ArticleLiterature Review

Ehlers A, Clark DM. A cognitive model of posttraumatic stress disorder. Behav Res Ther 38: 319-345

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Posttraumatic stress disorder (PTSD) is a common reaction to traumatic events. Many people recover in the ensuing months, but in a significant subgroup the symptoms persist, often for years. A cognitive model of persistence of PTSD is proposed. It is suggested that PTSD becomes persistent when individuals process the trauma in a way that leads to a sense of serious, current threat. The sense of threat arises as a consequence of: (1) excessively negative appraisals of the trauma and/or its sequelae and (2) a disturbance of autobiographical memory characterised by poor elaboration and contextualization, strong associative memory and strong perceptual priming. Change in the negative appraisals and the trauma memory are prevented by a series of problematic behavioural and cognitive strategies. The model is consistent with the main clinical features of PTSD, helps explain several apparently puzzling phenomena and provides a framework for treatment by identifying three key targets for change. Recent studies have provided preliminary support for several aspects of the model.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... 1.6.17). The concept of reprocessing traumatic memories is also a core feature of the prevailing cognitive models of PTSD (Ehlers & Clark, 2000;Foa & Kozak, 1986). Thus, best practice guidance appears to require the presence of memory to effectively treat PTSD. ...
... due to physical evidence) and may ruminate on the causes and consequences of the assault. Ehlers and Clark (2000) suggested that re-experiencing may also manifest as emotional or sensory reactions to trauma triggers, in the absence of cognitive memories. They termed this affect without recall and theorised that people may be unable to recognise this as a form of trauma memory. ...
... A prominent theme in Challenges concerned participants' emotional and/or sensory responses resulting from PwM, unconnected to cognitive memory. This seems congruent with Ehlers and Clark's (2000) description of affect without recall. Since our study was designed, Woodward (2020) has provided preliminary evidence of this formerly theoretical concept and concluded that affect without recall may represent a form of perceptual memory where dislocated trauma reactions occur in the absence of memory. ...
Article
Full-text available
Background: It is possible for people to have post-traumatic stress disorder (PTSD) without memory of the trauma event, such as in drug-facilitated sexual assault. However, there is little evidence available on treatment provision for this population. Objective: This study aimed to address this gap by exploring the experiences of people who have had psychological intervention for PTSD without memories (PwM). Method: Interpretative phenomenological analysis was used to explore the lived experience of nine women with PwM, who had sought psychological assessment/therapy. Participants were recruited via social media and completed semi-structured interviews online/via telephone. Results: Identified themes concerned two broad areas: (i) the challenges of having therapy whilst lacking memories and (ii) what was helpful in therapy. Challenges included: delayed help-seeking; having emotional/sensory reactions in the absence of recognisable triggers; experiencing therapy as more applicable to remembered trauma (vs. unremembered); and difficulty discussing and processing unremembered trauma. However, participants also described helpful aspects of therapy including: feeling safe and supported; working with emotional and sensory forms of experience; having scientific explanations for trauma and memory; and having 'permission' from therapists not to remember. Conclusions: Recommendations for clinicians included: being aware that clients with PwM may have more difficulty accessing treatment and perceive it as less applicable to them; focussing on clients' emotions and sensations (not cognitive memories) in therapy; and supporting clients to develop a more self-compassionate understanding of their experiences and lack of memory, thus supporting them to accept that not remembering is 'permitted'. Highlights: • Having therapy for unremembered trauma involves unique challenges, but aspects of therapy can still be helpful.• Suggested 'dos and don'ts' for therapists include recognising the additional barriers to treatment, focussing on emotions (not memories), and normalising memory loss.
... The first aim of the present study was to explore reasons for DFSA being treatment-refractory by (1) quantitatively comparing DFSA-I, DFSA-V, and NDFSA survivors to see whether specific differences in sociodemographics, assault characteristics, prior sexual trauma, and substance use exist between groups; (2) quantitatively comparing post-trauma PTSD and depression symptoms (PTS) among the three SA groups, with hypotheses of fewer symptoms for DFSA given the early post-assault assessment timeframe in the present study and prior research indicating fewer PTS early on for DFSA; and (3) qualitatively identifying and comparing among the three SA groups, emergent treatment themes in trauma cognitions and treatment foci from the study clinic's psychotherapy records. Dysfunctional cognitions have been identified in the etiology and maintenance of PTSD in general (Ehlers & Clark, 2000), and are considered to mediate the development of PTSD after SA (Foa & Rothbaum, 2001;Gong et al., 2019). A second aim of the present study was to specifically explore whether there are differences in depression and PTSD symptoms among SA survivors absent trauma memory compared to those with intact trauma memory. ...
... Even with extensively impaired explicit memory, case studies note distressing somatic memory intrusions such as feeling a heavy weight, inability to awaken, or feeling limp and paralyzed (Padmanabhanunni & Edwards, 2012). These phenomena have been termed 'affect without recollection' and 'sensory memories' (Ehlers & Clark, 2000;Gauntlett-Gilbert et al., 2004;King, 2001). Bryant (1996) proposed that TBI patients may reconstruct an account based on communicated or imagined events, forming pseudo-memories along the lines of confabulation that cause distressing intrusions. ...
... In this case, it might not be noted in records as a focus of treatment, yet still has implications in providing therapy. Disrupted or disorganized processing of trauma memories has been shown to increase symptomatology in SA survivors (Ehlers & Clark, 2000;Halligan, Michael, Clark, & Ehlers, 2003). Therapies with the strongest empirical support generally focus on processing of traumarelated cognitions or memories (Schnyder et al., 2015). ...
Article
Full-text available
Background: Sexual assault (SA) is a highly prevalent global public health problem and a robust predictor of posttraumatic stress disorder (PTSD), substance use disorder (SUD), and suicidality. A large percentage are drug or alcohol facilitated (DFSA), impairing trauma memory and affecting the application of evidence-based treatments. Despite these problems, few have investigated DFSA-specific mental health (MH) needs. Objective: Goals of this study were (1) to identify psychological sequelae characterizing DFSA towards explaining why symptoms have been treatment-refractory, comparing survivors with involuntary substance ingestion (forced, covert: DFSA-I), voluntary ingestion (DFSA-V), and non-DFSA; and (2) to determine how impaired trauma memory relates to the development of PTSD and depression symptoms. Method: Data from a retrospective chart review of 74 adults receiving SA MH services at an outpatient trauma center are presented. The sample includes a 2-year cohort seen acutely at an urban rape treatment center. The study is one of the first to examine therapy records beyond case studies for DFSA. Logistic, Poisson, and negative binomial regression analyses of quantitative data and qualitative thematic analysis of trauma cognitions and treatment foci were conducted. Results: DFSA-V had five times greater odds of SUD, and notable substance-related self-blame compared to DFSA-I. DFSA-I had prominent relationship distress and self-blame for missing danger of perpetrator drugging. Survivors with impaired trauma memory had significantly fewer hyper-arousal and overall PTSD symptoms, and specifically less hypervigilance. No differences were found in re-experiencing symptoms. Conclusion: Impaired trauma memory is common in DFSA and is associated with fewer baseline hyper-arousal and overall PTS. Despite this, DFSA issues including re-experiencing symptoms that are particularly distressing without the ability to cognitively connect the intrusions contribute to increased treatment needs. Impaired memory limits the application of evidence-based treatments, and collectively these findings call for the development of trauma-specific treatment protocols to enhance recovery for DFSA survivors. Highlights: Survivors of drug-facilitated sexual assault have prominent PTSD including reexperiencing, though trauma memory may not be encoded. • Those absent trauma memory have less hyperarousal, but DFSA complications explain why it is treatment refractory and inform treatment development.
... Although not explicitly assessed, there are a number of plausible mechanisms through which perceived social support from coworkers might prove beneficial. Perceived social support from coworkers may bolster adaptive coping by allowing affected individuals to process violence cognitively and emotionally, reducing the subsequent risk of psychopathologies (Ehlers & Clark, 2000;Joseph & Williams, 2005;Stanley et al., 2019). The shared experience among coworkers may facilitate unit cohesion, communication, and subsequent support concerning WPV. ...
... Meyer et al. (2012) found in a sample of firefighters that those with lower levels of social support experienced greater self-blame and subsequent PTSD-related symptoms. As such, communicating with coworkers may facilitate the opportunity to make sense of the incident and allow individuals to gain a more accurate interpretation of the event, thus reducing the possibility of self-blame or overgeneralization, known contributors to psychopathologies (Ehlers & Clark, 2000;Horowitz, 1976;Setlack et al., 2021). Nevertheless, further research is needed to distinguish what kinds of words or actions communicate support, how or why workplace support levels vary, and what constitutes an adequate amount of coworker support. ...
... The personally directed nature of WPV may be such that when experiencing violence, paramedics, and firefighters may feel a greater sense of responsibility with subsequent feelings of self-blame, shame or embarrassment regarding the incident. As such, they may actively choose not to seek support from family and friends for fear of causing additional worries for loved ones, appearing weak, or being misunderstood due to the potential lack of shared experiences (Bigham et al., 2014;Ehlers & Clark, 2000;Guay et al., 2006). Moreover, it is conceivable that the lack of shared experiences with loved ones may result in perceived negative social support (i.e., "you need to be more careful," "why don't you quit"), which has been associated with an increased risk of psychopathologies (Andrews et al., 2003;Wagner et al., 2016). ...
... Furthermore, post-traumatic cognitions are also key factors in the development of PTSS. Cognitive theories of PTSS (Ehlers & Clark, 2000;Foa, Ehlers, Clark, Tolin, & Orsillo, 1999) have suggested that cognitive risk factors, such as attentional bias, could put individuals at risk for developing PTSS. Attentional bias usually manifests as a tendency to focus on threatening stimuli or information, difficulty in withdrawing attention from relevant stimuli, or trying to avoid stimuli (Bar-Haim, Lamy, Pergamin, Bakermans-Kranenburg, & van IJzendoorn, 2007). ...
... In addition to discussing the impact of attention to negative information, Ehlers and Clark's (2000) cognitive model proposed that the negative cognitions associated with both an event and its consequences would make individuals feel threatened. This prompts them to adopt a series of maladaptive cognitive strategies to cope with the event, which could ultimately impact PTSS (Chukwuorji, Ifeagwazi, & Eze, 2017;Kulkarni, Pole, & Timko, 2013). ...
... Like catastrophizing, rumination may also mediate the association between event centrality and PTSS in college students. Event centrality can cause immersion in post-traumatic negative emotions and memories and facilitate the retrieval of traumatic memories (Deprince, Zurbriggen, Chu, & Smart, 2010;Ehlers & Clark, 2000). As this can then result in intrusive feelings and thoughts, it may trigger rumination. ...
Article
Full-text available
Background: The coronavirus disease 2019 (COVID-19) pandemic has affected college students' mental health and caused post-traumatic stress symptoms (PTSS). Event centrality is thought to play a key role in the development of PTSS, but it is not yet clear by what mechanism. Theoretically, event centrality may affect the retrieval of traumatic memories and further prompt post-traumatic cognitions to understand events, and so may in turn be associated with PTSS in college students. However, few empirical studies have examined the mediating role of post-traumatic cognitions in the relationship between event centrality and PTSS, especially among college students during the COVID-19 pandemic. Objectives: The objective of this study was to examine the mediating roles of post-traumatic cognitive factors (e.g. attention to negative information, catastrophizing, and rumination) in the relationship between event centrality and PTSS among college students during the COVID-19 pandemic. Methods: We recruited 1153 college students who completed the pandemic experiences scale, the centrality of event scale, the attention to positive and negative information scale, the cognitive emotion regulation questionnaire, and the PTSD Checklist for DSM-5 during the COVID-19 pandemic in May 2020. Results: In this sample of college students, event centrality directly predicted PTSS, and PTSS was also indirectly predicted by event centrality through attention to negative information, catastrophizing, and rumination. Conclusions: These findings support the existing literature on the relationship between event centrality, proposed cognitive variables, and PTSS, and shed light on the mechanisms underlying PTSS. Our findings also highlight the importance and applicability of targeted cognitive interventions for PTSS in college students during the COVID-19 pandemic. Highlights: The COVID-19 pandemic has caused post-traumatic stress symptoms among college students.Event centrality is a risk factor of post-traumatic stress symptoms among college students during the COVID-19 pandemic.Attention to negative information, catastrophizing and rumination mediate the relationship between event centrality and post-traumatic stress symptoms.
