Trauma-related Memories Research Articles

Eye for Detail: Local versus Global Visual Processing Style Predicts the Development of Re-experiencing after Analogue Trauma

Cognitive theories of posttraumatic stress disorder (PTSD) posit that peritraumatic data-driven processing plays a role in the development of intrusive trauma-related memories (i.e., re-experiencing). Peritraumatic processing may be determined by a pre-existing attentional processing style. This study tested whether a general attentional processing style (relative preference for local or global processing of visual stimuli) was associated with re-experiencing symptoms after analogue trauma. Participants completed measures for neuroticism and reappraisal and an emotional Local-Global Processing task. The next day, they watched an aversive film and indicated horror and perceived control during the film. PTSD symptoms were assessed one week later. A relative preference for local processing was associated with less reappraisal and with less perceived control and more horror during the film. Moreover, it predicted re-experiencing of the film, even after controlling for neuroticism, horror, control, and reappraisal. The results are a first step in exploring the role of pre-trauma cognitive processing styles on traumamemory development and may benefit the identification of risk factors for PTSD.

Binding neutral information to emotional contexts: Brain dynamics of long-term recognition memory.

There is abundant evidence in memory research that emotional stimuli are better remembered than neutral stimuli. However, effects of an emotionally charged context on memory for associated neutral elements is also important, particularly in trauma and stress-related disorders, where strong memories are often activated by neutral cues due to their emotional associations. In the present study, we used event-related potentials (ERPs) to investigate long-term recognition memory (1-week delay) for neutral objects that had been paired with emotionally arousing or neutral scenes during encoding. Context effects were clearly evident in the ERPs: An early frontal ERP old/new difference (300-500 ms) was enhanced for objects encoded in unpleasant compared to pleasant and neutral contexts; and a late central-parietal old/new difference (400-700 ms) was observed for objects paired with both pleasant and unpleasant contexts but not for items paired with neutral backgrounds. Interestingly, objects encoded in emotional contexts (and novel objects) also prompted an enhanced frontal early (180-220 ms) positivity compared to objects paired with neutral scenes indicating early perceptual significance. The present data suggest that emotional--particularly unpleasant--backgrounds strengthen memory for items encountered within these contexts and engage automatic and explicit recognition processes. These results could help in understanding binding mechanisms involved in the activation of trauma-related memories by neutral cues.

Regulation of fear extinction versus other affective behaviors by discrete cortical scaffolding complexes associated with NR2B and PKA signaling.

In patients suffering from post-traumatic stress disorder (PTSD), fear evoked by trauma-related memories lasts long past the traumatic event and it is often complicated by general anxiety and depressed mood. This poses a treatment challenge, as drugs beneficial for some symptoms might exacerbate others. For example, in preclinical studies, antagonists of the NR2B subunit of N-methyl-d-aspartate receptors and activators of cAMP-dependent protein kinase (PKA) act as potent antidepressants and anxiolytics, but they block fear extinction. Using mice, we attempted to overcome this problem by interfering with individual NR2B and PKA signaling complexes organized by scaffolding proteins. We infused cell-permeable Tat peptides that displaced either NR2B from receptor for activated C kinase 1 (RACK1), or PKA from A-kinase anchor proteins (AKAPs) or microtubule-associated proteins (MAPs). The infusions were targeted to the retrosplenial cortex, an area involved in both fear extinction of remotely acquired memories and in mood regulation. Tat-RACK1 and Tat-AKAP enhanced fear extinction, all peptides reduced anxiety and none affected baseline depression-like behavior. However, disruption of PKA complexes distinctively interfered with the rapid antidepressant actions of the N-methyl-D-aspartate receptors antagonist MK-801 in that Tat-MAP2 blocked, whereas Tat-AKAP completely inverted the effect of MK-801 from antidepressant to depressant. These effects were unrelated to the MK-801-induced changes of brain-derived neurotrophic factor messenger RNA levels. Together, the findings suggest that NR2B–RACK1 complexes specifically contribute to fear extinction, and may provide a target for the treatment of PTSD. AKAP-PKA, on the other hand, appears to modulate fear extinction and antidepressant responses in opposite directions.

