Trauma-related versus positive involuntary thoughts with and without meta-awareness

To be aware or not aware: Do intrusions with and without meta-awareness differ?

People sometimes re-experience traumatic events via intrusive memories that spontaneously and unintentionally intrude into consciousness (i.e., intrusions). Such intrusions can be experienced without explicit awareness (i.e., meta-awareness). However, we do not know whether intrusions with and without meta-awareness differ in how people experience them (i.e., characteristics) or react to them via maladaptive responses (i.e., suppression, negative interpretations), and therefore whether they are important to differentiate. To investigate this issue, we asked participants to watch a trauma analogue film and-during a subsequent unrelated reading task-intermittently probed them to capture and assess one film-related intrusion. Intrusion meta-awareness positively correlated with intrusion negativity, re-experiencing, and suppression, but not with how people interpreted the meaning of their intrusion. Our findings suggest intrusions with and without meta-awareness can differ in how they are experienced and associated with thought suppression-highlighting the importance of considering both types of intrusions in theory and practice.

Beneficial effects of mindfulness-based intervention on hippocampal volumes and episodic memory for childhood adversity survivors

Background

Adverse Childhood Experience (ACE) has detrimental impacts on neural development, especially hippocampal morphometry. Mindfulness-Based Interventions (MBI) has been shown to induce adaptive hippocampal changes especially at the subiculum. The present study aims to investigate the effects of MBI on subiculum volumes among ACE survivors, as well as the effects on episodic memory as a probe into hippocampal functionality.

Methods

We analyzed anatomical MRI data and performance indices from an episodic memory task called the Mnemonic Similarity Task (MST) collected from a randomized controlled longitudinal study that compared an 8-week MBI (N = 20) to an active control condition of Stress Management Education (SME) (N = 19). FreeSurfer 6.0 was used for automated hippocampal subfield segmentation and volumetric estimation.

Results

Significant group differences were observed with the volumetric changes of the right whole hippocampus and right subiculum. Only the MBI group showed improved pattern separation capability from MST, which was associated with stress reduction and right subiculum volumetric changes.

Limitations

Modest sample size. MST task was performed outside of MRI.

Conclusions

These findings suggest beneficial effects of MBI for hippocampal volumes and episodic memory, while highlighting the importance of the subiculum for MBI-induced neural and cognitive changes. The subiculum's known role in inhibitory control was interpreted as a potential mechanism for it to exhibit MBI-induced volumetric changes, which sheds light on the potential neural underpinnings of mindfulness meditation for reducing stress reactivity among ACE survivors.

Daily-level associations between posttraumatic stress disorder symptoms and reactions to retrieving positive autobiographical memories

Trauma survivors with posttraumatic stress disorder (PTSD) report difficulties accessing and describing positive memories. To understand these patterns, we examined daily-level relations of PTSD symptoms with affective, cognitive (dwelling/rumination; pushing memory out of one's mind; suppression; avoidance; distraction; thinking about something else; remembering negative or positive memories/events; negative or positive thoughts; accepting or disapproving memory; reinterpreting memory), and behavioral (using alcohol/drugs; smoking cigarettes; cravings for or seeking out cigarettes/alcohol/drugs; craving, seeking out, or consuming large amounts of food; dissociation; engaging in risky behaviors; sharing memories; interference with ongoing task; arousal) reactions to retrieving positive memories. Eighty-eight trauma survivors (Mage= 39.89 years; 59.1% female) completed 7 daily measures of PTSD and reactions to retrieving positive memories. Days with more PTSD severity were associated with higher odds of same-day suppression, avoidance, distraction, thinking about something else, smoking cigarettes, craving substances, craving, seeking out, or consuming large amounts of food, dissociation, remembering negative memories/events/thoughts, engaging in risky behaviors, interference with ongoing tasks, and arousal (ORs=1.10-1.22); and greater negative affect (β = 0.27). Supplemental lagged analyses indicated some associations between previous-day reactions to positive memory retrieval and next-day PTSD severity and vice versa. Trauma survivors with PTSD symptoms report negative and avoidance-oriented reactions to retrieving positive memories.

Exploring intrusions without awareness: A preliminary study of the characteristics and influences of meta-awareness failures

BACKGROUND AND OBJECTIVES

Research shows that people can lack meta-awareness (i.e., being explicitly aware) of their trauma-related thoughts, which impacts our understanding of re-experiencing symptoms, a key symptom type in posttraumatic stress disorder (PTSD), assessed through self-report. This preliminarily study explored differences between (meta-)aware and unaware intrusion characteristics to understand why some intrusions are not immediately apparent to individuals.

METHODS

Trauma-exposed participants (N = 78) were recruited from online crowd-sourcing platforms to complete an online meta-awareness task. During a reading task, participants were intermittently probed to index the occurrence of unreported (i.e., unaware) trauma-related intrusions. Once participants indicated trauma-related intrusions were present, they then completed a questionnaire that indexed intrusion characteristics.

RESULTS

Although unaware intrusions did occur in a subset of the sample, there were no fundamental differences between aware and unaware intrusions in terms of modality of experience (imagery vs. non-imagery), meaningfulness, accessibility, or other characteristics (e.g., vividness).

LIMITATIONS

There was potential for lower participant engagement and attention due to the online delivery of the meta-awareness task, which may have minimized meta-awareness failure. Future research could consider using a continuous measure to index levels of meta-awareness. In addition, recruiting clinical samples (e.g., individuals with PTSD) who typically experience multiple daily intrusions would allow generalizability of the current findings to be tested.

