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”).     

The Effect of Cognitive Complexity and Nature of the Outcome on Causal Attribution

Because even subtle forms of racial discrimination can damage well-being, identifying individual differences that shape this stress process is important. Dispositional forgiveness has been shown to influence how people perceive and react to interpersonal transgressions, yet its role in the context of racial discrimination has not received much research attention. In the current study, participants completed an initial measure of dispositional forgiveness and then considered a scenario that could be deemed racially discriminatory. Next, participants' perceptions of the scenario, negative affect, and cognitive performance were assessed. Dispositional forgiveness predicted all three outcomes such that more forgiving individuals were less likely to view the event as racially discriminatory and showed lower negative affect and greater cognitive performance after reading the scenario. Moreover, race moderated these relationships such that forgiveness played a more beneficial role for ethnic minorities than for whites.     

The relation between emotion regulation choice and posttraumatic growth

ABSTRACT

Previous research has examined emotion regulation (ER) and trauma in the context of psychopathology, yet little research has examined ER in posttraumatic growth (PTG), the experience of positive psychological change following a traumatic event. ER typically involves decreasing negative affect by engaging (e.g. reappraisal) or disengaging (e.g. distraction) with emotional content. To investigate how ER may support PTG, participants who experienced a traumatic event in the past 6 months completed a PTG questionnaire and an ER choice task in which they down regulated their negative emotion in response to negative pictures of varying intensity by choosing to distract or reappraise. Latent growth curve analyses revealed that an increase in reappraisal choice from low to high subjective stimulus intensity predicted higher PTG, suggesting that individuals who chose reappraisal more as intensity increased reported higher PTG. Findings suggest that reappraisal of negative stimuli following a traumatic event may be a key component of PTG.     

The Social Context of Adaptation to Traumatic Events: Soviet Jews and the Holocaust

Much of the literature on trauma focuses on the impact of a single traumatic event and its psychological sequelae on a given individual. Little attention has been paid to the effects of multiple traumatic events within one lifetime, or the importance of understanding the relation of the social context of the trauma(s) to the experience of the trauma survivor. This study presents a qualitative analysis of interviews with older survivors of the Nazi attempt to exterminate the Jews (the Holocaust), who had recently migrated from the former Soviet Union to the United States. In-depth depictions of the effects of multiple traumas on the mental health of single individuals are presented. Further emphasis is placed on the specific social context of trauma to more fully understand the older adult trauma survivor.     

A systems view of psychological trauma: Developing post-traumatic stress response paradigms

This article traces the development of traumatic stress paradigms within the context of emerging psychological and organizational theories. It traces the evolution of the systems view of trauma from an early stimulus-response model using a biological perspective through the development of cybernetic, information-processing to the field systems perspectives of trauma. This article concludes by examining the evolutionary and contextualist paradigms of trauma theory and its value to the psychotherapist working with trauma victims.     

Responses to the September 11, 2001, Terrorist Attacks: Experience of an Indirect Traumatic Event and Its Relationship With Perceived Benefits

Little is known about how people might benefit from an indirectly experienced traumatic event. The authors examined the relationship between perception of benefit and trauma symptoms in response to a relatively severe, but indirectly experienced, traumatic event. The authors sampled from 2 colleges located in the southeastern United States (N = 136). Individuals responded to questionnaires that assessed perceived benefits and trauma symptoms 1-2 weeks after the terrorist attacks of September 11, 2001, and again approximately 10 weeks later. Participants did perceive benefits from witnessing this event, although their perception of benefit declined over time. Level of trauma symptoms correlated positively with perception of benefit, and experiencing a previous trauma also correlated positively with perceived benefits. Additional analysis indicated that level of trauma symptoms mediated the relationship between previous trauma and perception of benefit. These findings help to elucidate understanding of the development of perceived benefits in response to indirectly experienced events.     

Reshaping Couple Configurations that Get in the Way of Relationship Repair and Healing

In the context of relationship trauma, partners' reactive patterns of engagement can disrupt and derail attempts at relationship correction and healing. A circumplex typology of couple patterns of engagement in relational trauma context is defined in terms of partners' underlying views of self in relation to other (VSIRO). VSIRO is conceptualized along a continuum anchored at opposite poles by inflated (self-aggrandizing) versus collapsed (self-abnegating) VSIRO, with a balanced (egalitarian) VSIRO, characterized by accountability and forbearance, as the target position. The circumplex model delineates four problematic couple configurations—a dejected couple, a taker–enabler couple, an ultimate fighting couple, and a debtor–collector couple. Where problematic engagement occurs, therapists need to reshape couple engagement toward the balanced, egalitarian position prior to relational trauma work. Clinical vignettes depict these couples and springboard an analysis of unique needs and interventions associated with each couple configuration. Reshaping couple patterns of engagement using a circumplex model of couple configurations is an essential prerequisite to effective and ethical relational trauma work.     

