Article

A novel virtual reality paradigm: Predictors for stress-related intrusions and avoidance behavior

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

Abstract

Background and objectives: Most people are exposed to a violent or life-threatening situation during their lives, but only a minority develops a stress-related disorder. To examine risk factors for the development of stress-related symptoms, such as intrusions and avoidance, analogue trauma studies are necessary. The often-used trauma film paradigm has proven to be valuable to examine intrusions, but inherently to its technique is less suitable for assessing behavioral avoidance, a core symptom of stress-related disorders. The aim of the present study was twofold, first to further develop an analogue that explicitly addresses behavioral avoidance and second, to link previously-established risk factors for the development of stress-related symptoms. Method: Eighty-two healthy participants were subjected to a trauma induction using virtual reality (VR). At follow-up, participants were placed in a similar VR environment and could approach or avoid the trauma-scene, a trauma-related scene or a neutral, unrelated scene. Several pre- and peri-trauma risk factors were measured. Results: The VR paradigm increased negative mood and heart rate, decreased positive mood and heart rate variability, and resulted in stress-related symptoms as trauma-related thoughts and beliefs, intrusions and avoidance behavior. The most prominent risk factors that contributed to the stress-related symptoms were negative emotions during the trauma induction, trait anxiety, and avoidant coping strategies. Limitations: The stress-related symptoms were mild, resulting in a vast amount of participants without intrusions and limited avoidance behavior. Conclusion: The current VR paradigm can elicit stress-related symptoms, including avoidance; risk factors contributing to these symptoms were similar to those observed in clinical research, indicating the potential of the general set up.

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 author.

... Authentic sensory cues affect presence by masking the sensory information coming from the real world, directing the focus of attention (Ermi and Mäyrä, 2005;Gilbert, 2016) (Figure 1). Moreover, they facilitate a richer recollection of the traumatic experience, thereby increasing the sensus of attention (Tielman et al., 2015;Dibbets, 2020). ...
... For example, personal images can be collected offline, and used within the VE to assist in recalling associated memories that help shape the subject's trauma narrative and increase the presence and engagement in his or her treatment (van Gelderen et al., 2018). To tailor the immersion online, the branching of the narrative may be directed towards exposure or reduction of tension depending on the subject's response (Dibbets, 2020). Recall of the trauma narrative can be consolidated with active guidance of the therapist, for example by online creation of a written record of memories and associated feelings. ...
Article
Full-text available
With the application of virtual reality (VR), tailored interventions can be created that mirror the traumatic experiences of veterans with post-traumatic stress disorder (PTSD). Visual elements can be mimicked, and auditory and other senses stimulated. In doing so, the degree of immersion can be adjusted to optimize the therapeutic process. Objectively measuring the sensory immersion is key to keep subjects within their personal window of tolerance. Based on this information the therapist can decide manipulate the sensory stimulation embedded in the treatment. The objectives of this article are to explore the different immersive design aspects of VRET that can be modified to influence the experienced presence in veterans with PTSD, and to discuss possible methods of measuring the emotional response facilitated by immersive design aspects and experienced presence. Four design aspects are discussed: system, sensory cues, narrative and challenge. We also report on a user experiment in three veterans that informed on quality and depth of immersion. Believability of the neutral virtual environment was important for maintaining the veterans' presence within the VR experience. The immersive design aspects that were personalized and supportive in the narrative of the veteran such as music and self-selected images appeared to have a strong influence on recall and reliving of the traumatic events. Finally, in order to increase the therapeutic effect in veterans with PTSD, the highlighted design aspects should be recognized and tailored to maximize immersion in virtual reality exposure therapy.
... Travma öncesi ve sonrası risk durumları ölçülmüştür. Travma sırasındaki olumsuz duygular ve sürekli anksiyete durumlarına katkıda bulunarak kullanıcılar sanal gerçeklik deneyimleri esnasında stresle başa çıkmayı öğrenmişlerdir [29]. ...
... Gerçekleştirilen uygulamaların amacı hastalığın getirdiği semptomları azaltmak ve kişilerin hastalık durumlarını ortadan kaldırmaya yardımcı olarak yaşam kalitesini arttırmaktır. Literatürde yer alan çalışmalar gösteriyor ki sanal gerçeklik ve artırılmış gerçeklik uygulamalarının otizmli kişilerde sosyal beceriler, biliş ve işleyiş durumunu geliştirdiği ve uygulanabilir olduğu [7,10,11,12,13], dikkat eksikliği ve hiperaktivite bozukluğu olan kişilerde dikkat eksikliği durumunda iyileşme gözlendiği [8], fobi durumunda sıklıkla sanal gerçeklik gözlüklerinin tercih edildiği görülmekte olup uygulamalara bağlı olarak kişilerin korku ve anksiyete durumlarında azalma olduğu [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] görülmektedir. Diğer mental bozukluk durumlarında ise kişilerin günlük aktivitelerini daha kolay yapabilmelerine, yaşam kalitesini artırdığı yapılan çalışmalar ile ortaya koyulmuştur [35,38,48]. ...
Article
In this study, studies conducted in the last 10 years in psychiatric disorders with virtual reality and augmented reality application were examined. Studies done so far; The psychiatric disorder studied, the equipment used, the number of people participating in the study, the database in which the study was scanned, and the results of the studies were evaluated according to the criteria. Studies using disease-specific questionnaires include 30% of all studies. In some studies, it is seen that physiological parameters are also used. Studies using physiological parameters correspond to only 10% of all studies. The practices carried out are to reduce the symptoms brought by the disease and to increase the quality of life by helping to eliminate the disease conditions of the people. Approximately 77% of the studies were carried out in the field of virtual reality and 23% in the field of augmented reality. Based on the articles examined within the scope of the study, some deficiencies in virtual reality and/or augmented reality applications in psychiatric diseases were identified. For example, whether the applications made have a disturbing effect on the users should be determined by using the SSQ questionnaire. In addition, the auditory parameters as well as the visual parameters that make up the virtual environment should be used effectively in this process. It has been observed that among the studies in the literature, the positive or negative effects of auditory parameters on users are not mentioned. It is considered that it will be beneficial for studies to examine the effect of auditory elements in the use of virtual reality environment.
... Realistic 360° film footage as an appropriate analogue for a real-life trauma event is difficult to attain. As a result, VR studies typically rely on programmed animations of simulated stressful environments such as an animation of the aftermath of a train collision (Boskovic et al., 2019;Dibbets, 2020) or simulated bomb detonation (Schweizer et al., 2017;Schweizer et al., 2019). Such VR scenes have been found to increase physiological response (Schweizer et al., 2018) and evoke intrusions later (Cuperus et al., 2016;Dibbets, 2020). ...
... As a result, VR studies typically rely on programmed animations of simulated stressful environments such as an animation of the aftermath of a train collision (Boskovic et al., 2019;Dibbets, 2020) or simulated bomb detonation (Schweizer et al., 2017;Schweizer et al., 2019). Such VR scenes have been found to increase physiological response (Schweizer et al., 2018) and evoke intrusions later (Cuperus et al., 2016;Dibbets, 2020). Yet without a direct comparison with on-screen presentation, it is unclear whether the benefit of increased immersion from VR outweighs the potential costs in realism from using an animated analogue trauma. ...