... More specifically, manipulations enhancing memory consolidation have been associated both with enhanced (Rombold et al., 2016) and reduced (Kleim et al., 2016) intrusions after trauma. Based on theoretical models of PTSD, the direction of this relationship depends on the extent to which individuals encode and stabilize sensory cues that later function as triggers for intrusions vs. the extent to which individuals concomitantly encode and stabilize contextual details which aid integrating the event in context, and thereby can inhibit involuntary retrieval (Brewin et al., 2010;Ehlers and Clark, 2000). ...
... Conceivably, by strengthening the consolidation of hippocampal-dependent memories, higher peritraumatic E2 may, similarly to sleep, secure greater availability of trauma-related contextual details. This contextual information allows individuals to properly integrate the traumatic event in place, time, and autobiographical memory base, and thereby prevents a fragmented, poorly-contextualized memory as commonly observed in PTSD patients (Brewin et al., 2010;Ehlers and Clark, 2000). Importantly, gist-like memory representations increase over time, as memory precision fades (Wiltgen and Silva, 2007), and fear generalization arises (Dunsmoor et al., 2017). ...
... Although we expect that such cues also trigger pain-intrusions (Franke et al., 2022), since humans are inclined to predominantly focus on visual information, most of the re-encountered trauma-related cues might have rather resembled elements concerning the film-US than the pain-US. Due to greater sensory-perceptual resemblance (Ehlers and Clark, 2000), participants probably more readily recalled the films and reported most cue-elicited intrusions as film-related. Therefore, the initial positive relationship between E2 and intrusions may not have applied to pain-intrusions because most sensory-perceptual cues encountered during daily-life prompted film-over pain-intrusions. ...
Article
Full-text available
Intrusions, a key symptom of posttraumatic stress disorder (PTSD), can occur in the form of images but also as pain sensations. Similar to audiovisual intrusions, the frequency and persistence of pain intrusions varies greatly between individuals. In the current study, we examined whether peritraumatic circulating 17β-estradiol (E2) levels are a biologic factor associated with subsequent audiovisual (i.e., film) and pain intrusion development, and whether peritraumatic stress levels modulate this relationship. Forty-one free-cycling women participated in an ecologically informed trauma-pain-conditioning (TPC) paradigm, using trauma-films and pain as unconditioned stimuli. Independent variables were salivary peritraumatic E2 levels and stress indexed by salivary cortisol and self-reported state-anxiety during TPC. Outcomes were film- and pain-intrusions occurring during daily-life in the week following TPC and a Memory-Triggering-Task in response to conditioned stimuli 24 h after TPC. In the week after analogue-trauma, higher peritraumatic E2 levels were associated with a greater probability of experiencing film-intrusions in the beginning of the week, which switched to a lower probability toward the end of the week. This time-dependent relationship between E2 and film-intrusions only held for higher state-anxious women. In contrast, results indicated a consistent inverse relationship between peritraumatic E2 levels and pain-intrusions during daily-life and Memory-Triggering-Task. Together, these data suggest that higher peritraumatic E2 levels could be associated with lower long-term visual trauma intrusions, as well as lower pain-intrusions, and thereby possibly constitute a protective biologic factor for PTSD and potentially also for chronic pain.
... Integrative models of PTSD include factors outlined in earlier standalone models of PTSD and, therefore, provide more comprehensive accounts with augmented explanatory power (Brewin & Holmes, 2003;Dalgleish, 2004;Ehlers & Clark, 2000). Except for the meta-cognitive model of psychosis (Morrison, 2001), there is less mechanistic overlap between theories of voices compared to models of PTSD. ...
... Ehlers and Clark's (2000) cognitive model of PTSD suggests that impaired cognitive processing during trauma, which may be attributed to dissociative reactions at the time of trauma (peri-traumatic dissociation), combined with pre-existing beliefs about trauma, its sequelae, and oneself, influences the development of PTSD symptoms. The authors suggest that the central characteristic of PTSD is a sense of current threat, which is maintained by two key cognitive processes. ...
Article
Background: Most voice hearers report childhood trauma. Many voice hearers report comorbid post-traumatic stress symptoms and that the content of their voices (auditory verbal hallucinations) is directly (voices repeat phrases spoken by perpetrators) or indirectly (voice content and trauma is thematically similar) related to their trauma. The factors that maintain trauma-related voices are unknown and there is limited research in this area. This study aimed to identify potential maintaining factors of trauma-related voices by reviewing models of PTSD and positive symptoms of psychosis. Method: Models of PTSD and positive symptoms were reviewed to identify potential factors that are unique and common to both sets of symptoms. Results: We reviewed 10 models of PTSD, four models of positive symptoms, and two trauma-informed models of voice hearing were reviewed. One model provided a theoretical explanation of different types of trauma-related voices. Twenty-one factors were extracted from sixteen theoretical models. No existing model incorporated all these factors. Discussion: Existing PTSD and positive symptom models present a range of common and unique factors. There may be value in extending existing integrative models to include a broader range of potential factors that could explain different pathways to, and expressions of, trauma-related voices. A future research agenda is presented to investigate how such an extension could lead to more complete individualised case formulations and targeted treatments.
... A meta-analysis of 33 studies reported that approximately 23% of veterans returning from recent military operations met full criteria of PTSD (Fulton et al., 2015). Five factors characterize PTSD according to Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) criteria: exposure to a traumatic or stressful event, repeated and unwanted reexperiencing of the event, hyperarousal, emotional numbing (memory impairment, diminished interest, detachment), and avoidance (including behavioral and experiential) of reminders of traumatic events (American Psychiatric Association, 2013;Ehlers & Clark, 2000). Studies have mixed research findings related to gender differences in PTSD symptoms among service members and veterans (Haskell et al., 2010;Hourani et al., 2015). ...
Article
Full-text available
Objective: Relying upon the military family stress model, we evaluated the associations between combat exposure, PTSD symptoms, and parental locus of control (PLOC) among mothers and fathers with history of deployment, using a multigroup analysis. Background: Few studies have investigated the correlates of deployment-related stressors for deployed mothers and none have examined perceptions of parenting efficacy. The relationship between combat exposure and PTSD symptoms may differ by gender. Method: The sample (421 fathers and 117 mothers) was selected by combining baseline data from two distinct randomized controlled trials of a parenting program for post-deployed military families: ADAPT and ADAPT 4 U (Gewirtz et al., 2018a). Results: Our analyses revealed a significant indirect effect of PTSD symptoms between combat exposure and PLOC, among deployed parents, with no gender differences in the indirect effect. Conclusion: Relationships between combat exposure, PTSD symptoms, and PLOC support a military family stress model, and highlight the need to support parents with PTSD symptoms because PTSD symptoms appear to be a mechanism through which combat exposure affects parenting beliefs and perceptions. Implications: Prevention and intervention research should focus on how parenting programs might help to reduce The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
... CBT-TF is one of the primary treatments for PTSD adopted by IAPT in England and by psychological therapy services in Scotland and Wales. Cognitive therapy for PTSD (CT-PTSD), 24 one of the CBT-TF implemented by IAPT, was used as the CBT-TF in RAPID. Participants received up to 12 face-to-face individual sessions, of 60-90 minutes. ...
Article
Full-text available
Objective To determine if guided internet based cognitive behavioural therapy with a trauma focus (CBT-TF) is non-inferior to individual face-to-face CBT-TF for mild to moderate post-traumatic stress disorder (PTSD) to one traumatic event. Design Pragmatic, multicentre, randomised controlled non-inferiority trial (RAPID). Setting Primary and secondary mental health settings across the UK’s NHS. Participants 196 adults with a primary diagnosis of mild to moderate PTSD were randomised in a 1:1 ratio to one of two interventions, with 82% retention at 16 weeks and 71% retention at 52 weeks. 19 participants and 10 therapists were purposively sampled and interviewed for evaluation of the process. Interventions Up to 12 face-to-face, manual based, individual CBT-TF sessions, each lasting 60-90 minutes; or guided internet based CBT-TF with an eight step online programme, with up to three hours of contact with a therapist and four brief telephone calls or email contacts between sessions. Main outcome measures Primary outcome was the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) at 16 weeks after randomisation (diagnosis of PTSD based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders , fifth edition, DSM-5). Secondary outcomes included severity of PTSD symptoms at 52 weeks, and functioning, symptoms of depression and anxiety, use of alcohol, and perceived social support at 16 and 52 weeks after randomisation. Results Non-inferiority was found at the primary endpoint of 16 weeks on the CAPS-5 (mean difference 1.01, one sided 95% confidence interval −∞ to 3.90, non-inferiority P=0.012). Improvements in CAPS-5 score of more than 60% in the two groups were maintained at 52 weeks, but the non-inferiority results were inconclusive in favour of face-to-face CBT-TF at this time point (3.20, −∞ to 6.00, P=0.15). Guided internet based CBT-TF was significantly (P<0.001) cheaper than face-to-face CBT-TF and seemed to be acceptable and well tolerated by participants. The main themes of the qualitative analysis were facilitators and barriers to engagement with guided internet based CBT-TF, treatment outcomes, and considerations for its future implementation. Conclusions Guided internet based CBT-TF for mild to moderate PTSD to one traumatic event was non-inferior to individual face-to-face CBT-TF and should be considered a first line treatment for people with this condition. Trial registration ISRCTN13697710 .
... lead to treatment stagnation, prolonged treatment, or reduced treatment outcome) (Arntz et al., 2007;Brewin et al., 1996;Resick & Schnicke 1993). Øktedalen et al. (2014) also report that shame can maintain PTSD symptoms (Harman & Lee, 2010) and that both trauma-related shame and guilt can function as reminders of trauma memories by reinforcing the sense of ongoing threat (Ehlers & Clark, 2000). 'The Role of Trauma Intervention on the Self ' described how trauma focused intervention (EMDR) supported participants to feel more in control in comparison to offence focused treatment which was experienced with a feeling of punishment, lack of choice/control, and fear, leading to a lack of engagement with the treatment and the risk of recidivism. ...
Article
Full-text available
Offence related trauma refers to a trauma reaction following the perpetration of a violent offence. This research explores the lived experience of offence related trauma, in two forensic patients. The meaning and understanding these individuals make of their own coping strategies, triggers and treatment and how this contributes to their behaviour was explored using a semi-structured interview and analysed using Interpretative Phenomenological Analysis. Two super-ordinate themes emerged from the data: ‘Journey to Forgiveness’ and ‘Living with the Whole Me.’ These themes and their subthemes highlight the nuances of offence related trauma and raise the question of how processes such as complicated grief and associated shame can impact on recovery and rehabilitation. The implications of the findings for professionals providing treatment in forensic settings are considered.
... However, an over-generalization can induce conditioned fear reactions towards a set of non-threatening stimuli, linked to CS only for some more or less marked similarity aspects. As with failed extinction, over-generalization can also cause pathological levels of anxiety (Craske et al., 2009;Ehlers & Clark, 2000;Foa et al., 1989;and see Webler et al., 2021 for review). (CS and US respectively). ...
Thesis
Full-text available
Forty years have passed since the coining of the term "peripersonal space" (PPS), that region of space in which our daily life takes place, in which we can interact with the objects and people around us. The first studies of the electrophysiological literature of this spatial representation have observed in specific regions of the macaque’s brain the existence of multisensory neurons capable of encoding tactile, visual and / or auditory stimuli according to their distance from specific parts of the body. These bi- or trimodal neurons, indeed, show tactile receptive fields centered on a specific part of the body, such as the face or hand, and visual and / or auditory receptive fields overlapping spatially with the formers. In this way, the same neurons are able to respond to tactile, visual and auditory stimulations delivered on or close to a specific body-part. Furthermore, these multisensory receptive fields are "anchored" to each other: the movement of the monkey's hand involves a coherent displacement not only of the tactile receptive fields, but also of the visual ones. This body-part centered reference frame of the coding of multisensory stimuli within PPS allows to keep the information relating to the position of the different parts of the body and surrounding objects always updated, with the aim of planning and implementing effective actions. Neurophysiological and behavioral studies on patients suffering from extinction and neglect following brain lesions of the right hemisphere have allowed to highlight, even in humans, the existence and modularity of the PPS. Subsequent neuroimaging studies have brought support to this evidence, highlighting a network of fronto-parietal and subcortical regions capable of coding multi-modal stimulations according to their distance from the body. The functions of this spatial representation are manifold: mediate the relationship between the perception of external stimuli and the execution of goal-directed actions, monitoring the space around the body in order to identify potential threats and implement defensive reactions, organize and manage the space between us and others in case of different types of social interaction and allow us to identify ourselves with our body, giving it a localization in space. However, despite the great scientific interest that this region of space has elicited over the past forty years, a direct comparison of its neural underpinnings in non-human primates and humans is still missing. For this reason, in the first chapter of this doctoral dissertation we will report the results of an fMRI study, conducted on human and macaque participants, which investigated the neural response patterns to stimulations close to or far from different body-parts, minimizing the differences among the experimental protocols used in the two species. For the first time PPS is tested in two different species but with the same experimental protocol, highlighting similarities and differences between the human and simian PPS circuit but also between the response patterns associated with the stimulation of different bodily districts. Starting from the second chapter we will instead focus our interest only on human participants, to try to shed light on a defining problem that has overlapped the concept of PPS representation to that of a second spatial representation: the arm reaching space (ARS). The latter, considered as the space around the body that we can reach by extending our arm, over time has often been used as a synonym for the PPS representation, leading to define PPS as ARS or to test the two spatial representations with the same experimental protocols. However, the different neural bases and the different characteristics of the encoding of stimuli within these two regions of space suggest their distinction. In chapter II, to this purpose, we will present a series of five behavioral experiments that investigated the differences and similarities between PPS and ARS .. [etc]
... These beliefs relate to several domains, including the self (e.g., "I am a weak person"), the world (e.g., "The world is completely dangerous"), and blame (e.g., "The event happened because of the way I acted"). Negative traumarelated cognitions are thought to arise from and contribute to distress as well as prompt avoidance of negative trauma-related beliefs and stimuli (Ehlers & Clark, 2000;Foa & Rothbaum, 1998). ...
