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Gamble B, Depa K, Holmes EA, Kanstrup M. Digitalizing a Brief Intervention to Reduce Intrusive Memories of Psychological Trauma: Qualitative Interview Study. JMIR Ment Health 2021; 8:e23712. [PMID: 33616540 PMCID: PMC7939943 DOI: 10.2196/23712] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/01/2020] [Accepted: 12/19/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has escalated the global need for remotely delivered and scalable interventions after psychological trauma. A brief intervention involving a computer game as an imagery-competing task has shown promising results for reducing the number of intrusive memories of trauma-one of the core clinical symptoms of posttraumatic stress disorder. To date, the intervention has only been delivered face-to-face. To be tested and implemented on a wider scale, digital adaptation for remote delivery is crucial. An important first step is to develop digitalized intervention materials in a systematic way based on feedback from clinicians, researchers, and students in preparation for pilot testing with target users. OBJECTIVE The first aim of this study is to obtain and analyze qualitative feedback on digital intervention materials, namely two animated videos and two quizzes that explain the target clinical symptoms and provide intervention instructions. The second aim is to refine the digitalized materials based on this feedback. METHODS We conducted semistructured interviews with 12 participants who had delivered or had knowledge of the intervention when delivered face-to-face. We obtained in-depth feedback on the perceived feasibility of using the digitalized materials and suggestions for improvements. Interviews were assessed using qualitative content analysis, and suggested improvements were evaluated for implementation using a systematic method of prioritization. RESULTS A total of three overarching themes were identified from the data. First, participants were highly positive about the potential benefits of using these digital materials for remote delivery, reporting that the videos effectively conveyed key concepts of the symptom and its treatment. Second, some modifications to the materials were suggested for improving clarity. On the basis of this feedback, we made nine specific changes. Finally, participants raised some key challenges for remote delivery, mainly in overcoming the lack of real-time communication during the intervention. CONCLUSIONS Clinicians, researchers, and clinical psychology students were overall confident in the use of digitalized materials to remotely deliver a brief intervention to reduce intrusive memories of trauma. Guided by participant feedback, we identified and implemented changes to refine the intervention materials. This study lays the groundwork for the next step: pilot testing remote delivery of the full intervention to trauma survivors.
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Affiliation(s)
- Beau Gamble
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Katherine Depa
- Department of Psychology, Uppsala University, Uppsala, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marie Kanstrup
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Bryant RA. A critical review of mechanisms of adaptation to trauma: Implications for early interventions for posttraumatic stress disorder. Clin Psychol Rev 2021; 85:101981. [PMID: 33588312 DOI: 10.1016/j.cpr.2021.101981] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 11/23/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
Although many attempts have been made to limit development of posttraumatic stress disorder (PTSD) by early intervention after trauma exposure, these attempts have achieved only modest success. This review critiques the biological and cognitive strategies used for early intervention and outlines the extent to which they have prevented PTSD. The major predictors of PTSD are reviewed, with an emphasis on potential mechanisms that may underpin the transition from acute stress reaction to development of PTSD. This review highlights that there is a wide range of biological and cognitive factors that have been shown to predict PTSD. Despite this, the major attempts at early intervention have focused on strategies that attempt to augment extinction processes or alter appraisals in the acute period. The documented predictors of PTSD indicate that a broader range of potential strategies could be explored to limit PTSD. The evidence that people follow different trajectories of stress response following trauma and there is a wide array of acute predictors of PTSD indicates that a flexible and tailored approach needs to be investigated to evaluate more effective early intervention strategies.
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Kanstrup M, Singh L, Göransson KE, Widoff J, Taylor RS, Gamble B, Iyadurai L, Moulds ML, Holmes EA. Reducing intrusive memories after trauma via a brief cognitive task intervention in the hospital emergency department: an exploratory pilot randomised controlled trial. Transl Psychiatry 2021; 11:30. [PMID: 33431807 PMCID: PMC7798383 DOI: 10.1038/s41398-020-01124-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/10/2020] [Accepted: 11/23/2020] [Indexed: 02/06/2023] Open
Abstract
Intrusive memories are common after trauma, and can cause significant distress. Interventions to prevent/reduce the occurrence of this core clinical feature of posttraumatic stress disorder are needed; they should be easy to deliver, readily disseminated and scalable. A novel one-session intervention by Iyadurai et al. 2018, Molecular Psychiatry, resulted in intrusion reduction over the subsequent week. Its feasibility in a different setting and longer-term effects (>1 month) need investigation. We conducted an exploratory open-label pilot randomised controlled trial (RCT) to investigate the feasibility and effects of a brief behavioural intervention to reduce intrusive memories in trauma-exposed patients in a Swedish hospital emergency department (ED). Participants (final N = 41) were randomly allocated to either intervention (including memory reminder cue then visuospatial cognitive task "Tetris" with mental rotation instructions) or active control (podcast) condition within 72 h of presenting to the ED (both conditions using their smartphone). Findings were examined descriptively. We estimated between-group effect sizes for the number of intrusive memories post-intervention at week 1 (primary outcome) and week 5 (secondary outcome). Compared to the control condition, participants in the intervention condition reported fewer intrusive memories of trauma, both at week 1 and week 5. Findings extend the previous evaluation in the UK. The intervention was readily implemented in a different international context, with a mixed trauma sample, with treatment gains maintained at 1 month and associated with some functional improvements. Findings inform future trials to evaluate the capacity of the cognitive task intervention to reduce the occurrence of intrusive memories after traumatic events.
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Affiliation(s)
- Marie Kanstrup
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Functional Area Medical Psychology, Karolinska University Hospital, Stockholm, Sweden.
| | - Laura Singh
- Department of Psychology, Uppsala University, Uppsala, Sweden.
| | - Katarina E Göransson
- Emergency and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Julia Widoff
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - Beau Gamble
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | | | - Michelle L Moulds
- School of Psychology, The University of New South Wales, UNSW Sydney, Sydney, Australia
| | - Emily A Holmes
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Uppsala University, Uppsala, Sweden
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54
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Weigl T, Beck-Hiestermann FML, Stenzel NM, Benson S, Schedlowski M, Garthus-Niegel S. Assessment of Childbirth-Related PTSD: Psychometric Properties of the German Version of the City Birth Trauma Scale. Front Psychiatry 2021; 12:731537. [PMID: 34690839 PMCID: PMC8527008 DOI: 10.3389/fpsyt.2021.731537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/08/2021] [Indexed: 11/21/2022] Open
Abstract
Background: About 3-4% of women in community samples suffer from childbirth-related posttraumatic stress disorder (PTSD). Surprisingly, the recently developed City Birth Trauma Scale (City BiTS) was the first diagnostic tool for childbirth-related PTSD covering DSM-5 criteria for PTSD. Since no questionnaire on childbirth-related PTSD is available in German, we aimed to validate a German translation of the City BiTS and to provide information on its psychometric properties. Methods: A community sample of 1,072 mothers completed an online survey, which included questions on sociodemographic and obstetric characteristics, the German version of the City BiTS, the Impact of Event Scale-Revised (IES-R), the PTSD Checklist for DSM-5 (PCL-5), Edinburgh Postnatal Depression Scale (EPDS), and the anxiety subscale of the Depression, Anxiety, and Stress Scale (DASS-Anxiety). Results: Exploratory factor analysis (EFA) on a random split-half sample confirmed the previously reported two-factorial structure of the City BiTS. The factors "Childbirth-related symptoms" and "General symptoms" explained about 53%, 52% of variance. Internal consistency was good to excellent for the subscales and the total scale (Cronbach's Alpha = 0.89-0.92). In a confirmatory factor analysis (CFA) in the holdout sample the two-factorial solution reached the best model fit out of three models. Correlation analyses showed convergent validity of the City BiTS (total scale and subscales) with the IES-R and PCL-5 and divergent validity with the EPDS and the DASS-Anxiety. Limitations: Data were acquired in a community sample and prevalence rates might not be representative for mothers of high-risk groups, e.g., after preterm birth. Conclusions: The German version of the City BiTS is the first German questionnaire which allows to assess symptoms of childbirth-related PTSD according to DSM-5 criteria. Besides an improvement in clinical routine it will help to make data on prevalence of childbirth-related PTSD internationally comparable. In addition, this work provides a basis to assess childbirth-related PTSD in studies conducted with a longitudinal study design or in high-risk samples.
