Cognitive processing,memory, and the development of PTSD symptoms: two experimental analogue studies

Memory deficits are implicated in the development of posttraumatic stress disorder (PTSD). Intentional recall of trauma memories is frequently disorganised or incomplete, whilst involuntary memory fragments are easily triggered by perceptual cues. Ehlers and Clark (Behaviour Research and Therapy 38 (2000) 319-345) propose that a predominance of data-driven processing (i.e., processing sensory impressions) during the trauma contributes to the development of this memory pattern, and therefore, predicts PTSD symptoms after trauma. Two experimental studies examined these hypotheses. Student volunteers viewed a distressing videotape as an analogue for a traumatic event. In Study 1, cognitive processing was manipulated; in Study 2, extreme scorers on a processing screening questionnaire were pre-selected. The results indicated that data-driven processing is associated with the development of PTSD-like memories and analogue symptoms.     

The relationship between cognitive control and posttraumatic stress symptoms

Background and objectivesRecently researchers have theorized that individual differences in cognitive control (i.e., the ability to complete goal-directed behavior by actively maintaining information while inhibiting irrelevant information) may elucidate processes involved in disorders characterized by intrusive thoughts and memories. By this account, the relationship between cognitive control and emotional disorders would be specific to symptoms associated with intrusive cognitions, such as re-experiencing symptoms of posttraumatic stress disorder (PTSD).MethodsIn the present study, 77 undergraduate participants with a self-reported history of trauma exposure were administered assessments of cognitive control (working memory capacity; WMC), PTSD symptoms, trait anxiety, and depression. PTSD symptoms from each of the three symptom clusters (re-experiencing, avoidance, and hyperarousal) were predicted from trait anxiety, depression, and WMC performance scores using separate regression models.ResultsAfter controlling for trait anxiety and depression, there was a negative, statistically significant relationship between cognitive control and re-experiencing symptoms but not avoidance or hyperarousal symptoms.LimitationsThe study was completed cross-sectionally and did not include a diagnostic assessment of PTSD.ConclusionsFindings add to extant literature suggesting a relationship between cognitive control and intrusive cognitions. Moreover, the present study expands the current literature by demonstrating the specificity of this relationship within individuals with varying degrees of PTSD symptom severity.     

The “HEALTH” model – Part 1: treatment program guidelines for Complex PTSD

This paper outlines the development and piloting of the “HEALTH” model for treatment of Complex PTSD in clients who have experienced multiple traumas across childhood and adulthood – particularly child sexual abuse and sexual assault in adulthood. As a guideline-based treatment model, HEALTH outlines six stages of intervention: (1) having a supportive therapist; (2) ensuring personal safety; (3) assisting with daily functioning; (4) self-regulation – learning to manage core PTSD symptoms; (5) treating Complex PTSD symptoms; and, finally, (6) having patience and persistence to enable “ego strengthening”. Using a case study approach, we provide both qualitative and quantitative assessment data for the individuals in the study, all of whom displayed numerous pre-treatment symptoms of Complex PTSD. Such programs are different to standard PTSD treatment programs that focus predominantly on core PTSD symptoms of re-experiencing, avoidance and arousal. The results of this study provided support for the use of guideline-based treatment programs that cater specifically for the needs of those who have suffered long-term/multiple trauma experiences by targeting Complex PTSD symptoms.     

The association between traumatic experience, paranoia and hallucinations: a test of the predictions of psychological models

OBJECTIVE: The current study investigated the relationship between trauma and predisposition to hallucinations and to paranoia in a non-clinical sample. METHOD: A total of 228 students completed online measures of trauma, post traumatic stress disorder (PTSD), schematic beliefs, perceptual anomalies, and predisposition to hallucinations and paranoia. RESULTS: Associations were found between negative schematic beliefs, PTSD and predisposition to both paranoia and hallucinations. PTSD reexperiencing-symptoms were most strongly associated with a predisposition to hallucinations. Negative beliefs about self and others were most strongly associated with a predisposition to paranoia. CONCLUSION: The results provide support for the prediction that there may be two routes between trauma and predisposition to psychosis. Clear support was found for a link between trauma and psychosis mediated by negative beliefs about self and others. There may also be a direct association between re-experiencing symptoms and hallucinations.     

