Does post-event cognitive load undermine thought suppression and increase intrusive memories after exposure to an analogue stressor?

Ironic process theory has been used in part to explain the phenomenon of intrusive memories in various disorders including post-traumatic stress disorder. How thought suppression interacts with other cognitive processes believed to be instrumental in the development of traumatic intrusive memory was tested. In an analogue design 120 participants were randomised to five conditions, four of which also required participants to attempt to suppress intrusive memories after viewing a film of traumatic content. Participants in three conditions were also required to perform concurrent tasks that acted as a cognitive load during suppression. Intrusive memories were recorded during the experimental phase and at 1-week follow-up. Contrary to predictions, post-film processing did not undermine suppression success. There was some suggestion that post-film processing resulted in those participants experiencing intrusions of shorter duration than the no-suppression control group in two 5-minute intrusion monitoring intervals at the initial and follow-up phase of the experiment, but this was not reflected in a 1-week diary measure of intrusions. All experimental groups performed in a similar fashion in terms of memory testing of the film's content. The findings are discussed in the context of ironic process theory and cognitive models of post-traumatic stress.     

Treating Survivors of Terrorism While Adversity Continues

Abstract

The current situation in Israel of continuous terrorist attacks poses unique challenges to the treatment of Posttraumatic Stress Disorder (PTSD). This article addresses issues that arise when treating survivors of ongoing terrorism. These include: (a) Is PTSD treatable during ongoing adversity? (b) When should treatment be offered? (c) Is avoidance maladaptive or adaptive? (d) How does one deal with re-exposure? (e) How to define the end of treatment? and (f) What are the effects on the therapist when conducting treatment during ongoing adversity? Case studies are provided to illustrate these issues when treating clients with PTSD during ongoing terror.     

Interpersonal Violence,Recovery, and Resilience in Incarcerated Women

Abstract

Our first study focuses on interpersonal violence and characteristics of resilience (evaluated by the Multidimensional Trauma Resilience and Recovery [MTRR] interview and rating scales) in a sample of incarcerated women. The second study applies qualitative data analysis to a case study of one participant in group therapy for incarcerated women with a history of childhood sexual abuse. Despite extensive history of both frequent and severe abuse, the women displayed a high degree of resilience across multiple domains, including, in particular, the ability to derive meaning from traumatic events and to place the memories into context, ability to form meaningful relationships with others, and ability to regulate affect. These findings were replicated in study two, which illustrates the process of recovery from a poly-traumatic history.     

Change in sleep symptoms across Cognitive Processing Therapy and Prolonged Exposure: A longitudinal perspective

Sleep disturbance is a core component in posttraumatic stress disorder (PTSD). Although cognitive-behavioral treatments for PTSD reduce the severity of sleep symptoms, they do not lead to complete remission. The present study examines the impact of Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) on subjective measures of sleep disturbance from treatment randomization through long-term follow-up (LTFU). Participants were 171 female rape victims with PTSD who were randomly assigned to CPT, PE, or Minimal Attention (MA). After 6-weeks, the MA group was randomized to CPT or PE. Sleep symptoms were assessed at baseline, post-MA, post-treatment, 3-months, 9-months and LTFU using the Pittsburgh Sleep Quality Index (PSQI) and nightmare and insomnia items from the Clinician Administered PTSD Scale. Change in sleep during MA, from pre- to post-treatment for CPT and PE, and from post-treatment through LTFU was assessed using piecewise hierarchical linear modeling with the intent-to-treat sample. Controlling for medication, sleep improved during CPT and PE compared to MA, and treatment gains were maintained through LTFU. CPT and PE were equally efficacious and improvements persist over LTFU, yet, neither produced remission of sleep disturbance. Overall, sleep symptoms do not remit and may warrant sleep-specific treatments.     

