A comparison of normal forgetting, psychopathology, and information-processing models of reported amnesia for recent sexual trauma

The Impact of Childhood Maltreatment on Long-Term Outcomes in Disorder-Specific vs. Nonspecific Psychotherapy for Chronic Depression

BACKGROUND

Childhood maltreatment (CM) predicted poorer outcomes in acute depression treatment with CBT, IPT and Supportive Psychotherapy (SP). The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) fared well in patients with chronic depression and CM during acute treatment, yet there is a considerable lack of empirical evidence for long-term outcomes.

METHODS

We analyzed one and two-year follow-up data of 268 patients randomized to 24 sessions (20 weeks) of acute and 8 sessions (28 weeks) of extended treatment with CBASP or SP. Primary outcome was the number of well weeks as measured by the Longitudinal Interval Follow-Up Evaluation Interview (LIFE). Secondary outcomes included self- and clinician-rated depression symptoms. We investigated this moderating effect for any CM and for specific subtypes of CM.

RESULTS

Intent-to-treat analyses revealed that the presence of CM did not significantly moderate long-term effects of CBASP compared to SP. The analysis of trauma subtypes revealed that patients with childhood emotional abuse had statistically significant worse outcomes than patients without (main effect, p=.015) and that the advantage of CBASP over SP was larger in patients with childhood emotional abuse than in patients without (interaction effect, p=.045) after 1 year. No significant effects were found for other trauma subtypes.

LIMITATIONS

The measurement of CM was limited to retrospective self-assessment.

CONCLUSIONS

The presence of CM did not significantly moderate long-term treatment effects of CBASP compared to SP. When trauma subtypes were considered, CBASP was more effective than SP after one year in patients who retrospectively reported emotional abuse.

"They destroyed my life because I do not feel like a man anymore": An Interpretative Phenomenological Analysis of Men's lived experiences of rape victimization

Over the past three decades, rape victimization has been regarded as a women-only issue, with men regarded as the only offenders. This has resulted in a narrow-focused approach in addressing this scourge where men who could be primary victims are marginalized. This marginalization has also occurred in research, resulting in the paucity of literature on men's experiences of rape victimization in South Africa and globally. The main aim of the study was to explore, analyze and interpret men's lived experiences of rape victimization and the meaning they attached to such experiences. An Interpretative Phenomenological Analysis research design was used to collect and analyze data from a purposive sample of 11 participants, using semi-structured face-to-face interviews. The findings of the study revealed eight superordinate themes and related subordinate themes as follows: unexpected overpowering experience, forceful sexual violations, rape as torture, intense emotions attached to being raped, rape as a permanent emotional scar, negative perceptions of self, rape as something being taken away, and rape as divine punishment. The findings highlight the experiences and meanings which men attach to being raped, thus demonstrating the need to develop men-specific post-rape care management guidelines to support and care for men who are rape victims.

Post-traumatic Stress Disorder in Victims of Sexual Assault With Pre-assault Substance Consumption: A Systematic Review

Background: Post-traumatic stress disorder (PTSD) and substance consumption commonly co-occur in victims of sexual assault. Substance consumption can occur pre- andi/or post-assault. Pre-assault substance consumption may have an impact on the subsequent development of PTSD. This review aims to provide an overview of current understanding of the effects of acute substance intoxication and chronic pre-assault problematic substance use on symptoms of PTSD amongst individuals who were victims of sexual assault. Methods: PsycINFO, EMBASE, and MEDLINE were searched using terms related to PTSD, sexual assault, and substance consumption. These yielded 2,121 articles, 268 of which were retrieved for more detailed evaluation and 13 of these met inclusion criteria and were appraised in full. Results: Overall, the reviewed papers supported our hypothesis that acute substance intoxication and chronic pre-assault problematic substance use are associated with fewer initial PTSD symptoms but less improvement over time, resulting in slower overall PTSD recovery. They also highlighted post-assault characterological self-blame and negative social reactions as mediators of recovery in the context of pre-assault substance consumption. Conclusions: Acute substance intoxication and chronic pre-assault problematic substance use appear to have an impact on the development of PTSD symptoms amongst victims of sexual assault. The importance of developing early interventions and routine screening and assessment for PTSD and pre-assault substance consumption is emphasized. The limited research on male victims and on substances other than alcohol is highlighted.