Article
Due to the unpredictable nature of traumatic events, prospective research into trauma relies upon laboratory methods utilising distressing film scenes to act as a trauma analogue measuring vulnerability factors and testing interventions applied to posttraumatic stress disorder (PTSD). This is the first study to test whether Virtual Reality (VR) provides a more effective trauma analogue than traditional on-screen presentation by direct comparison of the same real-life trauma film. Participants viewed footage of a staged car accident either presented in VR (N=31) or on-screen (OS) (N=30). Both groups recorded sense of presence, pre-and post-film mood and state anxiety. After the film, some participants (VR: n=18; OS: n=12) reported involuntary intrusions of the film and recorded the emotionality of these. VR presentation evoked a greater sense of presence, yet both VR and OS presentation elicited negative mood and involuntary intrusions. Although intrusions were more vivid in the VR condition, there were no significant differences in frequency or distress. However, a greater sense of presence, regardless of medium, was predictive of increased emotional reaction to the film and greater intrusion frequency and distress. Therefore, implementing a VR paradigm could be directly beneficial for TFP research concerning sense of presence or vividness of intrusions. The association between enhanced sense of presence and stress response suggests that an effective trauma analogue should be immersive, and VR presentation is a useful medium to elicit a greater sense of immersion.
... Moreover, VR has been shown to be effective in inducing stress and anxiety reactions which are comparable to those observed in analogous real-life situations (e.g. Dibbets, 2019;Kothgassner et al., 2016). These characteristics have all contributed to the implementation of VR as a method for exposure therapy. ...
... In general, VRET constitutes an ecologically valid, safe and controlled environment for the induction of emotional, cognitive and behavioural as well as physiological reactions which are equivalent to those found in comparable in vivo surroundings (e.g. Dibbets, 2019;Kothgassner et al., 2016). In the past, high costs for the hardware and software of the respective systems may have limited the access to this technology. ...
Article
Full-text available
Contrary to specific phobias, for which Virtual Reality Exposure Therapy (VRET) constitutes an effective treatment, uncertainty still exists regarding the usefulness of VRET for posttraumatic stress disorder (PTSD). Therefore, this meta-analysis investigated the efficacy of VRET for PTSD as compared to waitlist and active comparators. A literature search yielded nine controlled studies encompassing 296 participants (124 VRET, 172 controls). The differences between conditions regarding the primary outcome of PTSD symptom severity and the secondary outcome of depressive and anxiety symptoms post-treatment were calculated using Hedges’ g. Compared to waitlist controls, VRET showed a significantly better outcome for PTSD symptoms (g = 0.62, p = .017) and depressive symptoms (g = 0.50, p = .008). There was no significant difference between VRET and active comparators regarding PTSD symptoms (g = 0.25, p = .356) and depressive symptoms (g = 0.24, p = .340) post-treatment. No significant effects emerged for anxiety symptoms. These findings suggest that VRET may be as effective as active comparators for PTSD patients. However, the results must be interpreted with caution due to the limited number of trials and the substantial number of – predominantly male – military service members studied. Additional controlled trials, considering a wider range of trauma types and balanced gender, are required to strengthen the evidence.
... Used the VR paradigm to induce intrusive emotions and avoidant behaviors, They found that the VR paradigm increased negative emotions and heart rate, decreased positive emotions and heart rate variability, and observed the symptoms that caused stress (Dibbets, 2020) Risk factor 2: Trait anxiety None Participants are non-clinical people, so it isn't easy to popularize the results to clinical people. ...
... Both VR and AR have been widely explored for promoting, through their power of immersion and stimulation, several positive experiences for different audiences, in other contexts, such as the improvement of physical, psychological, and social factors; treatment of symptoms associated with stress and trauma (Dibbets, 2019;Zimmer et al., 2019); cognitive assessment and rehabilitation (Tuena et al., 2020); contribution to the treatment of schizophrenia (Dyck et al., 2010;Macedo et al., 2015); and disaster training with students (Caroca et al., 2016). ...
Chapter
Virtual reality (VR) and augmented reality (AR) have been explored to be an effective alternative to integrating mental health intervention proposals, particularly in eldercare. The objective is to map the usability and applications of VR and AR technologies in interventions for the elderly population. The main areas of interventions in AR and VR applied to the elderly are stimulation and cognitive rehabilitation, physical rehabilitation, treatment of mental diseases, and promotion of quality of life. Despite the need for further studies, VR and AR have strong adherence among the elderly and demonstrate promising potential in interventions that seek to promote mental health and improve the quality of life.
... Furthermore, VR has also been applied as an experimental psychopathology model to study traumarelated symptoms among healthy participants. Several studies provide evidence that VR can successfully elicit negative affect and induction-related symptoms (e.g., Cuperus et al., 2017;Dibbets, 2020;Dibbets & Schulte-Ostermann, 2015;Meyer et al., n.d.). The aim in these studies is to assess relevant cognitive, behavioural and physiological processes involved in stress-related symptoms, aiming at increasing our knowledge about PTSD by modelling processes related to trauma exposure. ...
Article
Full-text available
In recent years the development of new virtual environments has been qualitatively high and fast at the same time, but the dissemination of virtual reality (VR) in clinical practice is still scarce. The aim of this review is to give an insight into the state of the art of the use of VR as an assessment tool and treatment intervention in anxiety and related disorders as posttraumatic stress disorder and obsessive-compulsive disorders. Besides an overview into the efficacy of VR, an summary will be given on assumed working mechanisms in virtual reality exposure therapy and how this aligns with current theoretical models. Further, it will be discussed how VR is accepted by patients and research into the reluctance of therapist to use this technology during treatment with focus on the therapeutic alliance and how it may be influenced by the use of VR. Finally, we discuss clinical and future issues as e.g. dissemination into clinical practice and what VR has to offer therapists in future. This not only in adult population but as well in younger patients, as young adolescents VR has a great potential as it connects easily with its playful elements to this population and might be a low threshold step to offer treatment or preventive interventions.
... The reader will be provided with a critical appraisal of different types of virtual reality and a matrix how a better understanding of technological aspects can lead to more high quality research and use of virtual reality in clinical practice.In research, virtual reality has finally become more accepted as highly standardized research paradigm. Its additional value has been demonstrated in research into disorder relevant aspects(Dibbets, 2020) and potential treatment mechanisms(Kampmann et al., 2019). With its potential to manipulate certain aspects within a virtual environment and the high control virtual reality provides, it is of additional value in treatment research. ...
... Due to the negative effects on the emotional and physical state of the subjects, it is necessary to follow strict ethical requirements, and it is also difficult to attract subjects to participate in such study. Investigations of pre-, peri-, and posttraumatic processes in the VR paradigm have revealed that VR content induces traumatic stress [23], and they also showed that stressful VR content causes mild stress symptoms, such as those related to trauma thoughts and beliefs, intrusion, and avoidance behavior [24,25]. The assumption that people with OCD, PTSD, and psychotic disorders are more vulnerable to cybersickness has previously been put forward, but when tested, conflicting results were received. ...
Article
Full-text available
The evolution of virtual reality (VR) technologies requires setting boundaries of its use. In this study, 3 female participants were experiencing VR scenarios with stressful content and their activity of the autonomic nervous system and EEG were recorded. It has been discovered that virtual reality can evoke acute stress reactions accompanied by activation of the sympathetic nervous system and a decrease in the activity of the parasympathetic nervous system. The high-stress response is accompanied by a decrease in the power of the EEG, and, on the contrary, the activation of the avoidance reaction is accompanied by an increase in the power of the EEG alpha waves. Therefore, the use of stressful VR content can cause high emotional stress to a user and restrictions should be considered.
