Autobiographical memory in posttraumatic stress disorder before and after treatment

Although overgeneral retrieval of autobiographical memories has been repeatedly demonstrated in posttraumatic stress disorder (PTSD), no studies have indexed overgeneral retrieval before and after treatment of PTSD. Autobiographical memory was assessed in PTSD participants (n=20) prior to commencing cognitive behaviour therapy and 6 months after therapy completion. Fifteen participants completed both assessments. Improvement in PTSD symptoms was significantly associated with improved retrieval of specific memories and decreased retrieval of categoric memories in response to positive cues. These data suggest that symptom reduction during treatment of PTSD leads to greater access to specific memories of positive experiences.     

Genetics of posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) is a prevalent anxiety disorder marked by behavioral, physiologic, and hormonal alterations. PTSD is disabling and commonly follows a chronic course. The etiology of PTSD is unknown, although exposure to a traumatic event constitutes a necessary, but not sufficient, factor. A twin study of Vietnam veterans has shown significant genetic contribution to PTSD. The fact that PTSD's underlying genotypic vulnerability is only expressed following trauma exposure limits the usefulness of family-based linkage approaches. In contrast to the other major psychiatric disorders, large studies for the search of underlying genes have not been described in PTSD to date. Complementary approaches for locating involved genes include association-based studies employing case-control or parental genotypes for transmission dysequilibrium analysis and quantitative trait loci studies in animal models. Identification of susceptibility genes will increase our understanding of traumatic stress disorders and help to elucidate their molecular basis. The current review provides an up-to-date outline of progress in the field of PTSD.     

Gender differences in posttraumatic stress disorder

One of the most consistent findings in the epidemiology of posttraumatic stress disorder (PTSD) is the higher risk of this disorder in women. Explanations reviewed within a psychobiological model of PTSD suggest that women's higher PTSD risk may be due to the type of trauma they experience, their younger age at the time of trauma exposure, their stronger perceptions of threat and loss of control, higher levels of peri-traumatic dissociation, insufficient social support resources, and greater use of alcohol to manage trauma-related symptoms like intrusive memories and dissociation, as well as gender-specific acute psychobiological reactions to trauma. This review demonstrates the need for additional research of the gender differences in posttraumatic stress. Recommendations are made for clinical practice.     

Psychodynamic group treatment of posttraumatic stress disorder in Vietnam veterans.

Exposure to combat frequently imparts a sense of aloneness, guilt, and helplessness. These and other intrapsychic and interpersonal issues need to be addressed in treating Vietnam veterans suffering from posttraumatic stress disorder (PTSD). Group therapy is proposed as a core treatment modality for dealing with these problems. A model is proposed in which patients are treated for 1 year or more in weekly groups that meet for 16-week sequential segments. Clinical guidelines are made explicit to new members by the co-therapists. Discussion topics deal not only with traumatic experiences related to combat, but also with important pre- and postwar issues that are relevant to the symptoms of PTSD. Timely integration and working through of these issues in the group is critical.     

Emotional processing in posttraumatic stress disorder

The emotional deficits associated with posttraumatic stress disorder (PTSD) are the least understood and the most understudied aspect of the syndrome. In this study, the connection was evaluated between trauma-context reactivity and subsequent emotional deficits in PTSD. Combat veterans with PTSD and well-adjusted veteran control participants were exposed to reminders of combat, after which their emotional behavior was assessed in response to a series of emotionally evocative images. Under the neutral condition, both groups exhibited emotional behavior modulated by stimulus valence. Partially consistent with the conceptual model described by B. Litz (1992), the PTSD group exhibited suppressed expressive-motor responses to positively valenced images, in comparison with the control group, only after being exposed to a trauma-related prime. Contrary to expectations, the PTSD group showed no augmentation of emotional response to negatively valenced cues after being exposed to trauma reminders. However, the PTSD group responded to all images, in both prime conditions, with higher heart rate reactivity, suggesting an automatic preparation for demand or threat in any uncertain emotional context. Possible causes and consequences of these results are discussed.     