‘Battling with the unlaid ghost’: psychotherapy with a child traumatised in infancy

This paper attempts to explore the nature and consequences of early trauma on the mental development of a 9-year-old boy I have called Luke. The traumatic event occurred within the context of a more chronic and ongoing trauma, which was due to the lack of receptive and containing parental figures. The combination of these two kinds of traumatic experiences had a destructive impact on the making of Luke's internal world and greatly disrupted the development of his capacity for thought. I will specifically refer to the theory of trauma and to Bion's theory of thinking in order to illustrate the crucial link between trauma and mental work and the complex challenge it brings. I will describe how, during the course of 2 years of intensive treatment, Luke gradually became able to restore his capacity for mental functioning, which made it possible for him to begin to think about and make sense of his extreme emotional experiences.

Dans cet article, l'auteur cherche à explorer la nature et les conséquences, pour le développement psychique d'un garçon de neuf ans qu'il appelle Luke, d'un traumatisme précoce. L'événement traumatique s'est produit dans le contexte d'une situation traumatique plus chronique et plus globale en raison de l'absence de figures parentales réceptives et contenantes. L'association de ces deux types de vécu traumatique, avec leur impact destructeur sur la construction du monde interne de Luke, a créé des perturbations majeures du développement de sa capacité à penser. L'auteur se réfère tout particulièrement à la théorie du traumatisme ainsi qu'à la théorie de l'activité de pensée de W. R. Bion afin d'illustrer le lien fondamental qui existe entre traumatisme et travail psychique, ainsi que le défi complexe que ce travail doit confronter. L'auteur montre qu'au cours de deux années de traitement intensif Luke a progressivement retrouvé ses capacités de fonctionnement psychique, de sorte qu'il a pu commencer à réfléchir à ses vécus émotionnels insoutenables et réussir à y comprendre quelque chose.

Mots-clés: Traumatisme, “pare-excitation”, fonctionnement psychique, théorie de l'activité de pensée, fonction alpha, attaques contre l'activité de liaison

Riassunto: In questo articolo si cerca di esplorare la natura e le conseguenze del trauma precoce sullo sviluppo mentale di un bambino di nove anni che chiamerò Luca. L'evento traumatico accadde all'interno di un contesto di trauma pi[ugrave] cronico e duraturo dovuto all'assenza di figure parentali recettive e contenitive. La combinazione di questi due tipi di esperienze traumatiche ebbe un impatto distruttivo sul mondo interno di Luca e interferì enormemente con lo sviluppo della sua capacità di pensare. Farò principalmente riferimento alla teoria del trauma e alla teoria del pensiero di Bion per illustrare il legame particolare tra trauma e lavoro mentale e la complessa sfida che ne consegue. Descriverò come durante il lavoro intensivo di due anni, Luca divenne gradualmente capace di recuperare la sua capacità di funzionamento mentale che gli permise di incominciare a pensare e dare un senso alle sue esperienze emotive estreme.

Parole chiave: trauma, scudo protettivo, funzionamento mentale, teoria del pensiero, funzione alfa, attacco al legame

Der Artikel versucht, die Eigenschaften und Konsequenzen von frühem Trauma auf die psychische Entwicklung eines 9-jährigen Jungens, den ich Luke nenne, zu betrachten Das traumatische Ereignis passierte im Umfeld eines mehr chronischen und fortdauernden Traumas, wegen Mangel an rezeptiven und haltenden elterlichen Figuren. Die Kombination dieser zwei Arten von Trauma hatte eine destruktive Auswirkung auf das Entstehen von Lukes innerer Welt und störte erheblich die Entwicklung seiner Denkfähigkeit. Ich werden mich speziell auf Traumatheorie und auf Bion's Theorie des Denkens beziehen, um die entscheidende Verbindung zwischen Trauma und mentaler Arbeit und der komplexen Herausforderung, die das mit sich bringt, zu illustrieren. Ich werde beschreiben, wie Luke allmählich im Laufe einer zwei-jährigen intensiven Behandlung in der Lage war, seine Fähigkeit für mentales Funktionieren wiederherzustellen, was es ihm ermöglichte anzufangen, über seine extremen emotionalen Erfahrungen nachzudenken und Sinn herzustellen

Keywords: Trauma, Schutzschild, mentales Funktionieren, Theorie des Denkens, Alphafunktion, Angriffe auf Verbindungen     

