Perceptual processing advantages for trauma-related visual cues in post-traumatic stress disorder

The memory trace of an intrusive trauma-analog episode

Intrusive memories are a core symptom of posttraumatic stress disorder. Compared with memories of everyday events, they are characterized by several seemingly contradictory features: intrusive memories contain distinct sensory and emotional details of the traumatic event and can be triggered by various perceptually similar cues, but they are poorly integrated into conceptual memory. Here, we conduct exploratory whole-brain analyses to investigate the neural representations of trauma-analog experiences and how they are reactivated during memory intrusions. We show that trauma-analog movies induce excessive processing and generalized representations in sensory areas but decreased blood-oxygen-level-dependent (BOLD) responses and highly distinct representations in conceptual/semantic areas. Intrusive memories activate generalized representations in sensory areas and reactivate memory traces specific to trauma-analog events in the anterior cingulate cortex. These findings provide the first evidence of how traumatic events could distort memory representations in the human brain, which may form the basis for future confirmatory research on the neural representations of traumatic experiences.

Using experience sampling methodology (ESM) to improve our understanding of day-to-day intrusion frequency and related distress in survivors of trauma

BACKGROUND AND OBJECTIVES

Cognitive models of posttraumatic stress disorder (PTSD) suggest that appraisals of traumatic sequelae and subsequent distress drive the development and maintenance of PTSD. Posttraumatic research has relied heavily on macro-longitudinal designs, with weeks or months between assessments of trauma-related cognitions and symptoms. The present study uses experience sampling methodology (ESM) better understand the day-to-day experiences of trauma exposed individuals.

METHODS

One-hundred trauma exposed adults reported their posttraumatic symptoms, interpretations, and behaviours four times a day over a 10-day ESM period.

RESULTS

As anticipated, within-person fluctuations in negative appraisals of intrusions and maladaptive coping strategies (e.g., thought suppression) were significantly positively associated with intrusion frequency and related distress. In all cases, the associations for negative appraisals and maladaptive coping were stronger with intrusion related distress than intrusion frequency.

LIMITATIONS

The observed contemporaneous associations only demonstrate that variables reliably fluctuated together and cannot indicate causality.

CONCLUSIONS

The findings demonstrate that day-to-day fluctuations in trauma related perceptions and sequelae are significant and should be explored alongside broader individual differences to advance our understanding of the development, maintenance, and treatment of PTSD.

Prior Sexual Trauma Exposure Impacts Posttraumatic Dysfunction and Neural Circuitry Following a Recent Traumatic Event in the AURORA Study

Background

Prior sexual trauma (ST) is associated with greater risk for posttraumatic stress disorder after a subsequent traumatic event; however, the underlying neurobiological mechanisms remain opaque. We investigated longitudinal posttraumatic dysfunction and amygdala functional dynamics following admission to an emergency department for new primarily nonsexual trauma in participants with and without previous ST.

Methods

Participants (N = 2178) were recruited following acute trauma exposure (primarily motor vehicle collision). A subset (n = 242) completed magnetic resonance imaging that included a fearful faces task and a resting-state scan 2 weeks after the trauma. We investigated associations between prior ST and several dimensions of posttraumatic symptoms over 6 months. We further assessed amygdala activation and connectivity differences between groups with or without prior ST.

Results

Prior ST was associated with greater posttraumatic depression (F1,1120 = 28.35, p = 1.22 × 10-7, ηp2 = 0.06), anxiety (F1,1113 = 17.43, p = 3.21 × 10-5, ηp2 = 0.05), and posttraumatic stress disorder (F1,1027 = 11.34, p = 7.85 × 10-4, ηp2 = 0.04) severity and more maladaptive beliefs about pain (F1,1113 = 8.51, p = .004, ηp2 = 0.02) but was not related to amygdala reactivity to fearful versus neutral faces (all ps > .05). A secondary analysis revealed an interaction between ST and lifetime trauma load on the left amygdala to visual cortex connectivity (peak Z value: -4.41, corrected p < .02).

Conclusions

Findings suggest that prior ST is associated with heightened posttraumatic dysfunction following a new trauma exposure but not increased amygdala activity. In addition, ST may interact with lifetime trauma load to alter neural circuitry in visual processing regions following acute trauma exposure. Further research should probe the relationship between trauma type and visual circuitry in the acute aftermath of trauma.

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.

Spontaneous brain activity, graph metrics, and head motion related to prospective post-traumatic stress disorder trauma-focused therapy response

Introduction

Trauma-focused psychotherapy for post-traumatic stress disorder (PTSD) is effective in about half of all patients. Investigating biological systems related to prospective treatment response is important to gain insight in mechanisms predisposing patients for successful intervention. We studied if spontaneous brain activity, brain network characteristics and head motion during the resting state are associated with future treatment success.

Methods

Functional magnetic resonance imaging scans were acquired from 46 veterans with PTSD around the start of treatment. Psychotherapy consisted of trauma-focused cognitive behavioral therapy (tf-CBT), eye movement desensitization and reprocessing (EMDR), or a combination thereof. After intervention, 24 patients were classified as treatment responders and 22 as treatment resistant. Differences between groups in spontaneous brain activity were evaluated using amplitude of low-frequency fluctuations (ALFF), while global and regional brain network characteristics were assessed using a minimum spanning tree (MST) approach. In addition, in-scanner head motion was assessed.

Results

No differences in spontaneous brain activity and global network characteristics were observed between the responder and non-responder group. The right inferior parietal lobule, right putamen and left superior parietal lobule had a more central position in the network in the responder group compared to the non-responder group, while the right dorsolateral prefrontal cortex (DLPFC), right inferior frontal gyrus and left inferior temporal gyrus had a less central position. In addition, responders showed less head motion.

Discussion

These results show that areas involved in executive functioning, attentional and action processes, learning, and visual-object processing, are related to prospective PTSD treatment response in veterans. In addition, these findings suggest that involuntary micromovements may be related to future treatment success.

Acute Posttraumatic Symptoms Are Associated With Multimodal Neuroimaging Structural Covariance Patterns: A Possible Role for the Neural Substrates of Visual Processing in Posttraumatic Stress Disorder

BACKGROUND

Although aspects of brain morphology have been associated with chronic posttraumatic stress disorder (PTSD), limited work has investigated multimodal patterns in brain morphology that are linked to acute posttraumatic stress severity. In the present study, we utilized multimodal magnetic resonance imaging to investigate if structural covariance networks (SCNs) assessed acutely following trauma were linked to acute posttraumatic stress severity.

METHODS

Structural magnetic resonance imaging data were collected around 1 month after civilian trauma exposure in 78 participants. Multimodal magnetic resonance imaging data fusion was completed to identify combinations of SCNs, termed structural covariance profiles (SCPs), related to acute posttraumatic stress severity collected at 1 month. Analyses assessed the relationship between participant SCP loadings, acute posttraumatic stress severity, the change in posttraumatic stress severity from 1 to 12 months, and depressive symptoms.