Psychotic symptoms in posttraumatic stress disorder

Recent data suggest that the presence of psychotic symptoms in patients suffering from posttraumatic stress disorder (PTSD) may represent an underrecognized and unique subtype of PTSD. Among combat veterans with PTSD, 30% to 40% report auditory or visual hallucinations and/or delusions. The presence of psychotic symptoms in PTSD is associated with a more severe level of psychopathology, similar to that of chronic schizophrenia. In this review, the differential diagnosis of psychotic symptoms in PTSD is discussed, including possible comorbid schizophrenia, psychotic depression, substance-induced psychosis, and personality disorder. A recent biologic study supporting the existence of a unique subtype of PTSD with psychotic features is also addressed, as are the similarities between PTSD with psychotic features and psychotic depression disorder. Finally, data on the treatment implications of psychotic symptoms in PTSD are presented. The intriguing recent findings on psychotic symptoms in PTSD need further investigation in noncombat-related PTSD populations before findings can be generalized to all individuals with PTSD.     

Brain-imaging studies of posttraumatic stress disorder

Brain-imaging studies of posttraumatic stress disorder (PTSD) have rapidly increased in recent years. Structural studies have identified potential smaller volumes of the hippocampus of traumatized and/or PTSD subjects. Functional activation studies have implicated hyperactive or altered functioning of brain regions, such as the amygdala and the insula, and a failure to engage emotional regulatory structures, such as the medial prefrontal and anterior cingulate cortex. Recent neurochemical investigations have suggested that neuromodulatory systems (eg, gamma-aminobutyric acid, micro-opioid) may underlie these aberrant brain activation patterns. This article reviews the literature on structural, functional, and neurochemical brain-imaging studies of PTSD.     

Toward a phenomenology of trance logic in posttraumatic stress disorder

Some induction procedures result in trance logic as an essential feature of hypnosis. Trance logic is a voluntary state of acceptance of suggestions without the critical evaluation that would destroy the validity of the meaningfulness of the suggestion. Induction procedures in real and simulated conditions induce a conflict between two contradictory messages in experimental hypnosis. In military induction the conflict is much more subtle involving society's need for security and its need for ethics. Such conflicts are often construed by the subject as trance logic. Trance logic provides an opportunity for therapists using the phenomenology of "presence" to deal with the objectified concepts of "avoidance," "numbing" implicit in this kind of dysfunctional thinking in Posttraumatic Stress Disorder. An individual phenomenology of induction procedures and suggestions, which trigger trance logic, may lead to a resolution of logical fallacies and recurring painful memories. It invites a reconciliation of conflicting messages implicit in phobias and avoidance traumas. Such a phenomenological analysis of trance logic may well be a novel approach to restructure the meaning of trauma.     

The psychophysiology of posttraumatic stress disorder: a meta-analysis

This meta-analysis of 58 resting baseline studies, 25 startle studies, 17 standardized trauma cue studies, and 22 idiographic trauma cue studies compared adults with and without posttraumatic stress disorder (PTSD) on psychophysiological variables: facial electromyography (EMG), heart rate (HR), skin conductance (SC), and blood pressure. Significant weighted mean effects of PTSD were observed for HR (r = .18) and SC (r = .08) in resting baseline studies; eyeblink EMG (r = .13), HR (r = .23), and SC habituation slope (r = .21) in startle studies; HR (r = .27) in standardized trauma cue studies; and frontalis EMG (r = .21), corrugator EMG (r = .34), HR (r = .22), and SC (r = .19) in idiographic trauma cue studies. The most robust correlates of PTSD were SC habituation slope, facial EMG during idiographic trauma cues, and HR during all study types. Overall, the results support the view that PTSD is associated with elevated psychophysiology. However, the generalizability of these findings is limited by characteristics of the published literature, including its disproportionate focus on male veterans and neglect of potential PTSD subtypes.     

A cognitive neuroscience account of posttraumatic stress disorder and its treatment

Recent research in the areas of animal conditioning, the neural systems underlying emotion and memory, and the effect of fear on these systems is reviewed. This evidence points to an important distinction between hippocampally-dependent and non-hippocampally-dependent forms of memory that are differentially affected by extreme stress. The cognitive science perspective is related to a recent model of posttraumatic stress disorder, dual representation theory, that also posits separate memory systems underlying vivid reexperiencing versus ordinary autobiographical memories of trauma. This view is compared with other accounts in the literature of traumatic memory processes in PTSD, and the contrasting implications for therapy are discussed.     

Sustained attention in combat-related posttraumatic stress disorder

There is substantial evidence that PTSD patients have information processing abnormalities for stimuli that are highly relevant to the traumas they have endured. The goal of the present study was to examine whether this extends to neutral stimuli as well. Twenty-four male Vietnam combat veterans with PTSD were compared to fifteen normal male comparison subjects on their performance on a sensitive measure of sustained attention, the Continuous Performance Test-Identical Pairs version (CPT-IP). PTSD subjects did not differ from controls in their ability to discriminate target stimuli from background noise on the CPT. Additionally they performed as well as controls, even in the presence of external distraction. Thus, this study did not find a generalized deficit in attention associated with PTSD on the CPT-IP. Nevertheless, further clarification of the nature of the information processing disturbance in PTSD is warranted.     

