Individual differences in emotionality and peri-traumatic processing

Examining the role of trait anxiety and attentional bias to negative information in intrusion vulnerability following an emotionally negative event

BACKGROUND AND OBJECTIVES

Research shows that individuals with heightened trait anxiety are more likely to experience intrusions; however, the mechanism that accounts for this relationship is unclear. Two alternative hypotheses were tested to determine the nature of the associations between trait anxiety, attentional bias to negative information, and intrusion vulnerability.

METHODS

Intrusions were elicited using the trauma film paradigm, and post-event attentional bias to negative information was assessed using the dot-probe task. Participants then completed a week-long intrusions diary.

RESULTS

Results showed that attentional bias to negative information mediated the effect of heightened trait anxiety on elevated intrusion frequency. It was also revealed that heightened trait anxiety was associated with elevated intrusion-related distress, though attentional bias to negative information did not mediate this relationship.

LIMITATIONS

Our sample was comprised of undergraduate students who were not selected based on a previous pathology. Replication in clinical samples is warranted.

CONCLUSIONS

These findings provide new insight regarding individual differences in the experience of intrusions and suggest that both the frequency and distress associated with intrusions could represent clinical targets.

Content specificity of attentional bias to COVID-19 threat-related information in trait anxiety

Introduction

Anxious individuals selectively attend to threatening information, but it remains unclear whether attentional bias can be generalized to traumatic events, such as the COVID-19 pandemic. Previous studies suggested that specific threats related to personal experiences can elicit stronger attentional bias than general threats. The current study aimed to investigate the relationship between content-specific attentional bias and trait anxiety during the COVID-19 pandemic.

Methods

Attentional bias was assessed using the dot-probe task with COVID-19-related, general threat-related, and neutral words at two exposure times, 200 and 500 ms.

Results

We found participants with high trait anxiety exhibited attentional bias toward COVID-19- related stimuli and attentional bias away from general threat-related stimuli, while participants with low trait anxiety showed attentional bias away from both types of stimuli.

Discussion

Results suggest that individuals with high trait anxiety show a content-specific attentional bias to COVID-19-related information during the COVID-19 pandemic. Apart from the innate attentional bias toward biological threats, individuals with high trait anxiety may also learn from trauma and develop trauma-specific attentional bias.

Multisensory processing of emotional cues predicts intrusive memories after virtual reality trauma

Research has shown that high trait anxiety can alter multisensory processing of threat cues (by amplifying integration of angry faces and voices); however, it remains unknown whether differences in multisensory processing play a role in the psychological response to trauma. This study examined the relationship between multisensory emotion processing and intrusive memories over seven days following exposure to an analogue trauma in a sample of 55 healthy young adults. We used an adapted version of the trauma film paradigm, where scenes showing a car accident trauma were presented using virtual reality, rather than a conventional 2D film. Multisensory processing was assessed prior to the trauma simulation using a forced choice emotion recognition paradigm with happy, sad and angry voice-only, face-only, audiovisual congruent (face and voice expressed matching emotions) and audiovisual incongruent expressions (face and voice expressed different emotions). We found that increased accuracy in recognising anger (but not happiness and sadness) in the audiovisual condition relative to the voice- and face-only conditions was associated with more intrusions following VR trauma. Despite previous results linking trait anxiety and intrusion development, no significant influence of trait anxiety on intrusion frequency was observed. Enhanced integration of threat-related information (i.e. angry faces and voices) could lead to overly threatening appraisals of stressful life events and result in greater intrusion development after trauma.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10055-023-00784-1.

Insights into the antecedents of cyberchondria: a perspective from the USA

This study establishes a theoretical framework for assessing antecedents of cyberchondria, which is a process of amplified anxiety about one's health because of excessive online health information seeking. We examined the framework through partial least squares structural equation modeling after collecting data through a cross-sectional online survey. This research contributes to the literature by (i) evaluating the roles of health anxiety (HA) and affective responses (AR) on cyberchondria; (ii) equipping health strategists with understanding about ways to tailor their educational and communication strategies to specific segments by importance-performance map analysis and necessary condition analysis. Finally, by (iii) providing strategic tactics to curb cyberchondria so that it becomes possible to attain a better patient outcome. Findings suggest that the existing association between intolerance of uncertainty and cyberchondria is serially mediated by HA and AR. For healthcare educators and practitioners, the findings of this research deliver a blueprint for effectively controlling cyberchondria.

Lifetime adversity interacts with peritraumatic data-driven processing to predict intrusive memories

BACKGROUND AND OBJECTIVES

Although most trauma survivors experience some intrusive recollections of the traumatic event, only few subsequently develop posttraumatic stress disorder (PTSD). A well-established proximal risk-factor predictive of post-trauma psychopathology is peritraumatic cognitive processing. Another, more distal risk-factor is pre-trauma lifetime adversity. The present experimental analogue study tested the hypothesis that pre-trauma lifetime adversity interacts with peritraumatic perceptual (i.e., data-driven) processing to predict intrusive memory development.

