE may enhance treatment engagement in patients who are typically drowsy or not well-rested, thus facilitating fear extinction. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Processing of Positive Memories Technique among Clients Reporting Traumatic Experiences: A Case Series

Many current treatments for posttraumatic stress disorder (PTSD) emphasize processing and engaging with trauma memories as the key mechanism of therapeutic change. However, promising emerging research indicates links between PTSD symptoms and positive memories. Processing positive memories, to therapeutically impact health outcomes for trauma-exposed individuals, may have several benefits, including (a) increasing access to positive coping mechanisms via activating positive affect and thoughts; (b) addressing avoidance of positive affect and thoughts; and (c) honing skills that will aid in the eventual processing of trauma memories. The present article demonstrates the utility and effects of a novel Processing of Positive Memories Technique (PPMT) with three clients who reported a history of traumatic experiences. We outline the procedures of a 5-session PPMT, that incorporates symptom assessment, detailed imaginal experiencing of positive memories, and processing of associated positive values, affect, strengths, and thoughts. We utilize longitudinal assessment data to demonstrate the clinical benefits of PPMT, such as less PTSD severity, improved mood (e.g., less negative affect), and greater self-esteem. Finally, we discuss treatment considerations based on unique client factors and treatment modalities (i.e., in-person vs. video telehealth).

An in-Vivo Daily Self-Report Approach to the Assessment of Outcomes of Two Psychotherapies for Women With Posttraumatic Stress Disorder

Emotion regulation and interpersonal psychotherapies that do not require trauma memory processing have been shown to be effective in treating posttraumatic stress disorder (PTSD). This study used a novel method to assess in vivo outcomes in a randomized clinical trial with women (N = 147; ages 18–54; 61% of color; 94% low income) with full (79%) or partial (21%) PTSD. Participants were assigned to affect regulation or interpersonal therapy, or wait-list, and completed daily self-reports for 2 to 4 weeks at baseline and up to 30 days at posttest. Mixed model regression analyses tested pre-post change on five factor analytically derived aggregated daily self-report scores. Emotion regulation-focused therapy was associated with reduced PTSD symptoms, dysregulation, and negative affect, and improvement in adaptive self-regulation and positive affect. Interpersonal-focused therapy was associated with reduced PTSD symptoms and dysregulation. Although both therapies were associated with reduced PTSD symptoms, whether this was due to nonspecific factors rather than the treatments per se could not be determined. Daily self-report data warrant further investigation in psychotherapy research with disorders such as PTSD, in order to assess affective and interpersonal dysregulation and adaptive regulation as they occur in daily life.