RESULTS

We identified an SCP that reflected greater gray matter properties of the anterior temporal lobe, fusiform face area, and visual cortex (i.e., the ventral visual stream) that varied curvilinearly with acute posttraumatic stress severity and the change in PTSD symptom severity from 1 to 12 months. The SCP was not associated with depressive symptoms.

CONCLUSIONS

We identified combinations of multimodal SCNs that are related to variability in PTSD symptoms in the early aftermath of trauma. The identified SCNs may reflect patterns of neuroanatomical organization that provide unique insight into acute posttraumatic stress. Furthermore, these multimodal SCNs may be potential candidates for neural markers of susceptibility to both acute posttraumatic stress and the future development of PTSD.

The Role of Implicit Memory in the Development and Recovery from Trauma-Related Disorders

Post-traumatic Stress Disorder is a chronic condition that occurs following a traumatic experience. Information processing models of PTSD focus on integrating situationally triggered sensory-emotional memories with consciously accessible autobiographical memories. Review of the nature of implicit memory supports the view that sensory-emotional memories are implicit in nature. Dissociation was also found to be associated with the development and severity of PTSD, as well as deficits in autobiographical memory. Moreover, disorganized attachment (DA) was associated with greater degrees of dissociation and PTSD, and like the defining neural activation in PTSD, was found to be associated with basal ganglia activity. In addition, subcortical neuroception of safety promotes a neurophysiological substrate supportive of social engagement and inhibition of fear-based responses. Furthermore, activation of representations of co-created imagined scenes of safety and secure attachment are associated with increases in this neurophysiological substrate. Repeated priming of secure attachment imagery was associated with modification of internal working models of DA along with reductions in dissociation and recovery from complex PTSD. In conclusion, it is posited that adequate recovery from extensive trauma experiences requires more than conscious elaboration of traumatic autobiographical memories and that the application of implicit nonconscious memory modification strategies will facilitate more optimal recovery.

Traumatized Refugees in Psychotherapy: Long-Term Changes in Personality, Mental Health, Well-Being, and Exile Life Functioning

ABSTRACT

This pre- and posttreatment study of 22 severely traumatized adult refugees spanned a mean of 6.5 years. Changes in personality functioning, mental health, and well-being were examined using the Rorschach Performance Assessment System, Harvard Trauma Questionnaire, Hopkins Symptom Checklist-25, and the World Health Organization's Quality of Life-BREF questionnaire. A paired samples t-test revealed significant improvement after psychotherapy in traumatic ideation and initial severe disruptions in thought processes, reality testing, perception, self and other representations, and relational capacity (Cohen's d = 0.46-0.59). Symptoms of anxiety, depression, and posttraumatic stress were significantly reduced (d = 0.54-0.84), quality of life in the physical health and psychological health domains increased significantly (d = 0.87 and 0.97), and percentage of participants with exile language proficiency and work/study status increased significantly. The findings demonstrate the potential of psychotherapy to contribute to normalizing perceptual, cognitive, and relational capacities in severely traumatized refugees, paramount to well-being and functioning in exile.

Clinical Outcomes of Severe Forms of Early Social Stress

Early social stress, particularly severe but nevertheless frequent forms such as abuse and neglect, are among the major risk factors for the development of mental disorders. However, we only have very limited knowledge of the psychobiological disease mechanisms underlying the influence of early life stress and stress-related disorders during this vulnerable phase of life. Early stress can have long-lasting adverse effects on the brain and other somatic systems, e.g. through influences on brain development. In adulthood, the prior experience of abuse or neglect can result in complex clinical profiles. Besides conditions such as mood and anxiety disorders as well as posttraumatic stress disorder, substance use disorders (SUD) are among the most prevalent sequelae of early social stress. Current social stress further influences the development and maintenance of these disorders, e.g., by increasing the risk of relapses. In this chapter, we will first give an overview of currently used methods to assess the phenomenology and pathophysiology of stress-related disorders and then focus on the phenomenological and neurobiological background of the interaction between early social stress and SUD. We will give an overview of important insights from neuroimaging studies and will also highlight recent findings from studies using digital tools such as ecological momentary assessment or virtual reality to capture the influence of early social stress as well as current social stress in everyday life of persons with SUD.

Perceptual processing of stimuli related to an analogue traumatic event: An ERP study

Previous research has suggested that exposure to potentially traumatic events can lead to increased perceptual processing specific to trauma-related stimuli. Moreover, conceptual processing strategies during encoding may reduce the effect of trauma exposure on perceptual processing. The current study investigated the effect of a trauma film on perceptual processing with visual evoked potentials. Participants were primed with perceptual or conceptual processing strategies, then viewed a trauma film and a control film. Participants then looked at emotionally negative and neutral images that were related or unrelated to the films. The amplitude of the P1 evoked potential was measured during image presentation. P1 amplitude was more positive specifically for negative film-related stimuli. Moreover, this effect was stronger in participants primed with perceptual processing. These results suggest that potentially traumatic events increase perceptual processing specifically for trauma-related stimuli, and that conceptual encoding strategies attenuate the effect of exposure to potentially traumatic events on perception.

Cognitive paths from trauma to posttraumatic stress disorder: a prospective study of Ehlers and Clark's model in survivors of assaults or road traffic collisions

BACKGROUND

Individual differences in cognitive responses to trauma may represent modifiable risk factors that could allow early identification, targeted early treatment and possibly prevention of chronic posttraumatic stress disorder (PTSD). Ehlers and Clark's cognitive model of PTSD suggests that negative appraisals, disjointed trauma memories, and unhelpful coping strategies maintain PTSD. These are thought to be influenced by cognitive processing during trauma. The aim of this study was to test this model prospectively with path analyses.

METHODS

Participants (N = 828) were recruited from an emergency department following injury in a violent assault or road traffic collision and 700 participated in the 6-month assessments. Cognitive processing was assessed shortly after the event, negative appraisals, disjointed memories, and unhelpful coping strategies at 1 month, persistent PTSD symptom severity at 6 months, and early PTSD symptom severity at 2 weeks.

RESULTS

Cognitive variables, with trauma type and gender, explained 52% of the variance in PTSD symptom severity at 6 months. Including early symptom severity in the model did not explain more variance (53%). Early PTSD symptom severity, with trauma type and gender, only predicted 40%. Negative appraisals and disjointed memories predicted persistent symptom severity both directly and indirectly via unhelpful strategies. Peritraumatic processing predicted persistent symptom severity mainly indirectly. The effects of trauma type and gender were fully mediated by the cognitive factors.

CONCLUSIONS

The results are consistent with theoretically derived predictions and support cognitive factors as indicators of risk for chronic PTSD and as a target for the treatment and prevention of PTSD.

