Integration and organization of trauma memories and posttraumatic symptoms

Investigating traumatic memory integration in people with and without post-traumatic stress disorder using the event-cueing paradigm

Poor integration and landmark views make opposing claims regarding the relationship between post-traumatic stress symptoms and trauma memory integration. This study tested these approaches using an event cluster paradigm. In total, 126 participants (Nptsd = 61; Nnon-ptsd = 65) remembered memories from the same story as trauma, positive and neutral memories and reported whether each memory was directly retrieved or generated. Moreover, the retrieval time (RT) was recorded. Finally, the participants completed the Centrality of Event Scale (CES) and Post-traumatic Stress Disorder Symptom Scale-Self Report (PSS-SR). The results demonstrated that participants with post-traumatic stress disorder (PTSD) recalled their clusters of memories more slowly and less directly than those without PTSD. However, the CES predicted PTSD severity more strongly than RT and retrieval strategy. These results suggest that traumatic memories are more disorganised but perceived as more central in PTSD.

An Examination of the Synergy of Age and PTSD on Narrative Coherence in Child Sexual Abuse Testimony

In a criminal proceeding, a witness is considered as reliable if he/she can recall in narrative form the events, chronologically ordered, with salient contextual (place and time) details, and essential evaluations for the definition of meanings. This study aimed to confirm the effects of age and PTSD on narrative coherence and to investigate the moderating role of age on the association between PTSD and narrative coherence. Narrative coherence was analyzed in 92 allegations of children (M = 10.3; range: 4-17), who were victims of sexual abuse. Thirty-five children presented the symptoms for a diagnosis of PTSD. Each deposition has been codified through the Narrative Coherence Coding Scheme, a coding scheme based on the three independent dimensions (context, chronology, and theme). Correlation analysis indicated the positive associations between age and context, chronology, and theme; and the negative associations between PTSD symptoms and context, chronology, and theme. Predictive effect of PTSD became less and less significant with increasing age. This study could underline the importance of age and PTSD (and their synergy) in legal testimony of children who have been sexually abused.

Recognizing hotspots in Brief Eclectic Psychotherapy for PTSD by text and audio mining

Background: Identifying and addressing hotspots is a key element of imaginal exposure in Brief Eclectic Psychotherapy for PTSD (BEPP). Research shows that treatment effectiveness is associated with focusing on these hotspots and that hotspot frequency and characteristics may serve as indicators for treatment success. Objective: This study aims to develop a model to automatically recognize hotspots based on text and speech features, which might be an efficient way to track patient progress and predict treatment efficacy. Method: A multimodal supervised classification model was developed based on analog tape recordings and transcripts of imaginal exposure sessions of 10 successful and 10 non-successful treatment completers. Data mining and machine learning techniques were used to extract and select text (e.g. words and word combinations) and speech (e.g. speech rate, pauses between words) features that distinguish between 'hotspot' (N = 37) and 'non-hotspot' (N = 45) phases during exposure sessions. Results: The developed model resulted in a high training performance (mean F ₁-score of 0.76) but a low testing performance (mean F ₁-score = 0.52). This shows that the selected text and speech features could clearly distinguish between hotspots and non-hotspots in the current data set, but will probably not recognize hotspots from new input data very well. Conclusions: In order to improve the recognition of new hotspots, the described methodology should be applied to a larger, higher quality (digitally recorded) data set. As such this study should be seen mainly as a proof of concept, demonstrating the possible application and contribution of automatic text and audio analysis to therapy process research in PTSD and mental health research in general.

Assessing the coherence of narratives of traumatic events with latent semantic analysis

OBJECTIVE

Memories of traumatic events are thought to be less coherent than memories for nontraumatic events, and expressive writing about traumatic events may help create more organized, coherent memories. Investigations of traumatic memories have been hampered by limitations in conceptualizing and measuring memory organization and coherence. The objective of this investigation was to compare the coherence of written narratives of trauma and neutral memories and examine changes in coherence of trauma narratives as a function of repeated expressive writing about the trauma using an atheoretical, computational method for assessing the coherence of text.

METHOD

Participants (N = 246) wrote 3 times about either their daily activities (neutral condition) or the most traumatic event of their lives. Latent semantic analysis, a method of calculating meaning from text based on semantic association between words, was used to assess narrative coherence as the average semantic association between contiguous sentences.

RESULTS

Neutral narratives were more coherent than trauma narratives overall, but neutral narratives decreased whereas trauma narratives increased in coherence from the first to the final session.

