Memory in posttraumatic stress disorder: properties of voluntary and involuntary, traumatic and nontraumatic autobiographical memories in people with and without posttraumatic stress disorder symptoms

One hundred fifteen undergraduates rated 15 word-cued memories and their 3 most negatively stressful, 3 most positive, and 7 most important events and completed tests of personality and depression. Eighty-nine also recorded involuntary memories online for 1 week. In the first 3-way comparisons needed to test existing theories, comparisons were made of memories of stressful events versus control events and involuntary versus voluntary memories in people high versus low in posttraumatic stress disorder (PTSD) symptom severity. For all participants, stressful memories had more emotional intensity, more frequent voluntary and involuntary retrieval, but not more fragmentation. For all memories, participants with greater PTSD symptom severity showed the same differences. Involuntary memories had more emotional intensity and less centrality to the life story than voluntary memories. Meeting the diagnostic criteria for traumatic events had no effect, but the emotional responses to events did. In 533 undergraduates, correlations among measures were replicated and the Negative Intensity factor of the Affect Intensity Measure correlated with PTSD symptom severity. No special trauma mechanisms were needed to account for the results, which are summarized by the autobiographical memory theory of PTSD.     

Trauma-Related Cognitions and Cognitive Emotion Regulation as Mediators of PTSD Change Among Treatment-Seeking Active-Duty Military Personnel With PTSD

Trauma-related cognitions about the self and the world have been identified as a mediator of posttraumatic stress disorder (PTSD) change during prolonged exposure (PE) therapy. However, the extent to which negative cognitions mediate PTSD change in other PTSD treatments is unclear. In addition, previous studies have not tested alternate mediators of PTSD change during PE. In a sample of 216 treatment-seeking active-duty military personnel with PTSD, the present study examined the specificity of the negative cognition mediation effect in both PE and present-centered therapy (PCT). In addition, we examined another possible mediator, cognitive emotion regulation. Lagged mediational analyses indicated that negative cognitions about the self and world and the unhelpful cognitive emotion regulation strategy of catastrophizing each significantly mediated change in PTSD from baseline to 6-month follow-up. In a combined model, the mediating effect of catastrophizing was greater than negative cognitions about the world, and similar to negative cognitions about the self. Moderated mediation analyses revealed that the effect of catastrophizing was greater in PE than in PCT. Findings show that trauma-related cognitions and, to a greater degree, the emotion regulation strategy catastrophizing, both mediate PTSD change. Further research is needed to determine whether these mediating variables represent mechanisms of therapeutic change.     

Inducing and modulating intrusive emotional memories: a review of the trauma film paradigm

Highly affect-laden memory intrusions are a feature of several psychological disorders with intrusive images of trauma especially associated with post-traumatic stress disorder (PTSD). The trauma film paradigm provides a prospective experimental tool for investigating analogue peri-traumatic cognitive mechanisms underlying intrusion development. We review several historical papers and some more recent key studies that have used the trauma film paradigm. A heuristic diagram is presented, designed to simplify predictions about analogue peri-traumatic processing and intrusion development, which can also be related to the processing elements of recent cognitive models of PTSD. Results show intrusions can be induced in the laboratory and their frequency amplified/attenuated in line with predictions. Successful manipulations include competing task type (visuospatial vs. verbal) and use of a cognitive coping strategy. Studies show that spontaneous peri-traumatic dissociation also affects intrusion frequency although attempts to manipulate dissociation have failed. It is hoped that further use of this paradigm may lead to prophylactic training for at risk groups and an improved understanding of intrusions across psychopathologies.     

Questioning the Link Between PTSD and Cognitive Dysfunction

Posttraumatic stress disorder (PTSD) has been linked with impairment in cognitive functioning, but anomalies appear to arise on several levels, masking the true nature of the relationship. On one level, there is a blurring of the emotional and physical causes of cognitive dysfunction, especially with memory problems that are similar to those due to neurological disorders. At other levels, problems are evident due to issues such as overgeneralizing from specific populations to the general population, and the use of narrow-focused neuropsychological assessment instruments that neither dissociate among precise memory components nor relate to everyday situations. In this review we highlight methodological problems and concerns, and make suggestions to establish valid links between PTSD and cognitive dysfunction.     