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Affiliation(s)
- Tobias Weigl
- Psychology School, Hochschule Fresenius - University of Applied Sciences Düsseldorf, Düsseldorf, Germany
| | | | - Nikola Maria Stenzel
- Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Sven Benson
- Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Susan Garthus-Niegel
- Institute for Systems Medicine (ISM), Faculty of Human Medicine, Medical School Hamburg, Hamburg, Germany.,Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway.,Faculty of Medicine, Institute and Policlinic of Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany
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Condensed internet-delivered prolonged exposure provided soon after trauma: A randomised pilot trial. Internet Interv 2020; 23:100358. [PMID: 33384946 PMCID: PMC7771112 DOI: 10.1016/j.invent.2020.100358] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/05/2020] [Accepted: 11/10/2020] [Indexed: 12/14/2022] Open
Abstract
Exposure to trauma is common and may have detrimental psychological consequences. Brief exposure therapy provided early after trauma has shown encouraging results in promoting recovery. To scale up treatment availability, we developed a 3-week internet-delivered intervention comprised of four modules based on prolonged exposure (condensed internet-delivered prolonged exposure; CIPE) with therapist support. In this pilot study, we assessed the feasibility, acceptability, and preliminary efficacy of CIPE delivered within 2 months after the index event. Thirty-three participants were randomised to CIPE or a waiting list (WL). The frequency, vividness and distress of intrusive recollections or flashback memories of the traumatic event were assessed using an intrusive memory smartphone app. Symptoms of post-traumatic stress were assessed by the PTSD Symptom Checklist for DSM-5 (PCL-5). The most common index traumas in the sample were rape, interpersonal violence and life-threatening accidents. A majority of participants (82%) randomised to CIPE completed all modules, and the number of logins per participant to the Internet platform was high during the three-week intervention (M = 19.6, SD = 11.8). At post-treatment, the CIPE participants had a more favourable reduction than the WL group on the vividness and distress ratings, as well as on the PCL-5 sum score (bootstrapped d = 0.85; 95% CI [0.25-1.45]). Treatment effects were sustained at 6-months follow up and no severe adverse events associated with the intervention were found. CIPE seems to be a feasible and possibly efficacious early intervention after trauma. Large-scale trials are needed to assess its efficacy and long-term benefits.
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56
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Experimental Psychopathology at the Crossroads: Reflections on Past, Present, and Future Contributions to Cognitive Behavioural Therapy. Int J Cogn Ther 2020. [DOI: 10.1007/s41811-020-00093-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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57
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Kessler H, Dangellia L, Herpertz S, Kehyayan A. [Digital Media in Psychotherapy - New Approaches and Perspectives in the Treatment of Trauma-Related Disorders]. Psychother Psychosom Med Psychol 2020; 70:371-377. [PMID: 32252120 DOI: 10.1055/a-1120-8976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This article provides an insight into novel approaches and perspectives using digital technologies in the treatment of trauma-related disorders. Therapy options for patients with trauma-related disorders are not easily available on a global scale and there is a search for new specific therapeutic strategies. In the first part of this article, examples of digital approaches are provided that are based on established analogue treatments and are designed mainly to increase availability and cost-effectiveness of these treatments. In the second part, the focus lies on digital treatments that employ novel approaches, which are e. g. informed by cognitive science, to specifically target particular symptoms in clinical populations after their development in lab studies. Examples given are visuospatial interventions used to reduce intrusive symptoms, or training programmes to increase levels of interference control (to control trauma-related stimuli), or to change automatic dysfunctional cognitions. These interventions will be presented with their respective theoretical frameworks, along with results from first (partially clinical) studies, which are promising concerning acceptance, applicability and effectiveness.
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Affiliation(s)
- Henrik Kessler
- Klinik für Psychosomatische Medizin und Psychotherapie, LWL-Universitätsklinikum Bochum der Ruhr-Universität Bochum
| | - Luisa Dangellia
- Klinik für Psychosomatische Medizin und Psychotherapie, LWL-Universitätsklinikum Bochum der Ruhr-Universität Bochum
| | - Stephan Herpertz
- Klinik für Psychosomatische Medizin und Psychotherapie, LWL-Universitätsklinikum Bochum der Ruhr-Universität Bochum
| | - Aram Kehyayan
- Klinik für Psychosomatische Medizin und Psychotherapie, LWL-Universitätsklinikum Bochum der Ruhr-Universität Bochum
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58
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Zehetmair C, Nagy E, Leetz C, Cranz A, Kindermann D, Reddemann L, Nikendei C. Self-Practice of Stabilizing and Guided Imagery Techniques for Traumatized Refugees via Digital Audio Files: Qualitative Study. J Med Internet Res 2020; 22:e17906. [PMID: 32965229 PMCID: PMC7542415 DOI: 10.2196/17906] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/20/2020] [Accepted: 04/30/2020] [Indexed: 01/17/2023] Open
Abstract
Background Refugees have an increased risk of developing mental health problems. There are insufficient psychosocial care structures to meet the resulting need for support. Stabilizing and guided imagery techniques have shown promising results in increasing traumatized refugees’ emotional stabilization. If delivered via audio files, the techniques can be practiced autonomously and independent of time, space, and human resources or stable treatment settings. Objective This study aimed to evaluate the self-practice of stabilizing and guided imagery techniques via digital audio files for traumatized refugees living in a reception and registration center in Germany. Methods From May 2018 to February 2019, 42 traumatized refugees participated in our study. At T1, patients received digital audio files in English, French, Arabic, Farsi, Turkish, or Serbian for self-practice. Nine days later, at T2, a face-to-face interview was conducted. Two months after T2, a follow-up interview took place via telephone. Results At T2, about half of the patients reported the daily practice of stabilizing and guided imagery techniques. At follow-up, the average frequency of practice was once weekly or more for those experiencing worse symptoms. No technical difficulties were reported. According to T2 and follow-up statements, the techniques helped the patients dealing with arousal, concentration, sleep, mood, thoughts, empowerment, and tension. The guided imagery technique “The Inner Safe Place” was the most popular. Self-practice was impeded by postmigratory distress factors, like overcrowded accommodations. Conclusions The results show that self-practice of stabilizing and guided imagery techniques via digital audio files was helpful to and well accepted by the assessed refugees. Even though postmigratory distress factors hampered self-practice, “The Inner Safe Place” technique was particularly well received. Overall, the self-practiced audio-based stabilizing and guided imagery techniques showed promising results among the highly vulnerable group of newly arrived traumatized refugees.
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Affiliation(s)
- Catharina Zehetmair
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Ede Nagy
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Carla Leetz
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Anna Cranz
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - David Kindermann
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Luise Reddemann
- Department of Clinical Psychology, Psychotherapy and Psychoanalysis, University of Klagenfurt, Klagenfurt, Austria
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
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Singh L, Espinosa L, Ji JL, Moulds ML, Holmes EA. Developing thinking around mental health science: the example of intrusive, emotional mental imagery after psychological trauma. Cogn Neuropsychiatry 2020; 25:348-363. [PMID: 32847486 DOI: 10.1080/13546805.2020.1804845] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION One route to advancing psychological treatments is to harness mental health science, a multidisciplinary approach including individuals with lived experience and end users (e.g., Holmes, E. A., Craske, M. G., & Graybiel, A. M. (2014). Psychological treatments: A call for mental-health science. Nature, 511(7509), 287-289. doi:10.1038/511287a). While early days, we here illustrate a line of research explored by our group-intrusive imagery-based memories after trauma. METHOD/RESULTS We illustrate three possible approaches through which mental health science may stimulate thinking around psychological treatment innovation. First, focusing on single/specific target symptoms rather than full, multifaceted psychiatric diagnoses (e.g., intrusive trauma memories rather than all of posttraumatic stress disorder). Second, investigating mechanisms that can be modified in treatment (treatment mechanisms), rather than those which cannot (e.g., processes only linked to aetiology). Finally, exploring novel ways of delivering psychological treatment (peer-/self-administration), given the prevalence of mental health problems globally, and the corresponding need for effective interventions that can be delivered at scale and remotely for example at times of crisis (e.g., current COVID-19 pandemic). CONCLUSIONS These three approaches suggest options for potential innovative avenues through which mental health science may be harnessed to recouple basic and applied research and transform treatment development.
