A randomised controlled trial of the effectiveness of writing as a self-help intervention for traumatic injury patients at risk of developing post-traumatic stress disorder

The study investigated the effects of writing and self-help information on severity of psychological symptoms in traumatic injury patients at risk for developing post-traumatic stress disorder (PTSD). Patients attending Accident and Emergency (A & E), were screened for Acute Stress Disorder and randomised to an information control group (n = 36) or a writing and information group (n = 31). Participants in both groups received an information booklet one-month post-injury. Participants in the writing group also wrote about emotional aspects of their trauma during three 20-min sessions, five to six weeks post-injury. Psychological assessments were completed within one month and at three and six months post-injury. There were significant improvements on measures of anxiety, depression and PTSD over time. Differences between groups on these measures were not statistically significant. However, subjective ratings of the usefulness of writing were high. In conclusion, the results do not currently support the use of writing as a targeted early intervention technique for traumatic injury patients at risk of developing PTSD.     

Trauma and Grace: Psychology and Theology in Conversation

This paper explores the contours of a conversation between recent developments in trauma theory and Christian systematic theology. Toward this end, I examine three levels of theological discourse in a linear progression and responses based on the work of some trauma theorists: (a) twentieth century conceptualizations of divine revelation using the metaphor of a “bridge,” (b) configurations of evil, sin, redemption, and theodicies, and (c) the use of sacraments and iconography as vehicles of solidarity and flourishing. As a burgeoning area of inquiry in academic circles, trauma theory both resists and is in need of the discipline of theology. I conclude that trauma theory and theology are not antithetical disciplines, and a consideration of both brings greater insights than the disciplines considered alone.     

Evaluation of the Dispositional Hope Scale in injury survivors

Hope is a higher-order cognitive construct that encompasses the belief in one’s ability to accomplish personal goals. Hope has been conceptualised as consisting of two constructs – Pathways (the individual’s perceived means available to achieve goals) and Agency (belief in ones ability to succeed in using the identified Pathways). This study aimed to validate a measure of hope, the Dispositional Hope Scale (DHS: [Snyder, C. R., Harris, C., Anderson, J. R., Holleran, S. A., Irving, L. M., Sigman, S. T., et al. (1991). The will and the ways: Development and validation of an individual differences measure of hope. Journal of Personality and Social Psychology, 60(4), 570–585]) in a large sample of traumatic injury survivors (N = 1025). The findings support the psychometric properties of the scale, as well as the two-factor structure of Agency and Pathways, in this population. This study provides support for the use of the DHS as a measure of hope in traumatised populations.     

Posttraumatic Overmodulation,Callous–Unemotional Traits,and Offending Among Justice-Involved Youth

A large body of research has demonstrated an association between childhood trauma exposure (TE) and adolescent delinquency. This association may be explained by callous–unemotional (CU) traits, which may stem from TE and are associated with persistent offending and recidivism. However, research on the mechanisms underlying TE and delinquency has lacked specificity regarding the posttraumatic symptoms that may drive this effect, particularly new models that distinguish between posttraumatic symptoms (PTS) of overmodulation versus undermodulation. This article sought to investigate the role of overmodulation in the association between TE and CU traits and their relations with persistent offending. Participants included 829 detained youth who completed self-report measures of TE, PTS, and CU traits. Official records of youth offenses were also obtained. Results of path analyses demonstrated that the association between interpersonal TE and persistent offending exhibited an indirect effect through overmodulation and CU traits. Efforts to address overmodulation among traumatized detained youth may represent a promising avenue of intervention for reducing recidivism.     

Underestimation of prior remembering and susceptibility to false memories: two sides of the same coin?

