Longitudinal relationships among posttraumatic stress disorder symptom clusters in response to positive memory processing

Therapeutic impacts of recalling and processing positive autobiographical memories on posttrauma health: An open-label study

The processing of positive memories technique (PPMT) entails detailed narration and processing of specific positive autobiographical memories (AM) and has shown promise in improving posttraumatic stress disorder (PTSD) symptoms. We examined whether participants receiving PPMT reported decreases in PTSD and depressive symptom severity, negative affect levels/reactivity, posttrauma cognitions, and positive emotion dysregulation, as well as increases in positive affect levels/reactivity and the number of retrieved positive AMs across four PPMT sessions. Individuals (N = 70) recruited from the community completed surveys at baseline (pre-PPMT), each PPMT session, and after completing all four PPMT sessions. Multilevel linear growth models indicated session-to-session decreases in PTSD severity, β = -.17, p < .001; depressive symptom severity, β = -.13, p < .001; negative affect levels, β = -.13, p < .001; positive affect reactivity, β = -.14, p = .014; and posttrauma cognitions, β = -.12, p < .001; and session-to-session increases in negative affect reactivity, β = .18, p = .001. Paired-samples t tests indicated decreases in retrieved positive AMs, d = 0.40, p = .001, including specific positive AMs, and negative AMs, d = 0.23, p = .022, and increases in retrieved overgeneral positive AMs, d = -0.38, p = .002, from baseline to postintervention. Thus, PPMT may help decrease PTSD and depression severity, negative affect, posttrauma cognitions, and negative AM recall tendencies. Clinicians may need to incorporate additional skills into the PPMT framework to improve positive affect processes that can be sustained over time.

Augmenting trauma-focused cognitive behavior therapy for post-traumatic stress disorder with memory specificity training: a randomized controlled trial

Although trauma-focused cognitive behavior therapy (TF-CBT) is the recommended treatment for post-traumatic stress disorder (PTSD), up to one-half of patients do not respond to this intervention. There is an urgent need to develop new strategies to improve treatment response. Training people to recall specific positive memories may augment treatment gains in TF-CBT. We conducted a controlled trial in Australia with current or former first responders (including police, firefighters and paramedics) with PTSD, who were randomized on a 1:1 basis to 12 weekly 90-min individual sessions of either TF-CBT combined with memory specificity training (TF-CBT/MT) or TF-CBT alone. The primary outcome was change in PTSD severity independently assessed at baseline, post-treatment, and six months after treatment (primary outcome timepoint). Secondary outcomes included measures of depression, trauma-related cognitions, alcohol use, and quality of life. Between October 2021 and May 2023, fifty participants were randomized to TF-CBT/MT, and fifty to TF-CBT alone. Most participants were males (71.0%) and the mean age was 46.8±9.9 years. At the 6-month assessment, participants receiving TF-CBT/MT showed a greater reduction of PTSD severity than those randomized to TF-CBT alone (mean difference: 9.2, 95% CI: 3.2-15.1, p=0.003), indicating a large effect size (0.9, 95% CI: 0.1-1.6). Participants receiving TF-CBT/MT also had greater reductions in alcohol use (mean difference: 5.3, 95% CI: 1.5-9.2, p=0.007; effect size: 0.8, 95% CI: 0.2-1.4) and self-blame cognitions (mean difference: 0.8, 95% CI: 0.2-1.4, p=0.008; effect size: 0.5, 95% CI: 0.1-0.9). These data suggest that memory specificity training adds significantly to the effect of standard TF-CBT in reducing PTSD severity. This approach can offer a simple and easy to implement strategy to augment treatment for PTSD patients.

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.

Impacts of repeated retrieval of positive and neutral memories on posttrauma health: An investigative pilot study

BACKGROUND AND OBJECTIVES

Evidence indicates that positive memory processes play a role in the etiology and maintenance of posttraumatic stress symptoms (PTSS) and related posttrauma health indicators. To extend this research, the current pilot study examined if repeated retrieval of positive vs. neutral memories was associated with (1) less PTSS and depression severity; and (2) improved affect and cognitions (fewer posttrauma cognitions, more positively-valenced affect, less negatively-valenced affect, less negative affect interference, less anhedonia, retrieval of more positive specific memories, retrieval of fewer negative specific memories).

