Intrusive re-experiencing in post-traumatic stress disorder: phenomenology, theory, and therapy

The article describes features of trauma memories in post-traumatic stress disorder (PTSD), including characteristics of unintentional re-experiencing symptoms and intentional recall of trauma narratives. Reexperiencing symptoms are usually sensory impressions and emotional responses from the trauma that appear to lack a time perspective and a context. The vast majority of intrusive memories can be interpreted as re-experiencing of warning signals, i.e., stimuli that signalled the onset of the trauma or of moments when the meaning of the event changed for the worse. Triggers of re-experiencing symptoms include stimuli that have perceptual similarity to cues accompanying the traumatic event. Intentional recall of the trauma in PTSD may be characterised by confusion about temporal order, and difficulty in accessing important details, both of which contribute to problematic appraisals. Recall tends to be disjointed. When patients with PTSD deliberately recall the worst moments of the trauma, they often do not access other relevant (usually subsequent) information that would correct impressions/predictions made at the time. A theoretical analysis of re-experiencing symptoms and their triggers is offered, and implications for treatment are discussed. These include the need to actively incorporate updating information ("I know now ...") into the worst moments of the trauma memory, and to train patients to discriminate between the stimuli that were present during the trauma ("then") and the innocuous triggers of re-experiencing symptoms ("now").     

Intrusive re‐experiencing in post‐traumatic stress disorder: Phenomenology,theory, and therapy

The article describes features of trauma memories in post‐traumatic stress disorder (PTSD), including characteristics of unintentional re‐experiencing symptoms and intentional recall of trauma narratives. Re‐experiencing symptoms are usually sensory impressions and emotional responses from the trauma that appear to lack a time perspective and a context. The vast majority of intrusive memories can be interpreted as re‐experiencing of warning signals, i.e., stimuli that signalled the onset of the trauma or of moments when the meaning of the event changed for the worse. Triggers of re‐experiencing symptoms include stimuli that have perceptual similarity to cues accompanying the traumatic event. Intentional recall of the trauma in PTSD may be characterised by confusion about temporal order, and difficulty in accessing important details, both of which contribute to problematic appraisals. Recall tends to be disjointed. When patients with PTSD deliberately recall the worst moments of the trauma, they often do not access other relevant (usually subsequent) information that would correct impressions/predictions made at the time. A theoretical analysis of re‐experiencing symptoms and their triggers is offered, and implications for treatment are discussed. These include the need to actively incorporate updating information ( “I know now …”) into the worst moments of the trauma memory, and to train patients to discriminate between the stimuli that were present during the trauma ( “then”) and the innocuous triggers of re‐experiencing symptoms ( “now”).     

Retrieval‐induced forgetting of autobiographical memory details

Several studies suggest that intrusive and overgeneral autobiographical memory are correlated. Thus, paradoxically, in some patients a hyperaccessibility of memory for one (series of) event(s) goes hand‐in‐hand with a scarcity of memories for other personal experiences. This clinical observation is reminiscent of the laboratory phenomenon of retrieval‐induced forgetting (RIF). This refers to the finding that repeatedly recalling some experimental stimuli impairs subsequent recall of related (i.e., tied to the same retrieval cue) stimuli. RIF of emotional autobiographical memories might provide an experimental model for the clinical memory phenomena in question. The present paper reports two experiments that explored the merits of applying the retrieval practice paradigm to relatively broad categories of autobiographical memories. Both studies found a significant RIF effect in that practised memories were recalled better than unrelated unpractised (baseline) memories. In addition, unpractised memories that were related to the practised memories were recalled more poorly than baseline memories. Implications of these findings for modelling the co‐occurrence of intrusive and overgeneral memories are discussed.     