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Affiliation(s)
- Laura Singh
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Lisa Espinosa
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Julie L Ji
- School of Psychological Science, The University of Western Australia, UWA Perth, Australia
| | - Michelle L Moulds
- School of Psychology, The University of New South Wales, UNSW Sydney, Australia
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Porcheret K, Iyadurai L, Bonsall MB, Goodwin GM, Beer SA, Darwent M, Holmes EA. Sleep and intrusive memories immediately after a traumatic event in emergency department patients. Sleep 2020; 43:zsaa033. [PMID: 32133531 PMCID: PMC7420515 DOI: 10.1093/sleep/zsaa033] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 02/11/2020] [Indexed: 12/24/2022] Open
Abstract
STUDY OBJECTIVES Intrusive memories of psychological trauma are a core clinical feature of posttraumatic stress disorder (PTSD), and in the early period post-trauma may be a potential target for early intervention. Disrupted sleep in the weeks post-trauma is associated with later PTSD. The impact of sleep and intrusive memories immediately post-trauma, and their relation to later PTSD, is unknown. This study assessed the relationship between sleep duration on the first night following a real-life traumatic event and intrusive memories in the subsequent week, and how these might relate to PTSD symptoms at 2 months. METHODS Patients (n = 87) recruited in the emergency department completed a sleep and intrusive memory diary from the day of their trauma and for the subsequent week, with optional actigraphy. PTSD, anxiety, and depression symptoms were assessed at 1 week and 2 months. RESULTS A U-shaped relationship was observed between sleep duration on the first night and intrusive memories over the subsequent week: sleeping "too little" or "too much" was associated with more intrusive memories. Individuals who met Clinician-Administered PTSD Scale (CAPS) criteria for PTSD at 2 months had three times more intrusive memories in the first week immediately post-trauma than those who did not (M = 28.20 vs 9.96). Post hoc analysis showed that the absence of intrusive memories in the first week post-trauma was only observed in those who did not meet CAPS criteria for PTSD at 2 months. CONCLUSIONS Monitoring intrusive memories and sleep in the first week post-trauma, using a simple diary, may help identify individuals more vulnerable to later psychopathology.
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Affiliation(s)
- Kate Porcheret
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Lalitha Iyadurai
- Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK
- Emergency Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Michael B Bonsall
- Department of Zoology and St. Peter’s College, University of Oxford, Oxford, UK
| | - Guy M Goodwin
- Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK
| | - Sally A Beer
- Emergency Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Melanie Darwent
- Emergency Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Emily A Holmes
- Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Department of Clinical Neurosciences, Karolinska Institutet, Uppsala, Sweden
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61
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Bragesjö M, Larsson K, Nordlund L, Anderbro T, Andersson E, Möller A. Early Psychological Intervention After Rape: A Feasibility Study. Front Psychol 2020; 11:1595. [PMID: 32733345 PMCID: PMC7360814 DOI: 10.3389/fpsyg.2020.01595] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/15/2020] [Indexed: 11/13/2022] Open
Abstract
Rape is the most common trauma leading to post-traumatic stress disorder (PTSD) among women, with a conditioned prevalence of up to 50%. PTSD is considered to be a lethal condition associated with increased risk of suicide, drug- and alcohol dependence, neurological- and vascular problems, as well as sick leave. Given the scope of this problem, novel and swiftly delivered interventions for this large vulnerable population are clearly warranted. One previous trial conducted in the United States (N = 137) showed that an adapted brief version of prolonged exposure (PE) to the fearful memory of the event and situations, provided in the immediate aftermath after trauma (<72 h after a traumatic event), was effective in reducing early PTSD symptoms in rape victims. The aims of the present study were to adapt the brief PE protocol to a Swedish context and investigate its feasibility and delivery in 10 executive patients recruited at the Emergency Clinic for Rape Victims in Stockholm. Ten participants were provided with three sessions of early PE with overall successful results in terms of session attendance, home-work compliance, and also symptom reduction of PTSD and depressive symptoms. However, only a fraction of the screened patients at the Emergency Clinic (5.2%) were eligible to be included in the study, where the majority (40%) were excluded due to the time criteria of 72 h. In this article, we will present detailed results of the intervention and elaborate on how to increase feasibility of preventive interventions for rape victims. In the current form, providing PE with the strict time criteria was not feasible in the clinical setting that constitutes the Emergency Department for rape.
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Affiliation(s)
- Maria Bragesjö
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Larsson
- Department of Obstetrics and Gynecology, Emergency Clinic for Rape Victims, Stockholm South Hospital, Stockholm, Sweden
| | - Lisa Nordlund
- Department of Obstetrics and Gynecology, Emergency Clinic for Rape Victims, Stockholm South Hospital, Stockholm, Sweden
| | - Therese Anderbro
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Erik Andersson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Anna Möller
- Department of Obstetrics and Gynecology, Emergency Clinic for Rape Victims, Stockholm South Hospital, Stockholm, Sweden
- Department of Clinical Science and Education, Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden
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Kanstrup M, Kontio E, Geranmayeh A, Olofsdotter Lauri K, Moulds ML, Holmes EA. A single case series using visuospatial task interference to reduce the number of visual intrusive memories of trauma with refugees. Clin Psychol Psychother 2020; 28:109-123. [PMID: 32525244 DOI: 10.1002/cpp.2489] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 11/07/2022]
Abstract
The current worldwide so-called "refugee crisis" has led to an unprecedented increase in migration globally. Because of stigma and language barriers, mental health care for refugees is limited. There is a need for novel, scalable psychological interventions. We investigated whether a brief behavioural intervention involving a memory reminder cue and Tetris gameplay on a smartphone reduces intrusive memories in refugees using a single case (N = 4) ABAB withdrawal design. The baseline phase (A) included a no-intervention week; the intervention phase (B) included an in-person session with the researchers, comprised of the behavioural intervention followed by self-guided use in daily life the following week. All participants reported a decrease in intrusive memories after the intervention, as well as functional improvements (e.g., in concentration). Importantly, participants rated the intervention as feasible and acceptable. As one in-person session was effective in persistent intrusion reduction, ABAB proved not to be the optimal design as intrusions did not rebound in the withdrawal phase. Findings are promising and highlight the need for further evaluation of novel interventions for mental health problems in refugees.
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Affiliation(s)
- Marie Kanstrup
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Evelina Kontio
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Anahita Geranmayeh
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Klara Olofsdotter Lauri
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Michelle L Moulds
- Department of Psychology, Uppsala University, Uppsala, Sweden.,School of Psychology, The University of New South Wales, UNSW, Sydney, New South Wales, Australia
| | - Emily A Holmes
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, Stockholm, Sweden.,Department of Psychology, Uppsala University, Uppsala, Sweden
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Butler O, Herr K, Willmund G, Gallinat J, Kühn S, Zimmermann P. Trauma, treatment and Tetris: video gaming increases hippocampal volume in male patients with combat-related posttraumatic stress disorder. J Psychiatry Neurosci 2020; 45:279-287. [PMID: 32293830 PMCID: PMC7828932 DOI: 10.1503/jpn.190027] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Tetris has been proposed as a preventative intervention to reduce intrusive memories of a traumatic event. However, no neuroimaging study has assessed Tetris in patients with existing posttraumatic stress disorder (PTSD) or explored how playing Tetris may affect brain structure. METHODS We recruited patients with combat-related PTSD before psychotherapy and randomly assigned them to an experimental Tetris and therapy group (n = 20) or to a therapy-only control group (n = 20). In the control group, participants completed therapy as usual: eye movement desensitization and reprocessing (EMDR) psychotherapy. In the Tetris group, in addition to EMDR, participants also played 60 minutes of Tetris every day from onset to completion of therapy, approximately 6 weeks later. Participants completed structural MRI and psychological questionnaires before and after therapy, and we collected psychological questionnaire data at follow-up, approximately 6 months later. We hypothesized that the Tetris group would show increases in hippocampal volume and reductions in symptoms, both directly after completion of therapy and at follow-up. RESULTS Following therapy, hippocampal volume increased in the Tetris group, but not the control group. As well, hippocampal increases were correlated with reductions in symptoms of PTSD, depression and anxiety between completion of therapy and follow-up in the Tetris group, but not the control group. LIMITATIONS Playing Tetris may act as a cognitive interference task and as a brain-training intervention, but it was not possible to distinguish between these 2 potential mechanisms. CONCLUSION Tetris may be useful as an adjunct therapeutic intervention for PTSD. Tetris-related increases in hippocampal volume may ensure that therapeutic gains are maintained after completion of therapy.