Emotional distress and positive and negative memories from military deployment: the influence of PTSD symptoms and time

During military deployment, soldiers are confronted with both negative and positive events. What is remembered and how it affects an individual is influenced by not only the perceived emotion of the event, but also the emotional state of the individual. Here we examined the most negative and most positive deployment memories from a company of 337 soldiers who were deployed together to Afghanistan. We examined how the level of emotional distress of the soldiers and the valence of the memory were related to the emotional intensity, experience of reliving, rehearsal and coherence of the memories, and how the perceived impact of these memories changed over time. We found that soldiers with higher levels of post-traumatic stress disorder (PTSD) symptoms were more affected by both their negative and positive memories, compared with soldiers with lower levels of PTSD symptoms. Emotional intensity of the most negative memory increased over time in the group with highest levels of PTSD symptoms, but dropped in the other groups. The present study adds to the literature on emotion and autobiographical memory and how this relationship interacts with an individual's present level of emotional distress and the passage of time.

The neural correlates of memory for a life-threatening event: An fMRI study of passengers from flight AT236

We investigated the neural correlates of remote traumatic reexperiencing in survivors of a life-threatening incident: the near crash of Air Transat (AT) Flight 236. Survivors' brain activity was monitored during video-cued recollection of the AT disaster, September 11^th, 2001 (9/11), and a comparatively non-emotional (neutral) event. Passengers showed a robust memory enhancement effect for the AT incident relative to the 9/11 and neutral events. This traumatic memory enhancement was associated with activation in the amygdala, medial temporal lobe, anterior and posterior midline, and visual cortex in passengers. This brain-behavior relationship also held in relation to 9/11, which had elevated significance for passengers given its temporal proximity to the AT disaster. This pattern was not observed in a comparison group of non-traumatized individuals who were also scanned. These findings suggest that remote, traumatic memory is mediated by amygdalar activity, which likely enhances vividness via influences on hippocampal and ventral visual systems.

The role of specific early trauma in adult depression: A meta-analysis of published literature. Childhood trauma and adult depression

BACKGROUND

A large literature has long focused on the role of trauma in childhood and risk for psychological disorders in adulthood. Despite several studies performed, to date, it is not clear which weight have different childhood stressors specifically on the risk for depression in adult life. In the present study, we performed a meta-analysis of the literature in order to assess the effective role of childhood traumas as risk factor in the onset of depressive disorders in adults.

METHODS

Previously published papers investigating the exposure to childhood trauma and their association with depression in adult subjects were retrieved in literature through common databases. Meta-analysis was conducted by the RevMan software. The quality of studies was evaluated by an adapted version of the New-Ottawa Quality Assessment Scale; bias publication was evaluated by the Egger's test. Meta-regression analysis was employed to detect potential confounders and/or moderating variables. Finally, a sensitivity analysis was post-hoc performed to control for potential confounders.

RESULTS

Emotional abuse showed the strongest association with depression (OR=2.78) followed by neglect (OR=2.75) and sexual abuse (OR=2.42). Significant associations were also found for domestic violence (OR=2.06) and physical abuse (OR=1.98). Nevertheless, in post-hoc analysis, emotional abuse and neglect showed the strongest associations with depression as compared to other kinds of child trauma.

CONCLUSIONS

These findings support the role of neglect and emotional abuse as significantly associated to depression. Sexual/physical abuse or violence in family may be unspecific risk factors for mental disturbance. Other kind of trauma may play a less relevant role in risk of adult depression, though they should be not underestimated.

Onset of common mental disorders and suicidal behavior following women's first exposure to gender based violence: a retrospective, population-based study

BACKGROUND

Women exposed to gender-based violence (GBV) experience a high rate of common mental disorders and suicidal behaviour ("mental disturbance"). Little is known however about the timing of onset of mental disturbance following first exposure to GBV amongst women with no prior mental disorder.