CONCLUSIONS

These findings provide evidence that memories for trauma experiences are less coherent than neutral memories and suggest that writing helps to create a more coherent representation of a traumatic event, highlighting a potential mechanism for expressive writing's effects. Results demonstrate the utility of latent semantic analysis for examining coherence of memories of traumatic events. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Investigating linguistic coherence relations in child sexual abuse: A comparison of PTSD and non-PTSD children

Background

Language is the most common way to communicate internal states and emotions into a narrative form. Studies on the use of language provide a useful understanding of how people process an event and interpret it.

Objective

The aim of this study was to investigate the effects of PTSD on the narrative coherence of children's reports of sexual abuse.

Participants and setting

Narrative coherence was analyzed within a group of 89 allegations of children (M = 10; range: 4–16), who were victims of sexual abuse. Thirty-seven children presented the symptoms for a diagnosis of PTSD.

Method

Linguistic Inquiry Word Count (LIWC) was employed and narrative coherence was analyzed through some linguistic markers (first-person singular pronouns, conjunctions, and cognitive words).

Results

Results illustrated the effects of PTSD on the narrative coherence, in terms of first-person singular pronouns, conjunctions, and cognitive processes. Indeed, compared with traumatic narratives of children without PTSD, traumatic narratives of children with PTSD contained a greater number of first-person singular pronouns (M_PTSD = 1.45 versus M_no-PTSD = 1.12) and a smaller number of conjunctions (M_PTSD = .37 versus M_non-PTSD = .67), cognitive (M_PTSD = 2.93 versus M_non-PTSD = 3.76) and insight words (M_PTSD = 2.29 versus M_non-PTSD = 3.09). Regression analyses were used to examine if age and PTSD were predictors of the narrative coherence, suggesting the effects of PTSD in predicting the use of the first-person singular pronouns and the conjunctions.

Conclusion

This study could underline the importance of considering the PTSD in legal testimony of children who have been sexually abused.

Narrative fragmentation in child sexual abuse: The role of age and post-traumatic stress disorder

The present study aimed to assess the effects of age and PTSD on the narrative fragmentation in memories for child sexual abuse. Lexical complexity, cohesion and coherence were analyzed within a group of 86 allegations of children (M=10years; SD=3.7; range: 4-17) who were victims of sexual abuse. Results illustrated that age played an important role in establishing narrative coherence and predicted the level of orientation, the sequence of events and the level of evaluation of the event. Instead, PTSD was related to narrative coherence and cohesion. Therefore, in children, the narrative fragmentation could be an effective diagnostic tool for understanding the effects of PTSD. Moreover in a legal setting the traumatic effects of PTSD on the narrative coherence and cohesion could be significant indices in the evaluation of child testimony.

Quality of Memories in Women Abused by Their Intimate Partner: Analysis of Traumatic and Nontraumatic Narratives

Traditional models of posttraumatic stress disorder (PTSD) claim that the high emotional intensity of traumatic events leads to deficits in the voluntary access of traumatic memories. This may result in disorganized narratives, with a high sense of emotional and sensory reliving. Alternatively, the basic mechanisms view suggests that high arousal leads to more available involuntary and voluntary memories. Traumatic narratives would not be impaired; indeed, they would be immersive and rich in detail. To test this perspective, this study compared the trauma narratives of 50 battered women (trauma-exposed group) with narratives about positive experiences and narratives of 50 nonexposed women (controls), and analyzed the relationship between trauma narrative aspects and the severity of PTSD. Results showed that trauma narratives were detailed, oriented, and coherent. Affective process words and emotional tone were related to trauma centrality and anxiety during disclosure, and predicted the severity of PTSD (R² = .26). These variables, together with the use of present tense verbs, accounted for a significant variance in intrusions (R² = .34). As hypothesized, narrative aspects related to a sense of reliving and narrative immersion were better predictors of PTSD than aspects reflecting impaired access to voluntary traumatic memories.

Encoding disorganized memories for an analogue trauma does not increase memory distortion or analogue symptoms of PTSD

BACKGROUND AND OBJECTIVES

Empirical studies with objective measures and control conditions have failed to demonstrate disorganization; yet people tend to self-report disorganization in their trauma narratives, which may have other effects. Thus, we investigated whether a disorganized trauma memory produces more analogue PTSD symptoms and memory distortion, compared to an organized memory.

METHODS

Participants watched a traumatic film with missing scenes. Some saw the scenes in their correct temporal sequence; others saw a random sequence; thus for some participants we implanted a disorganized memory. We also told some participants to focus on the meaning of the event (conceptual), some on the sensory details (data-driven), and some received no instruction (control). Participants recorded their intrusions for a week. Then, they reported analogue symptoms and we tested their memory for the film and their confidence in what they remembered.

