Chris R. Brewin's research while affiliated with University College London and other places

Publications (353)

Article
In cognitive-behaviour therapy attention paid to the self and identity has primarily involved self-representations (the Me-Self) rather than how the self is experienced (the I-Self). Within the I-Self experiences vary on a continuum from pre-reflective consciousness (raw experienced perceptions and states of being) to self-awareness (permitting ref...
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Based on research from previous pandemics, studies of critical care survivors, and emerging COVID-19 data, we estimate that up to 30% of survivors of severe COVID will develop PTSD. PTSD is frequently undetected across primary and secondary care settings and the psychological needs of survivors may be overshadowed by a focus on physical recovery. D...
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Background: The 11th revision of the International Classification of Diseases (ICD-11) includes a new diagnosis of complex posttraumatic stress disorder (CPTSD). The International Trauma Interview (ITI) is a novel clinician-administered diagnostic interview for the assessment of ICD-11 PTSD and CPTSD. Objective: The aim of this study was to evalua...
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Background: Disasters can have long-lasting impacts on mental health. Intrusive memories have been found to be common and persistent in the aftermath of earthquakes. Objective: To explore, using diaries, intrusive memories' presence, content, characteristics, and relationship with probable post-traumatic stress disorder (PTSD) in a small rural c...
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Although it is recognized that voice-hearers often report a large number and variety of voices there have been few investigations of this multiplicity. Understanding the phenomenology of voice-hearing can provide a firm foundation for theorizing about its causes. In this international online survey of voice-hearers, details were elicited of the con...
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It has been widely reported that surveys have found high levels of ICD-11 complex post-traumatic stress disorder (CPTSD) (12.6%) among police personnel, and a further 8.0% with PTSD. Until now, there has been little research linking PTSD to working conditions. This report examines how the prevalence of CPTSD varies with measures of job quality. Pos...
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Two recent surveys have reported widely differing prevalence rates for posttraumatic stress disorder (PTSD) within the U.K. police force. Stevelink et al. (2020) reported a rate of 3.9% whereas a survey conducted for the charity Police Care UK reported a rate of 20.6%. In this comment we discuss how definitions and methodological factors can impact...
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Among the important changes in the ICD-11 is the addition of 21 new mental disorders. New categories are typically proposed to: a) improve the usefulness of morbidity statistics; b) facilitate recognition of a clinically important but poorly classified mental disorder in order to provide appropriate management; and c) stimulate research into more e...
Article
Epidemiological studies show 30% to 50% of all patients in community mental health teams have personality disorders. These are normally comorbid with other psychiatric disorders, often as Galenic syndromes, and are seldom identified. In the Boston (UK) Personality Project all patients under a community health service in Boston in Lincolnshire will...
Article
Overgeneralizations by psychologists of the research evidence on memory and eyewitness testimony, such as “memory decays with time” or “memories are fluid and malleable,” are beginning to appear in legal judgements and guidance documents, accompanied by unwarranted disparagement of lay beliefs about memory. These overgeneralizations could have sign...
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Objectives Post-traumatic stress disorder (PTSD) is commonly experienced in the aftermath of major incidents such as terrorism and pandemics. Well-established principles of response include effective and scalable treatment for individuals affected by PTSD. In England, such responses have combined proactive outreach, screening and evidence-based int...
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Cognitive theories of posttraumatic stress disorder (PTSD) suggest that intrusive memories result from disrupted information processing during traumatic memory encoding and are characterized by fear, helplessness, and horror at recall. Existing naturalistic studies are limited by the absence of direct comparisons between specific moments that do an...
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Objectives COVID-19 has altered standard thresholds for identifying anxiety and depression. A brief questionnaire to determine when individuals are at a tipping point for severe anxiety or depression would greatly help decisions about when to seek assessment or treatment. Design Data were collected as part of the Frontline-COVID Study, a cross-sec...
Article
Objective The objectives of this study were to develop and refine EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), a brief manualized cognitive-behavioral, acceptance-based intervention for surrogate decision-makers of critically ill patients and to evaluate its preliminary feasibility, acceptability, and promise in imp...