A new psychological intervention: “512 Psychological Intervention Model” used for military rescuers in Wenchuan Earthquake in China

Objective

We sought to compare the efficacy of the “512 Psychological Intervention Model” (that is, “512 PIM”, a new psychological intervention) with debriefing on symptoms of post-traumatic stress disorder (PTSD), anxiety and depression of Chinese military rescuers in relation to a control group that had no intervention.

Method

We conducted a randomized controlled trial with 2,368 military rescuers 1?month after this event and then at follow-up 1, 2 and 4?months later to evaluate changes in symptoms of PTSD, anxiety and depression based on DSM-IV criteria, respectively.

Results

Baseline analysis suggested no significant differences between the study groups. Severity of PTSD, anxiety and depression decreased over time in all three groups, with significant differences between the groups in symptoms of PTSD (P?<?0.01). Compared with the debriefing and control group, significant lower scores of PTSD and positive efficacy in improving symptoms of re-experiencing, avoidance and hyperarousal were found in the “512 PIM” group.

Conclusion

“512 PIM” was an effective psychological intervention for military rescuers in reducing symptoms of PTSD, anxiety and depression after a crisis.     

Do PTSD symptoms and trauma-related cognitions about the self constitute a vicious cycle? Evidence for both cognitive vulnerability and scarring models

Cognitive models of post-traumatic stress disorder (PTSD) posit that negative cognitions regarding the self and the world underlie the disorder. In contrast, scarring models — which postulate that distress brings about an elevation in vulnerability — predict the inverse relationship. Both models were tested amongst 156 Israeli trauma victims. Participants were assessed for PTSD symptoms and trauma-related cognitions (negative thoughts regarding self and world) over 2 weeks (T1), 4 weeks (T2), and 12 weeks (T3) following the traumatic event. A cross-lagged structural equation modeling analysis yielded evidence for both cognitive vulnerability and scarring. Baseline PTSD was prospectively associated with an increase in negative cognitions regarding both the self and the world during the T1–T2 period. Negative cognitions regarding the self were prospectively associated with an increase in PTSD symptoms during both T1–T2 and T2–T3 periods. PTSD symptoms and negative cognitions regarding the self thus appear to form a vicious cognitive-symptomatic cycle which might impede recovery.     

Silence and Psychotherapy

With the growing interest in the role of cognitions in PTSD, this prospective study examined the course and bi-directional relationship between post-trauma cognitions and symptoms of PTSD. A sample of Israeli combat veterans, including former prisoners of war, was assessed in 1991, and later followed up in 2003 and 2008. PTSD symptoms were measured at three time points. Cognitions concerning the self and the world were measured twice. Applying Autoregressive Cross-Lagged (ARCL) modeling strategy, initial PTSD symptoms predicted subsequent negative cognitions but not vice versa. In addition, repeated measures design revealed that individuals with chronic PTSD symptoms had relatively negative cognitions that further amplified with time. More specifically, increasingly negative cognitions were documented among ex-prisoners of war. The main findings suggest that negative cognitions are fueled by PTSD and that in chronic PTSD there is an amplification of pathogenic outcomes over time. Discussion of the findings is in the context of current cognitive models of PTSD.     