The Trauma Time Line

Working with trauma is a process of bringing split emotional material to the level of consciousness and placing it into both the framework of the client's personality and the context of his or her life. Trauma-related memories may be indistinct, vague, confused, and fragmented. Relational trauma often has an ongoing aspect to it, as it is laced into relational dynamics that wax and wane over time. This makes it difficult to have a sense of a beginning, middle, or endpoint; thus clients may carry a feeling of having suffered year after year without breaks. The Trauma Time Line allows clients to get a basic sense of how trauma may have clustered in their lives and which parts of their lives may have been relatively free of trauma. The Trauma Time Line can also reveal how early trauma patterns may have affected further psychological and emotional development and how they may have continued to be recreated throughout clients' lives. The Trauma Time Line may be done as a paper-and-pencil activity, put into sociometrically aligned group processes, or serve as a warm-up for focused vignettes and psychodramas. I developed the Trauma Time Line in the 1980s and first published it in The Living Stage.

Tolerating Distress After Trauma: Differential Associations Between Distress Tolerance and Posttraumatic Stress Symptoms

Distress tolerance has been implicated in disorders of emotional regulation, such as eating disorders and borderline personality disorder; however, much less attention has been given to distress tolerance in the context of posttraumatic stress (PTS). Several conceptual linkages between distress tolerance and PTS exist. Low distress tolerance may increase negative appraisals, reducing an individual’s propensity to deal with distressing mental symptoms immediately after a trauma. Relatedly, a perceived inability to cope with the distress brought on by trauma-related memories and cues may engender maladaptive coping strategies. The few published studies examining the relationship between distress tolerance and PTS have demonstrated that lower distress tolerance was associated with increased PTS symptomatology, including increased avoidance, hyperarousal, and re-experiencing. The current study sought to replicate and extend the emerging empirical base by examining the relationship between distress tolerance and the four distinct PTS symptom clusters, while controlling for time since the index trauma and depressive symptoms. Results indicated that distress tolerance accounted for significant unique variance in re-experiencing and avoidance but not negative emotionality and hyperarousal symptoms. There was also a strong positive association between the number of traumas endorsed by participants, depression, and PTS symptoms. Findings suggest that distress tolerance is associated with PTS, lending further support to the putative relationship between PTS and distress tolerance. Accordingly, developing treatment protocols designed to increase distress tolerance in individuals affected by PTS may reduce symptom severity and increase coping abilities.