Cognitive avoidance of intrusive memories: recall vantage perspective and associations with depression

Although recent research demonstrates that intrusive memories represent an overlapping cognitive feature of depression and post-traumatic stress disorder (PTSD), there is still a general paucity of research investigating the prevalence and maintenance of intrusive memories in depression. The current study investigated the association between a range of cognitive avoidant mechanisms that characterize PTSD samples (i.e., suppression, rumination, emotional detachment, and an observer vantage perspective) and intrusive memories of negative autobiographical events in relation to dysphoria. Hypotheses were based on the proposition that employment of these cognitive mechanisms would hinder the emotional processing of the negative event, thus contributing to the maintenance of intrusions. Results supported an association between negative intrusive memories, dysphoria, and avoidant mechanisms. Significant differences were also found between field and observer memories and measures of emotional detachment and rumination. Implications relating to intrusive memory maintenance and treatment approaches are discussed.     

Are memories for sexually traumatic events "special"? A within-subjects investigation of trauma and memory in a clinical sample

According to a long-standing clinical tradition, sexually traumatic experiences are processed and recalled differently from other experiences, often leading to memory impairment. In this study, we compared the characteristics of traumatic memories for sexual violence and two other types of emotional experiences. N=44 women recruited from a local sexual trauma agency were asked to recall and describe three autobiographical events: sexual abuse/assault, a non-sexual trauma, and a positive emotional event. The characteristics of the three memory types were compared on both subjective and objective measures. Further, the potential influences of level of traumatic impact and dissociation were assessed. Results indicated that memories for sexual trauma were not impaired or fragmented relative to other memories. Instead, memories for sexual trauma were associated with a remarkably high level of vividness, detail, and sensory components. Further, high levels of traumatic impact were not associated with memory impairment. Implications for the ongoing traumatic memory debate are discussed.     

Reliving,emotions, and fragmentation in the autobiographical memories of veterans diagnosed with PTSD

Fifty veterans diagnosed with posttraumatic stress disorder (PTSD) each recalled four autobiographical memories: one from the 2 years before service, one non‐combat memory from the time in service, one from combat, and one from service that had often come as an intrusive memory. For each memory, they provided 21 ratings about reliving, belief, sensory properties, reexperiencing emotions, visceral emotional responses, fragmentation, and narrative coherence. We used these ratings to examine three claims about traumatic memories: a separation of cognitive and visceral aspects of emotion, an increased sense of reliving, and increased fragmentation. There was evidence for a partial separation of cognitive judgments of reexperiencing an emotion and reports of visceral symptoms of the emotion, with visceral symptoms correlating more consistently with scores on PTSD tests. Reliving, but not fragmentation of the memories, increased with increases in the trauma relatedness of the event and with increases in scores on standardized tests of PTSD severity. Copyright © 2004 John Wiley & Sons, Ltd.     

The impact of depression and PTSD symptom severity on trauma memory

Posttraumatic stress disorder (PTSD) and depression frequently co-occur following a traumatic event. Differences in the processing of autobiographical memory have been observed in both disorders in the form of overgeneralised memories and negative intrusive memories. The current study examined how symptoms of PTSD and depression influence the phenomenological characteristics of trauma memories. Undergraduate students who had experienced a traumatic event (n?=?696) completed questionnaires online including measures of PTSD and depressive symptom severity. They rated their trauma memory on several phenomenological characteristics using the Memory Experiences Questionnaire [Sutin, A. R., &; Robins, R. W. (2007). Phenomenology of autobiographical memories: The memory experiences questionnaire. Memory.]. Moderated multiple regression was used to examine how PTSD and depressive symptom severity related to each phenomenological characteristic. Symptoms of PTSD and depression were related separately and uniquely to the phenomenological characteristics of the trauma memory. PTSD severity predicted trauma memories that were more negative, contained higher sensory detail, and were more vivid. In contrast, depressive symptom severity predicted trauma memories that were less accessible and less coherent. These findings suggest that depressive and PTSD symptomatology affect traumatic memory differently and support a distinction between these two disorders.     