Negative item memory and associative memory: Influences of working memory capacity, anxiety sensitivity, and looming cognition

BACKGROUND AND OBJECTIVES

Traumatic or negative stimuli facilitate item memory but impair associated context memory. Vulnerability factors related to the maintenance and onset of posttraumatic stress disorder (PTSD), such as anxiety sensitivity, looming cognitive style, dissociation, and low working memory capacity, have been identified. However, little is known about how these factors influence negative item or associative memory.

METHODS

Eighty-five undergraduates completed self-report questionnaires, the operation span with words (OSPAN) task, and an item and associative memory task in which incidental encoding of negative and neutral items and context information (Day 1) was followed by an unexpected retrieval test (Day 2).

RESULTS

The results showed greater Hit rates and False Alarms on item memory and lower accuracy on context memory with negative stimuli than with neutral stimuli, replicating previous findings. Low working memory capacity and high dissociation were correlated with low negative item memory. Under low working memory capacity, high levels of anxiety sensitivity and looming cognitive style predicted high dissociation levels and low accuracy for negative item memory. There were no individual differences involving associative memory.

LIMITATIONS

A nonclinical sample was used, which limits the generalizability of our results to clinical samples.

CONCLUSIONS

Dissociation could be a coping strategy for reducing negative item memory. Anxiety sensitivity and looming cognitive style facilitate dissociative coping; however, working memory capacity buffers against these vulnerabilities.

Investigating predictors of trauma induced data-driven processing and its impact on attention bias and free recall

BACKGROUND

Whilst data-driven processing (DDP) during trauma has been shown to play a role in poor memory integration and is associated with post-traumatic stress disorder (PTSD) re-experiencing symptoms, the pre-trauma risk factors and related cognitive mechanisms are uncertain.

AIMS

This experimental study aimed to investigate predictors of peri-traumatic DDP, as well as its role in attention bias to threat and free recall.

METHOD

A virtual reality video was used to simulate an analogue trauma. Questionnaires, a free recall task, and an eye-tracking measure assessed cognitive changes after exposure.

RESULTS

Regression analysis demonstrated that trait dissociation at pre-exposure to trauma significantly predicted DDP. Attention bias towards threat-related images was found. Results showed that DDP and poorer free recall predicted attention bias to threat images and higher levels of DDP actually predicted higher overall scores in the free recall task.

CONCLUSIONS

This study showed that DDP is strongly linked to dissociative traits, and along with memory disintegration it may predict attention changes after exposure to a trauma.

Rethinking post-traumatic stress disorder - A predictive processing perspective

Predictive processing has become a popular framework in neuroscience and computational psychiatry, where it has provided a new understanding of various mental disorders. Here, we apply the predictive processing account to post-traumatic stress disorder (PTSD). We argue that the experience of a traumatic event in Bayesian terms can be understood as a perceptual hypothesis that is subsequently given a very high a-priori likelihood due to its (life-) threatening significance; thus, this hypothesis is re-selected although it does not fit the actual sensory input. Based on this account, we re-conceptualise the symptom clusters of PTSD through the lens of a predictive processing model. We particularly focus on re-experiencing symptoms as the hallmark symptoms of PTSD, and discuss the occurrence of flashbacks in terms of perceptual and interoceptive inference. This account provides not only a new understanding of the clinical profile of PTSD, but also a unifying framework for the corresponding pathologies at the neurobiological level. Finally, we derive directions for future research and discuss implications for psychological and pharmacological interventions.

The neural correlates of trauma-related autobiographical memory in posttraumatic stress disorder: A meta-analysis

BACKGROUND

Autobiographical memory (AM) refers to memories of events that are personally relevant and are remembered from one's own past. The AM network is a distributed brain network comprised largely by prefrontal medial and posteromedial cortical brain regions, which together facilitate AM. Autobiographical memories with high arousal and negatively valenced emotional states are thought to be retrieved more readily and re-experienced more vividly. This is critical in the case of trauma-related AMs, which are related to altered phenomenological experiences as well as aberrations to the underlying neural systems in posttraumatic stress disorder (PTSD). Critically, these alterations to the AM network have not been explored recently and have never been analyzed with consideration to the different processes of AM, them being retrieval and re-experiencing.

METHODS

We conducted a series of effect-size signed differential mapping meta-analyses across twenty-eight studies investigating the neural correlates of trauma-related AMs in participants with PTSD as compared with controls. Studies included either trauma-related scripts or trauma-related materials (i.e., sounds, images, pictures) implemented to evoke the recollection of a trauma-related memory.

RESULTS

The meta-analyses revealed that control and PTSD participants displayed greater common brain activation of prefrontal medial and posteromedial cortices, respectively. Whereby the prefrontal medial cortices are suggested to facilitate retrieval monitoring, the posteromedial cortices are thought to enable the visual imagery processes of AM.

CONCLUSIONS

Taken together, reduced common activation of prefrontal cortices may be interpreted as a bias toward greater re-experiencing, where the more salient elements of the traumatic memory are relived as opposed to retrieved in a controlled manner in PTSD.

Angiotensin involvement in trauma processing-exploring candidate neurocognitive mechanisms of preventing post-traumatic stress symptoms

The angiotensin-II antagonist losartan is a promising candidate that has enhanced extinction in a post-traumatic stress disorder (PTSD) animal model and was related to reducing PTSD symptom development in humans. Here, we investigate the neurocognitive mechanisms underlying these results, testing the effect of losartan on data-driven and contextual processing of traumatic material, mechanisms proposed to be relevant for PTSD development. In a double-blind between-subject design, 40 healthy participants were randomised to a single oral dose of losartan (50 mg) or placebo, 1 h before being exposed to distressing films as a trauma analogue while heart rate (HR) was measured. Peritraumatic processing was investigated using blurry picture stimuli from the films, which transformed into clear images. Data-driven processing was measured by the level of blurriness at which contents were recognised. Contextual processing was measured as the amount of context information retrieved when describing the pictures' contents. Negative-matched control images were used to test perceptual processing of peripheral trauma-cues. Post-traumatic stress symptoms were assessed via self-report questionnaires after analogue trauma and an intrusion diary completed over 4 days following the experiment. Compared to placebo, losartan facilitated contextual processing and enhanced detail perception in the negative-match pictures. During the films, the losartan group recorded lower HR and higher HR variability, reflecting lower autonomic stress responses. We discuss potential mechanisms of losartan in preventing PTSD symptomatology, including the role of reduced arousal and increased contextual processing during trauma exposure, as well as increased threat-safety differentiation when encountering peripheral trauma-cues in the aftermaths of traumatic events.

The Threatful Self: Midbrain Functional Connectivity to Cortical Midline and Parietal Regions During Subliminal Trauma-Related Processing in PTSD

BACKGROUND

The innate alarm system consists of a subcortical network of interconnected midbrain, lower brainstem, and thalamic nuclei, which together mediate the detection of evolutionarily-relevant stimuli. The periaqueductal gray is a midbrain structure innervated by the innate alarm system that coordinates the expression of defensive states following threat detection. In participants with post-traumatic stress disorder, the periaqueductal gray displays overactivation during the subliminal presentation of trauma-related stimuli as well as altered resting-state functional connectivity. Aberrant functional connectivity is also reported in post-traumatic stress disorder for the default-mode network, a large-scale brain network recruited during self-referential processing and autobiographical memory. Here, research lacks investigation on the extent to which functional interactions are displayed between the midbrain and the large-scale cortical networks in post-traumatic stress disorder.