METHODS

The analysis was undertaken on the Australian National Mental Health and Wellbeing Survey dataset (N = 8841). We assessed lifetime prevalence and first onset of common mental disorder and suicidal behaviour (mental disturbance) and exposure to GBV and its first occurrence based on the Composite International Diagnostic Interview Version 3 (WMH-CIDI 3.0). We used the Kaplan-Meier method to derive cumulative incident curves for first onset mental disturbance. The two derived subgroups were women who experienced GBV without prior mental disturbance; and women never exposed to GBV stratified to match the former group on age and socio-economic status.

RESULTS

For women with no prior mental disorder, the cumulative incidence curves showed a high incidence of all mental disturbances following first GBV, compared to women without exposure to GBV (all log rank tests <0.0001). Nearly two fifths (37%) of any lifetime mental disturbance had onset in the year following first GBV in women exposed to abuse. For these women, over half (57%) of cases of lifetime PTSD had onset in the same time interval. For GBV exposed women, half of all cases of mental disturbance (54%) and two thirds of cases of PTSD (66.9%) had onset in the five years following first abuse. In contrast, there was a low prevalence of onset of mental disturbance in the comparable imputed time to event period for women never exposed to GBV (for any mental disturbance, 1% in the first year, 12% in five years; for PTSD 3% in the first year, 7% in five years).

CONCLUSIONS

Amongst women without prior mental disturbance, common mental disorders and suicidal behaviour have a high rate of onset in the one and five year intervals following exposure to GBV. There is a particularly high incidence of PTSD in the first year following GBV.

Physiological predictors of posttraumatic stress disorder

Studies have assessed relationships between posttraumatic stress disorder (PTSD) symptoms and physiological reactivity concurrently; fewer have assessed these relationships longitudinally. This study tests concurrent and prospective relationships between physiological reactivity (heart rate and skin conductance) to a monologue procedure and PTSD symptoms in female assault survivors, tested within 1 and 3 months posttrauma. After controlling for initial PTSD and peritraumatic dissociation, 3 measures of increased physiological reactivity to the trauma monologue at 1 month predicted 3-month PTSD reexperiencing severity. Additionally, increased heart rate following trauma and neutral monologues at 1 month was predictive of 3-month numbing symptoms. Implications for the prospective relationship between physiological reactivity to trauma cues and PTSD over time are discussed.

Amnesia for violent crime among young offenders

Amnesia for the perpetration of violent offences is an important issue in medico-legal proceedings. Previous studies of amnesia have mainly relied on selected groups of unconvicted offenders, which raises the question of how reliable the findings are. The purpose of this study was to examine the prevalence and phenomenological qualities of amnesia in violent offenders. In semi-structured interviews with 105 young offenders convicted of serious violence, 20 (19%) reported partial amnesia for their offence and only one (1%) reported complete amnesia. Amnesia was associated with high alcohol intake, emotional ties to the victim, and cognitive processing during the assault. Complete amnesia for violent crime appears to be less frequent than suggested by previous reports using unconvicted samples. The findings have implications for the clinical assessment of claimed amnesia for violent crime and are potentially of medico-legal significance.

Autobiographical memory for trauma: update on four controversies

Empirical research since the year 2000 on trauma and autobiographical memory in adults is reviewed and related to four enduring controversies in the field: Whether traumatic memories are inherently different from other types of autobiographical memory; whether memory for trauma is better or worse than memory for non-traumatic events; whether traumas can be forgotten and then recalled later in life; and whether special mechanisms such as repression or dissociation are required to account for any such forgetting. The review concludes that trauma and non-trauma memories differ substantially, but only in clinical and not in healthy populations. Whereas involuntary memory is enhanced in clinical populations, voluntary memory is likely to be fragmented, disorganised, and incomplete. Progress in experimental and neuroimaging research will depend on analysing how task performance is affected by the interaction of voluntary and involuntary memory and by individual tendencies to respond to trauma with increased arousal versus dissociation.