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Freedman SA, Eitan R, Weiniger CF. Interrupting traumatic memories in the emergency department: a randomized controlled pilot study. Eur J Psychotraumatol 2020; 11:1750170. [PMID: 32922681 PMCID: PMC7448922 DOI: 10.1080/20008198.2020.1750170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 02/03/2020] [Accepted: 03/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The hours immediately following a traumatic event may present a window of opportunity to interrupt the consolidation of memories of the traumatic event, and this may prevent PTSD development. This theory has been validated in a series of analogue studies, showing that a visuo-spatial task reduces intrusive memories, however clinical studies are scarce. OBJECTIVE This pilot RCT examined the use of a semi-immersive Virtual Reality visuospatial task, as an intervention to interrupt memory consolidation, in the Emergency Department (ED) in the immediate hours following a traumatic event. We hypothesised that participants who had received the intervention would present with lower levels of PTSD symptoms than the control group who received no intervention. METHOD Seventy-seven adult survivors of traumatic events, meeting study criteria, were recruited in the ED of a Level III Trauma Centre. Survivors arrived at the ED less than one hour, on average, after the trauma. After signing informed consent, participants were randomized to the SnowWorld intervention or control group. Both groups completed self-report questionnaires, and the intervention group used SnowWorld for up to 10 minutes. RESULTS No significant differences between the intervention and control groups were found regarding PTSD symptom levels two weeks and six months following the traumatic event. CONCLUSIONS These results add to the growing literature examining the use of a concurrent task to reduce intrusions following a traumatic event. In contrast to previous clinical studies, this study did not show significant group differences; however, it replicates an analogue study that used a specifically developed app. Further studies are needed to elucidate possible reasons for these conflicting results.
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Affiliation(s)
| | - Renana Eitan
- Department of Medical Neurobiology, The Hebrew University, Jerusalem, Israel
- Functional Neuroimaging Laboratory, Brigham and Women’s Hospital, Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Carolyn F. Weiniger
- Division of Anesthesia, Critical Care and Pain, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv, Israel
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Witteveen AB, Stramrood CAI, Henrichs J, Flanagan JC, van Pampus MG, Olff M. The oxytocinergic system in PTSD following traumatic childbirth: endogenous and exogenous oxytocin in the peripartum period. Arch Womens Ment Health 2020; 23:317-329. [PMID: 31385103 PMCID: PMC7244459 DOI: 10.1007/s00737-019-00994-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/22/2019] [Indexed: 12/12/2022]
Abstract
Birth experiences can be traumatic and may give rise to PTSD following childbirth (PTSD-FC). Peripartum neurobiological alterations in the oxytocinergic system are highly relevant for postpartum maternal behavioral and affective adaptions like bonding and lactation but are also implicated in the response to traumatic events. Animal models demonstrated that peripartum stress impairs beneficial maternal postpartum behavior. Early postpartum activation of the oxytocinergic system may, however, reverse these effects and thereby prevent adverse long-term consequences for both mother and infant. In this narrative review, we discuss the impact of trauma and PTSD-FC on normal endogenous oxytocinergic system fluctuations in the peripartum period. We also specifically focus on the potential of exogenous oxytocin (OT) to prevent and treat PTSD-FC. No trials of exogenous OT after traumatic childbirth and PTSD-FC were available. Evidence from non-obstetric PTSD samples and from postpartum healthy or depressed samples implies restorative functional neuroanatomic and psychological effects of exogenous OT such as improved PTSD symptoms and better mother-to-infant bonding, decreased limbic activation, and restored responsiveness in dopaminergic reward regions. Adverse effects of intranasal OT on mood and the increased fear processing and reduced top-down control over amygdala activation in women with acute trauma exposure or postpartum depression, however, warrant cautionary use of intranasal OT. Observational and experimental studies into the role of the endogenous and exogenous oxytocinergic system in PTSD-FC are needed and should explore individual and situational circumstances, including level of acute distress, intrapartum exogenous OT exposure, or history of childhood trauma.
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Affiliation(s)
- A. B. Witteveen
- Department of Midwifery Science/AVAG, Amsterdam Public Health research institute, Amsterdam UMC, location VUmc, Van der Boechorststraat 7, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - C. A. I. Stramrood
- Department of Obstetrics and Gynaecology, Amsterdam UMC, location AMC, Meibergdreef 9, Amsterdam, 1105 AZ The Netherlands
| | - J. Henrichs
- Department of Midwifery Science/AVAG, Amsterdam Public Health research institute, Amsterdam UMC, location VUmc, Van der Boechorststraat 7, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - J. C. Flanagan
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., Charleston, 29425 SC USA
| | - M. G. van Pampus
- Department of Obstetrics and Gynaecology, OLVG, Oosterpark 9, Amsterdam, 1091 AC The Netherlands
| | - M. Olff
- Department of Psychiatry, Amsterdam UMC, location AMC, Meibergdreef 9, Amsterdam, 1105 AZ The Netherlands
- Arq Psychotrauma Expert Group, Nienoord 5, Diemen, 1112 XE The Netherlands
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Kessler H, Schmidt AC, James EL, Blackwell SE, von Rauchhaupt M, Harren K, Kehyayan A, Clark IA, Sauvage M, Herpertz S, Axmacher N, Holmes EA. Visuospatial computer game play after memory reminder delivered three days after a traumatic film reduces the number of intrusive memories of the experimental trauma. J Behav Ther Exp Psychiatry 2020; 67:101454. [PMID: 31036259 DOI: 10.1016/j.jbtep.2019.01.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/11/2018] [Accepted: 01/22/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The experience of intrusive memories is a core clinical symptom of posttraumatic stress disorder (PTSD), and can be distressing in its own right. Notions of dual task interference and reconsolidation-update mechanisms suggest novel approaches to target intrusive memories. This study tested the hypothesis that a single-session cognitive intervention (memory reminder task plus Tetris gameplay) would reduce the occurrence of experimental trauma memories even when delivered 3 days post-trauma. Critically, this study tested effects against two control groups: Reminder-only, and reminder plus another computer game (a form of Quiz). METHODS 86 healthy volunteers (59% female, age M = 24.35, SD = 4.59 years) watched a trauma film and then recorded their intrusive memories in a diary for 3 days (pre-intervention). They then returned to the lab. After presentation of visual reminder cues for the film plus a 10 min wait period (memory reminder task), participants were randomized into one of three task conditions (Tetris game play, Quiz game play, vs. reminder-only). They then kept the diary for a further 3 days (post-intervention). RESULTS As predicted, after the experimental manipulation, the reminder + Tetris group experienced significantly fewer intrusions than the reminder-only group (d = 1.37). Further, the reminder + Tetris group also experienced significantly fewer intrusions than the reminder + Quiz (d = 0.65) group. Contrary to predictions, the reminder + Quiz group experienced significantly fewer intrusions than the reminder-only group (d = 0.69). Prior to the experimental manipulation, there was no significant difference between groups in number of intrusions. Recognition memory test scores for facts of the trauma film after 6 days were comparable between groups. CONCLUSIONS We demonstrated that 3 days after experimental trauma (i.e. after memory consolidation) an intervention comprising a reminder task prior to a 15 min cognitive interference task (one of two computer games) led to a reduction in intrusion occurrence compared to reminder only. We interpret and discuss our findings within the framework of supposed reconsolidation-update mechanisms and competition for limited (visuospatial) working memory resources. Should these effects hold true in clinical populations, this type of simple intervention approach could help contribute to reducing intrusive memories of trauma.