METHODS

Twenty-five trauma-exposed participants were randomly assigned to a positive or neutral memory task condition. They participated in four weekly experimental sessions facilitated by an experimenter virtually; each consecutive session was separated by 6-8 days. We conducted mixed between-within subjects ANOVAs to examine study hypotheses.

RESULTS

No interaction effects were significant. There were significant main effects of time on PTSS and depression severity, posttrauma cognitions, positively-valenced and negatively-valenced affect, and negative affect interference.

LIMITATIONS

We used self-report measures, small and non-clinical sample with limited demographic diversity, and virtual format; did not record memory narratives; and did not have a trauma memory condition.

CONCLUSIONS

Based on pilot data, our findings suggest that individuals who retrieve positive or neutral memories repeatedly may report less PTSS and depression severity, fewer posttrauma cognitions, and improved affect. Results provide an impetus to examine impacts of and mechanisms underlying memory interventions (beyond a sole focus on negatively-valenced memories) in trauma work.

Relations Between Posttraumatic Stress Disorder Symptoms and Positive Memory Characteristics Among Women Reporting Intimate Partner Violence: A Micro-Longitudinal Study

Evidence links posttraumatic stress disorder (PTSD) symptoms to positive autobiographical memory characteristics. To extend this research, we uniquely utilized micro-longitudinal data to examine (1) the trajectory of PTSD symptom count across 30 days; and (2) if more vividness and accessibility of retrieved positive memories at the daily level predicted decreases in the trajectory of PTSD symptom count across 30 days. The current study was a secondary data analysis of a larger study. The sample included 74 women who reported physical or sexual victimization in the past 30 days by their current male partner and reported the use of alcohol and/or drugs during that time (M_age = 39.68 years; 37.80% with diagnostic PTSD; 43.2% White; 37.8% Black or African American). They completed thrice daily measures of PTSD symptoms and positive memory characteristics (vividness and accessibility) across 30 days. Results of the random effects longitudinal multilevel model indicated that, on average, the relation between PTSD symptom count and positive memory vividness was positive and statistically significant (0.19, 95% Confidence Interval [CI] [0.2, 0.35]); and the relation between PTSD symptom count and positive memory accessibility was positive and statistically significant (0.31, 95% CI [0.15, 0.47]). The relationship between PTSD symptom count and positive memory vividness/accessibility (i.e., slopes) varied significantly across participants, with a wide range of positive and negative regression coefficients. Future research needs to investigate why and how positive memory vividness and accessibility may relate to trajectories of PTSD symptoms over time, with potential clinical implications for positive memory interventions addressing PTSD.

Associations between positive memory count and hazardous substance use in a trauma-exposed sample: Examining the moderating role of emotion dysregulation

OBJECTIVES

Research has demonstrated links between autobiographical memory retrieval and hazardous substance use. However, limited work has examined relations between positive autobiographical memories and hazardous substance use, as well as moderating factors influencing these relations. Thus, we examined the potential moderating roles of negative and positive emotion dysregulation in the relations between count of retrieved positive memories and hazardous substance use (alcohol and drug use separately).

METHODS

Participants were 333 trauma-exposed students (Mage  = 21.05; 85.9% women) who completed self-report measures assessing positive memory count, hazardous alcohol and drug use, negative emotion dysregulation, and positive emotion dysregulation.

RESULTS

Positive emotion dysregulation significantly moderated the association between positive memory count and hazardous alcohol use (b = 0.04, 95% confidence interval [CI] [0.01, 0.06], p = 0.019), as well as the association between positive memory count and hazardous drug use (b = 0.02, 95% CI [0.01, 0.03], p = 0.002). Individuals with more positive emotion dysregulation had stronger associations between increases in positive memory count and increased hazardous substance use.

CONCLUSION

Findings indicate that trauma-exposed individuals who retrieve more positive memories and experience difficulties regulating positive emotions report greater hazardous substance use. Positive emotion dysregulation may be an important target for memory-based interventions among trauma-exposed individuals who report hazardous substance use.