Article
Berkowitz et al. (Berkowitz, S. R., Garrett, B. L., Fenn, K. M., & Loftus, E. F. (2020). Convicting with confidence? Why we should not over-rely on eyewitness confidence. Memory. https://doi.org/10.1080/09658211.2020.1849308) attribute to us the claim that "confidence trumps all", and the few out-of-context quotations they selected can certainly be...
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Background: Studies have shown that working in frontline healthcare roles during epidemics and pandemics was associated with PTSD, depression, anxiety, and other mental health disorders. Objectives: The objectives of this study were to identify demographic, work-related and other predictors for clinically significant PTSD, depression, and anxiety d...
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Adults with posttraumatic stress disorder from childhood trauma (ch‐PTSD) described their ‘worst’ traumatic event (a single or repeated event) pre‐post treatment for PTSD during an international clinical trial. The memory reports were coded for specificity (Episodic vs General) and level of detail. Repeated Event narratives contained more generic a...
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Peritraumatic reactions such as fear, psychic and somatoform dissociation, tonic immobility, data-driven processing, and mental defeat are important in the etiology of posttraumatic stress disorder (PTSD). However, current measures of such reactions overlap conceptually and do not clearly identify distinct peritraumatic processes. It is not known w...
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Experiencing psychological trauma during childhood and/or adolescence is associated with an increased risk of psychosis in adulthood. However, we lack a clear knowledge of how developmental trauma induces vulnerability to psychotic symptoms. Understanding the psychological processes involved in this association is crucial to the development of prev...
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It has often been suggested that the field would benefit from a single, unified classification of mental disorders, although the priorities and constituencies of the two sponsoring organizations are quite different. During the development of the ICD-11 and DSM-5, the World Health Organization (WHO) and the APA made efforts toward harmonizing the tw...
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This letter to the editor responds to a recent EJPT editorial and following commentary which express concerns about the validity of the ICD-11 complex PTSD (CPTSD) diagnosis. Achterhof and colleagues caution that latent profile analyses and latent class analyses, which have been frequently used to demonstrate the discriminative validity of the ICD-...
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The recent release of the 11th version of The International Classification of Diseases (ICD‐11: WHO, 2018) marked a significant departure from the previous similarities between it and the Diagnostic and Statistical Manual of Mental Disorders (DSM‐5; APA, 2013) in terms of their conceptualization of posttraumatic stress disorder (PTSD). The ICD‐11 p...
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Thoughts, feelings, and behaviors during traumatic events, that is, peritraumatic reactions, are key to post-trauma psychopathology development. Qualitative research is required to investigate whether existing quantitative methods capture the range and complexity of peritraumatic reactions as described by survivors. Semi-structured interviews were...
Preprint
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Background Studies have shown that working in frontline healthcare roles during epidemics and pandemics was associated with PTSD, depression, anxiety, and other mental health disorders. Objectives The objectives of this study were to identify demographic, work-related and other predictors for clinically significant PTSD, depression, and anxiety du...
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In this article, Chris Brewin and colleagues draw on their experiences of managing the mental health consequences of major incidents, including in the case of pandemics, and highlight how responses in this area tend to be inadequately planned and funded.
Article
In this response to Otgaar et al. (in press) we point out that their concern with the notion of unconscious repression is a classic example of a red herring, as it has never been endorsed as an explanation of recovered memories. We also note that Otgaar et al. have misunderstood the purpose of our article (Brewin, Li, Ntarantana, Unsworth, & McNeil...
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Objective: There is little evidence that posttraumatic stress disorder (PTSD) is more likely to follow traumatic events defined by Criterion A than non-Criterion A stressors. Criterion A events might have greater predictive validity for International Classification of Diseases (ICD)-11 PTSD, which is a condition more narrowly defined by core featu...
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Background: We investigated work-related exposure to stressful and traumatic events in police officers, including repeated exposure to traumatic materials, and predicted that ICD-11 complex PTSD (CPTSD) would be more prevalent than posttraumatic stress disorder (PTSD). The effects of demographic variables on exposure and PTSD were examined, along...