Article
Virtual reality (VR) research probes stress environments that are infeasible to create in the real world. However, because research simulations are applied to narrow populations, it remains unclear if VR simulations can stimulate a broadly applicable stress-response. This systematic review and meta-analysis was conducted on studies using VR stress tasks and biomarkers. Included papers (N=52) measured cortisol, heart rate (HR), galvanic skin response (GSR), systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory sinus arrhythmia (RSA), parasympathetic activity (RMSSD), sympathovagal balance (LF/HF), and/or salivary alpha-amylase (sAA). Effect sizes (ES) and confidence intervals (CI) were calculated based on standardized mean change of baseline-to-peak biomarker levels. From baseline-to-peak (ES, CI), analyses showed a statistically significant change in cortisol (0.56, 0.28-0.83), HR (0.68, 0.53-0.82), GSR (0.59, 0.36-0.82), SBP (0.55, 0.19-0.90), DBP (0.64, 0.23-1.05), RSA (-0.59, -0.88 to -0.30), and sAA (0.27, 0.092-0.45). There was no effect for RMSSD and LF/HF. VR stress tasks elicited a varied magnitude of physiological stress reactivity. VR may be an effective tool in stress research.
Article
Background The risk factors of Posttraumatic Stress Symptoms (PTSS) and depressive symptoms have been well-established, but whether the network structure of their symptoms changes over time remains unclear. This study aims to examine the six-year changes of network structure of PTSS and depressive symptoms among Wenchuan earthquake adult survivors in China. Methods In this pooled cross-sectional study, respondents were sampled from the same population at each of the five waves (N = 1343, 1205, 1177, 1376, and 1339). The network structure of them was investigated using network analyses. Results The study shows network connections stable across waves were the positive connections between hyperarousal and intrusions, hyperarousal and somatic symptoms, and two dimensions of positive effects. Stable negative connections were those between depressed affects and positive effects, avoidance and depressed affects, avoidance with interpersonal symptoms and avoidance with somatic symptoms. Across waves, fearful emotion consistently was the strongest bridge symptom connecting with PTSS symptoms. However, for PTSS the strongest bridge symptom varied across time as it was avoidance in wave 1 but were hyperarousal in other four waves. Limitations This study was based on a pooled cross-sectional survey, which inhibits conclusions regarding causal influences between symptoms at the individual patient level. Conclusions The network structure of PTSS and depressive symptoms was partly stable, yet also varied across survey waves. Core symptom clusters for PTSS and depressive symptoms were avoidance and depressed affect, respectively. The central role of these clusters in PTSS and depressive symptoms has important implications to future psychiatric programs.
Article
Вступ. В наш час актуальною проблемою є полишення професії спеціалістами в перші роки, коли вони тільки приступають до виконання своїх службових обов’язків. В першу чергу це стосується людей, чия професійна діяльність пов’язана з екстремальними умовами праці. Одним з факторів цього є низька стресостійкість, яка в подальшому може стати причиною виникнення захворювань як на фізичному, так і на психоемоційному рівні. Використання сучасних імерсійних технологій може допомогти на етапі навчання виявляти людей з низькою стійкістю до стресових чинників та розробити для них комплекс превентивної реабілітації для збільшення кількості спеціалістів, які будуть залишатися в професії. Мета. Оцінити стресостійкість курсантів Національної академії Національної гвардії України третього та четвертого року навчання на основі їх психофізіологічного статусу до та після впливу імерсійних технологій. Матеріали та методи. Проведено обсерваційне дослідження, на протязі якого було обстежено 88 курсантів НАНГУ з вересня по жовтень 2021 року. В обстеженні респондентів використовувався програмно-апаратний комплекс професійного психологічного відбору та психофізіологічної експертизи «Психолот-1». В основу дослідження було покладено моделювання мікро-стресового навантаження з використанням тренажеру екіпажів БТР-4E, на якому курсанти працювали протягом 25-30 хвилин. Зняття показників психофізіологічного статусу курсантів проводилося двічі, до та після роботи на тренажері БТР-4Е. Статистична обробка даних проводилася з використанням ліцензійного статистичного пакету IBM SPSS Statistics Base v.22. Результати. При аналізі мінімального часу експозиції фігури (до - 0,27±0,008, після - 0,25±0,008, p=0,002), який характеризує функціональну рухливість нервових процесів у респондентів, виявлено, що робота з тренажером БТР-4Е мала вплив на показник в бік його зменшення, а також була виявлена статистично значуща різниця середнього значення помилкових реакцій на коло (до - 8,24±0,35, після - 9,1±0,39, p=0,028) при використанні ІмТ. Проаналізувавши інтегральну оцінку стійкості до екстремальних умов до та після використання ІмТ статистично значущої різниці виявлено не було (до -0,287±0,25, після -0,382±0,3, p=0,61), що корелює із показником норми для інтегральної оцінки стійкості респондентів до стресових факторів, відхилення від якого не було виявлено. Висновки. В ході нашого дослідження доведено, що використання імерсійних технологій має вплив на стресостійкість курсантів, а саме відмічається зниження процесів пізнання при роботі з тренажером БТР-4Е в умовах як відсутності подразника зорового аналізатора (p=0,008), так і при його наявності (p
Article
Conditioned response (CRs) triggered by stimuli predicting aversive consequences have been confirmed across various species including humans, and were found to be exaggerated in anxious individuals and anxiety disorder patients. Importantly, contextual information may strongly modulate such conditioned responses (CR), however, there are several methodological boundaries in the translation of animal findings to humans, and from healthy individuals to patients. Virtual Reality (VR) is a useful technological tool for overcoming such boundaries. In this review, we summarize and evaluate human VR conditioning studies exploring the role of the context as conditioned stimulus or occasion setter for CRs. We observe that VR allows successful acquisition of conditioned anxiety and conditioned fear in response to virtual contexts and virtual cues, respectively. VR studies also revealed that spatial or temporal contextual information determine whether conditioned anxiety and conditioned fear become extinguished and/or return. Novel contexts resembling the threatening context foster conditioned fear but not conditioned anxiety, suggesting distinct context-related generalization processes. We conclude VR contexts are able to strongly modulate CRs and therefore allow a comprehensive investigation of the modulatory role of the context over CR in humans leading to conclusions relevant for non-VR and clinical studies.
Article
Full-text available
The development and implementation of new information and communication technologies provide new forms of interaction between a computer and a person. One of these forms is virtual reality. The article examines immersive virtual reality and provides an analysis of 71 Russian and foreign works devoted to the latest research in the field of studying the phenomenon of virtual reality from the point of view of pedagogical and psychological sciences. Particular attention is paid to the impact of virtual reality on brain activity, behavior and learning. The study of these issues is necessary to analyze the possibility of using virtual reality in education. The sensation of being in a virtual environment in health and disease is considered, a description of the characteristics of virtual environments used in education is given. It is shown that the use of virtual reality demonstrates excellent opportunities in education, but it can also have some negative psychophysiological effects. The review discusses the data obtained by Russian and foreign researchers on the possible psychological risks of prolonged immersion of children and adolescents in virtual reality and suggests the use of virtual reality only on the basis of preliminary testing or questioning. It is concluded that virtual reality, like any other new phenomenon, requires further study.
Article
Full-text available
Background: The trauma film paradigm (TFP) is a well-established method to study the effects of analogue psychological trauma under controlled laboratory settings. It has been used to examine pre-, peri-, and post-trauma processes, and to create and test interventions. A possible drawback is that watching films is a somewhat passive endeavour that lacks active behavioural engagement. Virtual reality (VR) may provide a better alternative. Like the TFP, VR allows for experimental control. In addition, it can induce a greater ‘feeling of presence’ and allows interaction with the environment, enabling research on action–reaction associations. Objective: We aimed to validate the utility of a VR paradigm as an experimental model to study psychological trauma by comparing its effectiveness with the TFP. Method: One group of participants (N = 25) was shown an aversive film, and another group (N = 25) moved through a VR scene. Main outcome measures were intrusion frequency assessed with a 7-day diary and self-rated vividness and emotionality of recalled memories related to the film or VR scene. Results: The results indicate that the film and VR scene were equally effective in inducing vivid and intrusive memories. However, self-reported emotional intensity appeared to be higher for memories related to the film than for memories related to the VR scene. Conclusions: Perhaps the film was more effective in inducing emotional memories than the VR scene due to its more aversive content. However, the VR scene seemed equally effective in inducing vivid and intrusive memories, and merits further exploration in light of ethical considerations (less aversive content) and other presumably beneficial qualities (e.g. inducing a greater feeling of presence and allowing interaction with the environment).