METHODS

Using a subliminal threat presentation paradigm, we investigated psycho-physiological interactions during functional neuroimaging in participants with post-traumatic stress disorder (n = 26) and healthy control subjects (n = 20). Functional connectivity of the periaqueductal gray was investigated across the whole-brain of each participant during subliminal exposure to trauma-related and neutral word stimuli.

RESULTS

As compared to controls during subliminal threat presentation, the post-traumatic stress disorder group showed significantly greater periaqueductal gray functional connectivity with regions of the default-mode network (i.e., angular gyrus, precuneus, superior frontal gyrus). Moreover, multiple regression analyses revealed that the functional connectivity between the periaqueductal gray and the regions of the default-mode network correlated positively to symptoms of avoidance and state dissociation in post-traumatic stress disorder.

CONCLUSION

Given that the periaqueductal gray engages the expression of defensive states, stronger midbrain functional coupling with the default-mode network may have clinical implications to self-referential and trauma-related processing in participants with post-traumatic stress disorder.

Differential effects of sleep on explicit and implicit memory for potential trauma reminders: findings from an analogue study

Background: Recent findings suggest that disruptions of sleep-related memory processing are involved in the development of posttraumatic stress symptoms. More specifically, exposure to an analogue traumatic event resulted in fewer intrusive memories, when it was followed by sleep instead of continued wakefulness. However, competing evidence suggests that sleep deprivation may reduce intrusive re-experiencing. To address these conflicting accounts, we examined how sleep - as opposed to partial sleep deprivation - modulates explicit and implicit trauma memory using an analogue procedure. Methods: Healthy participants (N = 41) were assigned to a Sleep or Partial sleep deprivation group. Prior to nocturnal sleep, both groups were exposed to "traumatic" picture stories. After sleep or partial sleep deprivation, participants were subjected to tests of explicit and implicit memory for potential trauma reminders. Thereafter, participants completed an intrusion triggering task that was embedded in a distractor task. Results: Analyses revealed higher explicit memory for potential trauma reminders after sleep as compared to partial sleep deprivation. No group differences were found for implicit memory. Participants responded with fewer intrusions after sleep than following partial sleep deprivation. Conclusions: The current findings support a protective role of sleep in trauma memory processing, which may be evident after the first night of sleep post-trauma. Although more research is needed, our results corroborate the importance of promoting restful sleep in trauma-exposed individuals.

Trauma Memory Processing in Posttraumatic Stress Disorder Psychotherapy: A Unifying Framework

Trauma memory processing (TMP) is an empirically supported approach to psychotherapy for posttraumatic stress disorder (PTSD). However, TMP is not a single, uniform intervention but instead a paradigm that can be operationalized through a variety of component procedures that have not been systematically elucidated and formally tested. Based on findings from phenomenological/structural and neuroimaging research, a central feature of PTSD is theorized to be the involuntary immersion in trauma memories with diminished awareness or negative appraisals of self and current context. Such intrusive reexperiencing-which is epitomized by, but not limited to, flashbacks-is postulated to underlie PTSD's avoidance, altered emotions and cognitions, dissociative, and hyperarousal/hypervigilance symptoms; it is thus a logical target for TMP. The varied approaches to TMP for PTSD are conceptualized as having the common goal of activation of the neural networks in the brain that underlie two key capacities disrupted by intrusive reexperiencing in PTSD: intentional self-referential retrieval of memories and suppression of memory retrieval. Therefore, TMP is postulated to involve two core functions (purposeful reflective remembering and memory awareness in situ) and three essential types (in vivo, imaginal, and cognitive reappraisal). Several implications of this framework for clinical practice and research on TMP for PTSD are discussed.

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

Who is afraid of ISIS? ISIS anxiety and its correlates

Islamic State of Iraq and the Levant (ISIS) is a relatively small organization, yet it wields its terror and media campaigns efficiently. Its presence has altered security measures in many western counties. In the current study, I assess anxiety of the ISIS threat and its correlates in a convenience sample of 1,007 adult Israelis (mean age = 29.61, SD = 7.16). Findings show that being female, a lower socioeconomic status, and having elevated post-traumatic stress disorder (PTSD) symptom levels were all associated with ISIS anxiety. Likewise, exposure to ISIS media, as well as having low resilience, was also correlated with ISIS anxiety. The correlations between ISIS anxiety on the one hand and ISIS media exposure, PTSD symptoms, and resilience on the other hand remained significant even after controlling for general anxiety symptoms. Finally, the PTSD- ISIS anxiety relationship was especially pronounced when resources (resilience/optimism) were low. This critical interaction also remained significant after controlling for general anxiety. Theoretical and practical ramifications of ISIS anxiety are discussed. Both resources for addressing current tasks (resilience), as well as those aimed at future outcomes (optimism), may be required for addressing ISIS anxiety, especially when PTSD symptoms are high.

Differential effects of negative emotion on memory for items and associations, and their relationship to intrusive imagery

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Negative emotion can affect memory for items and associations differentially.

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Strengthened item memory reflected in increased amygdala activity.

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Weakened contextual/associative memory reflected in reduced hippocampal activity.

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Imbalance between strong negative items and weak contextual associations predicts intrusions.

A crucial aspect of episodic memory formation is the way in which our experiences are stored within a coherent spatio-temporal context. We review research that highlights how the experience of a negative event can alter memory encoding in a complex manner, strengthening negative items but weakening associations with other items and the surrounding context. Recent evidence suggests that these opposing effects can occur through amygdala up-modulation to facilitate item encoding, while the hippocampal provision of contextual binding is down-modulated. We consider how these characteristics of memory for negative events might contribute to the development and maintenance of distressing intrusive imagery in posttraumatic stress disorder, and how they should influence therapeutic interventions.

Negative emotional content disrupts the coherence of episodic memories

Events are thought to be stored in episodic memory as coherent representations, in which the constituent elements are bound together so that a cue can trigger reexperience of all elements via pattern completion. Negative emotional content can strongly influence memory, but opposing theories predict strengthening or weakening of memory coherence. Across a series of experiments, participants imagined a number of person-location-object events with half of the events including a negative element (e.g., an injured person), and memory was tested across all within event associations. We show that the presence of a negative element reduces memory for associations between event elements, including between neutral elements encoded after a negative element. The presence of a negative element reduces the coherence with which a multimodal event is remembered. Our results, supported by a computational model, suggest that coherent retrieval from neutral events is supported by pattern completion, but that negative content weakens associative encoding which impairs this process. Our findings have important implications for understanding the way traumatic events are encoded and support therapeutic strategies aimed at restoring associations between negative content and its surrounding context.