Reliability of self-reported trauma exposure among people with heroin dependence: a longitudinal investigation

Estimates of trauma exposure rely almost exclusively on retrospective self-reports; however, the reliability of these reports has received little attention. The present study examined the reliability of self-reported lifetime trauma exposure among 309 dependent heroin users over 2 years, and the factors associated with inconsistent recall. The correlation between the number of events reported at baseline and follow-up was .72; however, 87% of the sample reported at least one event inconsistently. Variability in reporting was associated with trauma type, a lifetime posttraumatic stress disorder, and antisocial personality disorder. These findings suggest that dependent heroin users are moderately reliable in their reports of trauma exposure, and their reports of trauma exposure are as reliable as those of nonsubstance use disordered samples.

Recovered memory and the Daubert criteria: recovered memory as professionally tested, peer reviewed, and accepted in the relevant scientific community

Research during the past two decades has firmly established the reliability of the phenomenon of recovered memory. This review first highlights the strongest evidence for the phenomenon itself and discusses the survey, experimental, and biological evidence for the varying mechanisms that may underlie the phenomenon. Routes to traumatic amnesia from dissociative detachment (loss of emotional content leading to loss of factual content) and from dissociative compartmentalization (failure in integration) are discussed. Next, an argument is made that false memory is a largely orthogonal concept to recovered memory; the possibility of one phenomena is largely irrelevant to the potential for the other. Furthermore, some aspects of the false memory research offer supportive data for the recovered memory researcher. Finally, the issue of error rates in making the Daubert case is explored. It is concluded that the weight of the evidence should allow the recovered memory victim to come before the court.

Adult mood disorders and childhood psychological trauma

OBJECTIVE: To evaluate the association between adult mood disorders and childhood psychological trauma in a developing country. METHOD: Adults with and without mood disorders were assessed in a case-control study using the Mini International Neuropsychiatric Interview. Assessment of childhood trauma included physical and sexual abuse, frequent exposure to violence, and parental loss. RESULTS: In two independent multivariate analyses, after adjusting for potential confounding factors, we found a higher odds ratio for frequent exposure to violence in the community (p = .037) and for physical abuse by parents or caregivers during childhood/adolescence (p = .012) in the group with mood disorders than in the control group. In secondary analyses splitting the mood disorder group in two subgroups (manic episode, and major depressive episodes/ dysthymia), only manic patients showed significantly higher rates of frequent exposure to violence in the community (p = 0.01) and physical abuse during childhood (p = 0.02) than did patients in the control group. In addition, maniac patients had significantly higher rates of sexual abuse than did controls (p = .03). CONCLUSIONS: Our findings document an association between violence during childhood and adult mood disorders, especially for manic patients, in a developing country.

Psychological theories of posttraumatic stress disorder

We summarize recent research on the psychological processes implicated in posttraumatic stress disorder (PTSD) as an aid to evaluating theoretical models of the disorder. After describing a number of early approaches, including social-cognitive, conditioning, information-processing, and anxious apprehension models of PTSD, the article provides a comparative analysis and evaluation of three recent theories: Foa and Rothbaum's [Foa, E. B. & Rothbaum, B. O. (1998). Treating the trauma of rape: cognitive behavioral therapy for PTSD. New York: Guilford Press] emotional processing theory; Brewin, Dalgleish, and Joseph's [Psychological Review 103 (1996) 670] dual representation theory; Ehlers and Clark's [Behaviour Research and Therapy 38 (2000) 319] cognitive theory. We review empirical evidence relevant to each model and identify promising areas for further research.

Emotionally charged autobiographical memories across the life span: the recall of happy, sad, traumatic, and involuntary memories

A sample of 1,241 respondents between 20 and 93 years old were asked their age in their happiest, saddest, most traumatic, most important memory, and most recent involuntary memory. For older respondents, there was a clear bump in the 20s for the most important and happiest memories. In contrast, saddest and most traumatic memories showed a monotonically decreasing retention function. Happy involuntary memories were over twice as common as unhappy ones, and only happy involuntary memories showed a bump in the 20s. Life scripts favoring positive events in young adulthood can account for the findings. Standard accounts of the bump need to be modified, for example, by repression or reduced rehearsal of negative events due to life change or social censure.