RESULTS

Analogue symptoms and number of reported intrusions did not differ across conditions, nor did the degree of memory distortion or confidence in those memories. However, participants who self-reported feeling more memory disorganization reported more avoidance symptoms and more memory distortion.

LIMITATIONS

We did not measure memory for real trauma, nor did we assess for a history of PTSD. Our results may also be restricted to temporal disorganization.

CONCLUSIONS

Although objective assessments of disorganization do not appear important, people's feelings regarding the disorganization of their memories not only affect their assessment of the severity of their PTSD symptoms, but also the kinds of memory errors they make.

Narrative reconstruction therapy for prolonged grief disorder-rationale and case study

BACKGROUND

Prolonged grief disorder (PGD) is a potentially disabling condition affecting approximately 10% of bereaved people. It has been suggested that the impaired integration of the loss memory, as expressed in recurrent memories of the loss and disorganization of memory, is involved in the development of PGD. Narrative reconstruction (NR), originally designed for the treatment of posttraumatic stress disorder (PTSD) in an integrative therapy module, and consisting of exposure to the loss memory, detailed written reconstruction of the loss memory narrative and an elaboration of the personal significance of that memory for the bereaved, has been shown to be effective in the treatment of intrusion symptoms.

OBJECTIVE

In light of findings that cognitive behavior therapy (CBT), including cognitive restructuring and exposure, is effective in the treatment of PGD, we suggest the implementation of a somewhat novel therapy module, NR, for the treatment of intrusive phenomena in bereaved patients.

METHOD

The rationale for the implementation of NR for PGD and a case study of the treatment of a woman suffering from PGD after the death of her father are presented. Therapy took place in a university outpatient training clinic.

RESULTS

Evaluations conducted before and after treatment and at a 3-month follow-up demonstrated the effectiveness of NR in reducing symptoms of PGD and depression. The analysis of spontaneous narratives recorded before and after treatment showed an increased organization of the narratives.

CONCLUSIONS

This case report demonstrates an adaptation of NR for the treatment of PGD. The results provide preliminary support for the effectiveness of NR for PGD. The significance of the study and its limitations are discussed.

Narrative Length and Speech Rate in Battered Women

Narrative length and speech rate of traumatic recollections have been previously associated with different emotions and adjustment trajectories after trauma. However, the evidence is limited and the results are mixed. The present study aimed to evaluate length (i.e., word count) and speech rate (i.e., words per minute) in narratives of events with different valence (i.e., neutral, positive, and negative/traumatic) by 50 battered women (trauma group) and 50 non-traumatized women (controls). The results showed that traumatic narratives by the trauma group were longer than those by the control group. Moreover, they were inversely related to time since the event and anxiety during disclosure, whereas the speech rate was also inversely associated with anxiety, as well as with peritraumatic dissociation and avoidance. The shorter narratives for positive events and a decelerated speech pattern for traumatic experiences predicted psychological symptoms. Additionally, the individual's emotional state predicted narrative aspects, with bidirectional effects. Our findings showed that linguistic characteristics of traumatic narratives (but also of narratives of positive events) revealed information about how the victims elaborated autobiographical memories and coped with the trauma.

A comparison of the quality of intrusive memories in post-traumatic stress disorder and depression

As in post-traumatic stress disorder (PTSD), intrusive memories (IMs) also play an important role in depression. Evidence about the comparative quality of IMs in PTSD and depression is limited and inconsistent. A total of 28 adults with PTSD, 29 with depression, and 30 controls identified intrusive and voluntary segments of narrative memories of key events. Self-report and language measures of memory quality were obtained. Depressed and PTSD participants reported higher frequency of IMs and higher IM-related interference than controls. IMs in PTSD participants were distinguished from depressed and control participants by higher self-rated distress, higher self-rated sensory quality, and a higher proportion of sensory words in the narrative. The depressed and control groups did not differ on IM quality. PTSD IM segments had more sensory content than voluntary segments and fewer temporal markers. The IM segments of the depressed and control groups had fewer temporal markers than the voluntary segments. Depression severity predicted fewer sensory words in the IM after considering peri-event dissociation and arousal but did not add to the prediction of other IM qualities. A strong sensory quality is a distinctive feature of IMs in PTSD but not in depression. Basic sensory processes contribute to the intrusiveness of remembering in PTSD but not in depression.