The child who cannot bear to feel

Some children have such traumatic experiences that they need to defend vigorously against any thoughts or feelings which threaten to bring the painful memories back into consciousness. Repeated hurtful and traumatic experiences can affect the deeper structures of the brain, causing behaviour and learning difficulties, which are difficult to reverse. These defensive behaviours can be very hard for teachers to appreciate and cope with. Sometimes, when the threatened and feared feelings are triggered, a child's reaction can be beyond conscious control and reason, until they have calmed down. Very damaged children need emotional 'holding', as well as a facilitating environment, to be able to learn and function acceptably in school. 'The child who cannot bear to feel' looks at underlying causes, symptoms and difficulties experienced by these children, and discusses ways of reflecting on their defensive behaviours and offering emotional holding in school.     

Preliminary thoughts on the neurobiology of innate unconscious structures and the psychodynamics of language acquisition

This paper builds upon Britton's recent writing on ‘models in the mind’, in which he gives an account of preverbal metaphoric structures based on object relations (Britton 2015). These correspond with Jung's theory of innate unconscious structures. These innate models are considered alongside current linguistic theory following Chomsky and post‐Chomskyan views about language acquisition. Neuroscience evidence linking language and abstract thinking with structures involved in tool use are presented. The implications of these findings, and our understanding of the relational context within which language, metaphor and abstract thought are acquired, will be discussed along with the failures of symbolization and verbal communication common amongst those with severe narcissistic disorders.     

Do PTSD symptoms and course predict continued substance use for homeless individuals in contingency management for cocaine dependence?

Homeless individuals (n = 187) entering contingency management (CM) for cocaine dependence were assessed for PTSD diagnosis, and a subset of 102 participants reporting traumatic exposure also periodically completed a self-report measure of PTSD symptoms. Patients with PTSD in full remission at 6 months (end of active treatment) and 12 months (end of aftercare) used substances much less frequently during aftercare than those with no PTSD diagnosis. Those whose PTSD diagnosis improved to full remission status during active treatment, and remained in full remission at 12 months, also had superior substance use outcomes. Severity of PTSD symptoms at 6 months, but not baseline or 2 months, was associated with substance use across treatment phases. Substance use during aftercare, however, was better predicted by changes in PTSD symptom severity. Patients whose PTSD symptoms improved more during active treatment fared better during aftercare than those with less improvement. Findings suggest homeless individuals with comorbid PTSD entering CM for cocaine dependence are not necessarily at increased risk for substance use compared to those without the comorbidity. However, course of PTSD does predict substance use, with the potential for CM to be unusually effective for those who respond with substantial, lasting improvements in PTSD.     

Trauma und Traumafolgen aus psychodynamischer Sicht

Zusammenfassung Posttraumatische Störungen sind psychogene Erkrankungen, die durch Traumatisierungen bewirkt werden. Das sind seelische Verletzungen, die schwer oder gar nicht bewältigt werden können. Die Störungen beruhen auf unterschiedlichen Arten von katastrophalen Erlebnissen und können mit zeitlicher Verzögerung, unabhängig von einer spezifischen Disposition, also auch bei bis dahin völlig gesunden Menschen, zu einer vorübergehenden, länger andauernden oder lang anhaltenden Störung im seelischen und körperlichen Bereich und zu einer Veränderung der Persönlichkeit führen. Diese Störungen sind außerordentlich häufig und haben eine große Vielfalt in Hinblick auf ihre Entstehung und ihre Krankheitserscheinungen. Dynamik und Folgen traumatischer seelischer Verletzungen werden in diesem Beitrag systematisch aus psychoanalytisch orientierter Perspektive untersucht und dargestellt.     

Emotional Processing Theory (EPT) and Exposure Therapy for PTSD

Emotional processing theory developed by E. B. Foa and M. J. Kozak (1986) has informed the conceptualization of anxiety disorders and the development of effective treatments for these disorders, including posttraumatic stress disorder (PTSD). This article presents a summary and update of emotional processing theory as it applies to the treatment of PTSD, data in support of this theory, and clinical examples of how the theory can be used to assist in the treatment of clients with PTSD. Common difficulties confronted during exposure therapy for PTSD, including underengagement and overengagement, are discussed in the context of emotional processing theory and suggestions for how to manage these difficulties are presented.