Article
Objective: Greater duration of negative trauma-related beliefs may inhibit improvements in these cognitions during posttraumatic stress disorder (PTSD) treatment. The goal of the current study was to examine the impact of time since trauma on change in negative trauma-related beliefs during PTSD treatment. Method: A sample of 126 adults diagnosed with PTSD were randomized to Cognitive Processing Therapy (CPT) or Written Exposure Therapy (WET) and completed the Posttraumatic Cognitions Inventory (PTCI) at pretreatment and 6, 12, 24, 36, and 60 weeks following the first treatment session. Results: Consistent with past findings, negative cognitions related to the self, others, and self-blame decreased during and after trauma-focused therapy. Greater time since the trauma was associated with less improvement in negative trauma-related beliefs about the world and less early improvement in negative trauma-related beliefs about the self and self-blame. The effect of time since trauma on reduction in negative trauma-related beliefs about the world was stronger among participants randomized to CPT. Conclusions: These results indicate that trauma-focused therapies become less potent in reducing trauma-related beliefs as time progresses since trauma exposure, particularly in CPT, for beliefs about the world. Results indicate PTSD treatment should be provided in closer proximity to trauma exposure before negative trauma-related beliefs become inflexible. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... A similar perspective was echoed in the literature, supporting the idea that persistent PTSD could lead to a wide range of negative emotional responses including depression. According to the Cognitive Model of PTSD (Ehlers & Clark, 2000), individuals with persistent PTSD could have idiosyncratic negative appraisals of the experienced traumatic events and their sequelae. Such appraisal could directly lead to a sense of current threat that triggers mood swings and negative emotions in these individuals, resulting in the development of depression. ...
Article
Background: Childhood adversities have been increasingly recognized as a significant risk factor for depression. However, the underlying mediating mechanism between childhood adversities and depression requires further investigation. The literature shows that childhood adversities are also closely associated with post-traumatic stress disorder (PTSD) symptoms and that PTSD symptoms can predict depressive symptoms. It remains unexplored whether PTSD symptoms can act as a mediator between childhood adversities and depression. Objectives: The primary goal of this study was to examine whether PTSD symptoms would mediate the relationship between childhood adversities and depressive symptoms. Participants and setting: We examined in a convenience sample of Hong Kong adults aged 18 or above (N = 418) whether PTSD symptoms would mediate the relationship between childhood adversities and depressive symptoms. We then examined and compared the results with those in another convenience sample of Chinese-speaking young adults (mainly from Taiwan and Hong Kong) aged between 18 to 24 (N = 205). Participants in both samples completed online surveys that included measures of childhood adversities, PTSD symptoms and depressive symptoms. Results: Childhood adversities were significantly associated with depressive symptoms; and this relationship was mediated by PTSD symptoms in both samples. Conclusion: This study is one of very few studies demonstrating that PTSD symptoms mediate the relationship between childhood adversities and depressive symptoms. Our findings suggest that addressing unresolved PTSD symptoms for adults with childhood adversities may help in preventing or treating depressive symptoms. Therefore, PTSD symptoms should be taken into account in the prevention and management of depression. Keywords: Childhood adversities, Depression, Post-traumatic stress disorder (PTSD), Trauma-informed perspective, Child protection
... The sense of physical dirtiness can correspond to posttraumatic cognitions such as that the individual is a dirty or damaged person, contributing to psychopathology such as PTSS and mental contamination (Ehlers & Clark, 2000;Rachman, 2004;Resick, Monson, & Chard, 2016). Indeed, perceived violation appraisals have been shown to predict subsequent symptoms of mental contamination (Ishikawa et al., 2015). ...
Article
Full-text available
Extant research suggests there may be a relationship between sexual trauma and obsessive-compulsive (OC) contamination symptoms. Peritraumatic assault characteristics, such as physical force and peritraumatic fear, are related to more severe posttraumatic stress symptoms (PTSS), however assault characteristics may also predict OC symptoms. Limited research suggests that assault type and peritraumatic emotions may relate to increased OC contamination, yet little is known about how victim and perpetrator demographics and other peritraumatic assault characteristics may predict OC contamination over and above PTSS. To address this gap, participants included 164 undergraduate sexual assault survivors (74.4% female, 16.5% LGBTQ, 35% non-white) who completed a cross-sectional study involving self-report measures of OC contamination symptoms, PTSS, and peritraumatic assault characteristics. Correlations were run to determine independent variables in the ordinary least squares regression predicting OC contamination symptoms. Controlling for PTSS, greater contamination severity was predicted by nonwhite victim race, greater peritraumatic closeness to perpetrator, and injury severity. Assault severity, perpetrator force, and peritraumatic fear were not significant predictors of contamination symptoms. Findings support betrayal trauma theory and highlight peritraumatic characteristics that are important to consider as potential risk factors related to the development or exacerbation of contamination symptoms.
... Second, we considered adolescents' perceptions of the extent to which they were coerced into the abuse, because coercion has been associated with both self-blame and adjustment difficulties among adolescents who have been sexually abused (Jouriles et al., 2020). Third, we included adolescents' appraisals of the world as a dangerous place, because such appraisals have been implicated in theory on the persistence of trauma symptoms (Ehlers & Clark, 2000); considering this appraisal also differentiates self-blame from another potentially important negative cognition. Other variables considered included time since the first incident of sexual abuse, time between disclosure of the abuse in a forensic interview and the T1 screening assessment, the number of days on the waitlist for treatment, and adolescent sex and age. ...
Article
Objective: Adolescents who have been sexually abused commonly experience trauma symptoms, and many are referred for trauma-based treatment. However, they sometimes spend considerable time on waitlists before beginning treatment. This study examines the course of trauma symptoms among adolescents who have been sexually abused and are waiting for treatment, and the extent to which self-blame for the abuse predicts trauma symptoms at the beginning of treatment. Method: Participants were 127 adolescents (89.0% female, Mage = 13.61 years; 53.2% identified as Hispanic) at a Children's Advocacy Center in the southern United States. All had reported being sexually abused. Participants reported on their trauma symptoms and self-blame appraisals at a screening assessment (T1), and trauma symptoms were re-assessed at the beginning of treatment (T2). Results: The mean level of trauma symptoms declined over time for the total sample. Regression analyses indicated that greater self-blame for the abuse at T1 was associated with higher levels of trauma symptoms at T2, even when controlling for T1 trauma symptoms and other correlates of T2 trauma symptoms. Higher levels of trauma symptoms at T1 and adolescent sex (female) were also associated with higher levels of trauma symptoms at T2. Conclusions: Findings suggest that assessing for self-blame for sexual abuse may be important in triage and treatment planning for youth with trauma symptoms after experiencing sexual abuse.
Article
Dysfunctional expectations are a particularly important subset of cognitions that influence the development and maintenance of various mental disorders. This study aimed to develop and validate a scale to assess dysfunctional expectations in posttraumatic stress disorder (PTSD), the "Posttraumatic Expectations Scale" (PTES). In a cross-sectional study, 70 PTSD patients completed the PTES, the Posttraumatic Cognitions Inventory (PTCI), as well as measures of the severity of symptoms of PTSD and depression. The results show that the PTES has excellent internal consistency and correlates significantly with the PTCI and PTSD symptom severity. A regression analysis revealed that the PTES explained variance of PTSD symptom severity above the PTCI, supporting the incremental validity of the PTES. While the original version of the PTES comprises 81 items, short scales were constructed using the BISCUIT (best items scales that are cross-validated, unit-weighted, informative and transparent) method. The current findings provide preliminary psychometric evidence suggesting that the PTES is an internally consistent and valid novel self-report measure in patients with PTSD. However, conclusions about the psychometric properties of the PTES are limited because of the absence of criterion-related validity, factor structure evidence, variability over time/response to intervention, and test-retest reliability. Future research should use the PTES in large-scale longitudinal studies to address these aspects to further validate the scale.
Article
Despite the promise of past research on anxiety sensitivity (AS) and posttraumatic stress, extant work is limited, given (1) most studies consist of non-Hispanic White and middle-aged samples, (2) few have demonstrated incremental validity to general emotional traits and social determinants of health, and (3) limited work has characterized how AS relates to specific Posttraumatic Stress Disorder (PTSD) symptom clusters among those with (probable) PTSD. The current study evaluated the role of AS in relation to PTSD symptom clusters among a racially/ethnically diverse sample of young adults with probable PTSD. Participants included young adults who met the clinical cut-off for probable PTSD per the Posttraumatic Diagnostic Scale. Results indicated that AS was significantly related to overall posttraumatic stress symptom severity; the effect was evident after adjusting for a range of covariates including neuroticism and subjective social status. AS also was incrementally associated with arousal and hyperreactivity, changes in mood and cognition, and intrusion PTSD symptom clusters. In contrast to expectation, no effect for AS was evident for the avoidance PTSD symptom cluster. The current data uniquely add to the existing AS PTSD literature by showcasing distinct symptom cluster patterns among a racially/ethnically diverse sample of young adults with probable PTSD.
Preprint
Full-text available
Remembering an unfamiliar person and the contextual conditions of that encounter is important for adaptive future behavior, especially in a potentially dangerous situation. Initiating defensive behavior in the presence of former dangerous circumstances can be crucial. Recent studies showed selective electrocortical processing of faces that were previously seen in a threat context compared to a safety context, however, this was not reflected in conscious recognition performance. Here, we investigated whether previously seen threat-faces, that could not be remembered, were capable to activate defensive psychophysiological response systems. During an encoding phase, 50 participants with low to moderate levels of anxiety (partially inpatients) viewed 40 face pictures with neutral expressions (6s each), without an explicit learning instruction (incidental learning task). Each half of the faces were presented with contextual background colors that signaled either threat-of-shock or safety. In the recognition phase, all old and additional new faces (total of 60) were presented intermixed without context information. Participants had to decide whether a face was new or had previously been presented in a threatening or a safe context. Results show moderate face recognition independent of context conditions. Startle reflex and skin conductance response (SCR) were more pronounced for threat compared to safety during encoding. For SCR, this differentiation was enhanced with higher levels of depression and anxiety. There were no differential startle reflex or SCR effects during recognition. From a clinical perspective, these findings do not support the notion that perceptual biases and physiological arousal directly relate to threat-associated identity recognition deficits in healthy and clinical participants with anxiety and trauma-related disorders.
Article
Full-text available
Background Despite increasing interest in the association between mindfulness and reduced trauma vulnerability, and the use of mindfulness in the latest interventions for Post-Traumatic Stress Disorder (PTSD), few studies have examined the mechanisms through which mindfulness may influence post-trauma psychopathology. The present study aimed to determine whether negative interpretation bias, the tendency to interpret ambiguous information as negative or threatening rather than positive or safe, mediates the association between higher levels of trait mindfulness and lower levels of PTSD symptoms. Negative interpretation bias was examined due to prior evidence indicating it is associated with being less mindful and post trauma psychopathology. Methods The study examined 133 undergraduate students who reported exposure to one or more potentially traumatic events in their lifetime. Participants completed self-report measures of trait mindfulness (Five Facet Mindfulness Questionnaire – Short Form; FFMQ-SF) and PTSD symptoms (Post-Traumatic Stress Disorder Checklist – Civilian version; PCL-C) as well an interpretation bias task that assessed the degree to which participants interpreted a range of everyday hypothetical scenarios to be threatening to their physical and/or psychological wellbeing. Results Results of a mediation analysis indicated a significant negative direct effect of trait mindfulness on PTSD symptomatology ( p < .001). There was no evidence that negative interpretation bias mediated this relationship [BCa CI [-0.04, 0.03)], nor was it associated with trait mindfulness ( p = .90) and PTSD symptomatology ( p = .37). Conclusions The results of the current study provide further evidence of the link between trait mindfulness and reduced post-trauma psychopathology while providing no support for the role of negative interpretation bias in this relationship.