Overgeneral autobiographical memory recollection in Iranian combat veterans with posttraumatic stress disorder

This study examined the recollection of autobiographical material in memory among Iranian military veterans with and without posttraumatic stress disorder (PTSD), and healthy non-trauma-exposed control subjects. Participants completed the Autobiographical Memory Test, Autobiographical Memory Interview (counterbalanced), Impact of Event Scale-Revised, Beck Depression Inventory-II, Wechsler Memory Scale-III and Wechsler Adult Intelligence Scale-Revised. The PTSD group generated fewer specific episodic and semantic details of autobiographical memory compared to the non-PTSD and control groups. Working memory did not significantly moderate the relationship between PTSD diagnosis and reduced autobiographical memory specificity but did moderate the relationship between PTSD diagnosis and semantic recall; semantic memory recall was not significantly related to working memory ability for those with PTSD but was related to working memory ability for trauma survivors without PTSD. While the data provide some support for the expectation that higher working memory ability is associated with an increased ability to retrieve specific memories (i.e. semantic memory recall in those without PTSD), the findings are also consistent with the view that for those with PTSD the demands on working memory required for affect regulation cancel out this influence of working memory in augmenting access to specific memories.     

Young Children’s Physiological Reactivity during Memory Recall: Associations with Posttraumatic Stress and Parent Physiological Synchrony

Autonomic reactivity is implicated in stress response and social engagement – both key components of posttraumatic stress disorder (PTSD) – but few studies have examined autonomic reactivity in pediatric samples, and no known studies have examined physiological synchrony among children with PTSD and caregivers. In a sample of 247 young children (94 girls, 153 boys), most (85%) of whom had exposure to trauma and 40% who met criteria for PTSD, we examined children’s patterns of respiratory sinus arrhythmia (RSA) at baseline and in response to a memory recall task, as well as correspondence between parents’ and children’s RSA. Children with PTSD demonstrated significantly higher reactivity than other groups during their recollection of a traumatic memory, but not during other memory tasks. Regarding synchrony, caregivers’ and children’s RSA were more significantly and positively correlated during the trauma recall task among children who had had exposure to a potentially traumatic event but did not meet PTSD criteria, suggesting physiological synchrony may be protective in contexts of trauma. Overall, findings demonstrate physiological reactivity differences among young children with PTSD. While more work is needed to understand the meaning of parent-child physiological synchrony, these data suggest that children’s psychopathology is associated with physiological synchrony processes among young children with exposure to trauma.     

Selective processing of threat cues in posttraumatic stress disorder

Vietnam combat veterans with (n = 15) and without (n = 15) posttraumatic stress disorder (PTSD) performed a modified Stroop task in which they named the colors of neutral words (e.g., INPUT), positive words (e.g., LOVE), obsessive-compulsive disorder (OCD) words (e.g., GERMS), and PTSD words (e.g., BODYBAGS). In contrast to normal controls, PTSD patients took significantly longer to color-name PTSD words than to color-name neutral, OCD, and positive words. Because Stroop interference reflects involuntary semantic activation, it may provide a quantitative measure of intrusive cognitive activity--the hallmark symptom of PTSD.     

Physiological arousal and attention in veterans with posttraumatic stress disorder

Psychophysiological reactivity has been well documented in WWII, Korean Conflict, and Vietnam veterans with posttraumatic stress disorder (PTSD). In addition, these individuals have demonstrated cognitive impairments within the domains of attention, concentration, new learning, and memory. However, there has been no research examining the impact of physiological arousal on attention in individuals with PTSD. This study documents the level of physiological arousal and associated disruption of attentional abilities in 28 Persian Gulf War veterans (18 without PTSD or other psychopathology and 10 with PTSD). This population represents a group of combat trauma victims who experienced a relatively acute onset of PTSD, thus providing a unique opportunity to compare prior psychophysiological and cognitive results with a group of veterans who manifested a recent onset of PTSD. Results indicated relatively comparable psychophysiological reactivity and arousal between Persian Gulf War veterans with PTSD and Persian Gulf War veterans without PTSD. Furthermore, attentional processes of veterans with PTSD were not more disrupted than in comparison soldiers. Results suggest that the intensity and chronicity of the disorder may impact physiological arousal and disruption of cognitive functioning. Following Persian Gulf War veterans with PTSD over time may reveal that psychophysiological arousal becomes more pronounced with chronicity, perhaps as memory networks become strengthened and/or neuroendocrine systems become increasingly disrupted.     