Community based cognitive therapy in the treatment of posttraumatic stress disorder following the Omagh bomb

Studies in academic research centres with selected patients have shown that several cognitive behaviour therapies are effective in the treatment of PTSD following traumas affecting individuals or small groups. Little information is available on the extent to which these positive findings will generalize to more routine clinical settings with less selected patients or to a trauma that affects a whole community. The present study addresses these generalization issues. A consecutive series of 91 patients with PTSD resulting from a car bomb which exploded in the centre of Omagh, Northern Ireland in August 1998 were treated with cognitive therapy, along lines advocated by Ehlers and Clark (2000). There were no major exclusion criteria and 53% of patients had an additional axis I disorder (comorbidity). Therapists were NHS staff with heavy caseloads and modest prior training in CBT for PTSD. A brief training in specialist procedures for PTSD was provided. Patients received an average of eight treatment sessions. Significant and substantial improvements in PTSD were observed. Degree of improvement was comparable to that in previously reported research trials. Comorbidity was not associated with poorer outcome, perhaps because comorbid patients were given more sessions of treatment (average 10 vs 5 sessions). Patients who were physically injured improved less than those who were not physically injured. Overall, the results indicate that the positive findings obtained in research settings generalize well to a frontline, non-selective service.     

Interactive psychoeducational group therapy in the treatment of authority problems in combat-related posttraumatic stress disorder

The use of Interactive Psychoeducational Group Therapy to ameliorate authority problems of veterans with combat-related posttraumatic stress disorder is described. Despite the common occurrence of authority problems in this population, and the degree of damage they have caused in family, work, and legal domains, they are rarely specifically targeted by treatment interventions. A conceptual framework linking psychological trauma with distortions in authority relations is presented, followed by the format, procedures, and case examples of this form of group therapy. By uncovering the distorted beliefs associated with traumatic schemas as they emerge in the group interaction, the group therapist can first help the clients question their assumptions about authority, and then explore more adaptive behaviors. The need to examine in greater detail the causes and impact of authority problems among clients with posttraumatic stress disorder is emphasized.     

调控去甲肾上腺素能系统对防治创伤后应激障碍的影响

个体经历严重创伤性事件后可能会形成创伤后应激障碍(posttraumatic stress disorder, PTSD)。在创伤经历中形成的情绪记忆是以后发展为PTSD的重要病理机制。PTSD的形成涉及到情绪记忆的过度巩固, 而去甲肾上腺素能神经信号可增强情绪记忆的巩固和再巩固。因此, 在创伤记忆的巩固和再巩固期间阻断去甲肾上腺素能神经信号, 而在创伤记忆的消退期间增强去甲肾上腺素能神经信号, 可能会破坏和或抑制病理性的情绪记忆, 从而预防或治疗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.     

Support for the location of negative posttraumatic cognitions in the diagnosis of posttraumatic stress disorder

ObjectiveTo investigate the extent to which negative posttraumatic cognitions predict, and so can be best located within, the DSM-5 (APA, 2013) individual symptom clusters of posttraumatic stress disorder (PTSD).MethodAn online survey of traumatic experiences, featuring 528 adults.ResultsNegative posttraumatic cognitions seem best placed within the Numbing/Detachment symptom cluster. Negative posttraumatic cognitions relating to the self predict higher levels of symptoms across the clusters. While negative cognitions relating to the world contributed to most symptom groups, self-blame cognitions did not.ConclusionsOur findings support the placement of posttraumatic cognitions as part of the Numbing/Detachment symptom cluster within the DSM-5rather than the Intrusion, Avoidance and Hyperarousal clusters.     

Qualitative block design analysis in posttraumatic stress disorder

Qualitative and quantitative Block Design performance was examined in Vietnam combat veterans with PTSD diagnoses (n = 23) and Vietnam combat veterans without PTSD or other mental disorders diagnoses (n = 19). Results indicated that PTSD-diagnosed veterans committed more single block rotations than the comparison sample, and that their errors occurred more frequently in right hemispace than errors made by the comparison sample. The two groups did not differ in the number of configural errors made, errors committed in left hemispace, or in quantitative performance measures. Findings are suggestive of relative left hemisphere hypoactivation and are congruent with prior research documenting cerebral asymmetries in emotional disorders.