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Affiliation(s)
- Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany.
| | - Anna-Christine Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Ella L James
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Simon E Blackwell
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany
| | - Marcel von Rauchhaupt
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Katharina Harren
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Aram Kehyayan
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Ian A Clark
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, United Kingdom
| | - Magdalena Sauvage
- Leibniz Institute for Neurobiology, Functional Architecture of Memory Department, Magdeburg, Germany; Otto-von-Guericke-University Magdeburg, Medical Faculty, Magdeburg, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Nikolai Axmacher
- Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Sweden; Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
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Kamboj SK, Gong AT, Sim Z, Rashid AA, Baba A, Iskandar G, Das RK, Curran HV. Reduction in the occurrence of distressing involuntary memories following propranolol or hydrocortisone in healthy women. Psychol Med 2020; 50:1148-1155. [PMID: 31084640 DOI: 10.1017/s0033291719001028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Pharmacological treatments targeting the neuroendocrine stress response may hold special promise in secondary prevention of posttraumatic stress disorder (PTSD). However, findings from clinical trials have been inconsistent and the efficacy of specific drugs, their temporal window of efficacy, effective doses and the characteristics of likely treatment responders remain unclear. METHOD Using an experimental human model of distressing involuntary memory formation, we compare the effects of two drugs that have theoretical or empirical support as secondary preventive agents in PTSD. Eighty-eight healthy women (average age: 23.5 years) received oral propranolol (80 mg), hydrocortisone (30 mg), or matched placebo immediately after viewing a 'trauma film'. They then completed daily, time-stamped intrusion diaries for 1 week, at the end of which, voluntary memory was tested. RESULTS While neither drug affected voluntary memory for the trauma narrative, propranolol treatment was associated with 42% fewer, and hydrocortisone with 55% fewer intrusions across the week, relative to placebo. Additionally, propranolol reduced general trauma-like symptoms, and post-drug cortisol levels were negatively correlated with intrusion frequency in the hydrocortisone group. CONCLUSIONS Overall, this study shows substantial reductions in intrusive memories and preserved voluntary narrative-declarative memory following either propranolol or hydrocortisone in an experimental model of psychological trauma. As such, despite some inconsistencies in clinical trials, our findings support continued investigation of propranolol and hydrocortisone as secondary preventive agents for re-experiencing symptoms of PTSD. The findings also suggest that it is critical for future research to identify the conditions governing the preventive efficacy of these drugs in PTSD.
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Affiliation(s)
| | - An Tong Gong
- Clinical Psychopharmacology Unit, UCL, LondonWC1E 6BT, UK
| | - ZhiHui Sim
- Clinical Psychopharmacology Unit, UCL, LondonWC1E 6BT, UK
| | | | - Ami Baba
- Clinical Psychopharmacology Unit, UCL, LondonWC1E 6BT, UK
| | - Georges Iskandar
- Department of Anaesthesia and Perioperative Medicine, UCLH, London, UK
| | - Ravi K Das
- Clinical Psychopharmacology Unit, UCL, LondonWC1E 6BT, UK
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Sinclair VG, Adams SM, Dietrich M. Associations between changes in resilient coping and posttraumatic stress disorder symptoms. Res Nurs Health 2020; 43:255-262. [PMID: 32067237 DOI: 10.1002/nur.22014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 01/25/2020] [Indexed: 12/27/2022]
Abstract
The pervasive, damaging nature of posttraumatic stress disorder (PTSD) presents enormous clinical challenges. Understanding the relationship between patients' perceptions of PTSD symptoms and resilient coping strategies may prompt investigation of clinical interventions that improve adaptive, resilient coping skills. In this study, we examined whether changes in resilient coping were related to changes over time in the PTSD symptoms of intrusion and avoidance. A secondary analysis was conducted using longitudinal data from the community-based Washington State Twin Registry. Participants completed the four-item Brief Resilient Coping Scale (BRCS) and the Avoidance and Intrusion subscales of the Impact of Events Scale (IES) at two points in time that were at least 2 years apart. To limit analyses to participants reporting PTSD symptoms at baseline, an initial value of at least 1.0 on either Avoidance (n = 1,337) or Intrusion (n = 1,206) was required for inclusion in the sample. Using linear regression, we assessed associations of change in BRCS with a change in IES scores, controlling for the respective initial scores on each measure. Controlling for initial BRCS and IES-Intrusion values, we observed a small, statistically significant association between change in BRCS and change in IES-Intrusion scores (b* = -0.07; p = .003). There was no statistically significant association between change in BRCS and change in IES-Avoidance (b* < 0.01; p = .869). In this large, longitudinal sample, increases in resilient coping were related to decreases in intrusive thoughts over time. Because coping patterns can be taught, these results warrant further investigations into adaptive coping patterns associated with diminishing PTSD symptoms.
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Affiliation(s)
| | - Susan M Adams
- Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Mary Dietrich
- Vanderbilt University School of Nursing, Nashville, Tennessee
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Arresting visuospatial stimulation is insufficient to disrupt analogue traumatic intrusions. PLoS One 2020; 15:e0228416. [PMID: 32012193 PMCID: PMC6999047 DOI: 10.1371/journal.pone.0228416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/14/2020] [Indexed: 11/19/2022] Open
Abstract
Intrusive memories are a core symptom of Post-Traumatic Stress Disorder (PTSD). A growing body of analogue studies using trauma films suggest that carrying out specific demanding tasks (e.g., playing the video game Tetris, pattern tapping) after the analogue trauma can reduce intrusive memories. To examine the mechanism behind this effect, we tested whether mere engagement with attention-grabbing and interesting visual stimuli disrupts intrusive memories, and whether this depends on working memory resources and/or the concurrent activation of trauma film memories. In a total sample of 234 healthy participants, we compared no-task control conditions to a perceptual rating task with visually arresting video clips (i.e., non-emotional, complex, moving displays), to a less arresting task with non-moving, blurred pictures (Study 1), and to more demanding imagery tasks with and without repetitive reminders of the trauma film (Study 2). Generally, we found moderate to strong evidence that none of the conditions lead to differences in intrusion frequency. Moreover, our data suggest that intrusive memories were neither related to individual differences in working memory capacity (i.e., operation span performance; Study 1), nor to the degree of engagement with a visuospatial task (i.e., one-week recognition performance; Study 2). Taken together, our findings suggest that the boundary conditions for successful interference with traumatic intrusions may be more complex and subtle than assumed. Future studies may want to test the role of prediction errors during (re-)consolidation, deliberate efforts to suppress thoughts, or the compatibility of the task demands with the individual's skills.
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Schobinger E, Stuijfzand S, Horsch A. Acute and Post-traumatic Stress Disorder Symptoms in Mothers and Fathers Following Childbirth: A Prospective Cohort Study. Front Psychiatry 2020; 11:562054. [PMID: 33414729 PMCID: PMC7783161 DOI: 10.3389/fpsyt.2020.562054] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 11/30/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Up to 30% of women view their childbirth as traumatic. This experience can lead to acute stress disorder or post-traumatic stress disorder. The negative impact of maternal post-traumatic stress disorder following childbirth reaches beyond the mother, potentially affecting her child's development and the couple's relationship. Research on paternal post-traumatic stress disorder following childbirth is scarce. Acute stress disorder is suggested to be an important predictor of post-traumatic stress disorder in mothers, but little is known about paternal acute stress disorder following childbirth. Furthermore, there is limited information about the comparison or relation of acute stress disorder and post-traumatic stress disorder following childbirth between parents. Aim: [1] To compare the prevalence rates and severity of acute stress disorder and post-traumatic stress disorder symptoms between parents following childbirth by taking anxiety and depression symptoms, as well as obstetric variables and previous traumatic events into account and [2] To determine if acute stress disorder is a predictor of post-traumatic stress disorder. Method: A prospective population-based design was used. N = 647 participants were recruited from future parents who attended appointments at the Obstetrics and Gynecology unit at a Swiss university hospital. Self-report questionnaires were used: Post-traumatic Diagnostic Scale in the third trimester of pregnancy (T1) and 1 month post-partum (T3), Acute Stress Disorder Scale at 1 week post-partum (T2), and Hospital Anxiety and Depression Scale at all time points. Obstetric and neonatal variables were retrieved from hospital records. Results: At T2, 63.9% of mothers and 51.7% of fathers presented symptoms of acute stress disorder. At T3, 20.7% of mothers and 7.2% of fathers had symptoms of post-traumatic stress disorder. Acute stress disorder was a predictor of post-partum post-traumatic stress disorder (Odds ratio: 8.6, IC 95% [1.85; 40.42]). Depression symptoms was a significant confounder in the prediction of post-traumatic stress disorder following childbirth, but not anxiety or previous perinatal loss. Conclusion: Little is known about parental differences in acute stress disorder and post-traumatic stress disorder symptoms following childbirth. Results indicate that both parents may suffer from acute stress disorder and post-traumatic stress disorder symptoms after childbirth and that acute stress disorder is a predictor of post-traumatic stress disorder after childbirth for both parents. Sensitization of maternity staff to these results may assist in earlier identification of and appropriate treatment for at-risk parents.