METHODS

Fifty-three young adult women (non-clinical sample) indicated how much data-driven and conceptual processing they had engaged in while watching aversive film-clips (i.e., analogue trauma). On the subsequent three days, they reported intrusions of those clips. Moderation analyses tested for an interaction effect between lifetime adversity and data-driven processing in predicting intrusion load (number of intrusions weighted for their overall distress).

RESULTS

Increased data-driven processing predicted intrusion load primarily in individuals reporting more than three lifetime adversities, explaining 55% of variance. No such relationship was found for conceptual processing.

LIMITATIONS

Present analogue findings have yet to be replicated in a clinical population. Moreover, the conceptual processing scale was restricted by low internal consistency.

CONCLUSION

Present findings support the idea that intrusions are the result of poorly elaborated and primarily perceptually-formed memory traces; however, this was primarily the case in vulnerable individuals reporting several lifetime adversities. Results replicate the importance of peritraumatic processing in intrusion development but additionally point to a moderating effect of lifetime adversity.

Cardiorespiratory fitness as protection against the development of memory intrusions: A prospective trauma analogue study

Intrusive and distressing memories are at the core of post-traumatic stress disorder (PTSD). Since cardiorespiratory fitness (CRF) has been linked with improved mental health, emotion regulation, and memory function, CRF may, by promoting these capabilities, protect against the development of intrusions after trauma. We investigated the CRF-intrusion relationship and its potential mediators in 115 healthy individuals, using a trauma film to induce intrusions. As potential mediators, we assessed indices of pre-trauma mental health such as heart rate variability, subjective and psychobiological peri-traumatic responses, and memory. Critically, results showed that higher CRF was related to fewer intrusions, but no mediators emerged for the CRF-intrusion relationship. These results indicate that individuals displaying higher CRF are less prone to develop traumatic memory intrusions. Future studies may want to investigate whether promoting fitness prior to possible trauma exposure can boost resilience against the development of debilitating re-experiencing symptoms of PTSD.

When a maritime disaster disrupts the community: The longitudinal course of Post-traumatic stress disorder and predicted factors after Sewol ferry disaster in South Korea

BACKGROUND

The present study assessed acute, delayed, and chronic post-traumatic stress disorder (PTSD) in community residents affected by the disaster, as well as the factors related to the manifestation of symptoms.

METHODS

A total of 2,597 community residents who lived in Jindo, where the Sewol ferry disaster occurred, participated in a survey at baseline (1.5 months); 1,228 (47%) of these respondents were followed-up 15 months later. The variables included demographic characteristics, witnessing the rescue scene, being a community volunteer, and lifetime traumatic experiences. PTSD, depression, and anxiety symptoms were measured using the Impact of Events Scale-Revised (IES-R), Center for Epidemiologic Studies Depression (CESD), and Beck Anxiety Inventory (BAI), respectively. An assessment of property loss due to the Sewol ferry disaster was also included in the follow-up evaluation.

RESULTS

The proportion of PTSD cases among community residents at baseline and follow-up were 16.1% and 15.6% (delayed PTSD, 10.1; chronic PTSD, 5.5%), respectively. Depression and anxiety symptoms at each time point were consistently associated with acute, delayed, and chronic PTSD. Logistic regression analyses showed that anxiety symptoms at baseline predicted the delayed and chronic PTSD. Chronic PTSD was independently predicted by the witness rescue and loss of property immediately after the disaster.

CONCLUSIONS

The present findings provide important evidence supporting the need for comprehensive assessment and management of mental health problems in community residents exposed to a disaster. Financial losses experienced by community residents after a trauma must also be addressed, and psychiatric comorbidities such as depression and anxiety should be identified and treated.

Visuospatial computer game play after memory reminder delivered three days after a traumatic film reduces the number of intrusive memories of the experimental trauma

OBJECTIVE

The experience of intrusive memories is a core clinical symptom of posttraumatic stress disorder (PTSD), and can be distressing in its own right. Notions of dual task interference and reconsolidation-update mechanisms suggest novel approaches to target intrusive memories. This study tested the hypothesis that a single-session cognitive intervention (memory reminder task plus Tetris gameplay) would reduce the occurrence of experimental trauma memories even when delivered 3 days post-trauma. Critically, this study tested effects against two control groups: Reminder-only, and reminder plus another computer game (a form of Quiz).