Alternative Intensive Therapy for PTSD

Alternative Intensive Therapy for PTSD

Addressing Sleep Impairment in Treatment Guidelines for PTSD

Back to table of contents Previous article Next article Communications and UpdatesFull AccessAddressing Sleep Impairment in Treatment Guidelines for PTSDAna Nectara Ticlea, M.D., Laura A. Bajor, D.O., and David N. Osser, M.D.Ana Nectara TicleaSearch for more papers by this author, M.D., Laura A. BajorSearch for more papers by this author, D.O., and David N. OsserSearch for more papers by this author, M.D.Published Online:1 Sep 2013https://doi.org/10.1176/appi.ajp.2013.13050641AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: We reviewed Dr. Germain’s article (1) in the April issue with much interest. We would like to kindly correct Dr. Germain’s statement that no treatment guidelines have proposed that the initial treatment for posttraumatic stress disorder (PTSD) should focus on sleep impairment. The PTSD algorithm of the Psychopharmacology Algorithm Project at the Harvard South Shore Program (2), published in 2011, provides treatment guidelines that support exactly the idea that sleep evaluation and treatment should be the first step in assessing and treating PTSD. Notably, the first reference in the Psychopharmacology Algorithm Project article is to previous research by Dr. Germain and colleagues (3).From a psychopharmacological perspective, the availability of prazosin (4), which has demonstrated a much larger effect size than the selective serotonin reuptake inhibitors (SSRIs), a greater tolerability profile, and a shorter time to response, makes this approach possible. Many experts continue to promote SSRIs as a first-line treatment for this disorder, but the evidence—despite U.S. Food and Drug Administration approval of two SSRIs—remains not at all impressive (5, 6). SSRIs have a small effect size in ameliorating the range of PTSD symptoms, and they frequently exacerbate insomnia and nightmares. Furthermore, they often produce disabling sexual side effects.For many patients, sleep fragmentation may exacerbate daytime PTSD symptoms (hypervigilance, avoidance, and reexperiencing), and these symptoms may improve when sleep improves (7). The importance of sleep in regulating trauma-related memories and emotions has significant clinical implications, suggesting that prioritized interventions to correct sleep disturbances may facilitate the psychotherapeutic processing of traumatic events.From Harvard Medical School at the VA Boston Healthcare System, Brockton Division, Brockton, Mass.The authors report no financial relationships with commercial interests.References1 Germain A: Sleep disturbances as the hallmark of PTSD: where are we now? Am J Psychiatry 2013; 170:372–382Link, Google Scholar2 Bajor LA, Ticlea AN, Osser DN: The Psychopharmacology Algorithm Project at the Harvard South Shore Program: an update on posttraumatic stress disorder. Harv Rev Psychiatry 2011; 19:240–258Crossref, Medline, Google Scholar3 Germain A, Buysse DJ, Nofzinger E: Sleep-specific mechanisms underlying posttraumatic stress disorder: integrative review and neurobiological hypotheses. Sleep Med Rev 2008; 12:185–195Crossref, Medline, Google Scholar4 Raskind MA, Peterson K, Williams T, Hoff DJ, Hart K, Holmes H, Homas D, Hill J, Daniels C, Calohan J, Millard SP, Rohde K, O'Connell J, Pritzl D, Feiszli K, Petrie EC, Gross C, Mayer CL, Freed MC, Engel C, Peskind ER: A trial of prazosin for combat trauma PTSD with nightmares in active-duty soldiers returned from Iraq and Afghanistan. Am J Psychiatry 2013; 170:1003–1010 (Epub ahead of print: Jul 12, 2013)Link, Google Scholar5 National Collaborating Centre for Mental Health: Posttraumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care. London; Leicester, UK, Gaskell and the British Psychological Society, 2005Google Scholar6 Committee on Treatment of Posttraumatic Stress Disorder, Institute of Medicine: Treatment of posttraumatic stress disorder: an assessment of the evidence. Washington, DC, National Academies Press, 2008Google Scholar7 Thompson CE, Taylor FB, McFall ME, Barnes RF, Raskind MA: Nonnightmare distressed awakenings in veterans with posttraumatic stress disorder: response to prazosin. J Trauma Stress 2008; 21:417–420Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited bySleep, circadian system and traumatic stress28 September 2021 | European Journal of Psychotraumatology, Vol. 12, No. 1Traumatic stress and the circadian system: neurobiology, timing and treatment of posttraumatic chronodisruption27 November 2020 | European Journal of Psychotraumatology, Vol. 11, No. 1Multilevel Interactions of Stress and Circadian System: Implications for Traumatic Stress28 January 2020 | Frontiers in Psychiatry, Vol. 10Potential pleiotropic beneficial effects of adjuvant melatonergic treatment in posttraumatic stress disorder29 April 2016 | Journal of Pineal Research, Vol. 61, No. 1Current Opinion in Psychiatry, Vol. 27, No. 5 Volume 170Issue 9 September 2013Pages 1059-1059 Metrics PDF download History Accepted 1 June 2013 Published online 1 September 2013 Published in print 1 September 2013

Treatment of a Multitraumatized Tortured Refugee Needing an Interpreter with Exposure Therapy

This paper described the application and feasibility of exposure therapy treatment (ET) for posttraumatic stress disorder (PTSD) in a multitraumatized tortured refugee with chronic PTSD and depression, in need of an interpreter. The patient received 26 one-hour sessions of ET involving exposure to his trauma-related memories. Symptoms of PTSD, depression, and anxiety were assessed at pre- and posttreatment and 3-, 6-, and 12-month followup with the Harvard Trauma Questionnaire (HTQ-R), PTSD Symptom Scale-Self Report (PSS-SR), Major depression inventory (MDI), and Beck Anxiety Inventory (BAI). Treatment led to a significant improvement across all measures of posttraumatic stress disorder, anxiety, and depression, and the improvement was maintained at the 12-month follow-up. The results from this case study provide further preliminary evidence that ET may be effective in treating multi-traumatized torture survivors who are refugees and in need of an interpreter, despite the additional stressors and symptoms complexity experienced by tortured refugees.