The Writings: Psalms

The WritingsPsalms Christopher T. Begg, Fred W. Guyette, Joseph E. Jensen, and Frederick E. Greenspahn 2170. [Psalms] Jorge Blunda, "Los Salmos como 'espejo del alma.' Dimensión poética y antropológica del Salterio," Ebor 32 (2019) 113-40. It seems obvious that the psalms are poems. Nonetheless, a large part of the difficulty we experience in understanding and appropriating the psalms is the result of a lack of attention to this well-known characteristic of theirs. Poetry is that register of language that makes the fullest use of the resources that a given language makes available. In this study, we seek to enter more deeply into the poetic character of the psalms, above all their plasticity of language which makes it possible for them to create an alternative world. In so doing, we base ourselves on the inseparable unity of form and content which makes of the works of art that are the psalms irreducible to pure concepts in order to reach back to the activity of their authors who are skilled in saying important things (and making them sound important) and to ascertain the purpose for which the psalmists carried on their work. We show how in the psalms a human subject emerges who experiences himself as both unified and multifaceted, immersed in and surrounded by constitutive relationships with his fellows and as part of a world that is perceived, interpreted, and created for him, i.e. a being called to live out his vocation in that world in full and joyous dependence on God, the only true interlocutor for his most significant questions. [Translated and adapted from published abstract—C.T.B.] 2171. [Psalms; Land] Johannes Bremer, "'Land' as a Topic in the Book of Psalms?" OTE 32 (2019) 687-715. B.'s essay focuses on land conceptions in the Psalter, discussing those psalms that reflect on Israel's history and regard the land as an integral part of Israelite remembrance and Yhwh as a powerful and mighty savior. The message of these psalms is that, just as he fulfilled his promise of land in former times, now also Yhwh is able to rescue from distress and to grant land for the psalmist's own and subsequent generations. In his essay, B. distinguishes between two conceptions of the land that emerge from the psalms studied by him, i.e. a universal-cosmological and a particularizing perspective on the land. Whereas the former conception is the predominant one in the Psalter, a few psalms reflect a more particular conception of the land as a "reward" for those who live a God-fearing life. This latter conception suggests a metaphorical application of the concept and goes together with notions of Zion theology and the theology of the poor and poverty. [Adapted from published abstract—C.T.B.] 2172. [Biblical Lament Psalms; Trauma Memories] June F. Dickie, "The Intersection of Biblical Lament and Psychotherapy in the Healing of Trauma Memories," OTE 32 (2019) 885-907. A study of biblical lament psalms can help present-day sufferers express their own pain to God and lead to personal, social, and biological healing. In this empirical study, Zulu "pain-bearers" first studied Psalms 3 and 13 and then wrote and performed their own laments, using the biblical laments as a model. This "experiment" led to the conclusion that such a use of a poetic form has advantages over narrative therapy approaches. In particular, the compositions and performances of D.'s subjects were found by her to correspond with [End Page 786] the insights gained from cognitive psychotherapy approaches as well as the therapeutic process proposed by Judith Herman in her 1992 book Trauma and Recovery. Moreover, in addition to facilitating healing of the soul and interpersonal relations, the research insights of L. L. Cozolino cited by D. suggest that lament can stimulate the biological healing of the brain, this, in turn, enabling healthy processing of trauma memories. [Adapted from published abstract—C.T.B.] 2173. [Psalms] Jaco Gericke, "Restating the Psalter's Perspectives on Divine Justice in Philosophical Terms," OTE 32 (2019) 743-63. Prominent 20th-century theologians of the OT have offered comparative...

Differential effects of sleep on explicit and implicit memory for potential trauma reminders: findings from an analogue study

ABSTRACT Background: Recent findings suggest that disruptions of sleep-related memory processing are involved in the development of posttraumatic stress symptoms. More specifically, exposure to an analogue traumatic event resulted in fewer intrusive memories, when it was followed by sleep instead of continued wakefulness. However, competing evidence suggests that sleep deprivation may reduce intrusive re-experiencing. To address these conflicting accounts, we examined how sleep – as opposed to partial sleep deprivation – modulates explicit and implicit trauma memory using an analogue procedure. Methods: Healthy participants (N = 41) were assigned to a Sleep or Partial sleep deprivation group. Prior to nocturnal sleep, both groups were exposed to “traumatic“ picture stories. After sleep or partial sleep deprivation, participants were subjected to tests of explicit and implicit memory for potential trauma reminders. Thereafter, participants completed an intrusion triggering task that was embedded in a distractor task. Results: Analyses revealed higher explicit memory for potential trauma reminders after sleep as compared to partial sleep deprivation. No group differences were found for implicit memory. Participants responded with fewer intrusions after sleep than following partial sleep deprivation. Conclusions: The current findings support a protective role of sleep in trauma memory processing, which may be evident after the first night of sleep post-trauma. Although more research is needed, our results corroborate the importance of promoting restful sleep in trauma-exposed individuals.

Structural brain differences predict early traumatic memory processing.

Intrusive memories are a key symptom of post-traumatic stress disorder (PTSD). They emerge early after trauma exposure and are predictive for PTSD development. There is a high relevance in evaluating the neurobiological mechanisms of early stages of intrusive symptom development to provide a further understanding of PTSD. In the present study, we explore structural differences in healthy young female subjects preceding experimental trauma exposure and their relationship to early intrusive memory development using a traumatic film paradigm. With voxel-based morphometry, we demonstrate that smaller insular volume was associated with an increased number of early intrusive film memories. Moreover, larger lingual gyrus/cerebellar and inferior frontal gyrus/precentral gyrus volumes were also related to an increased number of early intrusive film memories. Our results identify unique brain areas associated with early experimental trauma memory processing and highlight the necessity of evaluating early symptom stages relevant for personalized PTSD prevention and treatment.