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In the November 2019 issue of Perspectives, Otgaar et al. argued that the “memory wars” persist and that “the controversial issue of repressed memories is alive and well and may even be on the rise” (p. 1072). Their thesis overlooked the well-established consensus that recovered memories of trauma may be genuine, false, or a mixture of the two and...
Preprint
Background Post-traumatic stress disorder (PTSD) is commonly experienced in the aftermath of major incidents such as terrorism and pandemics. Well-established principles of response include effective and scalable treatment for individuals affected by PTSD. In England, such responses have combined proactive outreach, screening, and evidence-based in...
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Posttraumatic stress disorder (PTSD) is characterized by disruptions in memory, including vivid sensory images of the trauma that are involuntarily reexperienced. However, the extent and nature of disruptions to deliberate memory for trauma remain controversial. A unitary account posits that all aspects of memory for a traumatic event are strengthe...
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Background: Older people are vulnerable to sustained high levels of psychosocial distress following a crime. A cognitive behavioural therapy (CBT)-informed psychological therapy, the Victim Improvement Package (VIP) may aid recovery. The VIP trial aims to test the clinical and cost-effectiveness of the VIP for alleviating depressive and anxiety sy...
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Intrusive memories are a core symptom of Post-Traumatic Stress Disorder (PTSD). A growing body of analogue studies using trauma films suggest that carrying out specific demanding tasks (e.g., playing the video game Tetris, pattern tapping) after the analogue trauma can reduce intrusive memories. To examine the mechanism behind this effect, we teste...
Article
In the last 20 years, the consensus about memory being essentially reliable has been neglected in favor of an emphasis on the malleability and unreliability of memory and on the public’s supposed unawareness of this. Three claims in particular have underpinned this popular perspective: that the confidence people have in their memory is weakly relat...
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An update of the chapter on Mental, Behavioral and Neurodevelopmental Disorders in the International Classification of Diseases and Related Health Problems (ICD) is of great interest around the world. The recent approval of the 11th Revision of the ICD (ICD-11) by the World Health Organization (WHO) raises broad questions about the status of nosolo...
Article
The primary aim of this study was to provide an assessment of the current prevalence rates of International Classification of Diseases (11th rev.) posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) among the adult population of the United States and to identify characteristics and correlates associated with each disorder. A total of 7.2%...
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Background: Attributions of both cause and blame form part of the diagnostic criteria for PTSD in DSM-5. Most work on attributions and psychopathology has focused on survivors of interpersonal violence and the two types of attribution have not been investigated together in natural disaster contexts. Previous work has identified that attributions to...
Article
Mental health responses for people caught up in terror attacks are often inadequate. Internationally, existing services repeatedly fail to identify those with short and long term needs, resulting in an increased prevalence of post-traumatic stress disorder, depression, and anxiety disorders compared with the general population. Health services shou...
Article
Mental health responses for people caught up in terror attacks are often inadequate. Internationally, existing services repeatedly fail to identify those with short and long term needs, resulting in an increased prevalence of post-traumatic stress disorder, depression, and anxiety disorders compared with the general population.1 Health services sho...
Article
The World Health Organization's proposals in ICD-11, released for comment by member states in 2018, introduce for the first time in a major diagnostic system a distinction between post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD). This article sets the new diagnosis of CPTSD within the context of previous simi...
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Background High numbers of patients experience severe acute stress in critical care units. Acute stress has been linked to post-critical care psychological morbidity, including post-traumatic stress disorder (PTSD). Previously, a preventive, complex psychological intervention [Psychological Outcomes following a nurse-led Preventative Psychological...
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Background Terrorist attacks have increased globally since the late 1990s with clear evidence of psychological distress across both adults and children and young people (CYP). After the Manchester Arena terrorist attack, the Resilience Hub was established to identify people in need of psychological and psychosocial support. Aims To examine the s...
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Background: Critical illness increases the risk for poor mental health outcomes among both patients and their informal caregivers, especially their surrogate decision-makers. Surrogates who must make life-and-death medical decisions on behalf of incapacitated patients may experience additional distress. EMPOWER (Enhancing & Mobilizing the POtentia...
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The distinction between natural and human-made disasters is ingrained in everyday language. Disaster scientists have long been critical of this dichotomy. Nonetheless, virtually no attention has been paid to how disaster survivors conceptualize the causes of the disasters they experience. In this mixed-methods longitudinal study, 112 survivors of t...