Memory representation of aversive social experiences in Social Anxiety Disorder

Aversive social experiences are proposed to be a risk factor for developing Social Anxiety Disorder (SAD). Many patients with SAD report associated daily life symptoms, such as intrusive re-experiencing (e.g., negatively distorted images of oneself), avoidance, alterations in cognitions and mood, as well as hyperarousal, resembling symptom dimensions of Posttraumatic Stress Disorder (PTSD). These PTSD-like symptoms may result from maladaptive processing and representation of the aversive social experiences in memory. Emotional hyperreactivity during memory retrieval of aversive social experiences is another feature of SAD which was found in previous studies. This study aimed to further investigate PTSD-like symptoms and emotional reactivity associated with etiologically relevant aversive social experiences and shed more light on a potential relationship between both. Eighty-five patients with SAD and 85 healthy controls (HC) participated in this cross-sectional study. It comprised an imagination task with self-report and physiological measures to assess emotional reactivity during the cued recall of the aversive social experience and clinical interviews to assess PTSD-like symptoms. We expected increased emotional reactivity and more severe PTSD-like symptoms in response to the aversive social experience in patients with SAD compared to HC, as well as a positive correlation between emotional reactivity and PTSD-like symptoms in patients with SAD. Indeed, patients with SAD showed emotional hyperreactivity (self-report, physiology) during the cued recall of the aversive social experiences, also when compared to two control memory conditions (neutral, negative non-social) and HC. Patients with SAD furthermore reported more severe PTSD-like symptoms compared to HC and intrusive re-experiencing symptoms were positively correlated with distress during imagery of the social aversive event in patients with SAD. These results might point toward a maladaptive representation of aversive social experiences in memory. Similar to PTSD, this maladaptive memory representation might promote the development of PTSD-like symptoms such as intrusive re-experiencing (e.g., in the form of intrusive self-images in patients with SAD), which might finally lead to and maintain symptoms of SAD.     

Coping flexibility predicts post-traumatic stress disorder and depression in human rights advocates

An emerging body of research on individuals exposed to trauma shows that the ability to flexibly employ different coping styles is associated with better adjustment. Specifically, individuals who use both “trauma-focused” (focusing on the experience and significance of a potentially traumatic event) and “forward-focused” (optimism, helping others, goal-oriented thinking) coping styles exhibit less psychological disturbance after trauma exposure than those with less coping flexibility. We investigated whether greater coping flexibility is associated with less Post-traumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) in an international sample of human rights advocates. In an online, cross-sectional study, 346 international human rights advocates completed self-reported measures of PTSD, MDD, trauma exposure, and the Perceived Ability to Cope with Trauma (PACT) scale. Results showed that coping flexibility was associated with lower rates and symptom severity of PTSD and MDD. Whereas both trauma-focused and forward-focused coping were associated with lower rates of PTSD, the inverse relationship between coping flexibility and MDD was driven primarily by less forward-focused coping. These findings are the first to show that lower levels of coping flexibility may be an important factor underlying vulnerability to PTSD and MDD among human rights advocates. Longitudinal studies are needed to clarify whether coping flexibility can mitigate the potential negative mental health impact of traumatic stress over the course of one’s career in international human rights advocacy.     

Retrieval and emotional processing of traumatic memories in posttraumatic stress disorder: peripheral and central correlates

Posttraumatic stress disorder (PTSD) is thought to be characterized by dysfunctional memory processes, i.e., the automatic re-experiencing of the traumatic event and the inability to consciously recall facts about the traumatic event, as well as altered emotional processing of trauma-relevant cues. The present study examined the cerebral mechanisms underlying the cued recall of trauma-specific memories and the emotional processing of the presented cues in 16 PTSD patients, 15 trauma-exposed subjects without PTSD and 16 healthy controls. Subjects received questions about their specific trauma as well as other disastrous and neutral events while the electroencephalogram and heart rate were measured. The PTSD patients showed no impairment in trauma-specific declarative memory compared to non-PTSD subjects but had some deficits in general declarative memory as assessed by the Wechsler Memory Scale-Revised. Compared to healthy control subjects, PTSD patients displayed increased P300 and late positive complex amplitudes to trauma-specific questions, indicating enhanced emotional processing of these cues. In line with their behavioral performance, both trauma-exposed groups showed decreased terminal contingent negative variation amplitudes to trauma-specific questions over frontal electrodes reflecting altered memory retrieval. Within-group comparisons revealed that only the PTSD group but not the other groups showed a differentiation between trauma-specific and neutral questions with respect to the LPC, tCNV and P300. Concordantly with previous studies, PTSD patients showed elevated resting heart rate compared to the healthy controls. These findings are discussed in the context of current models of the role of declarative memory in the development and maintenance of PTSD.     