Article
Full-text available
A better understanding of psychological trauma is fundamental to clinical psychology. Following traumatic event(s), a clinically significant number of people develop symptoms, including those of Acute Stress Disorder and/or Post Traumatic Stress Disorder. The trauma film paradigm offers an experimental psychopathology model to study both exposure and reactions to psychological trauma, including the hallmark symptom of intrusive memories. We reviewed 74 articles that have used this paradigm since the earliest review (Holmes & Bourne, 2008) until July 2014. Highlighting the different stages of trauma processing, i.e. pre, peri and post trauma, the studies are divided according to manipulations before, during and after film viewing, for experimental as well as correlational designs. While the majority of studies focussed on the frequency of intrusive memories, other reactions to trauma were also modelled. We discuss the strengths and weaknesses of the trauma film paradigm as an experimental psychopathology model of trauma, consider ethical issues, and suggest future directions. By understanding the basic mechanisms underlying trauma symptom development, we can begin to translate findings from the laboratory to the clinic, test innovative science-driven interventions, and in the future reduce the debilitating effects of psychopathology following stressful and/or traumatic events.
Article
Full-text available
Objectives: To present current, nationally representative US findings on the past-year and lifetime prevalences, sociodemographic correlates, psychiatric comorbidity, associated disability, and treatment of DSM-5 posttraumatic stress disorder (PTSD). Methods: Face-to-face interviews with 36,309 adults in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. PTSD, alcohol and drug use disorders, and selected mood, anxiety, and personality disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5. Results: Past-year and lifetime prevalences were 4.7 and 6.1 %, higher for female, white, Native American, younger, and previously married respondents, those with <high school education and lower incomes, and rural residents. PTSD was significantly associated with a broad range of substance use, mood, anxiety, and personality disorders, and past-month disability. Among respondents with lifetime PTSD, 59.4 % sought treatment; an average of 4.5 years elapsed from disorder onset to first treatment. Conclusions: DSM-5 PTSD is prevalent, highly comorbid, disabling, and associated with delayed help seeking. Additional research is needed to elucidate relationships identified herein, estimate PTSD-related costs, investigate hypotheses regarding etiology, course, and treatment, and support decisions about resource allocation to service delivery and research. Initiatives are needed to destigmatize PTSD, educate the public about its treatment, and encourage affected individuals to seek help.
Article
Full-text available
A review of 2,647 studies of posttraumatic stress disorder (PTSD) yielded 476 potential candidates for a meta-analysis of predictors of PTSD or of its symptoms. From these, 68 studies met criteria for inclusion in a meta-analysis of 7 predictors: (a) prior trauma, (b) prior psychological adjustment, (c) family history of psychopathology, (d) perceived life threat during the trauma, (e) posttrauma social support, (f) peritraumatic emotional responses, and (g) peritraumatic dissociation. All yielded significant effect sizes, with family history, prior trauma, and prior adjustment the smallest (weighted r = .17) and peritraumatic dissociation the largest (weighted r = .35). The results suggest that peritraumatic psychological processes, not prior characteristics, are the strongest predictors of PTSD.
Article
Full-text available
Most people will experience or witness a traumatic event. A common occurrence after trauma is the experience of involuntary emotional memories of the traumatic event, herewith "flashbacks". Some individuals, however, report no flashbacks. Prospective work investigating psychological factors associated with an absence of flashbacks is lacking. We performed an individual participant data meta-analysis on 16 experiments (n = 458) using the trauma film paradigm to investigate the association of emotional response to traumatic film footage and commonly collected baseline characteristics (trait anxiety, current depression, trauma history) with an absence of analogue flashbacks. An absence of analogue flashbacks was associated with low emotional response to the traumatic film footage and, to a lesser extent, low trait anxiety and low current depression levels. Trauma history and recognition memory for the film were not significantly associated with an absence of analogue flashbacks. Understanding why some individuals report an absence of flashbacks may aid preventative treatments against flashback development.
Article
Full-text available
Significance Media coverage of collective traumas may trigger psychological distress in individuals outside the directly affected community. We examined whether repeated media exposure to the Boston Marathon bombings was associated with acute stress and compared the impact of direct exposure (being at/near the bombings) vs. media exposure (bombing-related television, radio, print, online, and social media coverage) on acute stress. We conducted an Internet-based survey 2–4 wk postbombings with a nationally representative sample and representative subsamples from Boston and New York (4,675 adults). Repeated bombing-related media exposure was associated with higher acute stress than was direct exposure. Media coverage following collective traumas can diffuse acute stress widely. This unique study compares the impact of direct vs. indirect media-based community trauma exposure on acute stress responses.
Article
Full-text available
We conducted a systematic review of the literature to explore the longitudinal course of PTSD in DSM-5-defined trauma exposed populations to identify the course of illness and recovery for individuals and populations experiencing PTSD. We reviewed the published literature from January 1, 1998 to December 31, 2010 for longitudinal studies of directly exposed trauma populations in order to: (1) review rates of PTSD in the first year after a traumatic event; (2) examine potential types of proposed DSM-5 direct trauma exposure (intentional and non-intentional); and (3) identify the clinical course of PTSD (early onset, later onset, chronicity, remission, and resilience). Of the 2537 identified articles, 58 articles representing 35 unique subject populations met the proposed DSM-5 criteria for experiencing a traumatic event, and assessed PTSD at two or more time points within 12 months of the traumatic event. The mean prevalence of PTSD across all studies decreases from 28.8% (range = 3.1-87.5%) at 1 month to 17.0% (range = 0.6-43.8%) at 12 months. However, when traumatic events are classified into intentional and non-intentional, the median prevalences trend down for the non-intentional trauma exposed populations, while the median prevalences in the intentional trauma category steadily increase from 11.8% to 23.3%. Across five studies with sufficient data, 37.1% of those exposed to intentional trauma develop PTSD. Among those with PTSD, about one third (34.8%) remit after 3 months. Nearly 40% of those with PTSD (39.1%) have a chronic course, and only a very small fraction (3.5%) of new PTSD cases appears after three months. Understanding the trajectories of PTSD over time, and how it may vary by type of traumatic event (intentional vs. non-intentional) will assist public health planning and treatment.
Article
Full-text available
The study of individual differences in emotional responding can provide considerable insight into interpersonal dynamics and the etiology of psychopathology. Heart rate variability (HRV) analysis is emerging as an objective measure of regulated emotional responding (generating emotional responses of appropriate timing and magnitude). This review provides a theoretical and empirical rationale for the use of HRV as an index of individual differences in regulated emotional responding. Two major theoretical frameworks that articulate the role of HRV in emotional responding are presented, and relevant empirical literature is reviewed. The case is made that HRV is an accessible research tool that can increase the understanding of emotion in social and psychopathological processes. (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
Using emotional film clips is one of the most popular and effective methods of emotion elicitation. The main goal of the present study was to develop and test the effectiveness of a new and comprehensive set of emotional film excerpts. Fifty film experts were asked to remember specific film scenes that elicited fear, anger, sadness, disgust, amusement, tenderness, as well as emotionally neutral scenes. For each emotion, the 10 most frequently mentioned scenes were selected and cut into film clips. Next, 364 participants viewed the film clips in individual laboratory sessions and rated each film on multiple dimensions. Results showed that the film clips were effective with regard to several criteria such as emotional discreteness, arousal, positive and negative affect. Finally, ranking scores were computed for 24 classification criteria: Subjective arousal, positive and negative affect (derived from the PANAS; Watson & Tellegen, 1988), a positive and a negative affect scores derived from the Differential Emotions Scale (DES; Izard et al., 1974), six emotional discreteness scores (for anger, disgust, sadness, fear, amusement and tenderness), and 15 “mixed feelings” scores assessing the effectiveness of each film excerpt to produce blends of specific emotions. In addition, a number of emotionally neutral film clips were also validated. The database and editing instructions to construct the film clips have been made freely available in a website.