Source memory errors associated with reports of posttraumatic flashbacks: a proof of concept study

Flashbacks are involuntary, emotion-laden images experienced by individuals with posttraumatic stress disorder (PTSD). The qualities of flashbacks could under certain circumstances lead to source memory errors. Participants with PTSD wrote a trauma narrative and reported the experience of flashbacks. They were later presented with stimuli from flashback and non-flashback parts of their narrative, mixed with foils from the narrative of another participant, and judged whether they belonged to their own narrative. They also reported whether stimuli elicited a flashback during this recognition test. Overall reporting a flashback at test was associated with significantly better recognition performance. Flashbacks were occasionally reported to foil stimuli, which were then likely to be wrongly attributed to the person's own narrative. This provides proof of concept of a cognitive mechanism that could potentially account for some cases of false trauma memories.     

Experimentally manipulating the effects of involuntary conscious memory on a priming task

Recent studies showed that involuntary conscious memory can enhance priming in implicit tasks. However, because the results of these studies were based on post hoc selection methods in which subjects were assigned to conditions (aware or unaware) based on their responses on a posttest questionnaire, it is possible that subject selection effects may have influenced the results. The present study used a novel method that experimentally manipulated the effects of involuntary conscious memory on a word stem task. This was accomplished by inducing the experience of word recollection in one test condition while inhibiting it in another. This study showed that subjects who experienced word recollection showed significantly higher rates of priming than those who did not. The results represent the first purely experimental demonstration of involuntary conscious memory's ability to affect priming on implicit tasks.     

PTSD易感性人格特质、工作记忆能力和创伤期间认知加工对模拟创伤闪回的影响

基于模拟创伤研究范式, 采用道路交通事故影片对159名健康大学生进行模拟创伤, 考察PTSD易感性人格特质(特质焦虑、特质分离和神经质)、工作记忆能力(注意控制和工作记忆容量)和创伤期间认知加工(数据驱动加工和概念加工)对模拟创伤后不同时段闪回的影响。运用结构方程模型分析数据, 结果发现：(1)数据驱动加工正向预测不同时段闪回(即时闪回、一周闪回和触发闪回)的数量、生动性、痛苦度以及一周侵入频率; (2)神经质正向预测触发闪回痛苦度, 注意控制和工作记忆容量负向预测一周侵入频率; (3)概念加工在注意控制与即时闪回痛苦度之间起中介作用。研究结果提示：数据驱动加工是创伤后不同时段闪回的主要影响因素; 概念加工主要作用于早期急性应激反应, 注意控制是其保护因素; 神经质和工作记忆能力对闪回具有较长期的影响, 且工作记忆能力具有一定的保护作用。     

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.     

Human recognition memory: a cognitive neuroscience perspective

For many years the cognitive processes underlying recognition memory have been the subject of considerable interest in experimental psychology. To account for a broad range of behavioral findings, psychologists have put forward a variety of 'dual-process' models, all of which propose that recognition memory is supported by two forms of memory - familiarity and recollection - that differ in their speed of operation and the specificity of the retrieved information. More recently, the dual-process framework has been extended to encompass findings from studies investigating the neural basis of recognition memory. Results from neuropsychological, ERP and functional neuroimaging studies can be accommodated within the framework, and suggest that familiarity and recollection are supported by distinct neural mechanisms.     

Memory for emotionally neutral information in posttraumatic stress disorder: A meta-analytic investigation

Studies have come to conflicting conclusions about whether posttraumatic stress disorder (PTSD) is associated with poorer memory for emotionally neutral information. The authors report a meta-analysis of 27 studies that investigated verbal and/or visual memory in samples with PTSD and healthy controls. The results indicated that the association between PTSD and memory impairment appears to be robust, small to moderate in size, and stronger for verbal than for visual memory. Effect sizes did not vary according to whether recall was immediate or delayed. The association is found in both civilian and military samples and cannot be readily explained as being due to the use of nontraumatized healthy control groups or concurrent head injury. The findings are placed in the context of recent neurobiological and experimental cognitive research.     

Attention,Memory, Intrusive Thoughts,and Acceptance in PTSD: An Update on the Empirical Literature for Clinicians

Information processing theory suggests that cognitive changes following trauma are common and hypothesized to have an impact on attention, memory, and intrusive thoughts. There is an ever-expanding empirical literature where cognitive features of posttraumatic stress disorder (PTSD) are being explored. However, it can sometimes be difficult for front-line clinicians to stay abreast of this literature and how it impacts the treatment s/he provides. The goal of this paper is to provide an overview of some recent basic and applied research on information processing in PTSD and the implications of these findings for cognitive-behavioral clinicians. In particular, we explore recent findings regarding attention, memory, intrusive thoughts/thought suppression, and acceptance as they relate to clinical work in patients with PTSD.     