Longitudinal study of posttraumatic stress disorder, depression, and changes in traumatic memories over time in Bosnian refugees

This longitudinal study examined traumatic memory consistency over a 3-year period among a sample of highly traumatized Bosnian refugees, focusing on demographic factors, types of trauma, and posttraumatic stress disorder (PTSD) and depression. In 1996 and 1999, 376 Bosnian refugees were interviewed about 54 wartime trauma and torture events, and symptoms of PTSD and depression. Reports were compared for both time periods, and changed responses were analyzed for significance. Overall, there was consistency in reporting over time; when change occurred it was in the direction of decreased reports at follow-up. This downward trend was not associated with any particular diagnosis. However, PTSD alone, without comorbid symptoms of depression, was uniquely associated with the group that exhibited an upward trend. This implies that increased reporting is related specifically to the presence of PTSD symptoms, and that PTSD may be distinctly associated with the failed extinction of traumatic memories.     

Insomnia as a predictor of diagnosed memory problems: 2006–2016 Health and Retirement Study

ObjectiveTo evaluate the longitudinal relationship in insomnia symptoms over time with incident memory problems and dementia diagnoses among U.S. adults aged 65 years and older.MethodsSecondary analyses were performed on 9518 elderly participants (≥65 years) who completed the 2006 wave of the Health and Retirement Study (HRS) and were followed-up to determine if insomnia symptom scores (2006–2014) were associated with time-to-onset of [1] physician-diagnosed “memory-related disease”, “Alzheimer's disease” and/or “dementia, senility or any other serious memory impairment” and [2] diagnosis of dementia based on HRS-specific criteria. Cox proportional hazards models were constructed adjusting for socio-demographic, lifestyle, and health characteristics.ResultsIn fully adjusted models, severe insomnia symptoms were associated with increased risk of physician-diagnosed memory problems. Individuals reporting any change (increase or decrease) in insomnia symptoms during the 2006–2010 period were more likely to be diagnosed with dementia based on HRS criteria. Finally, those who experienced an increase in the severity of insomnia symptoms over time exhibited 41–72% increased risks of physician-diagnosed memory problems and 45–58% increased risks of dementia diagnosis based on HRS criteria.ConclusionsWhen severe insomnia symptoms increased over time, physician-diagnosed memory problems and dementia diagnoses also increased among U.S. elderly people over a 10-year follow-up period. More studies are required to confirm these findings using large prospective cohort designs and validated tools.     

Categorical and dimensional study of the predictive factors of the development of a psychotrauma in victims of car accidents

ObjectiveThis study aimed to evaluate the predictive factors of the emergence of complete PTSD and subsyndromal PTSD (defined as individuals exposed to a traumatic event with at least one psychopathological impact, such as hyperarousal, avoidance or persistent re-experiencing) following a motor vehicle accident (MVA).MethodsWe recruited 155 adult MVA patients, physically injured and admitted to trauma service, over two years. In the week following the accident, patients were asked to complete questionnaires assessing their social situation (sex, age, marital and employment status, prior MVA or trauma), comorbidity (MINI), distress (PDI) and dissociation (PDEQ) experienced during and immediately after the trauma. An evaluation using the CAPS was conducted six months after the trauma to assess a possible PTSD.ResultsAt six months, 25.8% of the participants developed subsyndromal symptoms and 7.74% developed complete PTSD. The three symptoms that best discriminated the groups were dysphoric emotion, perceived life threat and dissociation. Logistic regression results showed that the strongest predictor of PTSD was the perceived life threat.In addition, a dimensional approach to the results revealed significant correlations between (1) peritraumatic distress and persistent re-experiencing or hyperarousal and (2) dissociation score and avoidance strategy. The presence of a prior traumatic event reinforces avoidance strategies.ConclusionsOur results stress that peritraumatic factors (especially the perception of a life threat) are good predictors of PTSD development. A dimensional perspective allows better identification of psychological complications following an MVA.     