Preferential processing of visual trauma-film reminders predicts subsequent intrusive memories

This study used an analogue design to test the hypothesis that preferential processing of visual trauma reminders in the aftermath of a stressful or traumatic event gives rise to subsequent intrusive memories. Shortly after the presentation of a stressful film fragment, participants (n=36) were asked to detect neutral targets (rotated buildings or nature scenes) in a single target rapid serial visual presentation (RSVP) paradigm. During half of the streams, the target was preceded by a distracter. The distracters consisted of visual images extracted from an earlier presented stressful film (e.g., persons and objects that figured in the film). The degree of interference by these film reminders predicted subsequent intrusions recorded in a one-week diary. The results provide evidence that a deficient ability to obtain attentional control over perceptual “trauma” reminders during goal-directed behaviour may set people at risk for persistent intrusive memories. Implications for research investigating attentional bias and intrusive memories in context of posttraumatic stress disorder (PTSD) are discussed.     

The Mental Regulation of Autobiographical Recollection in the Aftermath of Trauma

ABSTRACT— Survivors of psychological trauma are frequently troubled by intrusive recollection of the traumatic event. We describe research showing that attempts to suppress such trauma memories can be associated with paradoxically enhanced remembering of the trauma, enhanced access to other negative personal material, and a lack of specificity in the recollection of the personal past. This suggests that attempted suppression is generally a counterproductive approach to the regulation of traumatic memories in distressed trauma survivors. Working with trauma memories, rather than suppressing them, is more adaptive.     

Vantage point in traumatic memory

Abstract— Persons with posttraumatic stress disorder (PTSD) spontaneously recalled the traumatic event that led to their condition from either a field or an observer vantage point. In the former case, participants recollected the event as if they were seeing it again through their own eyes; in the latter case, the event was recalled from the perspective of a detached spectator. Analysis of the two types of recollections revealed marked differences in their contents. Whereas field memories afforded richer accounts of the affective reactions, somatic sensations, and psychological states that participants experienced during the focal trauma, observer memories contained more information about participants' physical appearance and actions and the spatial layout of the traumatic scene. Observer trauma memories were also experienced as less emotional and anxiety provoking than field trauma memories. The discussion focuses on the clinical implications of these findings and prospects for future research on traumatic memory.     

Pre-stressor cognitive control is related to intrusive cognition of a stressful film

It has been suggested that relatively weak cognitive control existing prior to a stressful event may be associated with intrusive memories of that stressor afterwards. We explored this in two analog studies employing unselected participants who saw an emotional film fragment and completed behavioral (i.e., color-naming interference [CNI]) and self-report indices of intrusions. Prior to film presentation, several cognitive control tests were administered. Study 1 showed that better updating/monitoring was linked to less CNI from negative film-related words. However, better updating/monitoring was associated with more diary reports of intrusive memories. Study 2 showed that a better resistance to pro-active interference (PI) predicted less self-reported film-related intrusive cognition after 24h. However, after this delay, both self-reported intrusions and CNI were not related to updating/monitoring. Taken together, the results suggest that a specific pre-existing cognitive control function (i.e., resistance to PI) may be involved in the regulation of post-stressor intrusive memory phenomena.     

Enhanced perceptual priming for neutral stimuli occurring in a traumatic context: two experimental investigations

Intrusive memories in posttraumatic stress disorder are often triggered by stimuli that are perceptually similar to those present shortly before or during the trauma. The present study aims to examine the possible role of perceptual priming in this phenomenon. It further investigates whether the degree of perceptual priming is associated with dissociation and whether both perceptual priming and intrusive memories can be reduced through elaboration. Two experiments measured perceptual priming for neutral stimuli that immediately preceded a "traumatic" event. Volunteers (N=46, 92) watched a series of "traumatic" and neutral picture stories, and completed a blurred object identification (perceptual priming) memory task, and a recognition memory task. Participants in Experiment 1 were selected to score either high or low on the Trait Dissociation Questionnaire [Murray, Ehlers, & Mayou (2002). Dissociation and posttraumatic stress disorder: Two prospective studies of motor vehicle accident survivors. British Journal of Psychiatry, 180, 363-368]. They also completed a state dissociation measure in the session. Experiment 2 randomly allocated participants to an experimental condition designed to increase elaboration or to a control condition. This experiment also included a measure of intrusive memories. Both experiments found enhanced perceptual priming for the stimuli that immediately preceded the "traumatic" stories compared to those preceding neutral stories. Participants with high trait dissociation showed relatively stronger perceptual perceptual priming. The degree of perceptual priming for stimuli from the "traumatic" stories also correlated with state dissociation (Experiment 1). Experimental manipulation of the elaboration of the stories showed that elaboration reduced the enhanced perceptual priming effect and the relative probability of reexperiencing symptoms (Experiment 2). The results support the role of perceptual priming in intrusions after traumatic events.     