Posterior and prefrontal contributions to the development posttraumatic stress disorder symptom severity: an fMRI study of symptom provocation in acute stress disorder

Acute stress disorder (ASD) is predictive of the development of posttraumatic stress disorder (PTSD). In response to symptom provocation, the exposure to trauma-related pictures, ASD patients showed increased activation of the medial posterior areas of precuneus and posterior cingulate cortex as well as of superior prefrontal cortex in a previous study. The current study aimed at investigating which activated areas are predictive of the development of PTSD. Nineteen ASD patients took part in an fMRI study in which they were shown personalized trauma-related and neutral pictures within 4 weeks of the traumatic event. They were assessed for severity of PTSD 4 weeks later. Activation contrasts between trauma-related and neutral pictures were correlated with subsequent PTSD symptom severity. Greater activation in, among others, right medial precuneus, left retrosplenial cortex, precentral and right superior temporal gyrus as well as less activation in lateral, superior prefrontal and left fusiform gyrus was related to subsequently increased PTSD severity. The results are broadly in line with neural areas related to etiological models of PTSD, namely multisensory associative learning recruiting posterior regions on the one hand and failure to reappraise maladaptive cognitions, thought to involve prefrontal areas, on the other.

Prime and prejudice: The effect of priming context and prejudicial attitudes on post-traumatic stress disorder symptoms following immigrant violence

The recent arrival of immigrants into many western countries has become common. Clashes between immigrants and local residents may produce acts of violence. In two studies we assessed post-traumatic stress disorder (PTSD) symptoms in local residents exposed to immigrant violence, while addressing possible effects of priming context and prejudicial attitudes. In Study 1, context was either reminiscent/non-reminiscent of experiencing African immigrant violence (researcher with same/different ethnic origin to that of perpetrators). In Study 2, context was manipulated as a negative ("illegal-migrant") or neutral ("working-immigrant") framing for African immigrants. We also examined if effects of context on trauma symptoms are moderated by prejudicial attitudes towards African immigrants. As expected, higher PTSD symptom levels were evident in the presence of traumatic (Study 1) and negative (Study 2) context, yet only in residents with high prejudicial attitudes. Results suggest that both contexts and prejudice play a role in assessment of PTSD stemming from cultural conflicts. Theoretical implications of the data in terms of PTSD memory theories, are discussed including the notion of a PTSD context theory. Practical implications pertaining to the potential compatibility of researchers and therapists with trauma victims are also addressed.

Shadows of the past and threats of the future: ISIS anxiety among grandchildren of Holocaust survivors

The current study examined intergenerational transmission of trauma in grandchildren of Holocaust survivors. While many typically do not find evidence for such effects, careful reading of the relevant literature suggests conditions under which such effects may be obtained. Following, we made use of three factors. First, we took the number of grandparents exposed to the Holocaust into account. Second, we examined participants who were exposed to present terror and displayed posttraumatic stress disorder (PTSD) symptoms. Third, we measured anxiety of a future ISIS threat, which in its genocidal nature is reminiscent of the Holocaust. Results reveal that grandchildren having all four grandparents who survived the Holocaust in conjunction with them directly experiencing PTSD symptoms demonstrated greater ISIS anxiety than other groups. Results are discussed in reference to various conditions that may determine the likelihood of intergenerational transmission of trauma emerging.

Posttraumatic symptoms among maltreated youth using classification and regression tree analysis

Individual psychological factors have been shown to exacerbate risk for posttraumatic stress disorder (PTSD) symptoms in youth following maltreatment, but the novel contribution of the present study includes a focus on interactive relationships between these factors on specific PTSD symptom clusters. This study identified maltreated youth at highest risk for re-experiencing, avoidance, and hyperarousal symptom clusters via cognitive, affective, and demographic variables. Participants (n=400) included ethnically diverse maltreated youth. Classification and regression tree (CART) analysis, a form of binary recursive partitioning (BRP), identified subgroups of maltreated youth at highest risk for three core PTSD symptom clusters. Posttraumatic cognitions, anhedonia, negative mood, processing speed, and ethnicity best predicted re-experiencing symptoms. Depersonalization/derealization, verbal comprehension, sexual maltreatment, and age best predicted avoidance symptoms. Negative cognitions about self, IQ, dissociation, working memory, and posttraumatic cognitions best predicted hyperarousal symptoms. Core PTSD symptom clusters may thus be associated with unique collections of risk factors for maltreated youth. Clinical protocols for this population could be recalibrated to be more sensitive to specific profiles that more accurately identify highest risk maltreated youth and better inform evidence-based treatment practices.

Trauma-Related Context Increases Sleep Disturbances in People with Acute Stress Disorder Symptoms

In this study, we addressed how sleep is related to acute stress disorder (ASD) symptoms, and how the presence of a trauma related-context moderates this relationship. This study (N = 140) was carried out during the 2014 Israel-Gaza conflict, during which 70% of Israelis were exposed to missile attacks. Findings show that participants with clinical ASD symptom levels reported more sleep disturbances than participants without clinical ASD symptom levels. More critically, this effect was only evident among respondents who had a reinforced security room in their houses. While reinforced security rooms offer protection against indirect missile damage, their relevance is salient in negative traumatic situations, which individuals with a clinical level of ASD are more sensitive to. Conversely, in houses without a reinforced security room, there was no difference in subjective sleep reports between individuals with or without clinical levels of ASD symptoms. Results are discussed in reference to trauma being activated by context and the ensuing effects on sleep. Theoretical and clinical implications are discussed. Copyright © 2016 John Wiley & Sons, Ltd.

Psychological effects following the Iran nuclear deal: Iranian nuclear threat salience moderates the relationship between PTSD symptoms and sleep problems

Following the July-14th, 2015 Iranian agreement, we examined if preoccupation with the threat of a nuclear Iran moderates the relationship between posttraumatic stress disorder (PTSD) symptoms and reported sleep problems in individuals exposed to the 2014 Israel-Gaza conflict. While sleep problems were evident in individuals suffering from PTSD symptoms, they were especially pronounced when PTSD symptoms were coupled with increased Iranian nuclear threat salience. Preoccupation with future national threats may increase PTSD-related sleep problems. Therefore, it may be useful if such threats are accounted for in interventions aiming to ameliorate trauma-related sleep problems arising in the context of security situation.