Prolonged exposure for the treatment of Spanish-speaking Puerto Ricans with posttraumatic stress disorder: a feasibility study

BackgroundMost of the empirical studies that support the efficacy of prolonged exposure (PE) for treating posttraumatic stress disorder (PTSD) have been conducted on white mainstream English-speaking populations. Although high PTSD rates have been reported for Puerto Ricans, the appropriateness of PE for this population remains unclear. The purpose of this study was to examine the feasibility of providing PE to Spanish speaking Puerto Ricans with PTSD. Particular attention was also focused on identifying challenges faced by clinicians with limited experience in PE. This information is relevant to help inform practice implications for training Spanish-speaking clinicians in PE.ResultsFourteen patients with PTSD were randomly assigned to receive PE (n = 7) or usual care (UC) (n = 7). PE therapy consisted of 15 weekly sessions focused on gradually confronting and emotionally processing distressing trauma-related memories and reminders. Five patients completed PE treatment; all patients attended the 15 sessions available to them. In UC, patients received mental health services available within the health care setting where they were recruited. They also had the option of self-referring to a mental health provider outside the study setting. The Clinician-Administered PTSD Scale (CAPS) was administered at baseline, mid-treatment, and post-treatment to assess PTSD symptom severity. Treatment completers in the PE group demonstrated significantly greater reductions in PTSD symptoms than the UC group. Forty percent of the PE patients showed clinically meaningful reductions in PTSD symptoms from pre- to post-treatment.ConclusionsPE appears to be viable for treating Puerto Rican Spanish-speaking patients with PTSD. This therapy had good patient acceptability and led to improvements in PTSD symptoms. Attention to the clinicians' training process contributed strongly to helping them overcome the challenges posed by the intervention and increased their acceptance of PE.

Is Acoustic Startle a Viable Exposure Protocol for Posttraumatic Stress Disorder? A Clinical Case Study

Exaggerated startle is a common symptom (based on Diagnostic and Statistical Manual of Mental Disorders [fourth edition] Criterion D) for many patients with posttraumatic stress disorder (PTSD). Findings from previous studies suggest that exaggerated startle may be due to trauma exposure or pretrauma vulnerability factors for PTSD development. The present clinical case study reports on a patient with PTSD characterized by a very prominent startle response and preference against standard trauma-related exposure strategies. On the basis of recent findings that interoceptive exposure exercises (e.g. shaking head side to side, hyperventilation) elicit trauma-related memories (Wald & Taylor, 2008), the authors sought to determine whether repeated application of an acoustic startle stimulus would serve to diminish the prominent startle response and facilitate exposure and overall symptom reduction by eliciting trauma-related memories. The protocol was successful in eliciting vivid and distressing trauma-related memories. Over the course of seven exposure trials, the patient demonstrated a decrease in distress elicited during the protocol, improved mood, and reduced general anxiety and trauma-related distress. He also reported significantly decreased startle response to loud noises encountered during activities of daily living. Although preliminary, these finding suggest that the acoustic startle protocol may be a viable (interoceptive) exposure strategy for individuals with PTSD, particularly those with exaggerated startle responses and those who are not amenable to standard trauma-related exposure strategies.

Traces of a trauma – Long-lasting changes in brain activity in an animal model of PTSD