CONCLUSIONS

Our findings from this preliminary study suggest that unaware and aware intrusions show more commonality than not in their characteristics, with further research required to improve our understanding of the mechanisms leading to meta-awareness or lack of in PTSD.

Something Distressing This Way Comes: The Effects of Trigger Warnings on Avoidance Behaviors in an Analogue Trauma Task

Avoidance is one of the purported benefits and harms of trigger warnings-alerts that upcoming content may contain traumatic themes. Yet, previous research has focused primarily on emotional responses. Here, we used a trauma analogue design to assess people's avoidance behavior in response to stimuli directly related to an analogue trauma event. University undergraduates (n = 199) watched a traumatic film and then viewed film image stills preceded by either a trigger warning or a neutral task instruction. Participants had the option to "cover" and avoid each image. Apart from a minor increase in avoidance when a warning appeared in the first few trials, we found that participants did not overall avoid negative stimuli prefaced with a trigger warning any more than stimuli without a warning. In fact, participants were reluctant overall to avoid distressing images; only 12.56% (n = 25) of participants used the option to cover such images when given the opportunity to do so. Furthermore, we did not find any indication that trigger warning messages help people to pause and emotionally prepare themselves to view negative content. Our results contribute to the growing body of literature demonstrating that warnings seem trivially effective in achieving their purported goals.

Are Individuals Always Aware of Their Trauma-Related Intrusive Thoughts? A Study of Meta-Awareness

Individuals are not always aware of their mental content. We tested whether lack of awareness occurs in those who have experienced trauma, with and without posttraumatic stress disorder (PTSD). We also examined the role of proposed cognitive mechanisms (working memory and inhibition) in explaining unnoticed intrusions. Individuals with PTSD (n = 44), and varying levels of symptoms (high posttraumatic stress [PTS]: n = 24; low PTS: n = 37) reported on intrusive thoughts throughout a reading task. Intermittently, participants responded to probes about whether their thoughts were trauma related. Participants were "caught" engaging in unreported trauma-related thoughts (unnoticed intrusions) for between 24 and 27% of the probes in the PTSD and high PTS groups, compared with 15% of occasions in the low PTS group. For trauma-related intrusions only, participants lacked meta-awareness for almost 40% of probes in the PTSD group, which was significantly less than that observed in the other groups (∼60%). Contrary to predictions, working memory and response inhibition did not predict unnoticed intrusions. The results suggest that individuals who have experienced significant trauma can lack awareness about the frequency of their trauma-related thoughts. Further research is warranted to identify the mechanisms underpinning the occurrence of unnoticed intrusions.

Teaching During a Pandemic: A Model for Trauma-Informed Education and Administration

Coronavirus disease 2019 (COVID-19) realities have demanded that educators move swiftly to adopt new ways of teaching, advising, and mentoring. We suggest the centering of a trauma-informed approach to education and academic administration during the COVID-19 pandemic using the Substance Abuse and Mental Health Services Administration's (SAMHSA) guidance on trauma-informed approaches to care. In our model for trauma-informed education and administration (M-TIEA), SAMHSA's four key organizational assumptions are foundational, including a realization about trauma and its wide-ranging effects; a recognition of the basic signs and symptoms of trauma; a response that involves fully integrating knowledge into programs, policies, and practices; and an active process for resisting retraumatization. Since educators during the pandemic must follow new restrictions regarding how they teach, we have expanded the practice of teaching in M-TIEA to include both academic administrators' decision making about teaching, and educators' planning and implementation of teaching. In M-TIEA, SAMHSA's six guiding principles for a trauma-informed approach are infused into these two interrelated teaching processes, and include the following: safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and cultural, historical, and gender issues. M-TIEA's organizational assumptions, processes, and principles are situated within an outer context that acknowledges the potential influences of four types of intersectional traumas and stressors that may occur at multiple socioecological levels: pandemic-related trauma and stressors; other forms of individual, group, community, or mass trauma and stressors; historical trauma; and current general life stressors. This acknowledges that all trauma-informed work is dynamic and may be influenced by contextual factors.

Do meta-cognitive beliefs affect meta-awareness of intrusive thoughts about trauma?

BACKGROUND AND OBJECTIVES

People exposed to trauma often experience intrusive thoughts and memories about that event. Research examining people's responses to trauma assumes that people can accurately notice the occurrence of symptoms. However, we know from the broader cognitive literature on 'mind-wandering' that people are not always aware of their current focus of attention. That lack of awareness has implications for our theoretical and practical understanding of how trauma survivors recover from their experience. In the current study we investigated whether people's meta-cognitive beliefs about controlling trauma-related intrusions influenced the occurrence and meta-awareness of those intrusions.

METHODS

We recruited participants who scored high (strong beliefs) or low (weak beliefs) on beliefs regarding the importance of controlling intrusive thoughts. Participants viewed a trauma film then-during a subsequent reading task-reported any film-related intrusions they noticed. We also intermittently asked half the participants to report what they were thinking at that particular moment, to "catch" intrusions without meta-awareness.

RESULTS

People are not always aware of their trauma intrusions, and importantly, people with strong beliefs are more likely to notice trauma related intrusions both with and without meta-awareness than people with weak beliefs.

LIMITATIONS

We used an analogue trauma, and focused on a particular metacognitive belief, both of which somewhat limit generalizability. We also cannot definitively rule out demand effects.

CONCLUSIONS

Our data add to existing research showing people may lack meta-awareness of trauma-related thoughts, and suggest that survivors with particular metacognitive characteristics may be more vulnerable to 'mind-wandering' about trauma without awareness.