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Affiliation(s)
- Elisabeth Schobinger
- Institute of higher Education and Research in Healthcare in French, University of Lausanne, Lausanne, Switzerland
| | - Suzannah Stuijfzand
- Institute of higher Education and Research in Healthcare in French, University of Lausanne, Lausanne, Switzerland
| | - Antje Horsch
- Institute of higher Education and Research in Healthcare in French, University of Lausanne, Lausanne, Switzerland.,Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
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71
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Sandoz V, Deforges C, Stuijfzand S, Epiney M, Vial Y, Sekarski N, Messerli-Bürgy N, Ehlert U, Bickle-Graz M, Morisod Harari M, Porcheret K, Schechter DS, Ayers S, Holmes EA, Horsch A. Improving mental health and physiological stress responses in mothers following traumatic childbirth and in their infants: study protocol for the Swiss TrAumatic biRth Trial (START). BMJ Open 2019; 9:e032469. [PMID: 31892657 PMCID: PMC6955544 DOI: 10.1136/bmjopen-2019-032469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/20/2019] [Accepted: 12/02/2019] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Emergency caesarean section (ECS) qualifies as a psychological trauma, which may result in postnatal post-traumatic stress disorder (PTSD). Maternal PTSD may not only have a significant negative impact on mother-infant interactions, but also on long-term infant development. The partner's mental health may also affect infant development. Evidence-based early interventions to prevent the development of postpartum PTSD in mothers are lacking. Immediately after a traumatic event, memory formation is vulnerable to interference. There is accumulating evidence that a brief behavioural intervention including a visuospatial task may result in a reduction in intrusive memories of the trauma. METHODS AND ANALYSIS This study protocol describes a double-blind multicentre randomised controlled phase III trial testing an early brief maternal intervention including the computer game 'Tetris' on intrusive memories of the ECS trauma (≤1 week) and PTSD symptoms (6 weeks, primary outcome) of 144 women following an ECS. The intervention group will carry out a brief behavioural procedure including playing Tetris. The attention-placebo control group will complete a brief written activity log. Both simple cognitive tasks will be completed within the first 6 hours following traumatic childbirth. The intervention is delivered by midwives/nurses in the maternity unit.The primary outcome will be differences in the presence and severity of maternal PTSD symptoms between the intervention and the attention-placebo control group at 6 weeks post partum. Secondary outcomes will be physiological stress and psychological vulnerability, mother-infant interaction and infant developmental outcomes. Other outcomes will be psychological vulnerability and physiological regulation of the partner and their bonding with the infant, as well as the number of intrusive memories of the event. ETHICS AND DISSEMINATION Ethical approval was granted by the Human Research Ethics Committee of the Canton de Vaud (study number 2017-02142). Dissemination of results will occur via national and international conferences, in peer-reviewed journals, public conferences and social media. TRIAL REGISTRATION NUMBER NCT03576586.
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Affiliation(s)
- Vania Sandoz
- Institute of Higher Education and Research in Healthcare-IUFRS, University of Lausanne and Lausanne University Hospital, Lausanne, VD, Switzerland
| | - Camille Deforges
- Institute of Higher Education and Research in Healthcare-IUFRS, University of Lausanne and Lausanne University Hospital, Lausanne, VD, Switzerland
| | - Suzannah Stuijfzand
- Institute of Higher Education and Research in Healthcare-IUFRS, University of Lausanne and Lausanne University Hospital, Lausanne, VD, Switzerland
| | - Manuella Epiney
- Department Woman-Child-Adolescent, Geneva University Hospital and University of Geneva, Geneva, GE, Switzerland
| | - Yvan Vial
- Obstetrics and Gynecology Service, Woman-Mother-Child Department, Lausanne University Hospital and University of Lausanne, Lausanne, VD, Switzerland
| | - Nicole Sekarski
- Paediatric Cardiology Unit, Woman-Mother-Child Department, Lausanne University Hospital and University of Lausanne, Lausanne, VD, Switzerland
| | - Nadine Messerli-Bürgy
- Clinical Child Psychology & Biological Psychology, University of Fribourg, Fribourg, FR, Switzerland
| | - Ulrike Ehlert
- Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, ZH, Switzerland
| | - Myriam Bickle-Graz
- Neonatology Service, Woman-Mother-Child Department, University of Lausanne and Lausanne University Hospital, Lausanne, VD, Switzerland
| | - Mathilde Morisod Harari
- Service of Child and Adolescent Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, VD, Switzerland
| | - Kate Porcheret
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Daniel S Schechter
- Service of Child and Adolescent Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, VD, Switzerland
- Department of Psychiatry, University of Geneva Faculty of Medicine, Geneve, GE, Switzerland
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City University of London, London, London, UK
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare-IUFRS, University of Lausanne and Lausanne University Hospital, Lausanne, VD, Switzerland
- Neonatology Service, Woman-Mother-Child Department, University of Lausanne and Lausanne University Hospital, Lausanne, VD, Switzerland
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Lau-Zhu A, Henson RN, Holmes EA. Intrusive memories and voluntary memory of a trauma film: Differential effects of a cognitive interference task after encoding. J Exp Psychol Gen 2019; 148:2154-2180. [PMID: 31021150 PMCID: PMC7116494 DOI: 10.1037/xge0000598] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Methods to reduce intrusive memories (e.g., of traumatic events) should ideally spare voluntary memory for the same event (e.g., to report on the event in court). Single-trace memory accounts assume that interfering with a trace should impact both its involuntary and voluntary expressions, whereas separate-trace accounts assume these two can dissociate, allowing for selective interference. This possibility was investigated in 3 experiments. Nonclinical participants viewed a trauma film followed by an interference task (Tetris game-play after reminder cues). Next, memory for the film was assessed with various measures. The interference task reduced the number of intrusive memories (diary-based, Experiments 1 and 2), but spared performance on well-matched measures of voluntary retrieval-free recall (Experiment 1) and recognition (Experiments 1 and 2)-challenging single-trace accounts. The interference task did not affect other measures of involuntary retrieval-perceptual priming (Experiment 1) or attentional bias (Experiment 2). However, the interference task did reduce the number of intrusive memories in a laboratory-based vigilance-intrusion task (Experiments 2 and 3), irrespective of concurrent working memory load during intrusion retrieval (Experiment 3). Collectively, results reveal a robust dissociation between intrusive and voluntary memories, having ruled out key methodological differences between how these two memory expressions are assessed, namely cue overlap (Experiment 1), attentional capture (Experiment 2), and retrieval load (Experiment 3). We argue that the inability of these retrieval factors to explain the selective interference is more compatible with separate-trace than single-trace accounts. Further theoretical developments are needed to account for this clinically important distinction between intrusive memories and their voluntary counterpart. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Alex Lau-Zhu
- Medical Research Council Cognition and Brain Sciences Unit
| | | | - Emily A Holmes
- Medical Research Council Cognition and Brain Sciences Unit
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Milton AL. Fear not: recent advances in understanding the neural basis of fear memories and implications for treatment development. F1000Res 2019; 8:F1000 Faculty Rev-1948. [PMID: 31824654 PMCID: PMC6880271 DOI: 10.12688/f1000research.20053.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2019] [Indexed: 01/01/2023] Open
Abstract
Fear is a highly adaptive emotion that has evolved to promote survival and reproductive fitness. However, maladaptive expression of fear can lead to debilitating stressor-related and anxiety disorders such as post-traumatic stress disorder. Although the neural basis of fear has been extensively researched for several decades, recent technological advances in pharmacogenetics and optogenetics have allowed greater resolution in understanding the neural circuits that underlie fear. Alongside conceptual advances in the understanding of fear memory, this increased knowledge has clarified mechanisms for some currently available therapies for post-traumatic stress disorder and has identified new potential treatment targets.