History of childhood maltreatment augments dorsolateral prefrontal processing of emotional valence in PTSD

Posttraumatic stress disorder (PTSD) is characterized by conflicting findings of both increased and decreased amygdala and prefrontal reactivity to threat or trauma stimuli. Childhood maltreatment (CM), a potent risk factor for PTSD, exerts long-lasting influences on threat processing and prefrontal-amygdala function. This suggests that CM history may influence PTSD neural phenotypes related to threat processing. Here, we adapt a well-characterized emotional conflict paradigm to investigate CM effects on both emotional conflict and emotional valence processing within PTSD stratified by task relevance. Forty-two individuals with PTSD (22 reporting extensive CM history (PTSD-CM)) and 20 trauma-exposed healthy controls (TEHCs) underwent functional magnetic resonance imaging while identifying affect of emotional faces (fear and happy) overlaid with a goal-irrelevant emotional distractor word (“FEAR” or “HAPPY”). We examined effects of CM on conflict, conflict adaptation, valence-related activation (fear vs. happy) for goal-relevant (face) and goal-irrelevant stimuli (word), and valence effects in interaction with goal-relevancy (face vs. word). Though no activation differences between groups were observed for conflict contrasts nor for valence effects in the amygdala, CM status interacted with valence processing differences as a function of goal relevance in the left dorsolateral prefrontal cortex (dlPFC). Here, PTSD-CM displayed greater activation relative to PTSD to negative valence when stimuli were goal-irrelevant. CM history also moderated relationships between activation abnormalities and PTSD re-experiencing symptoms. These findings provide initial evidence that CM history augments dorsolateral prefrontal bias to implicitly processed stimulus valence in PTSD.     

Trauma and bereavement: examining the impact of sudden and violent deaths

The intersection between trauma and bereavement has only recently been explored. Prior studies of bereavement have often neglected to measure posttraumatic stress disorder (PTSD) symptoms; the few that have offer equivocal findings concerning the role of PTSD symptomatology following loss. Few studies have explored the relationship between PTSD and the other psychological sequelae more commonly associated with loss. The current investigation assessed PTSD symptoms over time following the death of a spouse, using violence and the suddenness of the loss as potential outcome predictors. In addition, the relationship between PTSD and depression symptoms was assessed. Violent death predicted PTSD symptoms and the persistence of depression over time. The suddenness of the loss was not related to PTSD symptoms. This investigation suggests that violent death results in development of PTSD symptoms over and above the normal grief response and thus, may contribute to a more severe grief response.     

Early symptom predictors of chronic distress in Gulf War veterans

Although there is evidence that specific early hyperarousal, avoidance, and emotional numbing symptoms are associated with later posttraumatic stress disorder (PTSD) symptomatology among veterans, little is known about predictors of later non-PTSD-related psychological symptoms. One and 2 years after serving in the Gulf War, 348 military reservists were assessed for severity of war zone stress, PTSD, psychological distress, and stress-mediated physical complaints. Overall PTSD symptomatology and emotional numbing and hyperarousal symptom clusters increased over time, whereas re-experiencing and avoidance symptoms showed no change. Emotional numbing and hyperarousal symptoms at 1 year predicted generalized distress, depression, anxiety, hostility, and somatic symptoms at 2 years, whereas re-experiencing and avoidance symptoms did not. Findings highlight the importance of targeting early emotional numbing and hyperarousal symptom clusters to reduce longer-term psychological distress.     

Preliminary evidence for a relationship between prospective memory and PTSD symptoms in the general population

IntroductionPTSD sufferers often have problems with remembering the past, but do they also have trouble remembering tasks to be completed in the future? We argue characteristics of PTSD—such as negative appraisals and maladaptive strategies—might contribute to biased reporting of prospective memory failures among PTSD sufferers—or people with severe PTSD symptoms—within a general population.MethodsMechanical Turk participants completed a questionnaire battery measuring self-report prospective memory, PTSD symptoms, negative appraisals and maladaptive strategies (e.g., suppression), and depression, anxiety and stress symptoms.ResultsPTSD symptom severity positively correlated with self-report prospective memory failures (rs = .42–49). PTSD symptoms affected self-report prospective memory via their influence on negative appraisals and maladaptive strategies.LimitationsOur findings rely on self-report, therefore we do not know if this relationship generalizes to objective prospective memory tasks.ConclusionsOur data provide preliminary evidence for a relationship between PTSD symptomatology and subjective prospective memory in the general population and suggest that the negative appraisals and maladaptive strategies that commonly accompany PTSD might underpin this relationship.     