PTSD and the influence of context: The self as a social mirror

The principal accepted models of posttraumatic stress disorder (PTSD) are based on both memory processing and biological/brain changes occurring when one's life or well-being is threatened. It is our thesis that these models would be greatly informed by community studies indicating that PTSD is predicted to a greater extent by earlier life experience and experiences that occur distant from the threatening event. These findings suggest posttraumatic responding is best conceptualized through the lens of the self-in-context, as opposed to imprinting that results from a given event at a given time. Moreover, studies of non-Western populations often do not express trauma as PTSD, or at least not primarily as PTSD, which argues against specific neural or memory encoding processes, but rather for a more plastic neural process that is shaped by experience and how the self develops in its cultural context, as a product of a broad array of experiences. We posit that fear and emotional conditioning as well as the ways traumas are encoded in memory are only partial explanatory mechanisms for trauma responding, and that issues of safety and harm, which are long term and developmental, are the common and principal underpinnings of the occurrence of posttraumatic distress, including PTSD.     

Languages of trauma; towards a phenomenological response

In this article, I explore the possibilities of a phenomenological perspective on trauma in psychoanalytic practice. I highlight the problem of interpretations that universalise experiences of trauma, provide explanations in terms of ‘causes’ and assume particular processes/stages of ‘recovery’ from it. The notion of trauma challenges dichotomies of ‘internal’ and ‘external’ worlds. Traumatic experiences always have a context – that of the immediate relational circumstances of the individual suffering from the trauma, including the wider social/relational context, and the person’s history. I argue for an attunement to the language and specificity of the meanings, verbal and non-verbal, conscious and unconscious, of the client’s suffering within the analytical relationship. This requires the therapist to avoid ‘ready-made’ interpretations from psychoanalytic theory and to be open to the poiesis of the speech, which emerges between therapist and client. My discussion of my reading of the Chilean documentary film, Nostalgia for the Light, which focuses on the traumatic experiences of those who survived Pinochet’s military regime (1973–1989), highlights how diverse responses to trauma are. The originality of the language of the film calls on us as therapists to discover new ways of listening and speaking to our clients’ suffering.     

Characteristics of memories for traumatic and nontraumatic birth

Evidence for memory characteristic differences between trauma and other memories in non‐clinical samples is inconsistent. However, trauma is frequently confounded with the event recalled. This study compares trauma and nontrauma memories for the same event, childbirth, in a non‐clinical sample of 285 women 4–6 weeks after birth. None of the women met diagnostic criteria for post‐traumatic stress disorder. Traumatic birth, defined by the DSM‐5 event criterion, was reported by 100 women. The ratings of some memory characteristics did not differ between memories for traumatic and nontraumatic birth: All were rated highly coherent and central to women's lives, with moderate sensory memory. However, women who experienced traumatic births reported more involuntary recall, reliving, and negative/mixed emotions. Thus, trauma memories differed from nontrauma memories. In this non‐clinical sample, this is likely to be due to encoding during trauma rather than the distinctive memory profile for memories retrieved by those experiencing trauma symptoms.     

An ecological approach to disjunctivism

In this paper I claim that perceptual discriminatory skills rely on a suitable type of environment as an enabling condition for their exercise. This is because of the constitutive connection between environment and perceptual discriminatory skills, inasmuch as such connection is construed from an ecological approach. The exercise of a discriminatory skill yields knowledge of affordances of objects, properties, or events in the surrounding environment. This is practical knowledge in the first-person perspective. An organism learns to perceive an object by becoming sensitized to its affordances. I call this position ecological disjunctivism. A corollary of this position is that a case of perception and its corresponding case of hallucination—which is similar to the former only in some respects—are different in nature. I show then how the distinguishability problem is addressed by ecological disjunctivism.

     

Vivid memories of distant trauma: Examining the characteristics of trauma memories and the relationship with the centrality of event and posttraumatic stress 26 years after trauma

In the present study, we investigated the phenomenological characteristics of distant trauma memories and the relationship between the vividness of trauma memories, the centrality of event and symptoms of posttraumatic stress in two groups with different types of trauma exposure, namely survivors and bereaved, from the fire on the passenger ferry, Scandinavian Star, 26 years earlier. More than two decades after the fire, the traumatic event was represented as a vivid, emotional recollection for many of the victims. For both the survivors and the bereaved, a higher degree of vividness of trauma memories and centrality of the event were associated with higher levels of posttraumatic stress. The present findings show that even very distant trauma memories can be represented as vivid recollections. Furthermore, the findings suggest that both vividness of trauma memories and event centrality may contribute to explain how posttraumatic stress reactions can remain present over a very long time.     

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.     