Flash Technique for Safe Desensitization of Memories and Fusion of Parts in DID: Modifications and Resourcing Strategies

This paper explores the use of the Flash technique in the treatment of extreme trauma in Dissociative Identity Disorder (DID) from satanic ritual abuse. The results include desensitization of trauma memories and the planned fusion of parts. I share my insights on safe application of the technique and modifications that can be used for highly fragmented DID clients and other complex trauma presentations. Strategies include ways to safely assess the severity of the memory, modifications in the Subjective Units of Distress (SUDS) measurement, instructions in applying the technique, modes of bilateral stimulation and use of the conference room technique. Nine case sessions are documented demonstrating nine variations in use of the technique. I describe how to install an engaging activity in parts that cannot come up with a resource. Additionally, I write about the use of playful extra resourcing to strengthen the engaging activity, leading to “boosting” of the Flash therapy session and hence faster processing of trauma memories. I hope that colleagues working in the field of trauma and dissociation can find the tools and strategies in this paper helpful for their professional development and also for treatment of their clients.

REM theta activity predicts re-experiencing symptoms after exposure to a traumatic film

BackgroundExtensive empirical evidence indicates that sleep plays an active role in memory consolidation. Moreover, sleep has been found to preferentially enhance emotional memories and may modulate affective reactions to previously encountered stimuli. Notably, recent findings suggest that disruptions of sleep-related memory processing could be involved in posttraumatic symptom development such that sleep disturbances may accelerate symptoms of intrusive re-experiencing. MethodsBased on this emerging evidence, we investigated whether an analogue traumatic event would result in immediate impairments of sleep quality in a group of healthy, robust sleepers. In addition, we examined associations between a specific oscillatory correlate of emotional memory consolidation processes (REM theta activity) and subsequent analogue PTSD symptoms. Thirty-three healthy participants entered the study and were exposed to either “traumatic” or neutral films. Thereafter, participants were subjected to an 8.5-hour-long nocturnal sleep opportunity under standardized laboratory conditions including full-night polysomnographic recordings. Ambulatory intrusive memories and subjective symptom ratings were assessed during a period of three consecutive days. Results and conclusionsOur results provide partial support for impaired sleep quality after exposure to a traumatic film. Correlation analyses further reveal that a longer REM sleep duration after “traumatic” exposure predicts reduced analogue PTSD symptoms. Critically, REM theta activity selectively predicts lower re-experiencing symptoms. As previous findings suggest that REM theta activity is reduced in patients with posttraumatic stress disorder, our findings provide a new perspective on the functional role of REM sleep in trauma memory processing.

Trauma Memory Processing in Posttraumatic Stress Disorder Psychotherapy: A Unifying Framework

Trauma memory processing (TMP) is an empirically supported approach to psychotherapy for posttraumatic stress disorder (PTSD). However, TMP is not a single, uniform intervention but instead a paradigm that can be operationalized through a variety of component procedures that have not been systematically elucidated and formally tested. Based on findings from phenomenological/structural and neuroimaging research, a central feature of PTSD is theorized to be the involuntary immersion in trauma memories with diminished awareness or negative appraisals of self and current context. Such intrusive reexperiencing-which is epitomized by, but not limited to, flashbacks-is postulated to underlie PTSD's avoidance, altered emotions and cognitions, dissociative, and hyperarousal/hypervigilance symptoms; it is thus a logical target for TMP. The varied approaches to TMP for PTSD are conceptualized as having the common goal of activation of the neural networks in the brain that underlie two key capacities disrupted by intrusive reexperiencing in PTSD: intentional self-referential retrieval of memories and suppression of memory retrieval. Therefore, TMP is postulated to involve two core functions (purposeful reflective remembering and memory awareness in situ) and three essential types (in vivo, imaginal, and cognitive reappraisal). Several implications of this framework for clinical practice and research on TMP for PTSD are discussed.