Article
Full-text available
Previously, we found that chronic PTSD relates to "intrusion-based reasoning" (IR), i.e. the tendency to interpret distressing intrusions themselves as evidence that danger is impending, regardless of objective danger information (Engelhard et al., Behav. Res. Ther. 39 (2001) 1139). This study was intended to elucidate the causal status of this relation. Twenty-nine residents of a Belgian town witnessed a train crash and were assessed for IR and PTSD symptoms within 1 month and were re-assessed for PTSD at 3.5 months. Fourteen control residents did not witness the crash and were also tested for IR. The IR paradigm involved rating the danger of brief scenarios in which objective danger and presence of intrusions about the crash were systematically varied. The directly exposed residents showed greater danger ratings to scenarios in which intrusions were included than did the controls. IR was strongly related to both acute and chronic PTSD symptoms. It did not significantly predict chronic PTSD symptoms after controlling for acute symptoms, although the partial correlation (r=0.26, p=0.09) was in the expected direction. The data suggest that IR is involved in the onset and maintenance of PTSD symptoms, but more clarity about causality awaits future larger and experimental studies.
Article
Full-text available
Three experiments indexed the effect of various concurrent tasks, while watching a traumatic film, on intrusive memory development. Hypotheses were based on the dual-representation theory of posttraumatic stress disorder (C. R. Brewin, T. Dalgleish, & S. Joseph, 1996). Nonclinical participants viewed a trauma film under various encoding conditions and recorded any spontaneous intrusive memories of the film over the following week in a diary. Changes in state dissociation, heart rate, and mood were also measured. As predicted, performing a visuospatial pattern tapping task at encoding significantly reduced the frequency of later intrusions, whereas a verbal distraction task increased them. Intrusive memories were largely unrelated to recall and recognition measures. Increases in dissociation and decreases in heart rate during the film were also associated with later intrusions.
Article
Full-text available
Reflective thinking occurs when information stored in long-term memory (LTM) is not sufficient to allow one to respond "automatically" to an object or event. Instead, stored information must be entered into working memory and a novel response or solution produced. In this article I argue that mental imagery plays a central role in this process, and that over the course of normal cognitive development the process of reflective thinking "programs" LTM so that an increasingly large number of tasks can be performed without reflective thinking. Normal cognitive development thus results in a decreasing reliance on imagery. However, if highly emotional images are formed, additional retrieval cues can be entered into LTM, making such images more likely to occur in the future. Such images induce arousal, similar to that induced by the actual event. This line of thinking leads to a novel perspective on the neurocognitive deficits that underlie the development of posttraumatic stress disorder, and may also help to explain some symptoms seen in hyperactivity, impulsiveness, and difficulties in self-control.
Article
Full-text available
The authors model the neural mechanisms underlying spatial cognition, integrating neuronal systems and behavioral data, and address the relationships between long-term memory, short-term memory, and imagery, and between egocentric and allocentric and visual and ideothetic representations. Long-term spatial memory is modeled as attractor dynamics within medial-temporal allocentric representations, and short-term memory is modeled as egocentric parietal representations driven by perception, retrieval, and imagery and modulated by directed attention. Both encoding and retrieval/imagery require translation between egocentric and allocentric representations, which are mediated by posterior parietal and retrosplenial areas and the use of head direction representations in Papez's circuit. Thus, the hippocampus effectively indexes information by real or imagined location, whereas Papez's circuit translates to imagery or from perception according to the direction of view. Modulation of this translation by motor efference allows spatial updating of representations, whereas prefrontal simulated motor efference allows mental exploration. The alternating temporal-parietal flows of information are organized by the theta rhythm. Simulations demonstrate the retrieval and updating of familiar spatial scenes, hemispatial neglect in memory, and the effects on hippocampal place cell firing of lesioned head direction representations and of conflicting visual and ideothetic inputs.
Article
Several factors have been linked to the severity of posttraumatic distress, although retrospective designs in much of the literature limit conclusions regarding the temporal relation between risk factors and corresponding symptoms. To address these concerns, the current project employed an analog trauma paradigm to assess the impact of background characteristics, stress response, and post-stressor affect regulation on subjective distress and intrusive memories experienced during the subsequent processing of emotional stimuli. University students (N = 184; 56% female, 42% White/Non-Hispanic) were shown graphic scenes of a televised suicide. Physiological activation was recorded during exposure with emotion ratings collected following the film. Participants then viewed a sadness- or humor-eliciting prime under instructions to inhibit or naturally express emotion. Intrusions experienced during the priming film and residual distress at study's conclusion were rated prior to debriefing. Hierarchical regression identified reductions in emotional valence as a robust predictor of intrusions and distress. Sympathetic activation and exposure to the sadness prime were associated with intrusion frequency, whereas attenuated parasympathetic response predicted intrusion intensity. Expressive inhibition demonstrated a unique association with residual distress. Results suggest peritraumatic processes and post-exposure factors may hold more prominent relations with immediate trauma-related distress as compared to pre-existing survivor characteristics.
Article
Background and objectives: In Eye Movement and Desensitization and Reprocessing (EMDR) therapy, a dual-task approach is used: patients make horizontal eye movements while they recall aversive memories. Studies showed that this reduces memory vividness and/or emotionality. A strong explanation is provided by working memory theory, which suggests that other taxing dual-tasks are also effective. Experiment 1 tested whether a visuospatial task which was carried out while participants were blindfolded taxes working memory. Experiment 2 tested whether this task degrades negative memories induced by a virtual reality (VR) paradigm. Methods: In experiment 1, participants responded to auditory cues with or without simultaneously carrying out the visuospatial task. In experiment 2, participants recalled negative memories induced by a VR paradigm. The experimental group simultaneously carried out the visuospatial task, and a control group merely recalled the memories. Changes in self-rated memory vividness and emotionality were measured. Results: The slowing down of reaction times due to the visuospatial task indicated that its cognitive load was greater than the load of the eye movements task in previous studies. The task also led to reductions in emotionality (but not vividness) of memories induced by the VR paradigm. Limitations: Weaknesses are that only males were tested in experiment 1, and the effectiveness of the VR fear/trauma induction was not assessed with ratings of mood or intrusions in experiment 2. Conclusions: The results suggest that the visuospatial task may be applicable in clinical settings, and the VR paradigm may provide a useful method of inducing negative memories.
Article
Previous research on vulnerability to Post-Traumatic Stress Disorder (PTSD) has been restricted by the absence of prospective studies that measure individual differences prior to traumatization. This study investigated the predictors of analogue post-traumatic intrusive cognitions using a fully prospective design. Non-patient participants completed a range of predictor measures before being exposed to a film about a traumatic fire. Film-induced changes in negative mood were also assessed. Subsequent intrusions were measured both within the experimental session and for a further seven days. The hypothesized predictors were: neuroticism, trait anxiety, extraversion, depression, a general tendency to suppress unpleasant thoughts, beliefs about being 'at risk' from fire, mental imagery, self-rated proneness to intrusions and negative mood changes. The results showed that intrusions were predicted by film-induced increases in negative mood, thought suppression tendencies, beliefs about vulnerability to fire and self-rated proneness to intrusive cognitions. The findings are discussed in relation to the literature on thought suppression and cognitive processes in PTSD.