Reduced amygdala responsivity during conditioning to trauma-related stimuli in posttraumatic stress disorder

Exaggerated conditioned fear responses and impaired extinction along with amygdala overactivation have been observed in posttraumatic stress disorder (PTSD). These fear responses might be triggered by cues related to the trauma through higher-order conditioning, where reminders of the trauma may serve as unconditioned stimuli (US) and could maintain the fear response. We compared arousal, valence, and US expectancy ratings and BOLD brain responses using fMRI in 14 traumatized persons with PTSD and 14 without PTSD (NPTSD) and 13 matched healthy controls (HC) in a differential aversive conditioning paradigm. The US were trauma-specific pictures for the PTSD and NPTSD group and equally aversive and arousing for the HC; the conditioned stimuli (CS) were graphic displays. During conditioning, the PTSD patients compared to the NPTSD and HC indicated higher arousal to the conditioned stimulus that was paired with the trauma picture (CS+) compared to the unpaired (CS-), increased dissociation during acquisition and extinction, and failure to extinguish the CS/US-association compared to NPTSD. During early and late acquisition, the PTSD patients showed a significantly lower amygdala activation to CS+ versus CS- and a negative interaction between activation in the amygdala and dorsolateral prefrontal cortex (PFC), while NPTSD and HC displayed a negative interaction between amygdala and medial PFC. These findings suggest maladaptive anticipatory coping with trauma-related stimuli in patients with PTSD, indicated by enhanced conditioning, with related abnormal amygdala reactivity and connectivity, and delayed extinction.

The impact of dissociation on perceptual priming and intrusions after listening to auditory narratives

This study investigates the causal role of dissociation in intrusive memory development and possible underlying aberrant memory processes (e.g., increased perceptual priming). Using an audio-only adaption of the trauma film paradigm, we divided 60 participants into 3 conditions and presented them with different visual tasks-mirror staring, dot staring, or neutral images. The former 2 conditions were hypothesized to induce dissociation. Postaudio, a number of factors were assessed, including state dissociation, perceptual priming and conceptual priming, as well as intrusions over 3 days. Participants in the dissociation conditions displayed an increase in perceptual priming compared to those in the control condition and reported more distressing intrusions. No differences were found in conceptual priming and the overall number of intrusions between conditions. Findings contribute to the growing knowledge on the impact of dissociation and cognitive processing in the etiology of posttraumatic stress disorder intrusions.

Soldiers With Posttraumatic Stress Disorder See a World Full of Threat: Magnetoencephalography Reveals Enhanced Tuning to Combat-Related Cues

BACKGROUND

Posttraumatic stress disorder (PTSD) is linked to elevated arousal and alterations in cognitive processes. Yet, whether a traumatic experience is linked to neural and behavioral differences in selective attentional tuning to traumatic stimuli is not known. The present study examined selective awareness of threat stimuli and underlying temporal-spatial patterns of brain activation associated with PTSD.

METHODS

Participants were 44 soldiers from the Canadian Armed Forces, 22 with PTSD and 22 without. All completed neuropsychological tests and clinical assessments. Magnetoencephalography data were collected while participants identified two targets in a rapidly presented stream of words. The first target was a number and the second target was either a combat-related or neutral word. The difference in accuracy for combat-related versus neutral words was used as a measure of attentional bias.

RESULTS

All soldiers showed a bias for combat-related words. This bias was enhanced in the PTSD group, and behavioral differences were associated with distinct patterns of brain activity. At early latencies, non-PTSD soldiers showed activation of midline frontal regions associated with fear regulation (90-340 ms after the second target presentation), whereas those with PTSD showed greater visual cortex activation linked to enhanced visual processing of trauma stimuli (200-300 ms).

CONCLUSIONS

These findings suggest that attentional biases in PTSD are linked to deficits in very rapid regulatory activation observed in healthy control subjects. Thus, sufferers with PTSD may literally see a world more populated by traumatic cues, contributing to a positive feedback loop that perpetuates the effects of trauma.

Associative learning and sensory neuroplasticity: how does it happen and what is it good for?

Historically, the body's sensory systems have been presumed to provide the brain with raw information about the external environment, which the brain must interpret to select a behavioral response. Consequently, studies of the neurobiology of learning and memory have focused on circuitry that interfaces between sensory inputs and behavioral outputs, such as the amygdala and cerebellum. However, evidence is accumulating that some forms of learning can in fact drive stimulus-specific changes very early in sensory systems, including not only primary sensory cortices but also precortical structures and even the peripheral sensory organs themselves. This review synthesizes evidence across sensory modalities to report emerging themes, including the systems’ flexibility to emphasize different aspects of a sensory stimulus depending on its predictive features and ability of different forms of learning to produce similar plasticity in sensory structures. Potential functions of this learning-induced neuroplasticity are discussed in relation to the challenges faced by sensory systems in changing environments, and evidence for absolute changes in sensory ability is considered. We also emphasize that this plasticity may serve important nonsensory functions, including balancing metabolic load, regulating attentional focus, and facilitating downstream neuroplasticity.

Mental Imagery and Post-Traumatic Stress Disorder: A Neuroimaging and Experimental Psychopathology Approach to Intrusive Memories of Trauma

This hypothesis and theory paper presents a pragmatic framework to help bridge the clinical presentation and neuroscience of intrusive memories following psychological trauma. Intrusive memories are a hallmark symptom of post-traumatic stress disorder (PTSD). However, key questions, including those involving etiology, remain. In particular, we know little about the brain mechanisms involved in why only some moments of the trauma return as intrusive memories while others do not. We first present an overview of the patient experience of intrusive memories and the neuroimaging studies that have investigated intrusive memories in PTSD patients. Next, one mechanism of how to model intrusive memories in the laboratory, the trauma film paradigm, is examined. In particular, we focus on studies combining the trauma film paradigm with neuroimaging. Stemming from the clinical presentation and our current understanding of the processes involved in intrusive memories, we propose a framework in which an intrusive memory comprises five component parts; autobiographical (trauma) memory, involuntary recall, negative emotions, attention hijacking, and mental imagery. Each component part is considered in turn, both behaviorally and from a brain imaging perspective. A mapping of these five components onto our understanding of the brain is described. Unanswered questions that exist in our understanding of intrusive memories are considered using the proposed framework. Overall, we suggest that mental imagery is key to bridging the experience, memory, and intrusive recollection of the traumatic event. Further, we suggest that by considering the brain mechanisms involved in the component parts of an intrusive memory, in particular mental imagery, we may be able to aid the development of a firmer bridge between patients' experiences of intrusive memories and the clinical neuroscience behind them.

Effects of acute cortisol administration on perceptual priming of trauma-related material

Intrusive memories are a hallmark symptom of posttraumatic stress disorder (PTSD). They reflect excessive and uncontrolled retrieval of the traumatic memory. Acute elevations of cortisol are known to impair the retrieval of already stored memory information. Thus, continuous cortisol administration might help in reducing intrusive memories in PTSD. Strong perceptual priming for neutral stimuli associated with a "traumatic" context has been shown to be one important learning mechanism that leads to intrusive memories. However, the memory modulating effects of cortisol have only been shown for explicit declarative memory processes. Thus, in our double blind, placebo controlled study we aimed to investigate whether cortisol influences perceptual priming of neutral stimuli that appeared in a "traumatic" context. Two groups of healthy volunteers (N = 160) watched either neutral or "traumatic" picture stories on a computer screen. Neutral objects were presented in between the pictures. Memory for these neutral objects was tested after 24 hours with a perceptual priming task and an explicit memory task. Prior to memory testing half of the participants in each group received 25 mg of cortisol, the other half received placebo. In the placebo group participants in the "traumatic" stories condition showed more perceptual priming for the neutral objects than participants in the neutral stories condition, indicating a strong perceptual priming effect for neutral stimuli presented in a "traumatic" context. In the cortisol group this effect was not present: Participants in the neutral stories and participants in the "traumatic" stories condition in the cortisol group showed comparable priming effects for the neutral objects. Our findings show that cortisol inhibits perceptual priming for neutral stimuli that appeared in a "traumatic" context. These findings indicate that cortisol influences PTSD-relevant memory processes and thus further support the idea that administration of cortisol might be an effective treatment strategy in reducing intrusive reexperiencing.