Posttraumatic stress disorder (PTSD) is characterized by exaggerated trauma-related memories, increased avoidance of trauma-related cues and hyperarousal. We employed our recently established mouse model of PTSD in order to characterize the brain matrix which underlies long-term maintenance of those PTSD-likes symptoms. To this end we measured Cytochrome C-oxidase activity (which serves as a marker for lasting changes in cellular metabolism) 2 days or 28 days after exposure to a brief inescapable foot shock. We observed a delayed and rather selective increase in metabolic activity, among others, throughout the hippocampus formation, the prelimbic cortex, the basolateral amygdala and the nucleus accumbens. Cross-correlation analyses revealed distinct patterns of brain activity which are ought to underlie the PTSD-like symptoms. Importantly, amelioration of these symptoms by chronic fluoxetine treatment was accompanied by changes in the activity patterns. Taken together our data demonstrate that the maintenance of PTSD-like symptoms is associated with a long-lasting increase in metabolic activity of distinct brain structures. Moreover, activity patterns appeared to be symptom-specific. Experiments in progress investigate whether disruption of such activity patterns by deep-brain stimulation may ameliorate the severity of PTSD-like symptoms.

Technical Considerations in the Psychotherapy of Traumatized Individuals: A Psychoanalytic Perspective

This paper addresses two specific aspects of clinical technique in the treatment of traumatized individuals. The first aspect involves the creation of a safe holding environment as an essential step for the emergence of trauma-related memories and the containment of the affects accompanying them. Such scenarios may appear in the clinical material only through the workings of "procedural memory." It is therefore important to contain and gradually decipher repetitive patterns of behavior and feelings of shame, guilt and rage that go with them. The second aspect examines the challenges such work poses to the analyst's containing capacities, credulousness and even his or her reality testing within a clinical situation. The resulting instability of the analyst's work ego can make it hard for him or her to remain vigilant yet empathic, and emotionally attuned but analytically skeptical. The analyst's flexibility to be utilized as a transference object, developmental object and self-object remains a critical determinant of the treatment outcome under such circumstances. The paper provides clinical material to illustrate these two aspects of clinical technique.

Expressive writing and post‐traumatic stress disorder: Effects on trauma symptoms, mood states, and cortisol reactivity

This study investigates the boundary conditions (feasibility, safety, and efficacy) of an expressive writing intervention for individuals with post-traumatic stress disorder [PTSD]. Randomized trial with baseline and 3-month follow-up measures of PTSD severity and symptoms, mood states, post-traumatic growth, and (post-only) cortisol reactivity to trauma-related stress. Volunteers with a verified diagnosis of PTSD (N=25) were randomly assigned to an experimental group (writing about their traumatic experience) or control group (writing about time management). Expressive writing was acceptable to patients with PTSD and appeared safe to utilize. No changes in PTSD diagnosis or symptoms were observed, but significant improvements in mood and post-traumatic growth were observed in the expressive writing group. Finally, expressive writing greatly attenuated neuroendocrine (cortisol) responses to trauma-related memories. The present study provides insight into several boundary conditions of expressive writing. Writing did not decrease PTSD-related symptom severity. Although patients continue to exhibit the core features of PTSD, their capacity to regulate those responses appears improved following expressive writing. Dysphoric mood decreased after writing and when exposed to traumatic memories, participants' physiological response is reduced and their recovery enhanced.

INTEGRATIVE ASSESSMENT OF BRAIN FUNCTION IN PTSD: BRAIN STABILITY AND WORKING MEMORY

Posttraumatic Stress Disorder (PTSD) is characterized by symptoms of hyperarousal, avoidance and intrusive trauma-related memories and deficits in everyday memory and attention. Separate studies in PTSD have found abnormalities in electroencephalogram EEG, in event-related potential (ERP) and behavioral measures of working memory and attention. The present study seeks to determine whether these abnormalities are related and the extent to which they share this relationship with clinical symptoms. EEG data were collected during an eyes-open paradigm and a one-back working memory task. Behavioral and clinical data (CAPS) were also collected. The PTSD group showed signs of altered cortical arousal as indexed by reduced alpha power and an increased theta/alpha ratio, and clinical and physiological measures of arousal were found to be related. The normal relationship between theta power and ERP indices of working memory was not affected in PTSD, with both sets of measures reduced in the disordered group. Medication appeared to underpin a number of abnormal parameters, including P3 amplitude to targets and the accuracy, though not speed, of target detection. The present study helps to overcome a limitation of earlier studies that assess such parameters independently in different groups of patients that vary in factors such as comorbidity, medication status, gender and symptom profile. The present study begins to shed light on the relationship between these measures and suggests that abnormalities in brain working memory may be linked to underlying abnormalities in brain stability.