Article
During imagery rescripting (ImRs) an aversive memory is relived and transformed to have a more positive outcome. ImRs is frequently applied in psychological treatment and is known to reduce intrusions and distress of the memory. However, little is known about the necessity to incorporate the central aversive parts of the memory in ImRs. To examine this necessity one hundred participants watched an aversive film and were subsequently randomly assigned to one of four experimental conditions: ImRs including the aversive scenes (Late ImRs), ImRs without the aversive scenes (Early ImRs), imaginal exposure (IE) or a control condition (Cont). Participants in the IE intervention reported the highest distress levels during the intervention; Cont resulted in the lowest levels of self-reported distress. For the intrusion frequency, only the late ImRs resulted in fewer intrusions compared to the Cont condition; Early ImRs produced significantly more intrusions than the Late ImRs or IE condition. Finally, the intrusions of the Late ImRs condition were reported as less vivid compared to the other conditions. To conclude, it seems beneficial including aversive scenes in ImRs after an analogue trauma induction.
Article
Most people are exposed to a violent or life-threatening situation during their lives, but only a minority develops post-traumatic stress disorder (PTSD). Experimental studies are necessary to assess risk factors, such as imagery ability, for the development of PTSD. Up to now the trauma film paradigm (TFP) has functioned as an analogue for PTSD. This paradigm is known to induce involuntary intrusions, a core symptom of PTSD. Though useful, the film paradigm has a drawback, the participant remains an “outsider” and does not immerse in the film scenes. The aim of the present study was to develop a fitting virtual reality (VR) analogue for PTSD and to assess risk factors for the development of PTSD-symptoms, such as intrusions. To this end a novel VR paradigm was compared to the traditional TFP. Both the VR and TFP elicited a negative mood and induction-related intrusions. More immersion was observed in the VR paradigm compared to the TFP. The results of the risk factors were mixed; more imagery ability coincided with a higher intrusion frequency, but also with less distressing intrusions. The results, implications and suggestions for future research are discussed.
Article
Unlabelled: Recent experimental data show that associative learning processes are involved not only in the acquisition but also in the spreading of pain-related fear. Clinical studies suggest involvement of positive affect in resilience against chronic pain. Surprisingly, the role of positive affect in associative learning in general, and in fear generalization in particular, has received scant attention. In a voluntary movement paradigm, in which one arm movement (reinforced conditioned stimulus [CS+]) was followed by a painful stimulus and another was not (unreinforced conditioned stimulus [CS-]), we tested generalization of fear inhibition in response to 5 novel but related generalization movements (GSs; within-subjects) after either a positive affect induction or a control exercise (Group = between-subjects) in healthy participants (N = 50). The GSs' similarity with the original CS+ movement and CS- movement varied. Fear learning was assessed via verbal ratings. Results indicated that there was an interaction between the increase in positive affect and the linear generalization gradient. Stronger increases in positive affect were associated with steeper generalization curves because of relatively lower pain-unconditioned stimulus expectancy and less fear of stimuli more similar to the CS-. There was no Group by Stimulus interaction. Results thus suggest that positive affect may enhance safety learning through promoting generalization from known safe movements to novel yet related movements. Improved safety learning may be a central mechanism underlying the association between positive affect and increased resilience against chronic pain. Perspective: We investigated the extent to which positive affect influences the generalization (ie, spreading) of pain-related fear inhibition in response to situations similar to the original, pain-eliciting situation. Results suggest that increasing positive affect in the acute pain stage may limit the spreading of pain-related fear, thereby potentially inhibiting transition to chronic pain conditions.
Article
Learning abnormalities have long been centrally implicated in posttraumatic psychopathology. Indeed, of all anxiety disorders, PTSD may be most clearly attributable to discrete, aversive learning events. In PTSD, such learning is acquired during the traumatic encounter and is expressed as both conditioned fear to stimuli associated with the event and more general over-reactivity—or failure to adapt—to intense, novel, or fear-related stimuli. The relatively straightforward link between PTSD and these basic, evolutionarily old, learning processes of conditioning, sensitization, and habituation affords models of PTSD comprised of fundamental, experimentally tractable mechanisms of learning that have been well characterized across a variety of mammalian species including humans. Though such learning mechanisms have featured prominently in explanatory models of psychological maladjustment to trauma for at least 90 years, much of the empirical testing of these models has occurred only in the past two decades. The current review delineates the variety of theories forming this longstanding tradition of learning-based models of PTSD, details empirical evidence for such models, attempts an integrative account of results from this literature, and specifies limitations of, and future directions for, studies testing learning models of PTSD.
Article
Prevalence of posttraumatic stress disorder (PTSD) defined according to the American Psychiatric Association's Diagnostic and Statistical Manual fifth edition (DSM-5; 2013) and fourth edition (DSM-IV; 1994) was compared in a national sample of U.S. adults (N = 2,953) recruited from an online panel. Exposure to traumatic events, PTSD symptoms, and functional impairment were assessed online using a highly structured, self-administered survey. Traumatic event exposure using DSM-5 criteria was high (89.7%), and exposure to multiple traumatic event types was the norm. PTSD caseness was determined using Same Event (i.e., all symptom criteria met to the same event type) and Composite Event (i.e., symptom criteria met to a combination of event types) definitions. Lifetime, past-12-month, and past 6-month PTSD prevalence using the Same Event definition for DSM-5 was 8.3%, 4.7%, and 3.8% respectively. All 6 DSM-5 prevalence estimates were slightly lower than their DSM-IV counterparts, although only 2 of these differences were statistically significant. DSM-5 PTSD prevalence was higher among women than among men, and prevalence increased with greater traumatic event exposure. Major reasons individuals met DSM-IV criteria, but not DSM-5 criteria were the exclusion of nonaccidental, nonviolent deaths from Criterion A, and the new requirement of at least 1 active avoidance symptom.
Article
The misinformation effect is defined as an impairment in memory for past events due to exposure to misleading information (E. F. Loftus, 2005 ). Some people may be more susceptible to the misinformation effect than others, and this may also depend on their response to a distressing event. The purpose of the current study was to investigate several key factors that may contribute to misinformation susceptibility for distressing events, namely posttraumatic stress disorder symptoms such as avoidance, intrusions, and dissociation. Participants watched either a neutral or trauma film, rated their level of distress, and completed measures of trait and state dissociation. When participants returned a week later, misinformation was introduced via an eyewitness statement and free recall was assessed. Findings indicated that dissociation was related to higher distress ratings following the film but was not related to acceptance of misinformation. However, avoidance scores were related to increased recall of misinformation items, and reported experiences of intrusions were related to greater accuracy. These results are discussed in light of the paradoxical negative emotion hypothesis.
Article
Posttraumatic stress disorder (PTSD) is characterized by vivid intrusive memories of the trauma. Among these, visual sensations of the trauma are most commonly reported. However, intrusions may involve other senses as well (e.g., acoustic, olfactory, or bodily sensations). It has been proposed that enhanced mental imagery may predispose individuals with traumatic experiences to intrusions and ultimately to PTSD. A total of 58 victims of interpersonal violence with current (n = 20), past (n = 19), and no lifetime PTSD (n = 19) as well as non-traumatized controls (n = 23) were assessed with the Vividness of Visual Imagery Questionnaire (VVIQ) and a modality-specific imagery questionnaire. Moreover, the sensory quality of the traumatic intrusions was assessed in traumatized participants. Participants with recovered PTSD displayed less overall mental imagery than the other three groups who were indistinguishable. No relation was found between the modality-specific mental imagery and the sensory quality of the intrusions. The impact of mental imagery on intrusive memories in PTSD is complex. Less mental imagery appears beneficial in the recovery process, but does not prevent the development of intrusive symptoms in the first place. Further investigation of perceptual and memory vividness as well imagery control (i.e., to sustain, modify, or terminate an image) also including trauma-related material may be important for trauma-specific interventions.