A systematic review and meta-analysis of group treatments for adults with symptoms associated with complex post-traumatic stress disorder

BackgroundNo previous meta-analyses have specifically investigated the effectiveness of psychological group therapy for symptoms associated with complex interpersonal trauma, including whether trauma memory processing (TMP) therapies are superior to psychoeducational approaches alone. MethodsA systematic review identified 36 randomised control trials (RCTs) which were included in the meta-analysis. ResultsLarge significant effect sizes were evident for TMP interventions when compared to usual care for three outcome domains including: PTSD (k = 6, g = -0.98, 95% CI -1.53, -0.43), Depression (k = 7, g = -1.12, 95% CI -2.01, -0.23) and Psychological Distress (k = 6, g = -0.98, 95% CI 1.66, -0.40). When TMP and psychoeducation interventions were directly compared, results indicated a small non-significant effect in favour of the former for PTSD symptoms, (k = 4, g = -0.34, 95% CI -1.05, 0.36) and small non-significant effect sizes in favour of the latter for Depression (k = 3, g = 0.29, 95% CI -0.83, 1.4) and Psychological Distress (k = 6, g = 0.19, 95% CI -0.34, 0.71). LimitationsHeterogeneity and a limited number of high quality RCTs, particularly in the Substance Misuse and Dissociation domains, resulted in uncertainty regarding meta-analytical estimates and subsequent conclusions. ConclusionsResults suggest that TMP interventions are useful for traumatic stress whereas non-TMP interventions can be useful for symptoms of general distress (e.g. anxiety and depression). Thus, both TMP and psychoeducation can be useful for the treatment of complex interpersonal trauma symptoms and further research should unravel appropriate sequencing and dose of these interventions.

Sleep and Processing of Trauma Memories.

Sleep has been implicated in learning processes that appear to underlie recovery from posttraumatic stress disorder (PTSD). The importance of quality and timing of sleep following exposure-based therapies has been suggested. The present study evaluated relationships between sleep and adaptive emotional processing following written narrative exposure (WNE) to memories of traumatic events experienced by participants with clinically significant PTSD symptoms. Participants included 21 urban-residing nontreatment-seeking adults with full or subthreshold symptoms of PTSD who completed 4 sessions of 30-min WNE with the first session either in the evening or the morning. There was a significant reduction of PTSD symptom severity after WNE sessions (partial η = .65), but there was no interaction between group assignment based on the initial session's proximity to sleep and initial reduction of PTSD symptom severity (partial η = .01). Polysomnography following evening WNE revealed increased duration of total sleep and N2%, reduced N3%, and increased eye movement density during REM sleep compared with baseline recordings (dz = 0.65 to 1.15). Reduced N3% and increased REM density were associated with less improvement of PTSD symptoms (r = .58 & -.63). These findings suggest a relationship between preservation of diminished arousal during sleep and adaptive trauma memory processing.

Process analysis of trauma-focused cognitive behavioural therapy for individuals with schizophrenia.

Therapeutic alliance, modality, and ability to engage with the process of therapy have been the main focus of research into what makes psychotherapy successful. Individuals with complex trauma histories or schizophrenia are suggested to be more difficult to engage and may be less likely to benefit from therapy. This study aimed to track the in-session 'process' of working alliance and emotional processing of trauma memories for individuals with schizophrenia. The study utilized session recordings from the treatment arm of an open randomized clinical trial investigating trauma-focused cognitive behavioural therapy (TF-CBT) for individuals with schizophrenia (N=26). Observer measures of working alliance, emotional processing, and affect arousal were rated at early and late phases of therapy. Correlation analysis was undertaken for process measures. Temporal analysis of expressed emotions was also reported. Working alliance was established and maintained throughout the therapy; however, agreement on goals reduced at the late phase. The participants appeared to be able to engage in emotional processing, but not to the required level for successful cognitive restructuring. This study undertook novel exploration of process variables not usually explored in CBT. It is also the first study of process for TF-CBT with individuals with schizophrenia. This complex clinical sample showed no difficulty in engagement; however, they may not be able to fully undertake the cognitive-emotional demands of this type of therapy. Clinical and research implications and potential limitations of these methods are considered. This sample showed no difficulties engaging with TF-CBT and forming a working alliance. However, the participants may not have achieved a level of active involvement required for successful cognitive restructuring of trauma memories. This discrepancy may relate to the mediating role of both working alliance and cognitive-emotional processing. The results underscore the importance of therapists understanding the relationship between alliance and other process factors which may be implicit in facilitating change.

What does the data say about the importance of eye movement in EMDR?