Article
Full-text available
Background A growing body of research highlights the experiences of moral injury among healthcare professionals during the COVID-19 pandemic. Moral injury (i.e., participating in or witnessing acts that violate one's central moral values), is associated with a host of psychological sequelae and corresponding negative psychosocial impacts. There is a lack of research examining the experiences of moral injury among those working in long-term care settings during the COVID-19 pandemic. Given the drastic impact that the COVID-19 pandemic has had on long-term care facilities in Canada, it is important to understand the experiences of moral injury among those working in long-term care settings to inform the development of effective prevention and intervention strategies. Objectives & Method The objectives of this study were to understand the experiences and impact of moral injury among Canadian frontline long-term care workers (staff and management) during the COVID-19 pandemic. Participants ( N = 32 long-term care staff and management working in Ottawa and Manitoba) completed in-depth, semi-structured qualitative interviews and clinical diagnostic assessments (Mini International Neuropsychiatric Interviews; MINI; Version 7.0.2) between March 2021-June 2021. Findings The core category of our qualitative grounded theory model of moral injury in long-term care exemplified four shared types of morally injurious experiences, paired with cognitive, affective, and physiological symptom domains. Seven associated main themes emerged, contributing to the experiences and impact of moral injury in long-term care: 1) Beliefs about older adults and long-term care; 2) Interpretation of morally injurious experiences; 3) Management of morally injurious experiences; 4) Long-term care pandemic impacts; 5) Personal pandemic impacts; 6) Structural impacts in long-term care; and 7) Mental health needs and supports. Clinical assessments demonstrated anxiety disorders ( n = 4) and feeding and eating disorders ( n = 3) were among the most frequently classified current psychiatric disorders among long-term care workers. Conclusions This is the first Canadian study to examine the experiences and impact of moral injury in long-term care during the COVID-19 pandemic using qualitative and clinical diagnostic methodologies. Implications and insights for screening and intervention are offered.
Article
Full-text available
The Leadership and Organizational Change for Implementation (LOCI) strategy is a multifaceted implementation strategy that aims to support successful evidence-based practice (EBP) implementation by fostering effective general leadership, implementation leadership, and implementation climate. How implementation strategies are experienced by participants is important for their utilization and effectiveness in supporting EBP implementation. The current study is the first in-depth qualitative study exploring first-level leaders’ experiences of participating in the LOCI strategy. Data were collected as part of a trial where Norwegian child and adult mental health outpatient clinics implemented EBPs for posttraumatic stress disorder (PTSD). Eleven first-level leaders from adult and child clinics participated in semi-structured interviews after completing the LOCI strategy. Data were analyzed through reflexive thematic analysis. The analysis generated four themes related to leaders’ experiences of participating in the LOCI strategy: (1) structuring the EBP implementation, (2) taking responsibility for the EBP implementation, (3) interacting with others about the EBP implementation, and (4) becoming aware of EBP implementation and their own leadership. Most participants experienced the LOCI strategy as beneficial for implementing EBPs for PTSD in their clinic. The strategy succeeded in raising awareness of leadership for EBP implementation, and simultaneously provided participants with tools and support for leading the implementation in their clinic. Two participants experienced LOCI as less beneficial than the others. Our results support the strategy’s potential to engage and empower first-level leaders to get involved in implementation processes and point to important challenges for future research on implementation strategies.
Article
Full-text available
Psychosis is the most ineffable experience of mental disorder. We provide here the first co‐written bottom‐up review of the lived experience of psychosis, whereby experts by experience primarily selected the subjective themes, that were subsequently enriched by phenomenologically‐informed perspectives. First‐person accounts within and outside the medical field were screened and discussed in collaborative workshops involving numerous individuals with lived experience of psychosis as well as family members and carers, representing a global network of organizations. The material was complemented by semantic analyses and shared across all collaborators in a cloud‐based system. The early phases of psychosis (i.e., premorbid and prodromal stages) were found to be characterized by core existential themes including loss of common sense, perplexity and lack of immersion in the world with compromised vital contact with reality, heightened salience and a feeling that something important is about to happen, perturbation of the sense of self, and need to hide the tumultuous inner experiences. The first episode stage was found to be denoted by some transitory relief associated with the onset of delusions, intense self‐referentiality and permeated self‐world boundaries, tumultuous internal noise, and dissolution of the sense of self with social withdrawal. Core lived experiences of the later stages (i.e., relapsing and chronic) involved grieving personal losses, feeling split, and struggling to accept the constant inner chaos, the new self, the diagnosis and an uncertain future. The experience of receiving psychiatric treatments, such as inpatient and outpatient care, social interventions, psychological treatments and medications, included both positive and negative aspects, and was determined by the hope of achieving recovery, understood as an enduring journey of reconstructing the sense of personhood and re‐establishing the lost bonds with others towards meaningful goals. These findings can inform clinical practice, research and education. Psychosis is one of the most painful and upsetting existential experiences, so dizzyingly alien to our usual patterns of life and so unspeakably enigmatic and human.
Article
The occurrence of HIV-related posttraumatic stress disorder (PTSD) compromises the physical and mental health of people living with HIV (PLWH). This study examined the psychological pathways of HIV-related PTSD symptoms considering the influence of rumination in PLWH of China. A cross-sectional survey was conducted in Changsha, China. The data were collected using the PTSD Checklist-Civilian Version, the Ruminative Response Scale, the Multidimensional Scale of Perceived Social Support, and measures of sociodemographic and HIV-related clinic characteristics. A total of 602 PLWH were surveyed. The average score of HIV-related PTSD symptoms was (34.54 ± 13.58). The mediation model showed that perceived social stigma and physical health exhibited direct associations with PTSD symptoms (β = 0.093, -0.145, respectively), while the direct relations of family support, friend support and significant others support to PTSD symptoms were not significant. Rumination mediated the effect of perceived social stigma (β = 0.077), physical health (β = -0.150), family support (β = -0.144) and friend support (β = -0.105) on PTSD symptoms. The study findings underscore the importance of routinely assessing PTSD for PLWH, and developing trauma-focused interventions that alleviate HIV-related PTSD symptoms and reduce rumination while improving social support and physical health and reducing social stigma.
Article
Background and objectives: Evidence links posttraumatic stress disorder (PTSD) with positive memory characteristics. To extend this research, we utilized daily diary data to examine (1) concurrent/lagged associations between daily PTSD symptom severity and positive memory vividness/accessibility; and (2) associations between baseline-assessed positive memory characteristics and changes in PTSD symptom severity over time. Design and methods: A sample of 238 trauma-exposed participants (Mage = 21.19 years; 86% women) completed baseline and 10 daily measures of PTSD symptoms and positive memory characteristics. Multilevel models covaried for gender, number of trauma types, and number of completed surveys. Results: Days with greater PTSD symptom severity than an individual's average associated with less vividness (b = -0.02, p < .001) and accessibility (b = -0.02, p < .001) of the positive memory on the same day. Days with greater positive memory vividness (b = -1.06, p < .001) and accessibility (b = -0.93, p < .001) than an individual's average associated with less PTSD symptom severity on the same day. There were no significant lagged associations between these constructs. There were significant interactions between baseline-assessed psychological distance and time (b = -0.04, p = .042) and between baseline-assessed visual perspective and time (b = 0.05, p = .023) on PTSD symptom severity across days. Conclusions: Findings inform positive memory intervention targets for PTSD and provide impetus for longitudinal investigations on their inter-relations.
Article
Objective: Combat-exposed veterans risk encountering events that disrupt beliefs. To facilitate reduced discrepancy between prior beliefs and current trauma appraisals, veterans may engage in a process of meaning-making. Meaning-making can lead to positive outcomes, such as integrating the traumatic event into one's life narrative or adapting global meaning (meaning made) or elicit distress. Given these potentially different outcomes, this study examined potential correlates of posttraumatic stress symptom (PTSS) severity and meaning made, including relationship attachment dimensions of anxiety and avoidance, and difficulties with emotion regulation, while controlling for combat exposure. Method: Veterans receiving mental health services at a Veterans Affairs (VA) Medical Center and a VA community-based outpatient clinic (N = 130) completed measures through a paper-and-pencil survey. Almost all participants (92%) were male, with a mean age of 55.92 years. Results: In terms of meaning made, lower levels of attachment anxiety and emotional clarity (an aspect of emotion regulation) predicted higher meaning made. In terms of PTSS severity, higher attachment avoidance, attachment anxiety, and difficulties engaging in goal-directed behavior (an aspect of emotion regulation) significantly predicted higher PTSS severity. Conclusion: Aspects of both attachment style and emotion regulation difficulties affect meaning made and PTSS severity. These constructs may be especially relevant for clinicians working with veterans to help PTSS and support meaning made postcombat.
Article
Objectives The impact of posttraumatic cognitions on the development and maintenance of posttraumatic stress symptoms (PTSS) is understudied among children and adolescents who have experienced commercial sexual exploitation/trafficking (CSE/T). The objectives of this study were to (1) explore posttraumatic cognitions among help-seeking young people aged 11-19 who have experienced CSE/T; (2) determine whether experiencing direct violence, witnessing violence, polyvictimization (ie, multiple exposures to different categories of potentially traumatic events), or demographic characteristics differentially affect whether these young people meet clinical criteria for posttraumatic cognitions using established cutoffs; and (3) explore associations between posttraumatic cognitions and PTSS among young people who have experienced CSE/T. Methods This study is a secondary analysis of a baseline cross-sectional survey of 110 young people with substantiated CSE/T experiences who started trauma-focused cognitive behavioral therapy (mean [SD] age = 15.8 [1.5]) from August 1, 2013, through March 31, 2020, in a southeastern US state. We used descriptive statistics, adjusted modified Poisson regression, and adjusted linear regression to test study objectives. Results Fifty-seven of 110 (51.8%) young people aged 11-19 met clinical criteria for posttraumatic cognitions. Increased age and a greater number of trauma categories experienced were significantly associated with meeting clinical criteria for posttraumatic cognitions. On average, higher posttraumatic cognition scores were associated with higher PTSS scores, controlling for demographic characteristics (β = 0.95; 95% CI, 0.64-1.26). Conclusions These findings underscore the importance of assessing comprehensive trauma history and PTSS of young people who have experienced CSE/T, with added usefulness of measuring cognitive appraisals to inform a therapeutic treatment plan. Measuring cognitive appraisals that may influence PTSS and therapeutic success can ensure an effective public health response for this population.
Article
Full-text available
The long-term health consequences of the COVID-19 pandemic on health care workers (HCWs) are largely unclear. The purpose of the present study was to investigate the development of posttraumatic stress disorder (PTSD) in HCWs in a longitudinal manner. Additionally, we further explored the role of risk perception in the evolution of PTSD over time based on a one-year follow-up study. HCWs were recruited from hospitals in Guangdong, China. Demographic information, the PTSD checklist for DSM-5 (PCL-5) and the risk perception questionnaire were obtained online at two different time points: May to June 2020 (T1), with 317 eligible responses, and June 2021 (T2), with 403 eligible responses. Seventy-four HCWs participated in the survey at both T1 and T2. The results revealed that (1) the PTSD prevalence rate in the HCWs (cut-off = 33) increased from 10.73% at T1 to 20.84% at T2, and the HCWs reported significantly higher PTSD scores at T2 than at T1 (p < 0.001); (2) risk perception was positively correlated with PTSD (p < 0.001); and (3) PTSD at T1 could significantly positively predict PTSD at T2 (β = 2.812, p < 0.01), and this longitudinal effect of PTSD at T1 on PTSD at T2 was mediated by risk perception at T2 (coefficient = 0.154, 95% CI = 0.023 to 0.297). Our data provide a snapshot of the worsening of HCWs’ PTSD along with the repeated pandemic outbreaks and highlight the important role of risk perception in the development of PTSD symptoms in HCWs over time.
Article
Cognitive behavioral therapy for psychosis (CBTp) is recommended by the National Treatment Guidelines in both the U.K. and the U.S. Consistent reports of moderate effect sizes have led to such interventions being suggested as part of routine clinical practice. However. Access to CBTp is poor due to a variety of factors, including training and resources. Therapeutic developments should be based on the theoretical understanding of cognitive models and psychological process associated with stress-vulnerability model. Cognitive models of psychosis incorporate the role of negative core beliefs, hypervigilance for threat, scanning for confirmatory evidence and safety behavior. The current evidence about CBTp is reviewed regarding various methods such as low-intensity of CBTp, different formats of therapy (e.g., individual or group), and phase of illness (e.g., acute or treatment-resistant) of subjects. This review suggests that that patients with psychosis with various disease phase need to be derived more benefit from appropriate adjunctive CBTp.