Article
Our contribution to this special issue focuses on the phenomenon of intrusive trauma memory. While intrusive trauma memories can undoubtedly cause impairment, we argue that they may exist for a potentially adaptive reason. Theory and experimental research on intrusion development are reviewed and possible functions of intrusive trauma memory are explored. These functions include aiding emotional processing, preventing future harm and protecting the coherence of the self. The issue of intrusive images in other disorders than posttraumatic stress disorder is briefly addressed. This review suggests that the study of function is important for a nuanced view on the modulation of intrusive trauma memory in both experimental psychopathology and clinical treatment. Copyright © 2009 John Wiley & Sons, Ltd.
Article
This study aimed to cross-validate earlier findings regarding the diagnostic efficiency of a modified version of the Primary Care Posttraumatic Stress Disorder (PC-PTSD) screening questionnaire (A. Prins, P. Ouimette, R. Kimerling, R. P. Cameron, D. S. Hugelshofer, J. Shaw-Hegwer, et al., 2004). The PC-PTSD is a four-item screening questionnaire for Posttraumatic Stress Disorder (PTSD). Based on former research, we adapted the PC-PTSD for use among civilian substance use disorder (SUD) patients (D. Van Dam, T. Ehring, E. Vedel, & P. M. G. Emmelkamp, 2010). This version will be referred to as the Jellinek-PTSD (J-PTSD) screening questionnaire. Results showed a high sensitivity (.87), specificity (.75), and overall efficiency (.77) of the J-PTSD in detecting PTSD when using a cutoff score of 2. This confirms findings in former research, and suggests that the J-PTSD is a useful screening instrument for PTSD within a civilian SUD population. Both PTSD and SUD are severe and disabling disorders causing great psychological distress. An early recognition of PTSD among SUD patients makes it possible to address PTSD symptoms in time, which may ultimately lead to an improvement of symptoms in this complex patient group.
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
While some individuals develop PTSD subsequent to traumatic experiences, many individuals resume prior functioning naturally. Diathesis-stress models suggest that stable individual differences present in individuals prior to trauma may serve as vulnerability factors to symptom development. The high levels of comorbidity and symptom similarity suggest that established vulnerability factors for anxiety and depression may also serve as vulnerability factors for PTSD. The examination of multiple vulnerability factors simultaneously may increase understanding of the etiology of PTSD and comorbid post-trauma symptomatology and account for a greater percentage of variance in PTSD symptoms. In addition, the vulnerability factors may be related to distinct sets of symptoms, with vulnerabilities predicting the PTSD symptoms most similar to their associated disorders. Research examining the relations between attributional style, rumination, anxiety sensitivity, and the looming cognitive style and the development of PTSD after trauma exposure is reviewed and suggestions for future research are provided.
Article
Contemporary theories predict PTSD development after trauma if trauma information is not adequately processed or negatively appraised. Mental imagery and emotional processing seem to be strongly related and evidence-based treatment strategies such as imaginal exposure and EMDR indeed include imagery as a main component. Moreover, imagery rescripting of traumatic memories is an effective treatment for PTSD. The present study combined these lines of research and investigated the impact of early imagery rescripting on intrusion development after an aversive film. Seventy-six participants were randomly allocated to one of three conditions: imagery rescripting (IRS), imagery reexperiencing (IRE) and positive imagery (PI). All participants watched an aversive film, had a 30-min break and then received a 9-min intervention (IRS, IRE or PI). They indicated subjective distress during the intervention, recorded intrusive memories of the film for 1 week and completed the Posttraumatic Cognitions Inventory (PTCI) and a cued recall test one week later. The IRS group developed fewer intrusive memories relative to the IRE and PI groups, and less negative cognitions than the IRE group, while cued recall was enhanced in IRS and IRE groups compared to the PI group. IRS and PI groups experienced less distress during the intervention than the IRE group. This is an analogue design and results should be replicated in clinical samples. The results suggest that IRS might be an adequate technique to change memory consolidation at an early stage and therefore a powerful and non-distressing strategy to prevent PTSD symptoms.
Article
Intrusive memories appear to enter consciousness via involuntary rather than deliberate recollection. Some clinical accounts of PTSD seek to explain this phenomenon by making a clear distinction between the encoding of sensory-based and contextual representations. Contextual representations have been claimed to actively reduce intrusions by anchoring encoded perceptual data for an event in memory. The current analogue trauma study examined this hypothesis by manipulating contextual information independently from encoded sensory-perceptual information. Participants' viewed images selected from the International Affective Picture System that depicted scenes of violence and bodily injury. Images were viewed either under neutral conditions or paired with contextual information. Two experiments revealed a significant increase in memory intrusions for images paired with contextual information in comparison to the same images viewed under neutral conditions. In contrast to the observed increase in intrusion frequency there was no effect of contextual representations on voluntary memory for the images. The vividness and emotionality of memory intrusions were also unaffected. The analogue trauma paradigm may fail to replicate the effect of extreme stress on encoding postulated to occur during PTSD. These findings question the assertion that intrusive memories develop from a lack of integration between sensory-based and contextual representations in memory. Instead it is argued contextual representations play a causal role in increasing the frequency of intrusions by increasing the sensitivity of memory to involuntary retrieval by associated internal and external cues.
Article
Human behavior can be organized around two fundamental motivational principles: the desire to approach positive outcomes and the desire to avoid negative outcomes. Both approach and avoidance motivation are relevant to a range of psychopathology, including depression. However, with some notable exceptions, avoidance processes have been underemphasized in the literature on motivational processes in depression. This review will examine the roles that approach and avoidance play in depression and will present an integrative model of approach and avoidance processes in depression. Both approach deficits and avoidance motivation are argued to play a role in limiting positive experiences and reinforcement for non-depressed behavior, contributing to the onset and maintenance of depression. In addition, avoidance processes are argued to play a role in negative information processing biases that may increase vulnerability to the onset and recurrence of depression. Lastly, avoidance processes and dysregulation in the connections between the approach and avoidance systems may contribute to depression by promoting inappropriate perseveration in the pursuit of unattainable approach goals. Theoretical rationales and empirical evidence for each of these roles are presented. Understanding the roles that both approach and avoidance play in depression may help to inform current conceptualizations of depression and improve treatment outcomes.
Article
To understand mental disorders, analogue paradigms provide an indispensable contribution. In posttraumatic stress disorder (PTSD), the stressful film paradigm is a frequently used analogue approach: Films depicting traumatic events are shown to non-clinical participants in order to elicit stress responses analogue to responses to traumatic events in real life. Previous studies used a large variety of films, which is problematic with regard to the comparability of results. The main goal of this study was to identify a film clip that (a) consistently provokes stress reactions and (b) provokes reactions that are as similar as possible to traumatic stress. We randomly exposed 105 male and female participants to one of four stressful films, differing, e.g., in content and origin. Intrusive memories of the film, reported immediately after the film and during a diary phase of three days, as well as distress, heart rate, and several mood states were measured. A film clip depicting rape elicited the most consistent reactions that were characterized by a higher heart rate, more distress and more intrusive memories, compared to the other three clips. Intrusive memories across all films were especially related to an increase in heart rate and disgust in response to the film.