Earlier this year we published a paper that gave an up-to-date review of the evidence for whether eye movement had an effect in facilitating the processing of trauma memories (Lee & Cuijpers, 2013). In this paper we did a meta-analysis to look at this issue both in laboratory contexts and in treatment studies that used Eye Movement Desensitisation and Reprocessing (EMDR). Devilly, Lohr, and Ono (2013) have provided a commentary on our article that contains many inaccuracies and several irrelevant points that could have the effect of clouding our findings. We therefore take this opportunity to repeat the main findings which were not addressed in their commentary and document both the irrelevancies and inaccuracies.

Randomized Clinical Trial Comparing Affect Regulation and Supportive Group Therapies for Victimization-Related PTSD With Incarcerated Women

Traumatic victimization and associated problems with posttraumatic stress disorder (PTSD) and affect dysregulation are prevalent among incarcerated women, but there is limited evidence to support psychotherapeutic interventions for these problems in this underserved population. A group psychotherapy designed to enhance affect regulation without trauma memory processing—Trauma Affect Regulation: Guide for Education and Therapy (TARGET)—was compared to a supportive group therapy (SGT) in a randomized clinical trial with 72 incarcerated women with full or partial PTSD. Both interventions achieved statistically significant reductions in PTSD and associated symptom severity and increased self-efficacy. Dropout rates for both interventions were low (<5%). TARGET was more effective than SGT in increasing sense of forgiveness toward others who have caused harm in the past. Group therapy that teaches affect regulation may enhance incarcerated women's ability to achieve affective resolution (forgiveness) while also reducing their victimization-related PTSD and associated symptoms. Experiential-focused supportive group therapy also may reduce victimization-related PTSD and associated symptoms. Both group therapy approaches warrant further study with this vulnerable population.

A Randomized Clinical Trial Comparing Affect Regulation and Social Problem-Solving Psychotherapies for Mothers With Victimization-Related PTSD

Addressing affect dysregulation may provide a complementary alternative or adjunctive approach to the empirically supported trauma memory processing models of cognitive behavior therapy (CBT) for posttraumatic stress disorder (PTSD). A CBT designed to enhance affect regulation without trauma memory processing—trauma affect regulation: guide for education and therapy (TARGET)—was compared to present centered therapy (PCT) and wait-list (WL) conditions in a randomized clinical trial with 146 primarily low-income and ethnoracial minority mothers with PTSD. TARGET achieved statistically and clinically significant improvement on PTSD and affect regulation measures compared to WL, with more consistent and sustained (over a 6-month follow-up period) evidence of improvement than PCT. Drop-out rates (~ 25%) were comparable in TARGET and PCT, similar to those previously reported for trauma memory processing CBTs. Symptom worsening was rare (2–8%) and transient. Affect regulation-based CBT without trauma memory processing warrants further research as a potentially efficacious therapy for victimization-related PTSD.

Using Systematic Case Studies to Investigate Therapist Responsiveness: Examples from a Case Series of PTSD Treatments

This article highlights the emerging literature on therapist responsiveness in psychotherapy and examines several concepts used to identify dimensions of responsiveness. Some methodological obstacles are identified to studying responsiveness in a systematic manner, and several examples of existing responsiveness research are reviewed. It is argued that meaningful theory on responsiveness has emerged from research methods that are qualitative and interpretive and that the writing of systematic case studies can be of particular importance since only the presentation of a case unfolding over time can disclose some of the more complex aspects of therapist responsiveness. Examination of a series of systematic case studies of the treatment of posttraumatic case disorder in South Africa was used to derive a model for guiding therapist responsiveness with respect with what to focus on at a particular phase of the therapy within a particular session. Material from the cases is used to illustrate aspects of the model related to building social support for the client and promoting emotional processing of trauma memories.

Empathy and emotion regulation: Reprocessing memories of childhood abuse

This article argues that therapist empathy is both an essential context and an active intervention for addressing the emotion regulation problems common among adult survivors of child abuse. We define healthy emotion regulation, the role of parental empathy in the development of these capacities, and the results of abuse and neglect as empathic failures. We define therapeutic empathy and outline how it functions both to modulate arousal and to increase client awareness of emotional experience, thus facilitating emotional processing of trauma memories. © 2001 John Wiley & Sons, Inc. J Clin Psychol/In Session 57: 213–226, 2001.