METHODS

86 healthy volunteers (59% female, age M = 24.35, SD = 4.59 years) watched a trauma film and then recorded their intrusive memories in a diary for 3 days (pre-intervention). They then returned to the lab. After presentation of visual reminder cues for the film plus a 10 min wait period (memory reminder task), participants were randomized into one of three task conditions (Tetris game play, Quiz game play, vs. reminder-only). They then kept the diary for a further 3 days (post-intervention).

RESULTS

As predicted, after the experimental manipulation, the reminder + Tetris group experienced significantly fewer intrusions than the reminder-only group (d = 1.37). Further, the reminder + Tetris group also experienced significantly fewer intrusions than the reminder + Quiz (d = 0.65) group. Contrary to predictions, the reminder + Quiz group experienced significantly fewer intrusions than the reminder-only group (d = 0.69). Prior to the experimental manipulation, there was no significant difference between groups in number of intrusions. Recognition memory test scores for facts of the trauma film after 6 days were comparable between groups.

CONCLUSIONS

We demonstrated that 3 days after experimental trauma (i.e. after memory consolidation) an intervention comprising a reminder task prior to a 15 min cognitive interference task (one of two computer games) led to a reduction in intrusion occurrence compared to reminder only. We interpret and discuss our findings within the framework of supposed reconsolidation-update mechanisms and competition for limited (visuospatial) working memory resources. Should these effects hold true in clinical populations, this type of simple intervention approach could help contribute to reducing intrusive memories of trauma.

Can't get it out of my mind: A systematic review of predictors of intrusive memories of distressing events

Intrusive memories, when persistent and distressing, are theorized to underlie a range of transdiagnostic psychological symptoms and associated impairment. However, little is known about factors predicting the development and persistence of intrusive memories. The aim of this systematic review is to evaluate the literature on pre-event, event-based, and post-event predictors of intrusive memories. A systematic review was conducted, searching for studies that examined intrusive, event-based memories. One hundred and six articles were identified from PsycInfo, PubMed, and Medline databases. Experimental and prospective studies with clinical (N = 14) and nonclinical (N = 92) samples were critically reviewed, provided the inclusion of an analogue stressor with nonclinical samples, and that intrusive memories frequency and/or distress were assessed as primary dependent variables. Pre-existing psychopathology and pre-event appraisal style appear to predict intrusive memories (small to medium effects), whereas trait dissociation did not predict intrusive memories. Of studies examining event-based predictors, higher data-driven processing appears to predict intrusive memories with generally large effects. Post-event negative appraisals consistently predicted intrusive memories (medium to large effects), and preliminary evidence suggests higher post-event conceptual processing predicting fewer intrusive memories. This review synthesizes findings regarding a broad range of pre-event, event-based, and post-event factors that may influence the development of intrusive memories. Methodological issues of current paradigms and the lack of emphasis on memory retrieval processes limit our understanding of what predicts intrusive memory persistence. These limitations are particularly important given that individuals typically seek treatment for distressing intrusive memories once a memory has been fully consolidated, where retrieval processes are of utmost importance. (PsycINFO Database Record

Development and testing of TraumaGameplay: an iterative experimental approach using the trauma film paradigm

Background: Vivid trauma-related intrusions are a hallmark symptom of posttraumatic stress disorder (PTSD), and may be involved in its onset. Effective interventions to reduce intrusions and to potentially prevent the onset of subsequent PTSD are scarce. Studies suggest that playing the videogame Tetris, shortly after watching aversive film clips, reduces subsequent intrusions. Other studies have shown that taxing working memory (WM) while retrieving an emotional memory reduces the memory's vividness and emotionality. Objective: We developed TraumaGameplay (TGP), a gaming app designed to reduce intrusions. This paper describes two successive experiments to determine whether playing TGP without memory retrieval (regular TGP) or TGP with memory retrieval (dual-task TGP) reduces intrusion frequency at one week compared to a no-game control. Method: For both experiments, healthy university students were recruited. Experiment 1: 92 participants were exposed to a trauma film and randomized to (1) regular TGP1 (n = 31), (2) dual-task TGP1 (n = 31) or (3) control (n = 30). In experiment 2, 120 healthy students were exposed to a trauma film and randomized to (1) regular TGP2 (n = 30), (2) dual-task TGP2 (n = 29), (3) recall only (n = 31) or (4) control (n = 30). Results: We found no significant difference between conditions on the number of intrusions for either playing regular TGP or dual-task TGP in both experiment 1 and experiment 2. Conclusion: Our results could not replicate earlier promising findings from preceding experimental research. Several reasons may underpin this difference ranging from the visuospatial videogame used in our experiments to the method of the experiment to the difficulties of replicability in general.