The hidden price of repeated traumatic exposure

Neuroimaging studies have demonstrated reduced hippocampal volume in trauma-exposed individuals without posttraumatic stress disorder (PTSD). However, the implications of such a deficit in this non-clinical population are still unclear. Animal and human models of PTSD suggest that hippocampal deficit may result in impaired learning and use of associations between contextual information and aversive events. Previous study has shown that individuals with PTSD have a selective impairment in reversing the negative outcome of context-related information. The aim of this study was to test whether non-PTSD individuals who are repeatedly exposed to traumatic events display similar impairment. To that end, we compared the performance of active-duty firefighters who are frequently exposed to traumatic events as part of their occupational routine and civilian matched-controls with no history of trauma-exposure. We used a novel cue-context reversal paradigm, which separately evaluates reversal of negative and positive outcomes of cue and context-related information. As predicted, we found that while both trauma-exposed firefighters and unexposed matched-controls were able to acquire and retain stimulus-outcome associations, firefighters struggled to learn that a previously negative context is later associated with a positive outcome. This impairment did not correlate with levels of PTSD, anxiety or depressive symptoms. The results suggest that similar to individuals with PTSD, highly exposed individuals fail to associate traumatic outcomes with their appropriate context. This impairment may reflect a possible hidden price of repeated traumatic exposure, which is not necessarily associated with PTSD diagnosis, and may affect the way highly exposed individuals interpret and react to their environment.

Posttraumatic stress disorder: a theoretical model of the hyperarousal subtype

Posttraumatic stress disorder (PTSD) is a frequent and distressing mental disorder, about which much remains to be learned. It is a heterogeneous disorder; the hyperarousal subtype (about 70% of occurrences and simply termed PTSD in this paper) is the topic of this article, but the dissociative subtype (about 30% of occurrences and likely involving quite different brain mechanisms) is outside its scope. A theoretical model is presented that integrates neuroscience data on diverse brain regions known to be involved in PTSD, and extensive psychiatric findings on the disorder. Specifically, the amygdala is a multifunctional brain region that is crucial to PTSD, and processes peritraumatic hyperarousal on grounded cognition principles to produce hyperarousal symptoms. Amygdala activity also modulates hippocampal function, which is supported by a large body of evidence, and likewise amygdala activity modulates several brainstem regions, visual cortex, rostral anterior cingulate cortex (rACC), and medial orbitofrontal cortex (mOFC), to produce diverse startle, visual, memory, numbing, anger, and recklessness symptoms. Additional brain regions process other aspects of peritraumatic responses to produce further symptoms. These contentions are supported by neuroimaging, neuropsychological, neuroanatomical, physiological, cognitive, and behavioral evidence. Collectively, the model offers an account of how responses at the time of trauma are transformed into an extensive array of the 20 PTSD symptoms that are specified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition. It elucidates the neural mechanisms of a specific form of psychopathology, and accords with the Research Domain Criteria framework.

Perceptual processing during trauma, priming and the development of intrusive memories

BACKGROUND

Intrusive reexperiencing in posttraumatic stress disorder (PTSD) is commonly triggered by stimuli with perceptual similarity to those present during the trauma. Information processing theories suggest that perceptual processing during the trauma and enhanced perceptual priming contribute to the easy triggering of intrusive memories by these cues.

METHODS

Healthy volunteers (N = 51) watched neutral and trauma picture stories on a computer screen. Neutral objects that were unrelated to the content of the stories briefly appeared in the interval between the pictures. Dissociation and data-driven processing (as indicators of perceptual processing) and state anxiety during the stories were assessed with self-report questionnaires. After filler tasks, participants completed a blurred object identification task to assess priming and a recognition memory task. Intrusive memories were assessed with telephone interviews 2 weeks and 3 months later.

RESULTS

Neutral objects were more strongly primed if they occurred in the context of trauma stories than if they occurred during neutral stories, although the effect size was only moderate [Formula: see text] and only significant when trauma stories were presented first. Regardless of story order, enhanced perceptual priming predicted intrusive memories at 2-week follow-up (N = 51), but not at 3 months (n = 40). Data-driven processing, dissociation and anxiety increases during the trauma stories also predicted intrusive memories. Enhanced perceptual priming and data-driven processing were associated with lower verbal intelligence.

LIMITATIONS

It is unclear to what extent these findings generalize to real-life traumatic events and whether they are specific to negative emotional events.

CONCLUSIONS

The results provide some support for the role of perceptual processing and perceptual priming in reexperiencing symptoms.

Vividness of general mental imagery is associated with the occurrence of intrusive memories

BACKGROUND AND OBJECTIVES

Intrusive memories of traumatic events constitute a core feature of post-traumatic stress disorder. However, the association of pre-traumatic factors with post-traumatic intrusive memories is still only poorly understood. The current study investigated the extent to which vividness of general mental imagery prior to an analogue stressor is positively associated with occurrence of intrusive images following such a stressor.

METHODS

Sixty-seven participants were exposed to video material depicting the aftermath of serious road traffic accidents. Additionally, participants filled in questionnaires on mental imagery, affect, peri-traumatic processing style, and intrusive memories.

RESULTS

Vividness of mental imagery before the analogue stressor correlated positively with the amount, vividness, and emotional distress due to intrusive images shortly after the analogue stressor and on the subsequently five days. Importantly, mental imagery assessed pre-stressor was associated with intrusive memories independently of trait anxiety and depression as well as participants' emotional response to the video. Peri-traumatic data-driven processing was also related to intrusive memories but not to the vividness of pre-stressor mental imagery.

LIMITATIONS

An analogue design was used. Results need to be replicated in a prospective design with survivors of traumatic events according to DSM-IV criteria.

CONCLUSIONS

The findings indicate that high levels of vividness of general mental imagery may contribute to the development of intrusive imaginal memories following exposure to traumatic events.