A cognitive model of posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) is a common reaction to traumatic events. Many people recover in the ensuing months, but in a significant subgroup the symptoms persist, often for years. A cognitive model of persistence of PTSD is proposed. It is suggested that PTSD becomes persistent when individuals process the trauma in a way that leads to a sense of serious, current threat. The sense of threat arises as a consequence of: (1) excessively negative appraisals of the trauma and/or its sequelae and (2) a disturbance of autobiographical memory characterised by poor elaboration and contextualization, strong associative memory and strong perceptual priming. Change in the negative appraisals and the trauma memory are prevented by a series of problematic behavioural and cognitive strategies. The model is consistent with the main clinical features of PTSD, helps explain several apparently puzzling phenomena and provides a framework for treatment by identifying three key targets for change. Recent studies have provided preliminary support for several aspects of the model.     

创伤后应激障碍中的非适应性泛化现象

过度泛化现象是区分普通心理问题和严重心理问题的重要指标。创伤后应激障碍(posttraumatic stress disorder, PTSD)患者在创伤事件后会出现非适应性的泛化。现有研究结果表明非适应性泛化(maladaptive generalization)可能是PTSD发生发展的一个重要因素, 但也有研究支持PTSD是导致了泛化从适应性向非适应性化转变的原因。虽然泛化现象的变化与PTSD症状的发展有相同趋势, 且具有共同的生理基础：记忆相关神经结构, 但二者之间的关系尚无明确定论。阐明PTSD与非适应性泛化之间的关系对PTSD的预测、诊断和治疗均有推进作用。     

The influence of data-driven processing on perceptions of memory quality and intrusive symptoms in children following traumatic events

Ehlers and Clark [(2000). A cognitive model of post-traumatic stress disorder. Behaviour Research and Therapy, 38, 319-345] cognitive model of post-traumatic stress disorder (PTSD) has been relatively untested with children. Seventy-five children (7-16 years) were interviewed within 4 weeks of an injury that led to hospital treatment to examine whether peri-traumatic processing strategies (data-driven processing and fear) were associated with perceptions of memory quality and intrusive memories. Perceptions of memory quality mediated the relationship between data-driven processing and intrusive reactions but not avoidance, arousal or depressive reactions. Finally, the relationship between peri-event fear and intrusion reactions was mediated by perceptions of memory quality even after data-driven processing was controlled. The implications of these findings are discussed in the context of a cognitive developmental model of PTSD in children.     

创伤后应激障碍患者情绪记忆优势研究述评

创伤后应激障碍(PTSD)是由高情绪刺激引起延迟出现和长期持续的精神障碍。闯入、闪回、病理性重复体验、持续性警觉性增高和回避等症状严重损害其认知功能。PTSD患者记忆形成了情绪网络。情绪记忆具有强烈、持久的特点, 在记忆中具有优势地位。回顾PTSD患者情绪记忆优势的行为及脑成像研究发现, PTSD患者情绪记忆优势研究结果并不完全一致, 受到诸多因素的影响, 这些影响因素需进一步探讨。     

Response bias,recollection, and familiarity in individuals with Highly Superior Autobiographical Memory (HSAM)

ABSTRACT

The current study focused on individuals with Highly Superior Autobiographical Memory (HSAM) and had two main objectives: 1) investigate whether HSAMs have increased recollection performance compared to controls, and 2) investigate whether HSAMs have a reliably different response bias than controls. While previous lab-based recognition tests have shown that HSAMs have normal memory performance, these tests were based on a mixture of both recollection and familiarity. Here, we employed recognition tests specifically designed to separate recollected responses from those based on familiarity. Additionally, we were interested in how HSAMs make their memory decisions. Several studies have shown a great deal of variability between individuals in their response bias. Here, individuals with HSAM and age- matched controls completed a remember/know and a source memory test. HSAMs behaved like controls in both overall and recollection-based memory discrimination. However, HSAMs showed a significantly more liberal response bias, endorsing more items as “old” than controls. These findings contribute to our understanding of how memory processes – especially those related to decision-making – function in those with superior memory abilities and may help elucidate how other (non-HSAM) memory experts make decisions.