The impact of pre-existing anxiety on affective and cognitive processing of a Virtual Reality analogue trauma

Dysfunctional processing of traumatic events may be in particular related to high trait anxiety as a pre-traumatic risk factor for the development of post-traumatic stress disorder (PTSD). However, as this has rarely been investigated in prospective, experimental studies, we aimed to analyse the association between high trait anxiety and affective as well as cognitive processing of stress using a new prospective Virtual Reality analogue trauma paradigm to overcome limitations of retrospective or current analogue designs. Individuals with high and low trait anxiety (N = 80) were exposed to a multi-sensory Virtual Reality emergency scenario while psychophysiological stress response, emotion regulation and intrusive memories were assessed. Our results showed that high trait anxiety individuals display increased (i) subjective stress responses, (ii) emotion dysregulation and (iii) intrusive memories upon VR analogue trauma exposure. In particular, our sample of high trait anxiety individuals displayed limited access to different emotion regulation strategies as well as increased worry and rumination regarding perceived intrusive memories. Considering the complex interplay of multiple risk factors, our findings suggests that peri-traumatic affective processing seems to mediate high trait anxiety and post-traumatic intrusive memories thereby pointing out the central role of peri-traumatic processes for intrusion development. In addition, HA as a modulating pre-traumatic risk factor might further increase the risk of later dysfunctional processing of an analogue trauma by interacting with factors of affective processing during analogue trauma exposure. Implications of these findings which may contribute to a higher risk to develop PTSD are discussed.

Cultural differences in the relationship between intrusions and trauma narratives using the trauma film paradigm

Two studies explored the influence of culture on the relationship between British and East Asian adults’ autobiographical remembering of trauma film material and associated intrusions. Participants were shown aversive film clips to elicit intrusive images. Then participants provided a post-film narrative of the film content (only Study 1). In both studies, participants reported intrusive images for the film in an intrusion diary during the week after viewing. On returning the diary, participants provided a narrative of the film (delayed). The trauma film narratives were scored for memory-content variables. It was found that for British participants, higher levels of autonomous orientation (i.e. expressions of autonomy and self-determination) and self-focus in the delayed narratives were correlated significantly with fewer intrusions. For the East Asian group, lower levels of autonomous orientation and greater focus on others were correlated significantly with fewer intrusions. Additionally, Study 2 found that by removing the post-film narrative task there was a significant increase in the number of intrusions relative to Study 1, suggesting that the opportunity to develop a narrative resulted in fewer intrusions. These findings suggest that the greater the integration and contextualization of the trauma memory, and the more the trauma memory reflects culturally appropriate remembering, the fewer the intrusions.

Neurophysiological markers that predict and track treatment outcomes in childhood anxiety

The present study examined the cortical processes that mediate cognitive regulation in response to emotion-eliciting stimuli, before and after anxious children participated in a cognitive behavioral therapy program. Electroencephalographic activity was recorded from anxious children (n = 24, 8 males) and comparison children (n = 16, 7 males) at pre-and post-treatment sessions. The change in anxiety T-scores from pre- to post-treatment was used to signify clinical improvement among anxious children (Improvers: n = 11 vs. Non-improvers: n = 13). Event-related potential components were recorded while children performed a Go/No-go task using emotional facial expressions. For the P1 component, believed to reflect attention and/or arousal processes, Non-improvers had greater activation levels relative to Improver and comparison groups at both sessions. Greater P1 amplitudes at pre-treatment predicted non-improvement following treatment. For the frontal N2 component, thought to reflect cognitive control processing, Improvers recruited greater activation from pre- to post-treatment, a change in activation that was predictive of treatment outcome. Non-improvers showed increased cortical activation within the time window of the P1, whether at pre- or post-treatment. These data suggest that heightened perceptual vigilance may have led to poorer outcomes. Improvers showed increased prefrontal activation within the time window of the N2 from pre- to post-treatment. These data suggest that increased cognitive control may have led to improved treatment outcomes. In sum, P1 activation may serve as a predictor of treatment outcome, while N2 activation may serve as an indicator of treatment response.

Intrusive images and voluntary memory for affective pictures: contextualization and dual-task interference

BACKGROUND AND OBJECTIVES

The present study addressed the role of context information and dual-task interference during the encoding of negative pictures on intrusion development and voluntary recall.

METHODS

Healthy participants were shown negative pictures with or without context information. Pictures were either viewed alone or concurrently with a visuospatial or verbal task. Participants reported their intrusive images of the pictures in a diary. At follow-up, perceptual and contextual memory was tested.

RESULTS

Participants in the context group reported more intrusive images and perceptual voluntary memory than participants in the no context group. No effects of the concurrent tasks were found on intrusive image frequency, but perceptual and contextual memory was affected according to the cognitive load of the task.

LIMITATIONS

The analogue method cannot be generalized to real-life trauma and the secondary tasks may differ in cognitive load.

CONCLUSIONS

The findings challenge a dual memory model of PTSD but support an account in which retrieval strategy, rather than encoding processes, accounts for the experience of involuntary versus voluntary recall.