Trauma-related memories in PTSD after interpersonal violence: an ambulatory assessment study

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.

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

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

Exam-related unwanted intrusive thoughts and related neutralizing behaviors: Analogues to obsessions and compulsions

Exam-related unwanted intrusive thoughts (UITs) and related neutralizing behaviors are common experiences among students. The present study investigated in what ways these UITs and behaviors are analogues to clinical obsessions and compulsions. Twenty-nine students completed three ecological momentary assessment surveys per day over 7 consecutive days, assessing the severity of exam-related UITs and related neutralizing behaviors, obsessive-compulsive (OC) symptoms, anxiety, distress, urge to neutralize, depressed mood, and stress in the week immediately before an exam period. Multilevel analysis demonstrated that the severity of exam-related UITs and related neutralizing behaviors was positively associated with OC symptoms, anxiety, distress, urge to neutralize, and stress but was not related to depressed mood. During the study period, the exam-related UITs occurred on average 7 times, and the related neutralizing behaviors on average 6 times. Overall, they were experienced with mild severity, low distress, and low urge to neutralize. Findings indicate that some aspects of exam-related UITs and related neutralizing behaviors (e.g., association with distress and urge to neutralize) might be analogous to OC symptoms but not all (e.g., no relation to depressed mood). We discuss how research on obsessive-compulsive disorder could benefit from considering exam-related UITs and related behaviors.

Remembering the earthquake: intrusive memories of disaster in a rural Italian community

BACKGROUND

Disasters can have long-lasting impacts on mental health. Intrusive memories have been found to be common and persistent in the aftermath of earthquakes.

OBJECTIVE

To explore, using diaries, intrusive memories' presence, content, characteristics, and relationship with probable post-traumatic stress disorder (PTSD) in a small rural community exposed to mass destruction and loss of life.

METHODS

Survivors of the 2016-2017 Central Italy earthquakes (N = 104) were first interviewed to investigate the presence of intrusive memories of the disaster. Those that reported intrusive memories were subsequently asked to complete a 7-day paper-and-pen diary tracking their spontaneous memories of the earthquake events.

RESULTS

Twenty months after the earthquakes, 49% (n = 51) of the sample reported having experienced intrusive memories post-earthquake and 38% (n = 39) reported at least one intrusive memory in their diaries. Memories were rated as being distressing, vivid, and experienced as a mixture of images and thoughts. The content of intrusive memories generally focused on sensations and experiences during the earthquake. Other common categories of content were the material environment and physical objects as well as human loss & death. Several memories had a social focus. A minority of memories contained more positive content as well as content from before and after the earthquake. Some participants (28%) experienced repeated intrusive memories of the same content. Memories of participants with and without probable PTSD did not significantly differ on characteristics or content.

CONCLUSIONS

Intrusive memories can be common, distressing, and persistent occurrences following disasters, even in survivors not suffering from probable PTSD.

HIGHLIGHTS

Intrusive memories were common, distressing, and vivid more than 1-year post-disaster.They captured peri-earthquake sensations, material destruction, death, and social interactions.No difference in content or characteristics was found between participants with and without probable PTSD.

Distinguishing between rumination and intrusive memories in PTSD using a wearable self-tracking instrument: a proof-of-concept case study

Rumination has been shown to play a part in post-traumatic stress disorder (PTSD), but its relation to the intrusions characteristic of PTSD has mainly been investigated experimentally. This proof-of-concept case study explored the occurrence, personal experiences, and possible relation between rumination and intrusions in two PTSD patients in their daily living using a mixed method approach. A novel wearable self-tracking instrument was employed which provided fine-grained temporal resolution of observation data and could eliminate recall bias. Furthermore, quantitative and qualitative data were collected on participants’ symptoms, rumination and experiences of using the self-tracking instrument. First, without distinguishing between the two phenomena, the participants tracked both for a week. After receiving psychoeducational training for distinguishing between rumination and intrusions, the differentiated phenomena were tracked for a week. Both participants reported being subjectively able to distinguish between rumination and intrusions and made observations with high adherence during the project. Data hinted at a possible temporal relation between the phenomena in line with theories posing rumination as a maladaptive coping strategy as well as an exacerbator of PTSD symptoms. However, relations to mood were inconclusive. Furthermore, by using the self-tracking instrument, participants gained a heightened awareness of the characteristics of rumination and intrusions and contextual cues for occurrence, as well as a greater sense of momentary agency. Results reveal promising prospects in using the wearable self-tracking instrument for further investigation of the relation between rumination and intrusions in the lived lives of PTSD patients, as well as potential for incorporating this method in clinical treatment.

Key learning aims

(1)

Intrusive memories of trauma: A target for research bridging cognitive science and its clinical application

Intrusive memories of a traumatic event can be distressing and disruptive, and comprise a core clinical feature of post-traumatic stress disorder (PTSD). Intrusive memories involve mental imagery-based impressions that intrude into mind involuntarily, and are emotional. Here we consider how recent advances in cognitive science have fueled our understanding of the development and possible treatment of intrusive memories of trauma. We conducted a systematic literature search in PubMed, selecting articles published from 2008 to 2018 that used the terms "trauma" AND ("intrusive memories" OR "involuntary memories") in their abstract or title. First, we discuss studies that investigated internal (neural, hormonal, psychophysiological, and cognitive) processes that contribute to intrusive memory development. Second, we discuss studies that targeted these processes using behavioural/pharmacological interventions to reduce intrusive memories. Third, we consider possible clinical implications of this work and highlight some emerging research avenues for treatment and prevention, supplemented by new data to examine some unanswered questions. In conclusion, we raise the possibility that intrusive memories comprise an alternative, possibly more focused, target in translational research endeavours, rather than only targeting overall symptoms of disorders such as PTSD. If so, relatively simple approaches could help to address the need for easy-to-deliver, widely-scalable trauma interventions.

Frequency of Intrusions and Appraisal of Related Distress After Analogue Trauma: A Comparative Ecological Momentary Assessment Methods Study

Intrusive thoughts, images, and their appraisal remain difficult to study despite their clinical relevance. Clinical studies typically used time-based (frequency and distress per observation period), while analogue studies mainly used event-based (report upon occurrence) assessment. A comparison of intrusion frequency, distress appraisal, compliance, and reactivity across different assessments is mostly lacking, particularly with regard to analogue research. Here, intrusions were induced via aversive films and assessed by a smart phone application for 4 days. Three sampling modes were compared by randomizing participants to one of three conditions: either one, or five time-based daily prompts, or event-based assessment. At the end of the study, all participants reported intrusions once again in a retrospective summary assessment. Results indicate that intrusions and their distress decayed over a few days. The three assessments did not differ in intrusion frequency, distress appraisal, compliance (generally high), reactivity (generally low), or retrospective summary assessment. Across groups, the more aversive and arousing participants rated the film clips and the more reactivity to the electronic-diary assessment they reported, the more intrusive memories they had; assessment modes did not differ on this. Thus, no general differences were found between electronic-diary assessment modes for analogue intrusions, giving researchers flexibility for tailoring ecological momentary assessment to specific study aims.