Longitudinal assessment of cognitive performance in Holocaust survivors with and without PTSD.

BACKGROUND: There are currently no longitudinal studies of cognitive performance in older patients with Posttraumatic Stress Disorder (PTSD). It is therefore unclear whether relationships between memory and symptoms differ over time among older persons with and without PTSD. METHODS: Twenty-eight Holocaust survivors and nineteen comparison subjects were evaluated 5 years after they had received a memory assessment including paired-associates learning and the California Verbal Learning Test (CVLT). RESULTS: While Holocaust survivors with PTSD showed a diminution in symptom severity (t = 2.99, df = 12, p = .011), they still manifested a decline in paired associates learning, suggesting an acceleration in age-related memory impairment (related word pairs: t = 2.87, df = 13, p = .013; unrelated word pairs: t = 2.06, df = 13, p = .060). The survivors with PTSD showed improvements on several CVLT measures over time. These improvements correlated with symptom improvements, such that group differences at the follow-up were no longer detected. CONCLUSIONS: The discrepancy in the pattern of performance on these two tests of memory following symptom improvement suggests possible differentiation between of aspects of memory functions associated with aging and trauma exposure and those associated with the severity of PTSD symptoms. Performance on the CVLT appeared related to clinical symptom severity while paired associate learning worsened over time in Holocaust survivors with PTSD, consistent with earlier cross-sectional findings.     

Neural basis of fear conditioning induced by video clip: positron emission tomography study

In patients with post-traumatic stress disorder (PTSD), re-experiencing the trauma is often induced by external cues in the environment. The cues, which were emotionally neutral for the patients before the traumatic event, become fearful ones after the event. This phenomenon is considered to be associated with fear conditioning. The paradigm was set up so that the emotionality changes in the patients with PTSD would be reproduced, and the regional cerebral blood flow (rCBF) measured with positron emission tomography (PET) was compared during exposure to the same stimuli before and after acquisition of fear conditioning. Ten healthy male subjects were asked to look at some emotionally neutral photos, then to watch a video with fearful content that also contained images similar to that presented in the photos, and afterwards to look at the photos again. Five of the 10 subjects felt that the object in the photos was more fearful after watching the video than before, and they were considered to have acquired fear conditioning. In those five subjects, the rCBF in the right amygdala and the left posterior cingulate gyrus after acquisition of fear conditioning significantly increased relative to the rCBF before conditioning. Thus, these regions seem to have a critical role in fear conditioning.     

Attributional style and anxiety sensitivity as maintenance factors of posttraumatic stress symptoms: A prospective examination of a diathesis–stress model

Diathesis–stress models of posttraumatic stress disorder (PTSD) assert that traumatic events function as stressors that interact with vulnerabilities to influence the development of PTSD. The present study prospectively examined negative attributional style (NAS) and anxiety sensitivity (AS) as maintenance factors for PTSD in female adult sexual assault victims. A diathesis–stress model was tested by examining interactions between the vulnerabilities and negative life events. The present study included both the traditional three-factor model of PTSD (re-experiencing, avoidance and emotional numbing, and arousal) and the dysphoria four-factor model of PTSD (re-experiencing, avoidance, arousal, and dysphoria). Robust regression analyses revealed that negative life events at Time 2 significantly predicted increases in all clusters of the three-factor model (i.e., re-experiencing, avoidance and numbing, and arousal) and the re-experiencing, arousal, and dysphoria clusters of the four-factor model (but not avoidance). Neither NAS nor AS significantly independently predicted any of the symptom clusters for either model. Both NAS and AS interacted with negative life events to predict increases in the avoidance and numbing symptoms. However, examination of the dysphoria four-factor model of PTSD revealed that the NAS and AS interactions with negative life events only predicted dysphoria symptoms.