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Affiliation(s)
- Amy L. Milton
- Department of Psychology, University of Cambridge, Cambridge, CB2 3EB, UK
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Brühl A, Heinrichs N, Bernstein EE, McNally RJ. Preventive efforts in the aftermath of analogue trauma: The effects of Tetris and exercise on intrusive images. J Behav Ther Exp Psychiatry 2019; 64:31-35. [PMID: 30743217 DOI: 10.1016/j.jbtep.2019.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 01/16/2019] [Accepted: 01/17/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Efficacious interventions soon after trauma exposure to prevent posttraumatic stress disorder (PTSD) are scarce. Evidence suggests that post-trauma, reminder cues to reactivate trauma memory followed by a cognitive visuospatial task, such as Tetris, reduce later intrusive images. Furthermore, studies indicate that aerobic exercise may reduce PTSD symptoms. The present study aimed to test whether playing Tetris, without prior reminder cues, after an experimental trauma limits the development of analogue symptoms and to compare Tetris to aerobic exercise, which could plausibly alter cognitive-affective processing of the trauma as well. METHODS Participants (N = 71) watched a distressing film and were randomly assigned to either playing Tetris, cycling, or remaining sedentary for 25 min without prior reminder cues. Intrusive images and co-occurring distress were recorded in a diary during the following week. After one week, participants completed a recognition test to assess voluntary memories of the film. RESULTS Neither Tetris nor exercise, without prior memory reactivation, reduced intrusive images and associated distress nor impeded voluntary memory compared to the control condition. There were no effects of physical fitness level at baseline or voluntary exercise during the subsequent week on analogue symptoms. LIMITATIONS Although participants were instructed to record intrusions as they occurred in diaries, they did not receive additional reminders throughout the follow-up period. CONCLUSIONS Our findings suggest that neither a single bout of aerobic exercise, nor playing Tetris without prior memory reactivation, after an analogue trauma reduces stress symptoms. Potential explanations and clinical implications are discussed.
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Affiliation(s)
- Antonia Brühl
- University of Braunschweig, Department of Psychology, Institute of Clinical Psychology, Psychotherapy and Assessment, Humboldtstr. 33, 38106, Braunschweig, Germany.
| | - Nina Heinrichs
- University of Braunschweig, Department of Psychology, Institute of Clinical Psychology, Psychotherapy and Assessment, Humboldtstr. 33, 38106, Braunschweig, Germany.
| | - Emily E Bernstein
- Harvard University, Department of Psychology, 1230 William James Hall, 33 Kirkland Street, Cambridge, MA, 02138-2044, USA.
| | - Richard J McNally
- Harvard University, Department of Psychology, 1230 William James Hall, 33 Kirkland Street, Cambridge, MA, 02138-2044, USA.
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75
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Barger MK. Current Resources for Evidence-Based Practice, September/October 2019. J Midwifery Womens Health 2019; 64:668-673. [PMID: 31433099 DOI: 10.1111/jmwh.13030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 07/10/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Mary K Barger
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, California
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77
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Perinatal Posttraumatic Stress Disorder: A Review of Risk Factors, Diagnosis, and Treatment. Obstet Gynecol Surv 2019; 74:369-376. [DOI: 10.1097/ogx.0000000000000680] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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78
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Beck CT, Casavant S. Synthesis of Mixed Research on Posttraumatic Stress Related to Traumatic Birth. J Obstet Gynecol Neonatal Nurs 2019; 48:385-397. [PMID: 30958993 DOI: 10.1016/j.jogn.2019.02.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2019] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To synthesize mixed-research results (quantitative and qualitative) on posttraumatic stress in women who experienced traumatic births. DATA SOURCES PubMed, Scopus, and PsycINFO databases. STUDY SELECTION Quantitative and qualitative studies were included if they were published in English from January 1, 2009, through December 31, 2018, and focused on posttraumatic stress in the postpartum period related to traumatic childbirth. DATA EXTRACTION The final sample consisted of 59 studies: 4 qualitative and 55 quantitative. Both authors independently appraised each study using the Critical Appraisal Skills Programme. Quantitative studies were synthesized by narrative synthesis and vote counting, and qualitative studies were synthesized by content analysis. DATA SYNTHESIS In the included studies, prevalence rates of elevated posttraumatic stress ranged from 0.8% to 26%. Significant predictors of posttraumatic stress that occurred before childbirth and those that were birth related were identified. Reports of six intervention studies to decrease posttraumatic stress symptoms after traumatic births were included. These interventions focused on postnatal debriefing, expressive writing, online cognitive behavioral therapy, a brief cognitive intervention, and the implementation of the nine instinctive stages of the infant during the first hour after birth. We created four themes from the findings of the qualitative studies: Distressing Symptoms, Detrimental Effect of Posttraumatic Stress on Women's Relationships With Their Infants and Partners, Critical Influence ofSupport, and Debriefing. CONCLUSION When a woman experiences posttraumatic stress related to a traumatic birth, the entire family unit is vulnerable. Findings from quantitative predictor studies can be used to develop an instrument to screen women for risk factors for posttraumatic stress related to birth trauma. Primary interventions are needed to prevent women from experiencing traumatic births.
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Teachman BA, Daniel KE, Eberle JW. Using Advances from Cognitive Science to Understand the Etiology and Maintenance of Psychopathology. Clin Psychol Rev 2019; 69:1-3. [PMID: 30975467 DOI: 10.1016/j.cpr.2018.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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80
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Iyadurai L, Visser RM, Lau-Zhu A, Porcheret K, Horsch A, Holmes EA, James EL. Intrusive memories of trauma: A target for research bridging cognitive science and its clinical application. Clin Psychol Rev 2019; 69:67-82. [PMID: 30293686 PMCID: PMC6475651 DOI: 10.1016/j.cpr.2018.08.005] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 08/17/2018] [Accepted: 08/17/2018] [Indexed: 01/01/2023]
Abstract
Intrusive memories of a traumatic event can be distressing and disruptive, and comprise a core clinical feature of post-traumatic stress disorder (PTSD). Intrusive memories involve mental imagery-based impressions that intrude into mind involuntarily, and are emotional. Here we consider how recent advances in cognitive science have fueled our understanding of the development and possible treatment of intrusive memories of trauma. We conducted a systematic literature search in PubMed, selecting articles published from 2008 to 2018 that used the terms "trauma" AND ("intrusive memories" OR "involuntary memories") in their abstract or title. First, we discuss studies that investigated internal (neural, hormonal, psychophysiological, and cognitive) processes that contribute to intrusive memory development. Second, we discuss studies that targeted these processes using behavioural/pharmacological interventions to reduce intrusive memories. Third, we consider possible clinical implications of this work and highlight some emerging research avenues for treatment and prevention, supplemented by new data to examine some unanswered questions. In conclusion, we raise the possibility that intrusive memories comprise an alternative, possibly more focused, target in translational research endeavours, rather than only targeting overall symptoms of disorders such as PTSD. If so, relatively simple approaches could help to address the need for easy-to-deliver, widely-scalable trauma interventions.
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Affiliation(s)
| | - Renée M Visser
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK; University of Amsterdam, Department of Psychology, Amsterdam, The Netherlands
| | - Alex Lau-Zhu
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK; Kings College London, Institute of Psychiatry, Psychology and Neuroscience, Social, Genetic and Developmental Psychiatry Centre, London, UK
| | - Kate Porcheret
- University of Oxford, Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, Oxford, UK
| | - Antje Horsch
- Lausanne University Hospital, Woman-Mother-Child Department, Lausanne, Switzerland; Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne University Hospital, Lausanne, Switzerland
| | - Emily A Holmes
- Karolinska Institutet, Division of Psychology, Department of Clinical Neuroscience, Stockholm, Sweden
| | - Ella L James
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK
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Interfering with emotional processing resources upon associative threat memory reactivation does not affect memory retention. Sci Rep 2019; 9:4175. [PMID: 30862869 PMCID: PMC6414694 DOI: 10.1038/s41598-019-40827-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 02/25/2019] [Indexed: 11/26/2022] Open
Abstract
Ample evidence suggests that memories enter a labile state upon retrieval, requiring reconsolidation processes in order to be retained. During this period of instability, various interventions can be applied to modify problematic memories. A novel behavioral intervention was designed, aimed at disrupting amygdala-based cognitive processing following the retrieval of a conditioned threat memory, in order to prevent its reconsolidation. We fear-conditioned participants on day 1, and reactivated their memory on day 2. Following reactivation, the reactivation plus emotional working memory task (R + EWMT) group completed an EWMT, while the reactivation only (RO) group served as a no-task control. On day 3, all participants were tested for memory retention, followed by a test for sensitivity to reinstatement. We observed successful acquisition and reactivation in fear-potentiated startle responding, skin conductance responding and US expectancies in both groups. Differential fear responding was fully preserved in the R + EWMT group relative to the RO group at the beginning of retention testing, and both groups were comparably sensitive to reinstatement. Thus, we failed to obtain any evidence that the execution of an EWMT after threat memory reactivation impairs reconsolidation. Further research is indicated to clarify whether threat memory reconsolidation can be disrupted by taxing relevant WM resources.