Thesis
Full-text available
It has frequently been observed that single emotional events are not only more efficiently processed, but also better remembered, and form longer-lasting memory traces than neutral material. However, when emotional information is perceived as a part of a complex event, such as in the context of or in relation to other events and/or source details, the modulatory effects of emotion are less clear. The present work aims to investigate how emotional, contextual source information modulates the initial encoding and subsequent long-term retrieval of associated neutral material (item memory) and contextual source details (contextual source memory). To do so, a two-task experiment was used, consisting of an incidental encoding task in which neutral objects were displayed over different contextual background scenes which varied in emotional content (unpleasant, pleasant, and neutral), and a delayed retrieval task (1 week), in which previously-encoded objects and new ones were presented. In a series of studies, behavioral indices (Studies 2, 3, and 5), event-related potentials (ERPs; Studies 1-4), and functional magnetic resonance imaging (Study 5) were used to investigate whether emotional contexts can rapidly tune the visual processing of associated neutral information (Study 1) and modulate long-term item memory (Study 2), how different recognition memory processes (familiarity vs. recollection) contribute to these emotion effects on item and contextual source memory (Study 3), whether the emotional effects of item memory can also be observed during spontaneous retrieval (Sstudy 4), and which brain regions underpin the modulatory effects of emotional contexts on item and contextual source memory (Study 5). In Study 1, it was observed that emotional contexts by means of emotional associative learning, can rapidly alter the processing of associated neutral information. Neutral items associated with emotional contexts (i.e. emotional associates) compared to neutral ones, showed enhanced perceptual and more elaborate processing after one single pairing, as indexed by larger amplitudes in the P100 and LPP components, respectively. Study 2 showed that emotional contexts produce longer-lasting memory effects, as evidenced by better item memory performance and larger ERP Old/New differences for emotional associates. In Study 3, a mnemonic differentiation was observed between item and contextual source memory which was modulated by emotion. Item memory was driven by familiarity, independently of emotional contexts during encoding, whereas contextual source memory was driven by recollection, and better for emotional material. As in Study 2, enhancing effects of emotional contexts for item memory were observed in ERPs associated with recollection processes. Likewise, for contextual source memory, a pronounced recollection-related ERP enhancement was observed for exclusively emotional contexts. Study 4 showed that the long-term recollection enhancement of emotional contexts on item memory can be observed even when retrieval is not explicitly attempted, as measured with ERPs, suggesting that the emotion enhancing effects on memory are not related to the task embedded during recognition, but to the motivational relevance of the triggering event. In Study 5, it was observed that enhancing effects of emotional contexts on item and contextual source memory involve stronger engagement of the brain's regions which are associated with memory recollection, including areas of the medial temporal lobe, posterior parietal cortex, and prefrontal cortex. Taken together, these findings suggest that emotional contexts rapidly modulate the initial processing of associated neutral information and the subsequent, long-term item and contextual source memories. The enhanced memory effects of emotional contexts are strongly supported by recollection rather than familiarity processes, and are shown to be triggered when retrieval is both explicitly and spontaneously attempted. These results provide new insights into the modulatory role of emotional information on the visual processing and the long-term recognition memory of complex events. The present findings are integrated into the current theoretical models and future ventures are discussed.
Chapter
Although the vast majority of research into posttraumatic mental health, including posttraumatic stress disorder (PTSD), emerges from western nations, most of the world’s population exposed to trauma and adversity live in non-western countries. People living in low- and middle-income countries (LMICs) are more likely to be exposed to a range of difficult live events and not surprisingly experience higher rates of mental disorders. This chapter reviews the current knowledge about mental health, and particularly posttraumatic mental health, in LMICs. It commences with a review of the prevalence of disorders in LMICs, outlines some of the major risk factors for disorders, and discusses current evidence pertaining to treatment initiatives. The chapter also focuses on the major challenges facing the field of mental health in balancing the need to address mental health problems in LMICs with the ongoing reality that LMICs have limited resources to allocate to mental health programs. The chapter outlines the role of scalable, task-shifting approaches that have implemented mental health non-specialists to deliver programs in settings where there is a large gap between mental health needs and treatment delivery.
Article
Despite the apparent relationship between past experiences and subsequent vaccination decisions, the role of traumatic events has been overlooked when understanding vaccination intention and behaviour. We conducted a systematic review to synthesize what is known about the relationship between traumatic events and subsequent vaccination decisions. MEDLINE, PsycINFO and CINHAL electronic databases were searched, and 1551 articles were screened for eligibility. Of the 52 articles included in full-text assessment, five met the eligibility criteria. Findings suggest that the experience of trauma is associated with individual vaccination decisions. Social and practical factors related to both trauma and vaccination may mediate this relationship. As this is a relatively new field of inquiry, future research may help to clarify the nuances of the relationship. This review finds that the experience of psychological trauma is associated with vaccination intention and behaviour and points to the potential importance of a trauma-informed approach to vaccination interventions during the current global effort to achieve high COVID-19 vaccine coverage.
Chapter
Psychological theories have been developed to explain why certain trauma survivors go on to develop posttraumatic stress disorder and others do not. These theories try to capture what happens at the level of the trauma survivor’s personal experiences, in terms of thoughts, memory, emotions, behaviours, and underlying processes of which the person is unaware. Moreover, psychological theories are essential to understanding the working mechanisms of psychotherapy for posttraumatic stress disorder. In this chapter, we successively focus on learning theories, dual representation theory, cognitive theory and ‘hotspots’, reconsolidation, psychodynamic theories, and posttraumatic stress disorder from a social and societal perspective. Some theories focus on fear as the primary emotional network involved, whereas others propose that emotions such as anger, grief, shame, and guilt are equally important. Some theories emphasize the role of negative appraisals; others focus on the role of different representations or the malleability of the traumatic memory. The social perspective is also important, as traumatic experiences happen in the context of responses of others and societal views on trauma, and these influence symptom expression. The most important concepts used by these theories are discussed, followed by their accounts of natural recovery and their proposed working mechanisms for psychological treatments.
Article
Kognitive Modelle der Posttraumatischen Belastungsstörung (PTBS) gehen davon aus, dass eine dysfunktionale Informationsverarbeitung in den Bereichen Aufmerksamkeit, Interpretation, Bewertung und Gedächtnis einen wichtigen Faktor für das Auftreten und die Aufrechterhaltung der PTBS darstellt. Parallel zeigen verschiedenste Entwicklungen in der klinisch-experimentellen Forschung, dass es möglich sein könnte, solche kognitiven Verzerrungen mithilfe von Cognitive Bias Modification (CBM)-Trainings zu modifizieren. In diesem Beitrag geben wir einen narrativen Überblick über die CBM-Forschung im Kontext von Trauma und PTBS, im experimentellen sowie klinisch-angewandten Bereich. Zudem werden Herausforderungen und neue Forschungslinien für die CBM-Forschung im Kontext der PTBS vorgestellt und diskutiert.
Chapter
The personal, social, and economic costs of posttraumatic stress disorder (PTSD) have stimulated enormous efforts over the past several decades into developing better strategies to reduce the adverse psychological effects of trauma. Much of this energy has been devoted to early intervention strategies. Early interventions involve those therapeutic endeavours that are implemented in the initial hours, days, or weeks after trauma exposure. The goals of these approaches are variably to reduce the acute stress or to achieve secondary prevention to avert subsequent PTSD. The current review includes discussion of universal versus targeted early interventions, the theoretical models and purported mechanisms underpinning early intervention strategies, and what is known about the efficacy of psychological and pharmacological approaches. This chapter also discusses the timing of early intervention, and identification of people who should be targeted for early intervention. Challenges facing the study of early intervention are also discussed.
Chapter
What people find most distressing about a traumatic event varies greatly from person to person. The personal meanings of trauma and their relationship with features of trauma memories are central to Cognitive Therapy for PTSD, which builds on Ehlers and Clark’s (Behaviour Research and Therapy, 38, 319–345, 2000) model of PTSD. Treatment focuses on changing excessively negative personal meanings of the trauma and its consequences, reducing reexperiencing through updating memories and trigger discrimination, and changing behaviors and cognitive strategies that maintain PTSD. Treatment procedures and the order in which they are conducted are tailored to the individual case formulation. CT-PTSD can be applied to a wide range of traumas and has been evaluated with adults, children, and adolescents.
Chapter
From episodic threats to social exclusion to the continuous wear and tear associated with living in adverse situations, stressors not only repeatedly activate the body’s defensive systems but also leave lasting traces in a web of memories. With an increasing number of threatful experiences, sensations, emotions, and cognitions belonging to different past events are no more recalled separately, but in mutually exciting associations. Therefore, cues (such as fire, anger, heart pounding) may lead to fear and defensive responding, even though there is no current threat. In order to disentangle these fused memory representations the arousing experiences must be recalled and sorted along the line of life. Consequently, in Narrative Exposure Therapy (NET), a client, with the assistance of the therapist, constructs a chronological narrative with details during moments of highest emotional arousal. To obtain a coherent narrative, the therapist asks for sensory information, emotions, cognitions, and physiological reactions, probes for respective observations, and encourages the client to detect how current feelings and physiological responses result from past experiences. The narrative is driven forward in a supportive but guiding style by the therapist. The report of the client’s story may be used for rights and human rights advocacy.
Article
Background In a recent eye-tracking study we found a differential dwell time pattern for negatively-valenced and neutral faces among patients with posttraumatic stress disorder (PTSD), trauma-exposed healthy control (TEHCs), and healthy control (HC) participants. Here, we explored whether these group differences relate to resting-state functional connectivity (rsFC) patterns of brain areas previously linked to both attention processes and PTSD. These encompass the amygdala, dorsal anterior cingulate cortex (dACC), dorsolateral prefrontal cortex (dlPFC), ventrolateral prefrontal cortex (vlPFC), and nucleus accumbens (NAcc). Methods Ten minutes magnetic resonance imaging rsFC scans were recorded in 17 PTSD patients, 21 TEHCs, and 16 HCs. Participants then completed a free-viewing eye-tracking task assessing attention allocation outside the scanner. Dwell time on negatively-valenced stimuli (DT%) were assessed relative to functional connectivity in the aforementioned seed regions of interest (amygdala, dACC, dlPFC, vlPFC, and NAcc) to whole-brain voxel-wise rsFC. Results As previously reported, group differences occurred in attention allocation to negative-valence stimuli, with longer dwell time on negatively valence stimuli in the PTSD and TEHC groups than the HC group. Higher DT% correlated with weaker NAcc-orbitofrontal cortex (OFC) connectivity in patients with PTSD. Conversely, a positive association emerged in the HC group between DT% and NAcc-OFC connectivity. Conclusions While exploratory in nature, present findings may suggest that reward-related brain areas are involved in disengaging attention from negative-valenced stimuli, and possibly in regulating ensuing negative emotions.
Article
In ambito giuridico, completezza e coerenza narrativa rappresentano due importanti elementi della credibilità del minore come testimone. Il presente studio si propone di analizzare com-pletezza e coerenza narrativa in 92 deposizioni di bambini sessualmente abusati, con parti-colare riferimento all'effetto dell'età e della presenza di sintomatologia post-traumatica. Ogni deposizione è stata analizzata attraverso le griglie di codifica Narrative Categories Used to Code the Memory Reports Narrative (Bauer et al., 2014) e Coherence Coding Scheme (Reese et al., 2011). I risultati confermano il ruolo significativo dell'età e del PTSD sui contenuti e sull'organizzazione narrativa delle memorie traumatiche infantili. Nello spe-cifico, i bambini più grandi e senza PTSD sono maggiormente capaci di fornire resoconti narrativi più ricchi di dettagli contestuali salienti e una descrizione più completa dei fatti, in termini temporali e causali, con valutazioni di senso sull'esperienza traumatica vissuta.
Article
To elucidate individual differences in sexual assault survivor outcomes, we examined locus of control as a moderator of the relationship between victim blaming and both posttraumatic stress disorder (PTSD) symptoms and unhealthy alcohol use. The sample consisted of 82 female sexual assault survivors who had disclosed their victimization to at least one person. The results of this survey demonstrated that locus of control did not moderate the relationship between victim blaming and PTSD, or the relationship between victim blaming and unhealthy alcohol use. The findings further supported the direct relationship between victim blaming and a range of negative mental health outcomes among survivors.