Preprint
Background: Critical illness increases the risk for poor mental health outcomes among both patients and their informal caregivers, especially their surrogate decision-makers. Surrogates who must make life-and-death medical decisions on behalf of incapacitated patients may experience additional distress. EMPOWER (Enhancing & Mobilizing the POtential...
Article
Despite the incidence of trauma in the histories of people with Hoarding Disorder (HD), reexperiencing symptoms, namely intrusive images, have not been investigated in the condition. To address this, 27 individuals who met DSM-5 criteria for HD and 28 community controls (CCs)were interviewed about (a)their everyday experiences of intrusive imagery,...
Article
It is frequently asserted that the understanding of memory among the general public and among legal and psychological professionals is deficient, the most prominent examples being that many people appear to liken memory to a video camera, overestimate the association between accuracy and confidence, and believe in repression. The existing evidence...
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Posttraumatic stress disorder (PTSD) is associated with wide-spread immune dysregulation; however, little is known about the gene expression differences attributed to each PTSD symptom cluster. This is an important consideration when identifying diagnostic and treatment response markers in highly comorbid populations with mental and physical health...
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The vulnerability paradox in global mental health and its applicability to suicide – CORRIGENDUM - Michel L. A. Dückers, Lennart Reifels, Derek P. De Beurs, Chris R. Brewin
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Background Previous research has identified a vulnerability paradox in global mental health: contrary to positive associations at the individual level, lower vulnerability at the country level is accompanied by a higher prevalence in a variety of mental health problems in national populations. However, the validity of the paradox has been challenge...
Preprint
Background Critical illness increases the risk for poor mental health outcomes among both patients and their informal caregivers or surrogate decision-makers. Surrogates who must make life-and-death medical decisions on behalf of incapacitated patients may experience additional distress. EMPOWER (Enhancing & Mobilizing the POtential for Wellness &...
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Compassion is a complex cognitive, emotional and behavioural process that has important real-world consequences for the self and others. Considering this, it is important to understand how compassion is communicated. The current research investigated the expression and perception of compassion via the face. We generated exemplar images of two compa...
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Background: In 2009, an aeroplane crashed near Amsterdam. To remedy unmet mental health needs, active outreach was used to identify victims at risk for post-traumatic stress disorder (PTSD) and depression. Objective: The active outreach strategy was evaluated by examining the accuracy of screening methods in predicting PTSD and depression, self-rep...
Chapter
What the chapters of this book have in common is that they explore cultural aspects of posttraumatic stress disorder (PTSD); however the current chapter is slightly different because of its emphasis on cross-national patterns and the relevance of country-level factors that turn out to be risk and protective factors themselves. Understanding prevale...
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We investigated whether the presence of imagery at retrieval was associated with the finding that negative pictures and scenes are recalled with greater perceptual detail. Participants were presented with 30 scenes taken from the International Affective Picture System that were rated either high or low on valence, but similarly on arousal. Recall w...
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Purpose of Review I summarize recent developments in understanding the phenomenology of memory in PTSD, describe the most prominent theoretical models, and outline new forms of treatment aimed at modifying the traumatic memory. Recent Findings Intrusive memories that have the quality of being relived in the present have been highlighted in ICD-11....
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Objectives: Adverse psychological outcomes, following stressful experiences in critical care, affect up to 50% of patients. We aimed to develop and test the feasibility of a psychological intervention to reduce acute stress and prevent future morbidity. Design: A mixed-methods intervention development study, using two stages of the UK Medical Re...
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Voluntary recall of trauma is a key element in exposure-based psychotherapies and can trigger spontaneous dissociative responses such as flashbacks, depersonalisation, and derealisation. In order to examine the associations between cardiovascular and psychological responses to voluntary recollection of trauma, individuals with PTSD recalled a traum...
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Background: The current study sought to advance the existing literature by providing the first assessment of the factorial and discriminant validity of the ICD-11 proposals for posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) in a nationwide level. Methods: A nationally representative sample from Israel (n = 1,003) using a disorder-...