“Why” or “How”: The Effect of Concrete Versus Abstract Processing on Intrusive Memories Following Analogue Trauma

Emergency service workers, military personnel, and journalists working in conflict zones are regularly exposed to trauma as part of their jobs and suffer higher rates of posttraumatic stress compared with the general population. These individuals often know that they will be exposed to trauma and therefore have the opportunity to adopt potentially protective cognitive strategies. One cognitive strategy linked to better mood and recovery from upsetting events is concrete information processing. Conversely, abstract information processing is linked to the development of anxiety and depression. We trained 50 healthy participants to apply an abstract or concrete mode of processing to six traumatic film clips and to apply this mode of processing to a posttraining traumatic film. Intrusive memories of the films were recorded for 1 week and the Impact of Events Scale–Revised (IES-R; Weiss & Marmar, 1997) was completed at 1-week follow-up. As predicted, participants in the concrete condition reported significantly fewer intrusive memories in response to the films and had lower IES-R scores compared with those in the abstract condition. They also showed reduced emotional reactivity to the posttraining film. Self-reported proneness to intrusive memories in everyday life was significantly correlated with intrusive memories of the films, whereas trait rumination, trait dissociation, and sleep difficulties were not. Findings suggest that training individuals to adopt a concrete mode of information processing during analogue trauma may protect against the development of intrusive memories.     

Characteristics and organization of the worst moment of trauma memories in posttraumatic stress disorder

It has been proposed that the organization of the worst moment in traumatic memories (“hotspots”) is of particular importance for the development of PTSD. However, current knowledge regarding the organization and content of worst moments is incomplete.In the present study, trauma survivors with (n = 25) and without PTSD (n = 54) were asked to indicate the worst moment of their trauma and to give a detailed narrative of the traumatic event. The worst moment and the remaining narrative were analyzed separately with regard to organization and emotional content.Results indicated that worst moments of trauma survivors with PTSD differed from the remaining narrative and from worst moments described by trauma survivors without PTSD in that they were characterized by more unfinished thoughts, more use of the present tense and lower levels of cognitive processing. However, hypotheses regarding differentiating emotional content were not supported. Implications for our theoretical understanding of PTSD and potential therapeutic interventions are discussed.     

Follow-up of a cross-national comparison on flashbulb and event memory for the September 11th attacks

Flashbulb memories are defined as vivid and long-lasting memories for the reception context of an important public event (Brown & Kulik, 1977). They are supposed to be triggered by both emotional reactions to the original event and rehearsal processes (Brown & Kulik, 1977; Finkenauer, Luminet, Gisle, El-Ahmadi, van der Linden, & Philippot, 1998; Neisser & Harsch, 1992). A test-retest design (21 vs 524 days after the event on average) was employed to assess flashbulb memory and event memory for the September 11th attacks and the impact of their emotional and rehearsal predictors in a sample of 985 respondents coming from six countries (i.e., Belgium, Italy, the Netherlands, Romania, Japan, and the USA). Results showed that national membership had a significant impact on event memory, and the emotional and rehearsal variables, but flashbulb memories for the September 11th attacks were found to be high and consistent across different countries. The implications of these findings for the debate about the nature and maintenance of flashbulb memories are discussed.     