Trauma event autobiographies: An exploratory multiple case study

This multiple case study explored trauma event memories of three individuals to characterise underlying meanings important for their recovery. The three participants were women in the age range of 43 to 54 years old, who shared their own memories of a trauma-laden event four to five years post-occurrence. Thematic analysis of the autobiographical narratives indicated underlying memories across cases of silence imposed on trauma victims by their social environments and communities. Differences in trauma autobiographical memories were in meaning making within the context of the participants’ own culture, society, and community. Autobiographical memory studies appear to have value for understanding likely pathways to recovery from trauma     

Perception Differences in Ambiguous Forms of Workplace Sexual Harassment: A Comparison between the United States and Turkey

Certain social–sexual behaviors that could be potentially encountered in workplaces are ambiguous in nature and perceiving them as sexual harassment can depend on the culture. With an aim to delineate the overlap and distinctions of sexual harassment perceptions of such behaviors across samples of women university students from Turkey (TR, N = 215) and the United States (US, N = 209), measurement invariance and latent mean differences in perceiving three ambiguous forms; sexist hostility, sexual hostility, and insinuation-of-interest, were examined. It was hypothesized that the US sample would perceive sexist hostility more sexually harassing as sexist workplace discriminatory practices are emphasized as a form of sexual harassment, and that the TR sample would perceive sexual hostility and insinuation-of-interest as more sexually harassing as women in TR operate in a conservative context. Despite similarities in rank ordering, US participants perceived sexist hostility more sexually harassing; insinuation-of-interest and sexual hostility less sexually harassing than Turkish participants, supporting all three hypotheses. There are implications of differing perceptions across cultures for organizations in terms of disseminating awareness via training programs about the forms of sexual harassment (SH) in a local context and for taking account of local findings in shaping the labor code of countries in relation to SH.     

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").     

Heart rate during group flooding therapy for PTSD

The objective of this study was to assess, via heart rate, the arousal levels of participants in group trauma reexposure therapy for posttraumatic stress disorder, and so to better understand this common mode of treatment, particularly in regards to its presumed curative factor, extinction. Six Vietnam combat-related PTSD inpatients participated twice weekly in group trauma reexposure therapy during which their electrocardiograms were recorded. Heart rate was quantified continuously off-line. Heart rates of participantsnot directly engaged in imaginal reexposure to their personal combat traumas consistently exhibited mild linear declines from the beginnings to the ends of the approximately 2.5 hour sessions. Participants actively engaged in personal combat trauma reexposure exhibited higher whole-session heart rates. Most also exhibited more specific elevation extending over the later portions of therapy sessions during which intensive reexposure usually occurred. Surprisingly, no patients exhibitedfocal increases in heart rate concurrent with periods of most intensive traumatic incident review as judged from videotape. Administering imaginal reexposure in a group context does not preclude substantial physiological (sympathetic) arousal, as is preconditional for extinction. Under conditions in which the actively engaged reexposure patient is reliably identified, group trauma reexposure therapy may not provide an opportunity for “vicarious” flooding in nonengaged participants.     

Reducing workplace bias toward people with disabilities with the use of imagined contact

In this research we test the effectiveness of imagined intergroup contact as an intervention that improves attitudes toward people with disabilities in organizational settings. We conducted two experimental studies with the aim of examining the bias‐reduction effects of imagined contact on attitudes toward people with disabilities. Furthermore, we examined how imagined contact can be most effective in improving attitudes in work situations. Both studies yielded evidence that the imagined contact intervention significantly impacted on two dependent variables: expected work‐related outcomes and support for the rights of people with disabilities, via enhancing the belief in performance level. We discuss the results in the context of developing effective and accessible intervention tools, which can be used in workplace trainings, and can promote anti‐discriminatory policies in organizations.     

Eye movements reveal rapid concurrent access to factual and counterfactual interpretations of the world

Imagining a counterfactual world using conditionals (e.g., If Joanne had remembered her umbrella . . .) is common in everyday language. However, such utterances are likely to involve fairly complex reasoning processes to represent both the explicit hypothetical conjecture and its implied factual meaning. Online research into these mechanisms has so far been limited. The present paper describes two eye movement studies that investigated the time-course with which comprehenders can set up and access factual inferences based on a realistic counterfactual context. Adult participants were eye-tracked while they read short narratives, in which a context sentence set up a counterfactual world (If . . . then . . .), and a subsequent critical sentence described an event that was either consistent or inconsistent with the implied factual world. A factual consistent condition (Because . . . then . . .) was included as a baseline of normal contextual integration. Results showed that within a counterfactual scenario, readers quickly inferred the implied factual meaning of the discourse. However, initial processing of the critical word led to clear, but distinct, anomaly detection responses for both contextually inconsistent and consistent conditions. These results provide evidence that readers can rapidly make a factual inference from a preceding counterfactual context, despite maintaining access to both counterfactual and factual interpretations of events.     

Relationship closeness and trauma narrative detail: A critical analysis of betrayal trauma theory

Betrayal Trauma Theory (BTT) holds that certain traumas, such as incest, should be uniquely categorized as betrayal trauma: a subcategory of trauma in which the violation of trust, within a close relationship, occurs in the context of a traumatic event. According to BTT, betrayal trauma results in either partial or complete traumatic amnesia because repression is adaptive when a victim depends on a perpetrator for physical or emotional needs. In a test of BTT, undergraduates screened for betrayal and non‐betrayal trauma histories provided detailed accounts of these events. In order to account for threats to internal validity that are often overlooked by traumatic amnesia researchers, we also assessed factors known to compromise narrative detail. Consistent with BTT predictions, more betrayal was associated with less detailed trauma narratives. However, this relationship was no longer significant after controlling for survivor age, avoidance symptoms, gender and purposeful omission of detail. Copyright © 2008 John Wiley & Sons, Ltd.