Article
Structural equation modeling was used to develop and test an integrated model of how emotional and cognitive factors contribute to the development of intrusive memories after a distressing event. The emotional constructs included preexisting emotion and emotional reactivity to the distressing event. Cognitive constructs included peritraumatic cognitive processing and maladaptive coping strategies. Using a prospective design, 148 undergraduate students viewed a distressing film and recorded their film-related intrusive memories over the following week. The results indicated that emotional reactivity and, to a lesser extent, preexisting emotion, predicted peritraumatic cognitive processing during the film, which in turn predicted the use of maladaptive coping strategies (i.e., rumination, thought suppression, and safety behaviors). Furthermore, emotional reactivity and maladaptive coping strategies directly predicted intrusive memories. The observed model supported the importance of cognitive variables central to cognitive models, placing them in a broader context.
Article
This study describes the initial reliability and validity data on the Adolescent Dissociative Experiences Scale (A-DES), a screening measure for pathological dissociation during adolescence. The A-DES showed good scale and subscale reliability, and, as hypothesized, increased scores were associated with reported trauma in a patient population. A-DES scores were able to distinguish dissociative disordered adolescents from a normal sample and from a patient sample with a variety of diagnoses.
Article
Meta-analyses were conducted on 14 separate risk factors for posttraumatic stress disorder (PTSD), and the moderating effects of various sample and study characteristics, including civilian/military status, were examined. Three categories of risk factor emerged: Factors such as gender, age at trauma, and race that predicted PTSD in some populations but not in others; factors such as education, previous trauma, and general childhood adversity that predicted PTSD more consistently but to a varying extent according to the populations studied and the methods used; and factors such as psychiatric history, reported childhood abuse, and family psychiatric history that had more uniform predictive effects. Individually, the effect size of all the risk factors was modest, but factors operating during or after the trauma, such as trauma severity, lack of social support, and additional life stress, had somewhat stronger effects than pretrauma factors.
Article
The occurrence of memory intrusions after a trauma has been linked to peri-traumatic dissociation. In this study, we attempted to induce dissociation experimentally and investigate the impact on intrusive memories. A total of 39 undergraduates were randomly assigned to watch a stressful film under standard conditions or under a dual-task condition in which they simultaneously performed a tapping task. They rated their distress post-film and again after 2 weeks, and kept a diary of intrusive memories. Contrary to prediction, there were no differences in levels of distress or explicit memory between the two conditions, and the dual-task condition was followed by significantly fewer memory intrusions. Dual-task conditions may not provide a good analogue to naturally occurring dissociation. The possible preventive effects of the tapping task are discussed in terms of the dual-representation theory of post-traumatic stress disorder.
Article
This study examined risk factors for posttraumatic stress disorder (PTSD) in Vietnam veterans: 68 women and 414 men of whom 88 were White, 63 Black, 80 Hispanic, 90 Native Hawaiian, and 93 Japanese American. Continuation ratio logistic regression was used to compare the predictive power of risk factors for the development versus maintenance of full or partial PTSD. The development of PTSD was related to premilitary, military, and postmilitary factors. The maintenance of PTSD was related primarily to military and postmilitary factors. Multivariate analyses identified different models for development and maintenance. We conclude that development of PTSD is related to factors that occur before, during, and after a traumatic event, whereas failure to recover is related primarily to factors that occur during and after the event.
Article
Posttraumatic stress disorder (PTSD) is one of the few psychiatric conditions where a specific psychosocial stressor is explicitly tied to etiology. Although a majority of people experience a traumatic event in their life, most of them will not develop PTSD or other mental health problems such as depressive or anxiety disorders. Emotional and neurobiological responses to psychosocial stressors show striking individual variation. In this paper cognitive appraisal and coping factors are explored as potential sources of individual differences in the neuroendocrinological stress response, and subsequently in mental health outcome. Continued study of the psychobiology of trauma and PTSD will enhance our understanding of adaptation to psychosocial stressors and support efforts to treat associated psychological and biological sequelae.
Article
Trauma-related cognitions play an increasingly prominent role in research on trauma and in clinical practice. The present study investigated the psychometric characteristics of the Dutch version of the posttraumatic cognitions inventory (PTCI) and evaluated its potential as an outcome measure. Data were collected from a treatment-seeking sample of trauma victims (n=158) and a college sample (n=178). The PTCI's three-factor structure was retained in both samples. The PTCI demonstrated high internal consistency and two-week test-retest reliability. Convergent validity was evidenced by a pattern of correlations with instruments for trauma-related cognitions, posttraumatic stress disorder, and depressive symptoms that largely met a priori expectations. Reductions in self-reported and clinician-assessed posttraumatic stress disorder symptoms were positively associated with decreased PTCI scores, indicating that the PTCI could assist treatment evaluation. It is concluded that the Dutch version of the PTCI exhibits good psychometric characteristics and has the potential to contribute to trauma-related research.
Article
This small-scale study investigates the relationships between the heart rate of motor vehicle accident survivors presenting in the emergency department (ED) and acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) symptom severity. It also examines the relationships between the survivor's heart rate in the ED and peritraumatic dissociation and peritraumatic distress reported 2 weeks posttrauma. Fifty motor vehicle accident (MVA) survivors were assessed 2 weeks, 1 (N = 42), 3 (N = 37), and 6 months (N = 37) post-MVA. The heart rate in the ED predicted self-reported ASD symptom severity and clinician-rated PTSD symptom severity at 6 months but not at 1 or 3 months. Survivors' heart rate in the ED was significantly correlated with peritraumatic dissociation but not peritraumatic distress. These findings support the role of elevated ED heart rate as a predictor of both ASD and chronic PTSD symptom severity and may help to clarify the discrepant findings of previous research.
Article
Clinical theories of post-traumatic stress suggest that encoding processes at the time of a trauma are critical in determining whether intrusive memories will develop. Potential mechanisms that might influence the development of intrusive memories were studied, as was objective memory performance. In an analogue design, 65 participants were randomised to three conditions (cognitive load, hyperventilation, and control), and then watched a film of traumatic content. Intrusive memories were recorded during the experimental phase and at 1-week follow-up. Support was found for the prediction that verbal cognitive load and hyperventilation would facilitate intrusion development immediately following exposure to the trauma film; however, this was not maintained at follow-up. Consistent with cognitive models of post-traumatic stress, thought suppression and the distress associated with intrusive experiences mediated the relationship between distress caused by the film and intrusions at 1-week follow-up. Objective memory testing indicated that the three experimental groups showed similar recall and recognition performance for the content of the film; however, relative to the control group, individuals in the cognitive load condition were significantly less able to place film scenes in the correct order.
Article
For many decades, the stress process was described primarily in terms of negative emotions. However, robust evidence that positive emotions co-occurred with negative emotions during intensely stressful situations suggested the need to consider the possible roles of positive emotions in the stress process. About 10 years ago, these possibilities were incorporated into a revision of stress and coping theory (Folkman, 1997). This article summarizes the research reported during the intervening 10 years that pertains to the revised model. Evidence has accumulated regarding the co-occurrence of positive and negative emotions during stressful periods; the restorative function of positive emotions with respect to physiological, psychological, and social coping resources; and the kinds of coping processes that generate positive emotions including benefit finding and reminding, adaptive goal processes, reordering priorities, and infusing ordinary events with positive meaning. Overall, the evidence supports the propositions set forth in the revised model. Contrary to earlier tendencies to dismiss positive emotions, the evidence indicates they have important functions in the stress process and are related to coping processes that are distinct from those that regulate distress. Including positive emotions in future studies will help address an imbalance between research and clinical practice due to decades of nearly exclusive concern with the negative emotions.
BDI-II-NL handleiding; de nederlandse versie van de Beck depression inventory
  • A J W Van Der Does
Van der Does, A. J. W. (2002). BDI-II-NL handleiding; de nederlandse versie van de Beck depression inventory-(2nd ed.). Enschede: Ipskamp.