In two studies, we explored whether susceptibility to false memories and the underestimation of prior memories (i.e., forgot-it-all-along effect) tap overlapping memory phenomena. Study 1 investigated this issue by administering the Deese/Roediger–McDermott task (DRM) and the forgot-it-all-along (FIA) task to an undergraduate sample (N = 110). It was furthermore explored how performances on these tasks correlate with clinically relevant traits such as fantasy proneness, dissociative experiences, and cognitive efficiency. Results show that FIA and DRM performances are relatively independent from each other, suggesting that these measures empirically apparently refer to separate dimensions. However, they do not seem to define different profiles in terms of dissociation, fantasy proneness, and cognitive efficiency. Study 2 replicated the finding of relative independence between false memory propensity (as measured with the DRM task) and the underestimation of prior memories (as measured with an autobiographical memory dating task) in people with a history of childhood sexual abuse (N = 35).     

A comparison of flashbacks and ordinary autobiographical memories of trauma: content and language

We investigated hypotheses derived from the dual representation theory of posttraumatic stress disorder, which proposes that flashbacks and ordinary memories of trauma are supported by different types of representation. Sixty-two participants meeting diagnostic criteria for posttraumatic stress disorder completed a detailed written trauma narrative, and afterwards identified those sections in the narrative that had been written in flashback and ordinary memory periods. As predicted, flashback periods were characterised by greater use of detail, particularly perceptual detail, by more mentions of death, more use of the present tense, and more mention of fear, helplessness, and horror. In contrast, ordinary memory sections were characterised by more mention of secondary emotions such as guilt and anger.     

Trauma and autobiographical memory specificity in depressed inpatients

Research on autobiographical memory has shown that clinical depression is associated with a difficulty in retrieving specific autobiographical memories in response to cue words. This study examined the relation between lack of autobiographical memory specificity and self-reported trauma in a group of depressed adults (N = 23). In addition to the Autobiographical Memory Test (AMT; Williams & Broadbent, 1986) participants completed a number of questionnaires assessing the presence of traumatic experiences in the past, level of depression and neuroticism. The number of specific responses was not related to depression severity, but was significantly associated with the presence and severity of reported physical abuse. Participants who had been victim of physical abuse were less specific than participants who had not been confronted with such physical adversities. The results are discussed in the context of a functional hypothesis about the developmental relations between memory specificity, trauma and depression.     

Peritraumatic dissociation and experiential avoidance as predictors of posttraumatic stress symptomatology

This study examined whether peritraumatic dissociation serves as a proxy risk factor for experiential avoidance in its relationship with posttraumatic stress disorder (PTSD) symptomatology. One hundred eighty-five trauma survivors completed measures that assessed for peritraumatic dissociation, experiential avoidance, and PTSD symptom severity. The results indicated that peritraumatic dissociation and experiential avoidance were significantly related to PTSD symptomatology at baseline. However, after initial levels of PTSD symptomatology were taken into account, only experiential avoidance was related to PTSD symptoms both 4- and 8-weeks later. These results indicate that peritraumatic dissociation is not a proxy risk factor for experiential avoidance and contributes to the growing body of literature indicating that experiential avoidance is an important factor related to the psychological symptoms experienced by trauma survivors.     

Unwanted memories of assault: what intrusion characteristics are associated with PTSD?

Intrusive memories are common in the immediate aftermath of traumatic events, but neither their presence or frequency are good predictors of the persistence of posttraumatic stress disorder (PTSD). Two studies of assault survivors, a cross-sectional study (N=81) and a 6-month prospective longitudinal study (N=73), explored whether characteristics of the intrusive memories improve the prediction. Intrusion characteristics were assessed with an Intrusion Interview and an Intrusion Provocation Task. The distress caused by the intrusions, their "here and now" quality, and their lack of a context predicted PTSD severity. The presence of intrusive memories only explained 9% of the variance of PTSD severity at 6 months after assault. Among survivors with intrusions, intrusion frequency only explained 8% of the variance of PTSD symptom severity at 6 months. Nowness, distress and lack of context explained an additional 43% of the variance. These intrusion characteristics also predicted PTSD severity at 6 months over and above what could be predicted from PTSD diagnostic status at initial assessment. Further predictors of PTSD severity were rumination about the intrusive memories, and the ease and persistence with which intrusive memories could be triggered by photographs depicting assaults. The results have implications for the early identification of trauma survivors at risk of chronic PTSD.