Article
Objective Posttraumatic stress disorder is one of the most studied outcomes after a disaster. Posttraumatic stress symptoms (PTSS) are maladaptive and disabling and can severely impair affected individuals’ psychosocial functioning and quality of life. Consequently, the objective of this research is to investigate the prevalence of PTSS and physical illness among disaster victims. Methods We analyzed disaster victims’ survey data in South Korea 1 year after a natural disaster (n = 1659). Then, we performed multivariable comparisons of social and work adjustments between individuals with PTSS and individuals with physical illness to examine the association between PTSS and functional impairment. Results Individuals with PTSS had a significant association with work and social maladjustments whether or not they had a physical illness; PTSS (+) physical illness (-) group (OR: 1.18, CI: 1.12–1.26, P < 0.001) and PTSS (+) physical illness (+) group (OR: 1.16, CI: 1.08–1.23, P < 0.001). Interestingly, this association was not significant in the group that exclusively presented physical illness. Conclusions Our results suggest that PTSS might be a critical factor in social maladjustment during the post-disaster period. Subsequently, an assessment of disaster victims’ PTSS would help ensure effective medical and governmental approaches to assist disaster victims.
Article
The current case study was conducted as part of the National Health Services and Health Education England implemented IAPT top-up training in trauma-focused cognitive therapy for post-traumatic stress disorder (PTSD). There has been an increase in the number of clients presenting to IAPT with COVID-19 intensive care unit PTSD since the pandemic. However, there are no current unitary guidelines for psychological therapy for this population. Treatment of PTSD using individual trauma-focused cognitive therapy has been shown to be effective for ICU-PTSD. The National Institute for Health and Care Excellence treatment guidelines recommend adapting existing protocols. This study describes how these recommendations were used in the treatment of COVID-19 ICU-PTSD in a 46-year-old male. It illustrates the use of trauma-focused cognitive therapy for PTSD and how ICU trauma memories including hallucinations were conceptualised. It also illustrates how the challenges of co-morbid panic attacks, long COVID and remote working were managed. The client attended 16 individual, 60- to 90-minute video sessions of trauma-focused cognitive therapy, conducted weekly via Microsoft Teams over a period of five months. The treatment plan was conducted in collaboration with the client’s general practitioner, physiotherapists, cardiopulmonary specialists, and his family. Treatment included a timeline, written narrative and imaginal reliving. It also applied stimulus discrimination, behavioural experiments and site visit. At the end of treatment, the client no longer showed clinically important symptoms of PTSD as assessed on the PCL-5 and interview. This was sustained at 3-month follow-up. Key learning aims It is hoped that the reader will increase their understanding of the following: (1) Delivery of trauma-focused cognitive therapy for ICU-PTSD. (2) Cognitive conceptualisation of the trauma memory including hallucinations. (3) Management of co-morbid symptoms.
Article
Veterans with PTSD often have substantial interpersonal difficulties and low levels of social support, which puts them at increased risk of mortality, but few treatments address global social impairment for veterans with PTSD. This study is a pilot randomized trial of Acceptance and Commitment Therapy to Improve Social Support for Veterans with PTSD (ACT-SS), a psychotherapy that targets social avoidance and eroded social relationships, compared to Person-Centered Therapy (PCT), a non-directive psychotherapy. Participants were randomized to twelve sessions of either ACT-SS (n = 21) or PCT (n = 19). The results showed that veterans with PTSD had high ratings of satisfaction for both treatments. Contrary to the PCT group, participants in the ACT-SS group showed a significant improvement in the quality of social relationships, engagement in social and leisure activities, and PTSD symptoms from the baseline assessment to the end of treatment and a three-month follow-up. Veterans in the ACT-SS group, but not the PCT group, also showed significant improvements in mindfulness and valued living and a reduction in experiential avoidance from baseline to the end of treatment, with sustained improvements in valued living at the three-month follow-up. Overall, the present study demonstrated the feasibility, acceptability, and positive preliminary outcomes of ACT-SS for veterans with PTSD.
Article
Full-text available
Posttraumatic stress disorder (PTSD) is a severe condition that is associated with trauma-related guilt. We aimed at providing a comprehensive quantitative systematic review on the relationship between trauma-related guilt and adult PTSD. Database searches in Medline, PsycINFO, PTSDpubs and Web of Knowledge resulted in the inclusion of 163 eligible studies with a total of 35 020 trauma survivors. The studies reported on 157 cross-sectional and 19 longitudinal data points. Overall, we included 135 studies not included in previous meta-analyses. Random-effect models yielded a moderate cross-sectional correlation (r = 0.38, 95% CI 0.35-0.42, p < 0.001, I 2 = 90.3%) and a small to moderate predictive correlation (r = 0.21, 95% CI 0.13-0.29, p < 0.001, I 2 = 66.7%). The association appeared to be stable over time and was robust to sensitivity analyses. All symptom clusters significantly correlated with guilt. No effects were found for military v. civilian populations or clinical v. non-clinical samples. Effects were smaller for high-quality studies and larger for instruments based on DSM-5. Further significant moderators were type of guilt measure and trauma type. The largest association was found among participants reporting war-related trauma (r = 0.44, 95% CI 0.36-0.51) and the smallest among survivors of motor-vehicle accidents (r = 0.18, 95% CI 0.02-0.33). The results underpin the role of trauma-related guilt in the onset and maintenance of PTSD symptoms, which have important clinical implications. Future studies should further explore the change interactions of guilt and PTSD symptoms.
Article
Full-text available
Trauma‐focused guided self‐help (TF‐GSH) is an important alternative to psychological therapy delivered by a therapist. This meta‐analysis evaluates the efficacy of TF‐GSH in reducing posttraumatic stress disorder (PTSD) symptoms and comorbid depressive and anxiety symptoms. A total of 17 trials were included that compared a TF‐GSH intervention (N = 610) to various control comparators (N = 570). Control conditions included treatment as usual (k = 2), waiting list (k = 11), phone monitoring (k = 1), nontrauma writing (k = 1), general support (k = 1), and supportive counseling (k = 1). A moderate‐ to large‐sized effect favouring TF‐GSH was observed for PTSD (k = 17, g = −0.81, 95% confidence interval [CI]: −1.24, −0.39) and a moderate‐sized effect was observed for depressive (k = 13, g = −0.73, 95% CI: −1.16, −0.31) and anxiety (k = 11, g = −0.72, 95% CI: −1.18, −0.27) symptoms, with considerable heterogeneity. Moderator analyses were all not statistically significant. Results indicate that TF‐GSH is a promising treatment for PTSD and comorbid depressive and anxiety symptoms. We discuss the nature, extent, and quality of the literature to provide a point of departure for future research. TF‐GSH (and unguided self‐help) may not be appropriate for certain individuals at certain times. Exploring a broad range of treatment delivery modalities will move the field closer towards a model of evidence‐based care in which the likely appropriate dose and type of intervention can be matched to individuals based on presenting problems and other variables.
Article
Full-text available
Trauma exposure is one of the most important and prevalent risk factors for mental and physical ill-health. Prolonged or excessive stress exposure increases the risk of a wide variety of mental and physical symptoms, resulting in a condition known as post-traumatic stress disorder (PTSD). The diagnosis might be challenging due to the complex pathophysiology and co-existence with other mental disorders. The prime factor for PTSD development is exposure to a stressor, which variably, along with peritraumatic conditions, affects disease progression and severity. Additionally, many factors are thought to influence the response to the stressor, and hence reshape the natural history and course of the disease. With sufficient knowledge about the disease, preventive and intervenient methods can be implemented to improve the quality of life of the patients and to limit both the medical and economic burden of the disease. This literature review provides a highlight of up-to-date literature on traumatic stress, with a focus on causes or triggers of stress, factors that influence response to stress, disease burden, and the application of the social-ecological public health model of disease prevention. In addition, it addresses therapeutic aspects, ethnic differences in traumatic stress, and future perspectives, including potential biomarkers.
Article
Full-text available
Background Despite interest in psychological inflexibility as a marker of suicide risk, no measure of psychological inflexibility specific to SI exists. Methods The present study utilized data from two internet- and one lab-based sample to establish and evaluate such a measure, the Acceptance and Action Questionnaire for Suicidal Ideation (AAQ-SI). Reliability analysis of seven initial items identified four items in Sample 1 that measured this construct. Results Confirmatory factor analysis demonstrated a one-factor solution fit these data in Samples 1 and 2. AAQ-SI scores demonstrated convergent validity (i.e., bivariate correlations) in all samples with another measure of general psychological inflexibility and measures of SI intrusiveness, avoidance, and comfort. AAQ-SI scores demonstrated a statistically significantly weaker correlation with depression symptoms compared to a measure of general psychological inflexibility in Sample 2. AAQ-SI scores were uniquely statistically significantly associated with SI severity in separate regression models within each sample, while an existing measure of general psychological inflexibility was not. Conclusions The AAQ-SI appears to be an appropriate measure of psychological inflexibility specific to the experience of suicidal thoughts. Clinicians and researchers interested in this construct among suicidal individuals may opt for the AAQ-SI over other alternatives.
Article
A small but clinically significant number of people experience delayed-onset Post-traumatic stress disorder (PTSD); symptoms of trauma years after the events which are now being re-experienced. The following case report describes the use of the cognitive-behavioural treatment for PTSD with a woman experiencing flashbacks to domestic abuse endured more than 20 years ago. Mask-wearing mandated as a result of the COVID-19 pandemic triggered non-contextualised memories of life-threatening physical violence by an abuser who covered his face. She had been managing her flashbacks and intrusive thoughts with both behavioural and experiential forms of avoidance. An 18-session intervention was provided in her own home due to physical health difficulties. Treatment focused on managing hyper-arousal, reducing thought suppression, in-vivo exposure, stimulus-discrimination and re-contextualising traumatic memories. Regular outcome measurements were kept and results are presented as a single-case experimental design in ‘AB’ format (i.e. baseline period pre intervention). Symptoms of trauma fell to levels non-indicative of PTSD and speak to the evidence base for this modality, even when applied to delayed-onset difficulties in a non-traditional therapy setting. This conclusion is lent extra credence by an experimental design with good internal validity.
Article
Full-text available
Defines posttraumatic stress disorder (PSD), which has been used to circumscribe the varied symptoms reported by combatants, and briefly presents a conditioning model for the development of PSD. The model explains PSD as a combination of high-order conditioning and stimulus generalization. The benchmark symptoms for a diagnosis of PSD are (1) intrusive thoughts regarding the traumatic event, (2) vivid recollections of the traumatic event wherein the individual reports that he/she feels that the trauma is actually reoccurring, and (3) terrifying nightmares that contain specific details of the event. A previous study by the authors (unpublished) is reported in which several symptoms were assessed by evaluating Ss' performance on cognitive and behavioral tasks and by questionnaires selected for their relationship to specific symptoms to the disorder. Responses of PSD veterans on these tasks were compared to those of well-adjusted Vietnam combat veterans without PSD. Results show that performance on 5 of the 6 tasks was effective in distinguishing Vietnam veterans with PSD from those who were well adjusted: PSD Ss demonstrated increased physiological arousal; motoric agitation; intrusive, combat-related cognitions when exposed to cues resembling the original traumatic event; poor concentration; and poor performance on emotion identification. (26 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Full-text available
This article describes the development and validation of a new measure of trauma-related thoughts and beliefs, the Posttraumatic Cognitions Inventory (PTCI), whose items were derived from clinical observations and current theories of post-trauma psychopathology. The PTCI was administered to 601 volunteers, 392 of whom had experienced a traumatic event and 170 of whom had moderate to severe posttraumatic stress disorder (PTSD). Principal-components analysis yielded 3 factors: Negative Cognitions About Self, Negative Cognitions About the World, and Self-Blame. The 3 factors showed excellent internal consistency and good test-retest reliability; correlated moderately to strongly with measures of PTSD severity, depression, and general anxiety; and discriminated well between traumatized individuals with and without PTSD. The PTCI compared favorably with other measures of trauma-related cognitions, especially in its superior ability to discriminate between traumatized individuals with and without PTSD. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Full-text available
In this article we propose mechanisms that govern the processing of emotional information, particularly those involved in fear reduction. Emotions are viewed as represented by information structures in memory, and anxiety is thought to occur when an information structure that serves as program to escape or avoid danger is activated. Emotional processing is defined as the modification of memory structures that underlie emotions. It is argued that some form of exposure to feared situations is common to many psychotherapies for anxiety, and that confrontation with feared objects or situations is an effective treatment. Physiological activation and habituation within and across exposure sessions are cited as indicators of emotional processing, and variables that influence activation and habituation of fear responses are examined. These variables and the indicators are analyzed to yield an account of what information must be integrated for emotional processing of a fear structure. The elements of such a structure are viewed as cognitive representations of the stimulus characteristic of the fear situation, the individual's responses in it, and aspects of its meaning for the individual. Treatment failures are interpreted with respect to the interference of cognitive defenses, autonomic arousal, mood state, and erroneous ideation with reformation of targeted fear structures. Applications of the concepts advanced here to therapeutic practice and to the broader study of psychopathology are discussed.