Self‐defining memories in post‐traumatic stress disorder

This study investigated the relationship between trauma survivors' goals and retrieval of self-defining memories in post-traumatic stress disorder (PTSD). Civilian trauma survivors with PTSD, trauma survivors with no PTSD and non-trauma-exposed control participants (N = 49) provided autobiographical memories of events that they believe shaped who they are. Participants also provided details about their major personal goals. Participants with PTSD reported more self-defining memories that were trauma-related, negative valence and from adult years than non-PTSD and control participants. Further, retrieval of trauma-related self-defining memories was strongly associated with reporting personal goals that were related to traumatic experiences. These findings are discussed in terms of the proposition that trauma survivors' current concerns may direct retrieval of trauma-related memories.

Autobiographical memories of anxiety-related experiences

Ninety-nine undergraduate students retrieved three memories associated with each of the five emotional experiences: panic, trauma, worry, social anxiety, and feeling content. Subsequently, they answered 24 questions assessing properties of each memory, including the vividness and perceived accuracy of the memories and sensory, emotional, and anxiety-related experiences during retrieval. Memories were coded for affective tone and specificity. Results indicated that panic-related and trauma-related memories were rated similarly as content memories, but that they generally were associated with more imagery and emotional experiencing than worry-related or social anxiety-related memories. Participants experienced panic and worry symptoms to the greatest degree when they retrieved panic-related and trauma-related memories. All anxiety-related memories were characterized by more negative tone than content memories. Panic-related and trauma-related memories were more specific than worry-related, social anxiety-related, and content memories. These findings can explain partially why individuals with some, but not all, anxiety disorders experience enhanced memory for threatening material.

Pavlovian eyeblink conditioning in combat veterans with and without post-traumatic stress disorder.

Several recent studies have investigated relationships between post-traumatic stress disorder (PTSD) and learning and memory problems. These reports have found in general that not only does PTSD affect trauma-related memories, but when patients with PTSD are compared with similar trauma patients without PTSD, general memory impairments have been found. The present paper reports a study in which associative learning, using Pavlovian eyeblink conditioning, was investigated in combat veterans with and without chronic PTSD, using interstimulus intervals of 500 and 1000 msec in two separate experiments. Although several recent reports suggest that larger-magnitude autonomic conditioned responses occur in patients with PTSD during Pavlovian conditioning, the present study found evidence of impaired Pavlovian eyeblink conditioning in combat veterans with and without PTSD, compared to non-combat veterans. Although these data suggest that combat leads to an impaired associative learning process regardless of whether PTSD is apparent, a group of community-dwelling combat veterans not under medical treatment showed normal conditioning, suggesting that variables other than prior combat must also be involved.

Visual processing of threat-related faces in deluded schizophrenia

Threat processing is central to understanding debilitating fear- and trauma-related disorders such as posttraumatic stress disorder (PTSD). Progress has been made in understanding the neural circuits underlying the “engram” of threat or fear memory formation that complements a decades-old appreciation of the neurobiology of fear and threat involving hub structures such as the amygdala. In this review, we examine key recent findings, as well as integrate the importance of hormonal and physiological approaches, to provide a broader perspective of how bodily systems engaged in threat responses may interact with amygdala-based circuits in the encoding and updating of threat-related memory. Understanding how trauma-related memories are encoded and updated throughout the brain and the body will ultimately lead to novel biologically-driven approaches for treatment and prevention.

Recurrence of Posttraumatic Stress Disorder in Late Life: A Cognitive Aging Perspective

Clinical experience with older adults shows that many will experience PTSD symptoms in older adulthood because of trauma exposure early in life. Some of these patients struggled with PTSD in the distant past and remained symptomfree for decades only to have a recurrence of PTSD in late life. This paper outlines a cognitive aging explanation for the recurrence of PTSD. It is proposed that the age-related decreases in attention make the intrusion of trauma-related memories more likely. The increase in intrusive memories, combined with age-related decreases in working memory, explicit memory, and prospective memory, increases the subjective distress associated with the memories and results in a recurrence of PTSD.