Neural, psychophysiological, and behavioral markers of fear processing in PTSD: a review of the literature

As presently defined, post-traumatic stress disorder (PTSD) is an amalgam of symptoms falling into: re-experiencing of the trauma, avoidance of reminders of it, emotional numbing and hyperarousal. PTSD has a well-known proximate cause, commonly occurring after a life-threatening event that induces a response of intense fear, horror, and helplessness. Much of the advancement in understanding of the neurobiology of PTSD has emerged from conceptualizing the disorder as one that involves substantial dysfunction in fear processing. This article reviews recent knowledge of fear processing markers in PTSD. A systematic search was performed of reports within the specific three-year publication time period of January 2010 to December 2012. We identified a total of 31 studies reporting fear processing markers in PTSD. We further categorized them according to the following classification: (1) neural-activation markers (n=10), (2) psychophysiological markers (n=14), and (3) behavioral markers (n=7). Across most studies reviewed here, significant differences between individuals with PTSD and healthy controls were shown. Methodological, theoretical and clinical implications were discussed.

Attentional bias for trauma-related words: exaggerated emotional Stroop effect in Afghanistan and Iraq war veterans with PTSD

BACKGROUND

Post-traumatic stress disorder (PTSD) involves debilitating symptoms that can disrupt cognitive functioning. The emotional Stroop has been commonly used to examine the impact of PTSD on attentional control, but no published study has yet used it with Afghanistan and Iraq war veterans, and only one previous study has compared groups on habituation to trauma-related words.

METHODS

We administered the emotional Stroop, the Beck Depression Inventory (BDI), and the PTSD Checklist (PCL) to 30 veterans with PTSD, 30 military controls, and 30 civilian controls. Stroop word types included Combat, Matched-neutral, Neutral, Positive and Negative.

RESULTS

Compared to controls, veterans with PTSD were disproportionately slower in responding to Combat words. They were also slower and less accurate overall, did not show interference on Negative or Positive words relative to Neutral, and showed a trend for delayed but successful habituation to Combat words. Higher PCL and BDI scores also correlated with larger interference effects.

CONCLUSIONS

Because of its specificity in detecting attentional biases to trauma-related words, the emotional Stroop task may serve as a useful pre- and post task with intervention studies of PTSD patients.

Emotion and cognition interactions in PTSD: a review of neurocognitive and neuroimaging studies

Posttraumatic stress disorder (PTSD) is a psychiatric syndrome that develops after exposure to terrifying and life-threatening events including warfare, motor-vehicle accidents, and physical and sexual assault. The emotional experience of psychological trauma can have long-term cognitive effects. The hallmark symptoms of PTSD involve alterations to cognitive processes such as memory, attention, planning, and problem solving, underscoring the detrimental impact that negative emotionality has on cognitive functioning. As such, an important challenge for PTSD researchers and treatment providers is to understand the dynamic interplay between emotion and cognition. Contemporary cognitive models of PTSD theorize that a preponderance of information processing resources are allocated toward threat detection and interpretation of innocuous stimuli as threatening, narrowing one's attentional focus at the expense of other cognitive operations. Decades of research have shown support for these cognitive models of PTSD using a variety of tasks and methodological approaches. The primary goal of this review is to summarize the latest neurocognitive and neuroimaging research of emotion-cognition interactions in PTSD. To directly assess the influence of emotion on cognition and vice versa, the studies reviewed employed challenge tasks that included both cognitive and emotional components. The findings provide evidence for memory and attention deficits in PTSD that are often associated with changes in functional brain activity. The results are reviewed to provide future directions for research that may direct better and more effective treatments for PTSD.

Bewältigungsverhalten in Notfallsituationen aus klinisch-psychologischer Perspektive

Ziel des vorliegenden Beitrags ist es, eine aktuelle Übersicht zu Annahmen und Befunden zu geben, die Hinweise darauf geben, welche Reaktionen bzw. welches Verhalten für die Bewältigung von Notfällen oder traumatischen Erlebnissen hilfreich bzw. gesundheitsförderlich sind. Ließen sich konkrete Aspekte von Bewältigungsverhalten während traumatischer Situationen identifizieren, die besonders adaptiv in Bezug auf die psychische bzw. psychobiologische Anpassung sind, so könnte dieses Wissen perspektivisch zur Entwicklung von Präventions- und Trainingsmaßnahmen genutzt werden. Der Beitrag beschreibt einleitend Traumareaktionen, psychische Traumafolgestörungen und deren Prävalenzraten und gibt eine knappe Übersicht über Prädiktoren für psychische Störungen in Folge traumatischer Erlebnisse. Im Unterschied zu dem Beitrag von Becker-Nehring, Witschen und Bengel (in diesem Heft) fokussiert unser Beitrag vor allem auf die Posttraumatische Belastungsstörung als Traumafolgestörung und auf Bewältigungsverhalten während einer Notfallsituation. Bewältigungsverhalten während und nach einer traumatischen Situation kann zum Teil auch im Forschungslabor experimentell untersucht werden, indem z. B. Methoden der Virtuellen Realität genutzt werden. Dies ist ein weiterer Fokus des Beitrags.

Emotion and cognition interactions in PTSD: a review of neurocognitive and neuroimaging studies

Posttraumatic stress disorder (PTSD) is a psychiatric syndrome that develops after exposure to terrifying and life-threatening events including warfare, motor-vehicle accidents, and physical and sexual assault. The emotional experience of psychological trauma can have long-term cognitive effects. The hallmark symptoms of PTSD involve alterations to cognitive processes such as memory, attention, planning, and problem solving, underscoring the detrimental impact that negative emotionality has on cognitive functioning. As such, an important challenge for PTSD researchers and treatment providers is to understand the dynamic interplay between emotion and cognition. Contemporary cognitive models of PTSD theorize that a preponderance of information processing resources are allocated toward threat detection and interpretation of innocuous stimuli as threatening, narrowing one's attentional focus at the expense of other cognitive operations. Decades of research have shown support for these cognitive models of PTSD using a variety of tasks and methodological approaches. The primary goal of this review is to summarize the latest neurocognitive and neuroimaging research of emotion-cognition interactions in PTSD. To directly assess the influence of emotion on cognition and vice versa, the studies reviewed employed challenge tasks that included both cognitive and emotional components. The findings provide evidence for memory and attention deficits in PTSD that are often associated with changes in functional brain activity. The results are reviewed to provide future directions for research that may direct better and more effective treatments for PTSD.

Combining clinical studies and analogue experiments to investigate cognitive mechanisms in posttraumatic stress disorder

Research into cognitive mechanisms in posttraumatic stress disorder (PTSD) typically comprises two types of studies. The first group of studies is conducted with survivors of traumatic events and assesses the association between PTSD and cognitive variables with questionnaires and/or information processing paradigms. In the second group of studies, healthy non-traumatized individuals are exposed to an analogue stressor (e.g., a stressful film) and cognitive variables of interest are usually experimentally manipulated to investigate their effects on analogue PTSD symptoms. This review illustrates how studies of trauma survivors and analogue studies with non-traumatized populations can be usefully combined. Two examples for this approach are presented: (1) research into the role of perceptual priming for trauma-related stimuli and (2) research into trauma-related rumination. The advantages and limitations of both types of studies are discussed and it is argued that a combination of both approaches is needed to investigate cognitive mechanisms in PTSD.