Article
Full-text available
Intrusive recollections are very common immediately after traumatic events and are considered necessary aspects of emotional processing. However, if these intrusive recollections persist over a long time, they are linked to long-term psychiatric disorder, especially Posttraumatic Stress Disorder (PTSD). This paper discusses the need to investigate factors involved in the maintenance of intrusive traumatic recollections. It is suggested that the idiosyncratic meaning of the intrusive recollections predicts the distress caused by them, and the degree to which the individual engages in strategies to control the intrusions. These control strategies maintain the intrusive recollections by preventing a change in the meaning of the trauma and of the traumatic memories. It is further suggested that what is needed is a comprehensive assessment of the processes that prevent change in meaning, going beyond the assessment of avoidance. In particular, safety behaviours, dissociation and numbing, suppression of memories and thoughts about trauma, rumination, activation of other emotions such as anger and guilt and corresponding cognitions, and selective information processing (attentional and memory biases) may be involved in the maintenance of intrusive recollections. Preliminary data supporting these suggestions from studies of individuals involved in road traffic accidents and survivors of child sexual abuse are described.
Article
Full-text available
Cognitive processing therapy (CPT) was developed to treat the symptoms of posttraumatic stress disorder (PTSD) in rape victims. CPT is based on an information processing theory of PTSD and includes education, exposure, and cognitive components. Nineteen sexual assault survivors received CPT, which consists of 12 weekly sessions in a group format. They were assessed at pretreatment, posttreatment, and 3- and 6-month follow-up. CPT subjects were compared with a 20-subject comparison sample, drawn from the same pool who waited for group therapy for at least 12 weeks. CPT subjects improved significantly from pre- to posttreatment on both PTSD and depression measures and maintained their improvement for 6 months. The comparison sample did not change from the pre- to the posttreatment assessment sessions.
Article
Full-text available
This study examines the usefulness of the Trauma Symptom Checklist (TSC-40) in measuring the long-term sequelae of sexual abuse. In a national survey of 2,963 professional women, the TSC-40 was found to be reliable and to display predictive validity with regard to childhood sexual victimization. Women who reported a sexual abuse history scored significantly higher than did women with no history of abuse on each of the six subscales and on the overall TSC-40 score. Various aspects of childhood victimization were associated with the subscale scores, with the Sexual Abuse Trauma Index and Dissociation subscales being more sensitive to the specific components of the abuse.
Article
Full-text available
We present proposed changes to the dissociative disorders section of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders and review the concept of pathological and nonpathological dissociation, including empirical findings on the relations between trauma and dissociative phenomenology and between dissociation and hypnosis. The most important proposals include the creation of two new diagnostic entities, brief reactive dissociative disorder and transient dissociative disturbance, and the readoption of the criterion of amnesia for a multiple personality disorder diagnosis. We conclude that further work on dissociative processes will provide an important link between clinical and experimental approaches to human cognition, emotion, and personality.
Article
Full-text available
Explicit measures of human memory, such as recall or recognition, reflect conscious recollection of the past. Implicit tests of retention measure transfer (or priming) from past experience on tasks that do not require conscious recollection of recent experiences for their performance. The article reviews research on the relation between explicit and implicit memory. The evidence points to substantial differences between standard explicit and implicit tests, because many variables create dissociations between these tests. For example, although pictures are remembered better than words on explicit tests, words produce more priming than do pictures on several implicit tests. These dissociations may implicate different memory systems that subserve distinct memorial functions, but the present argument is that many dissociations can be understood by appealing to general principles that apply to both explicit and implicit tests. Phenomena studied under the rubric of implicit memory may have important implications in many other fields, including social cognition, problem solving, and cognitive development.
Article
Full-text available
In this article we propose mechanisms that govern the processing of emotional information, particularly those involved in fear reduction. Emotions are viewed as represented by information structures in memory, and anxiety is thought to occur when an information structure that serves as program to escape or avoid danger is activated. Emotional processing is defined as the modification of memory structures that underlie emotions. It is argued that some form of exposure to feared situations is common to many psychotherapies for anxiety, and that confrontation with feared objects or situations is an effective treatment. Physiological activation and habituation within and across exposure sessions are cited as indicators of emotional processing, and variables that influence activation and habituation of fear responses are examined. These variables and the indicators are analyzed to yield an account of what information must be integrated for emotional processing of a fear structure. The elements of such a structure are viewed as cognitive representations of the stimulus characteristic of the fear situation, the individual’s responses in it, and aspects of its meaning for the individual. Treatment failures are interpreted with respect to the interference of cognitive defenses, autonomic arousal, mood state, and erroneous ideation with reformation of targeted fear structures. Applications of the concepts advanced here to therapeutic practice and to the broader study of psychopathology are discussed.
Article
Full-text available
Data were obtained on the general population epidemiology of DSM-III-R posttraumatic stress disorder (PTSD), including information on estimated life-time prevalence, the kinds of traumas most often associated with PTSD, sociodemographic correlates, the comorbidity of PTSD with other lifetime psychiatric disorders, and the duration of an index episode. Modified versions of the DSM-III-R PTSD module from the Diagnostic Interview Schedule and of the Composite International Diagnostic Interview were administered to a representative national sample of 5877 persons aged 15 to 54 years in the part II subsample of the National Comorbidity Survey. The estimated lifetime prevalence of PTSD is 7.8%. Prevalence is elevated among women and the previously married. The traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women. Posttraumatic stress disorder is strongly comorbid with other lifetime DSM-III-R disorders. Survival analysis shows that more than one third of people with an index episode of PTSD fail to recover even after many years. Posttraumatic stress disorder is more prevalent than previously believed, and is often persistent. Progress in estimating age-at-onset distributions, cohort effects, and the conditional probabilities of PTSD from different types of trauma will require future epidemiologic studies to assess PTSD for all lifetime traumas rather than for only a small number of retrospectively reported "most serious" traumas.
Article
Full-text available
In a cross-validated mediational model, the authors examined characteristics of memories formed in response to rape and other intense unpleasant and pleasant experiences. Data were responses to a mailed survey of women medical center and university employees. Measurement models of memory and symptom factors and a structural model with pathways among cognitive appraisal, emotional valence, memory characteristics, and health outcomes were developed in Sample 1 (N = 1,307) and confirmed in Sample 2 (N = 2,142). Rape had substantial direct effects on 2 memory factors (Clarity and Affect) and indirect effects through the construal of victimization. Rape was associated with memories described as more emotionally intense but less clear and coherent and less often thought of or talked about. Most effects on physical symptoms were nonsignificant. Implications of findings for neurohormonal and multiple representation models of emotional memory and to cognitive avoidance are discussed.
Article
Review of book: Recovered Memories and False Memories by Martin A. Conway, New York: Oxford University Press, 1997, 301 pp. Reviewed by C. Brooks Brenneis.
Conference Paper
Anxiety disorders are characterised by distorted beliefs about the dangerousness of certain situations and/or internal stimuli. Why do such beliefs persist? Six processes (safety-seeking behaviours, attentional deployment, spontaneous imagery, emotional reasoning, memory processes and the nature of the threat representation) that could maintain anxiety-related negative beliefs are outlined and their empirical status is reviewed. Ways in which knowledge about maintenance processes has been used to develop focussed cognitive therapy programmes are described and evaluations of the effectiveness of such programmes are summarized. Finally, ways of identifying the effective ingredients in cognitive therapy programmes are discussed.
Article
Summary The main and the latest trends in the world and in Cuba regarding Posttraumatic Stress Disorder in female victims of rape, as well as the social factors that determine the general facts all over the nation and particularly in Pinar del Rio were analyzed using the historical method.
Article
A patient with selective bilateral damage to the amygdala did not acquire conditioned autonomic responses to visual or auditory stimuli but did acquire the declarative facts about which visual or auditory stimuli were paired with the unconditioned stimulus. By contrast, a patient with selective bilateral damage to the hippocampus failed to acquire the facts but did acquire the conditioning. Finally, a patient with bilateral damage to both amygdala and hippocampal formation acquired neither the conditioning nor the facts. These findings demonstrate a double dissociation of conditioning and declarative knowledge relative to the human amygdala and hippocampus.
Article
Posttraumatic stress disorder (PTSD) is an illness of considerable prevalence, often characterized by high morbidity, treatment resistance, and a chronic course. The core symptoms of PTSD include persistent reexperiencing of the traumatic event, avoidance of stimuli associated with the trauma, and autonomic hyperarousal. We propose several neurobiologic mechanisms that may account for these primary symptoms of PTSD. Preclinical investigations of the effects of stress on learning and memory processes suggest that fear conditioning, behavioral sensitization, and a failure of extinction may be important in the persistence and reexperiencing of traumatic memories and stressor sensitivity. The pathophysiology of PTSD may involve dysfunction of several brain structures, particularly the amygdala, locus coeruleus, and hippocampus, as well as noradrenergic, dopamine, opiate, and corticotropinreleasing factor neurochemical systems. Acutely, severe psychological trauma results in the parallel activation of these systems, producing an array of adaptive behavioral and physiologic responses necessary for survival. In PTSD, however
Chapter
This chapter explores the nature of confession and inhibition. Conversely, not confiding significant experiences is associated with increased disease rates, ruminations, and other difficulties. This pattern of findings has helped in developing a useful theory of active inhibition that shares many of the assumptions of learning theory, psychodynamic models, and more recent cognitive perspectives. The chapter examines the nature of confession per se. The chapter focuses on the physiological and psychological effects of confronting or actively avoiding past traumatic experiences. Based on a number of laboratory and field studies, it is clear that requiring people to write or talk about traumas is associated with both immediate and long-term health benefits. The chapter presents a formal theory of active inhibition. The links among the theory and Freud, animal learning, and cognitive perspectives are discussed in the chapter. The chapter describes the reexamination of catharsis, the development and breakdown of the self, and the role of psychosomatics in social psychology.
Article
Background: Data were obtained on the general population epidemiology of DSM-III-R posttraumatic stress disorder (PTSD), including information on estimated lifetime prevalence, the kinds of traumas most often associated with PTSD, sociodemographic correlates, the comorbidity of PTSD with other lifetime psychiatric disorders, and the duration of an index episode.Methods: Modified versions of the DSM-III-R PTSD module from the Diagnostic Interview Schedule and of the Composite International Diagnostic Interview were administered to a representative national sample of 5877 persons aged 15 to 54 years in the part II subsample of the National Comorbidity Survey.Results: The estimated lifetime prevalence of PTSD is 7.8%. Prevalence is elevated among women and the previously married. The traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women. Posttraumatic stress disorder is strongly comorbid with other lifetime DSM-III-R disorders. Survival analysis shows that more than one third of people with an index episode of PTSD fail to recover even after many years.Conclusions: Posttraumatic stress disorder is more prevalent than previously believed, and is often persistent. Progress in estimating age-at-onset distributions, cohort effects, and the conditional probabilities of PTSD from different types of trauma will require future epidemiologic studies to assess PTSD for all lifetime traumas rather than for only a small number of retrospectively reported "most serious" traumas.
Article
A cognitive theory of posttraumatic stress disorder (PTSD) is proposed that assumes traumas experienced after early childhood give rise to 2 sorts of memory, 1 verbally accessible and 1 automatically accessible through appropriate situational cues. These different types of memory are used to explain the complex phenomenology of PTSD, including the experiences of reliving the traumatic event and of emotionally processing the trauma. The theory considers 3 possible outcomes of the emotional processing of trauma, successful completion, chronic processing, and premature inhibition of processing We discuss the implications of the theory for research design, clinical practice, and resolving contradictions in the empirical data.
Article
Current thinking about Pavlovian conditioning differs substantially from that of 20 years ago. Yet the changes that have taken place remain poorly appreciated by psychologists generally. Traditional descriptions of conditioning as the acquired ability of one stimulus to evoke the original response to another because of their pairing are shown to be inadequate. They fail to characterize adequately the circumstances producing learning, the content of that learning, or the manner in which that learning influences performance. Instead, conditioning is now described as the learning of relations among events so as to allow the organism to represent its environment. Within this framework, the study of Pavlovian conditioning continues to be an intellectually active area, full of new discoveries and information relevant to other areas of psychology.