Flashbulb memories in social groups: a comparative test-retest study of the memory of French President Mitterrand's death in a French and a Belgian group

Flashbulb memories are vivid and long-lasting memories for the reception context of an important public event (Brown & Kulik, 1977). They are assumed to be triggered by emotional factors (i.e., intensity of emotional feeling, appraisal of the original event) and by social factors (i.e., social sharing of the news, following media debate about the event). The present study investigated the memory for the death of the former President of France F. Mitterrand in two social groups, i.e., French and Belgian people. This study tests whether the flashbulb memory attributes, the memory for the original event, and the impact of the emotional and social determinants of flashbulb memory differed across groups. The results indicated that the flashbulb memory for Mitterrand's death is affected by group provenance, as French people showed higher levels of recall for the flashbulb memory attributes and their determinants than Belgian people. Time impaired recollections in both groups, so that flashbulb memories appear prone to decay and share the same destiny as ordinary memories. The theoretical construct of concern--as the most basic antecedent of emotional experiences and its related appraisal (Frijda, 1994)--is discussed in order to explain the differences in memory of the two social groups.     

Follow-up of a cross-national comparison on flashbulb and event memory for the September 11th attacks

Flashbulb memories are defined as vivid and long-lasting memories for the reception context of an important public event (Brown & Kulik, 1977). They are supposed to be triggered by both emotional reactions to the original event and rehearsal processes (Brown & Kulik, 1977; Finkenauer, Luminet, Gisle, El-Ahmadi, van der Linden, & Philippot, 1998; Neisser & Harsch, 1992). A test-retest design (21 vs 524 days after the event on average) was employed to assess flashbulb memory and event memory for the September 11th attacks and the impact of their emotional and rehearsal predictors in a sample of 985 respondents coming from six countries (i.e., Belgium, Italy, the Netherlands, Romania, Japan, and the USA). Results showed that national membership had a significant impact on event memory, and the emotional and rehearsal variables, but flashbulb memories for the September 11th attacks were found to be high and consistent across different countries. The implications of these findings for the debate about the nature and maintenance of flashbulb memories are discussed.     

Flashbulb memories in social groups: A comparative test–retest study of the memory of French President Mitterrand's death in a French and a Belgian group

Flashbulb memories are vivid and long-lasting memories for the reception context of an important public event (Brown & Kulik, 1977). They are assumed to be triggered by emotional factors (i.e., intensity of emotional feeling, appraisal of the original event) and by social factors (i.e., social sharing of the news, following media debate about the event). The present study investigated the memory for the death of the former President of France F. Mitterrand in two social groups, i.e., French and Belgian people. This study tests whether the flashbulb memory attributes, the memory for the original event, and the impact of the emotional and social determinants of flashbulb memory differed across groups. The results indicated that the flashbulb memory for Mitterrand's death is affected by group provenance, as French people showed higher levels of recall for the flashbulb memory attributes and their determinants than Belgian people. Time impaired recollections in both groups, so that flashbulb memories appear prone to decay and share the same destiny as ordinary memories. The theoretical construct of concern - as the most basic antecedent of emotional experiences and its related appraisal (Frijda, 1994) - is discussed in order to explain the differences in memory of the two social groups.     

The scars of memory: a prospective, longitudinal investigation of the consistency of traumatic and positive emotional memories in adulthood

We conducted a prospective study with individuals who first described their memories of both a recent traumatic and a highly positive emotional experience in 2001-2002. Of the 49 subjects interviewed after 3 months, 29 were re-interviewed after 3.45 to 5.0 years. Subjects answered questions from a 12-item consistency questionnaire (maximum possible score of 36), rated the qualities of their memories, and completed questionnaires concerning the impact of the trauma. Results indicated that traumatic memories (including memories for violence) were highly consistent (M= 28.04) over time relative to positive memories (M= 17.75). Ratings of vividness, overall quality, and sensory components declined markedly for positive memories but remained virtually unchanged for traumatic memories. The severity of traumatic symptoms diminished over time and was unrelated to memory consistency. These findings contribute to understanding of the impact of trauma on memory over long periods.