Article
This paper reviews the evidence for the existence of a complex form of post-traumatic disorder in survivors of prolonged, repeated trauma. This syndrome is currently under consideration for inclusion in DSM-IV under the name of DESNOS (Disorders of Extreme Stress Not Otherwise Specified). The current diagnostic formulation of PTSD derives primarily from observations of survivors of relatively circumscribed traumatic events. This formulation fails to capture the protean sequelae of prolonged, repeated trauma. In contrast to a single traumatic event, prolonged, repeated trauma can occur only where the victim is in a state of captivity, under the control of the perpetrator. The psychological impact of subordination to coercive control has many common features, whether it occurs within the public sphere of politics or within the private sphere of sexual and domestic relations.
Article
provide a detailed review of the literature on the psychobiology of traumatic stress response syndromes and discuss the treatment implications of recent findings in this area / after a brief discussion of four primary features of trauma—incomprehensibility, disrupted attachment, traumatic bonding, and inescapability—the authors review three animal models for PTSD [posttraumatic stress disorder]: inescapable stress, forced isolation, and disruption of attachments in nonhuman primates / [reviews] the role of endogenous opioids in trauma responses and the psychobiology of reliving and reenactment (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
highlight recent progress made in studies of the neurobiology of dissociative states, memory dysfunction, and hyperarousal in posttraumatic stress disorder (PTSD) patients / review and begin to integrate recent studies of PTSD patients, other patient populations, healthy Ss, and preclinical research / highlight the potential prognostic and therapeutic significance of recent research findings [on] the neurobiology of dissociative states and memory disturbance in PTSD (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Integrates findings from the fields of cognitive science, child development, and trauma to address basic questions about posttraumatic stress disorder (PTSD). Mechanisms of divided attention and emotional flooding during traumatic experiences may explain classic memory (ME) findings in PTSD: psychogenic amnesia in the setting of hyperarousal, startle response, intrusive images, and avoidance behaviors. Cognitive research shows that blocked focal attention leads to impaired explicit processing but intact implicit recall. The hippocampal formation is crucial for explicit ME processing, involving a subsequent consolidation process that is postulated to make MEs permanent in the cortex. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
From the perspective of memory researchers, there are 3 broad areas in which questions need to be posed about the state of evidence relevant to the recovered memories debate. The 1st set of questions concerns the issue of 'forgetting.' The 2nd set of questions concerns the issue of 'distortion.' The 3rd set of questions concerns the relation between recovered memories of actual abuse and illusory memories of abuse. In this chapter, we examine evidence that pertains to each set of questions. For each set, we summarize briefly the state of knowledge regarding memories of childhood sexual abuse. We also broaden the frame of analysis to consider relevant evidence from other areas of research, including clinical observations of traumatic memory as well as current cognitive psychology and cognitive neuroscience. Our goals are twofold. The first is to provide our own assessment of the state of the evidence in the recovered memories debate. Here, we emphasize that answers to the various questions we have posed need not all point toward the same side of the debate. For instance, it is perfectly possible to conclude, as we do, that illusory memories of abuse exist yet at the same time concede that some traumatic experiences can be forgotten and later recovered. The 2nd goal is to seek guidance and direction for future research from current work on remembering and forgetting. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Cognitive models have linked individual differences in the appraisal of traumatic events and their sequelae to the persistence of post-traumatic stress disorder (PTSD). A pilot study investigated this proposal with victims of assault. Eleven assault victims suffering from persistent PTSD and 9 victims who had recovered from PTSD were interviewed retrospectively and compared on potentially relevant cognitive factors. Groups were comparable in terms of characteristics of the assault, gender, age, and initial PTSD severity. Participants with persistent PTSD were less likely than those who had recovered to have engaged in mental planning during the assault and more likely to have experienced mental defeat, and to indicate negative appraisals of their actions during the assault, of others' reactions after the assault, and of their initial PTSD symptoms. They were also more likely to indicate global negative beliefs concerning their perception of themselves, their world or their future. These cognitive factors may maintain PTSD symptoms either directly or by motivating the individual to engage in behaviour that prevents change.
Article
This study examined feelings of anger among female victims of crime and the relation of anger to the development of post-traumatic stress disorder (PTSD). One hundred and sixteen women who had been victims of sexual or nonsexual criminal assaults were compared to a matched comparison group of 50 nonvictimized women on measures of anger and anger expression. Results indicate that victims were angrier than nonvictims. The level of anger was related to various aspects of the assault, such as the use of a weapon and the victim's response to the attack. In addition, the results indicate that elevated anger is positively related to the development of PTSD. Results are discussed in relation to a cognitive/behavioral conceptualization of PTSD.
Article
In this study we examined the relationship between posttrauma pathology and the level of articulation (complexity) in rape narratives recounted by victims shortly after the assault. Degree of articulation was operationalized as the reading level of the narratives as determined by a computer program. Shortly after the trauma, reading level was correlated with severity of anxiety but not with posttraumatic stress disorder (PTSD) symptoms. Degree of the narrative articulation shortly after the trauma, however, was related to severity of later PTSD. These results are consistent with the hypothesis that the less developed trauma narratives hinder recovery from trauma.
Article
Not all patients with posttraumatic stress disorder benefit from exposure treatment. The present paper describes two cognitive dimensions that are related to inferior response to exposure in rape victims. First, individuals whose memories during reliving of the trauma reflected mental defeat or the absence of mental planning showed little improvement. Second, inferior outcome was correlated with an overall feeling of alienation or permanent change following the trauma. These results are based on blind ratings of transcripts of exposure treatment sessions from 10 women with good outcome and 10 women with inferior outcome. Patients in the two groups were matched for initial symptom severity and were comparable in many aspects of the assault. Patients who experienced mental defeat, alienation, or permanent change may require cognitive restructuring in addition to exposure.
Article
This paper presents a coding system developed to explore changes in narratives of rape during therapy for posttraumatic stress disorder (PTSD) involving repeated reliving and recounting of the trauma. Relationships between narrative categories hypothesized to be affected by the treatment and treatment outcome were also examined. As hypothesized, narrative length increased from pre- to post-treatment, percentage of actions and dialogue decreased and percentage of thoughts and feelings increased, particularly thoughts reflecting attempts to organize the trauma memory. Also as expected, increase in organized thoughts was correlated negatively with depression. While indices of fragmentation did not significantly decrease during therapy, the hypothesized correlation between decrease in fragmentation and reduction in trauma-related symptoms was detected.
Article
Post-traumatic stress disorder (PTSD) and related psychopathology were examined in 95 female rape victims beginning soon after the assault (mean=12.64 days). Subjects were assessed weekly for 12 weeks. Ninety-four percent of women met symptomatic criteria for PTSD at Assessment 1, decreasing to 65% at Assessment 4 (mean=35 days postassault), and 47% at Assessment 12 (mean=94 days postassault). PTSD and related psychopathology decreased sharply between Assessments 1 and 4 for all women. Women whose PTSD persisted throughout the 3-month study did not show improvement after the fourth assessment; women who did not meet criteria for PTSD 3 months postassault showed steady improvement over time. This pattern was evidenced even after initial PTSD severity was statistically controlled. Moreover, PTSD status at 3 months postassault could be predicted with a high degree of accuracy by two brief self-report measures administered at the first assessment. The implications of the present findings and directions for future research are discussed.
Article
While amnesia and other cognitive disturbances are usually caused by structural brain damage, there are a few instances in which environmental stress may induce neuronal death in memory-sensitive brain regions such as the hippocampus. Here we report on a patient who, after a single brief exposure to an event reminding him of a similar stressful event from his childhood, deteriorated immediately and persistently without manifesting structural, but manifesting functional, brain damage as measured by position emission tomography. This patient probably represents the first case in which a direct relation between a single psychic event and the occurrence of brain malfunctioning in cognition is documented by dynamic neuroimaging methods. Psychic shock may cause lasting reductions in brain metabolism with the consequence of severe intellectual malfunctioning.
Article
The paper reviews and considers the existing cognitive and behavioral accounts for the acquisition and maintenance of post-traumatic stress disorder. Mowrer's two-stage theory as applied to rape victims and Vietnam veterans is critically reviewed. It was concluded that traditional S-R learning theories can adequately account for fear and avoidance consequent to a traumatic event, as well as the greater generalization as compared to simple phobics. However, these theories do not explain the remaining PTSD symptoms. The literature on experimental neurosis predicts that uncontrollable and unpredictable events produce responses that are highly reminiscent of PTSD irrespective of stimulus intensity and complexity. An additional shortcoming of S-R theory is the difficulty in incorporating meaning concepts which are so central to PTSD. Evidence for the necessity of a theory to accommodate meaning concepts is the finding that perceived threat is a better predictor of PTSD than actual threat. Therefore, we have presented a theoretical framework developed by Foa & Kozak (1986) which accommodates meaning concepts in explaining mechanisms of fear reduction and adapted this theory to PTSD.
Article
The paper suggests that the negative idiosyncratic meaning of posttraumatic intrusions (e.g., ‘I am going crazy’) and cognitive strategies intended to control the intrusions play a major role in maintaining posttraumatic stress disorder. Two studies of 159 and 138 motor vehicle accidents survivors showed that the dysfunctional meaning of intrusions explained a proportion of the variance of the intrusion-related distress, strategies used to end the intrusions, and PTSD severity that was not explained by intrusion frequency, accident severity, or by general catastrophic thoughts when anxious. Rumination, thought suppression, and distraction when having intrusions showed substantial correlations with PTSD severity, as did avoidance of reminders of the accident. The results have implications for the treatment of chronic PTSD.
Article
In search of a more thorough understanding of Posttraumatic Stress Disorder (PTSD), theories of etiology have emerged from virtually every theoretical persuasion. Many provide a framework useful for understanding certain facets of the disorder. However, based on current knowledge, a model must be comprehensive enough to encompass the constellation of symptoms that comprise the disorder, the differential severity of symptoms, the presence of PTSD in some individuals but not others experiencing similar trauma, and recent empirical research bearing on these factors. In this paper, we review etiological models of PTSD and propose a new model based on a recent conceptualization of the process and origins of anxiety and panic. This model includes consideration of the role of biological and psychological vulnerabilities, negative life events, alarms (fear reactions), perceptions of control, social support, and coping strategies. Empirical research supporting the inclusion of these components is presented. Finally, etiological and phenomenological similarities between anxiety disorders, specifically panic disorder and PTSD, are discussed.
Article
To test the hypothesis that dissociation in adolescence is positively correlated with stress or abuse experienced earlier, the authors assessed dissociation in a heterogeneous group of disturbed adolescents and examined the relationship between the degree of dissociation and the degree of reported childhood stress, abuse, or trauma. The subjects were 47 adolescents, 13-17 years old, who were institutionalized for periods of 1-13 weeks in a private mental hospital; 35 were girls and 12 were boys. Participants completed the Dissociative Experiences Scale and a child abuse and trauma questionnaire. The hospital records of 40 of the 47 adolescents were also available. Scores on the Dissociative Experiences Scale correlated significantly with self-reported physical abuse or punishment, sexual abuse, psychological abuse, neglect, and negative home atmosphere but not with abuse ratings made from hospital records. Together with the authors' previous work showing a relation between childhood stress and later dissociation in normal college students, these findings support the view that dissociation represents a reaction to early negative experience and places multiple personality disorder at the extreme end of a continuum of dissociative sequelae of childhood trauma. Researchers should continue to try to identify psychiatric patients with prominent dissociative characteristics or symptoms and attempt to correlate this phenomenology with negative earlier experiences.
Article
It is widely believed that verbal processing generally improves memory performance. However, in a series of six experiments, verbalizing the appearance of previously seen visual stimuli impaired subsequent recognition performance. In Experiment 1, subjects viewed a videotape including a salient individual. Later, some subjects described the individual's face. Subjects who verbalized the face performed less well on a subsequent recognition test than control subjects who did not engage in memory verbalization. The results of Experiment 2 replicated those of Experiment 1 and further clarified the effect of memory verbalization by demonstrating that visualization does not impair face recognition. In Experiments 3 and 4 we explored the hypothesis that memory verbalization impairs memory for stimuli that are difficult to put into words. In Experiment 3 memory impairment followed the verbalization of a different visual stimulus: color. In Experiment 4 marginal memory improvement followed the verbalization of a verbal stimulus: a brief spoken statement. In Experiments 5 and 6 the source of verbally induced memory impairment was explored. The results of Experiment 5 suggested that the impairment does not reflect a temporary verbal set, but rather indicates relatively long-lasting memory interference. Finally, Experiment 6 demonstrated that limiting subjects' time to make recognition decisions alleviates the impairment, suggesting that memory verbalization overshadows but does not eradicate the original visual memory. This collection of results is consistent with a recording interference hypothesis: verbalizing a visual memory may produce a verbally biased memory representation that can interfere with the application of the original visual memory.