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Abstract
Mental imagery refers to the experience of perception in the absence of external sensory input. Deficits in the ability to generate mental imagery or to distinguish it from actual sensory perception are linked to neurocognitive conditions such as dementia and schizophrenia, respectively. However, the importance of mental imagery to psychiatry extends beyond neurocognitive impairment. Mental imagery has a stronger link to emotion than verbal-linguistic cognition, serving to maintain and amplify emotional states, with downstream impacts on motivation and behavior. As a result, anomalies in the occurrence of emotion-laden mental imagery has transdiagnostic significance for emotion, motivation, and behavioral dysfunction across mental disorders. This review aims to demonstrate the conceptual and clinical significance of mental imagery in psychiatry through examples of mood and anxiety disorders, self-harm and suicidality, and addiction. We contend that focusing on mental imagery assessment in research and clinical practice can increase our understanding of the cognitive basis of psychopathology in mental disorders, with the potential to drive the development of algorithms to aid treatment decision-making and inform transdiagnostic treatment innovation.
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Milton AL, Holmes EA. Of mice and mental health: facilitating dialogue and seeing further. Philos Trans R Soc Lond B Biol Sci 2019; 373:rstb.2017.0022. [PMID: 29352022 DOI: 10.1098/rstb.2017.0022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2017] [Indexed: 12/15/2022] Open
Abstract
The science of mental life is critical for understanding both how we function, and impairments in our functioning. However, understanding the causal mechanisms underlying mental health disorders and developing new treatments are challenges too great to be solved by any individual approach. There is a growing awareness that translational research-from laboratory to patient and back again to animal models-will be critical for the improved understanding and treatment of mental health disorders. The motivation and intention to pursue translational approaches is therefore strong in mental health research, but critically, opportunities for interaction between basic scientists and clinicians are relatively limited, and vary depending on the institution in which researchers are working. This has promoted the development of a 'culture gap' between basic and clinical scientists that limits interaction and sharing of knowledge. Here, we provide 14 examples of contemporary translational research and call for an increased collaborative approach to mental health research that spans clinical diagnoses, levels of analysis and bridges between basic to clinical mental health sciences, including, but not limited to, psychology and neuroscience. What is needed is an inclusive and integrated approach, bringing together scientists working at all levels of enquiry with clinicians providing insights on what works (and what does not). To stimulate the much-needed innovation in therapeutic techniques, an analysis of component parts is critical. Our approach suggests simplifying complex behaviours into distinct psychological components. Asking collaboratively driven scientific questions about dysfunction will also benefit our fundamental understanding of mental life.This article is part of a discussion meeting issue 'Of mice and mental health: facilitating dialogue between basic and clinical neuroscientists'.
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Affiliation(s)
- Amy L Milton
- Department of Psychology, University of Cambridge, Downing Site, Cambridge CB2 3EB, UK
| | - Emily A Holmes
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
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Kessler H, Dangellia L, Kessler R, Mahnke V, Herpertz S, Kehyayan A. Mobilum-a new mobile app to engage visuospatial processing for the reduction of intrusive visual memories. Mhealth 2019; 5:49. [PMID: 31853450 PMCID: PMC6917555 DOI: 10.21037/mhealth.2019.09.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 09/19/2019] [Indexed: 01/07/2023] Open
Abstract
Intrusive memories are a key symptom of posttraumatic stress disorder (PTSD), a prevalent condition causing considerable personal suffering, and entailing large direct and indirect societal costs. While effective treatment options for PTSD exist, on a global scale they are not readily available to many patients in need. In the last years, several studies have shown that the computer game Tetris can reduce the frequency of intrusive memories in healthy subjects (after a trauma analogue), in populations at high risk of developing PTSD, as well as in patients already suffering from PTSD. The presumed mechanism behind this effect is that both Tetris and intrusions require-and therefore compete for-limited visuospatial working memory resources. In search for a new alternative tool that can engage visuospatial processing as effectively as Tetris, we developed a game named Mobilum. This is an app for Android devices, in which users have to rotate in an imaginative way around a translucent virtual cube in order to decide from which perspective a complex three-dimensional figure inside the cube is seen. Mobilum was developed to investigate whether the intrusion-reducing effect is exclusively inherent to Tetris, or if it can be achieved with another task engaging users in visuospatial processing. Also, unlike available versions of Tetris, Mobilum offers full control over key game parameters (e.g., difficulty, game duration), and is free of copyright and commercial issues. In this method paper, we describe the new Mobilum app, its theoretical background and development. Additionally, the first data on usability and feasibility are reported, as rated by N=16 inpatients. Finally, we will provide an outlook on the next steps necessary to investigate Mobilum's potential as a therapeutic tool.
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Affiliation(s)
- Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Luisa Dangellia
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
| | | | | | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Aram Kehyayan
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
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Luik AI, Iyadurai L, Gebhardt I, Holmes EA. Sleep disturbance and intrusive memories after presenting to the emergency department following a traumatic motor vehicle accident: an exploratory analysis. Eur J Psychotraumatol 2019; 10:1556550. [PMID: 30693073 PMCID: PMC6338269 DOI: 10.1080/20008198.2018.1556550] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 11/20/2018] [Accepted: 11/25/2018] [Indexed: 12/15/2022] Open
Abstract
Background: Sleep disturbances are common after traumatic events and have been hypothesized to be a risk factor in the development of psychopathology such as that associated with posttraumatic stress disorder (PTSD). Objective: To assess the association between intrusive memories, a core clinical feature of PTSD, and self-reported sleep disturbance shortly after experiencing or witnessing a motor vehicle accident, and whether a brief behavioural intervention (trauma reminder cue and Tetris gameplay) reduced sleep disturbance post-trauma. Method: The exploratory analyses included 71 participants (mean age 39.66, standard deviation 16.32; 37 women, 52.1%) enrolled in a previously published proof-of-concept randomized controlled trial. Participants were recruited from the emergency department after experiencing or witnessing a traumatic motor vehicle accident. Intrusive memories were assessed with a daily paper-and-pen diary for one week post-trauma, and sleep disturbances with three questions from the Impact of Event Scale-Revised assessing problems initiating sleep, problems maintaining sleep and dreams about the event at one week and one month post-trauma. Missing data were imputed 15 times. Results: The total number of intrusive memories during the first week post-trauma suggested weak to moderate pooled intercorrelations with problems initiating and maintaining sleep. An ordinal regression using imputed data suggested that the intervention had no effect on sleep disturbances, while completers only analyses suggested an improvement in problems maintaining sleep at one week. Conclusions: This exploratory study suggested that experiencing early intrusive memories is related to sleep disturbances. Sleep disturbance might be a particularly important construct to assess in studies involving intrusive memories post-trauma.
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Affiliation(s)
- Annemarie I Luik
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | | | - Isabel Gebhardt
- Institute of Psychology, Heidelberg University, Heidelberg, Germany
| | - Emily A Holmes
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Visuospatial word search task only effective at disrupting declarative memory when prediction error is present during retrieval. Neurobiol Learn Mem 2018; 156:80-85. [DOI: 10.1016/j.nlm.2018.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 09/18/2018] [Accepted: 11/08/2018] [Indexed: 12/18/2022]
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87
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Sjömark J, Parling T, Jonsson M, Larsson M, Skoog Svanberg A. A longitudinal, multi-centre, superiority, randomized controlled trial of internet-based cognitive behavioural therapy (iCBT) versus treatment-as-usual (TAU) for negative experiences and posttraumatic stress following childbirth: the JUNO study protocol. BMC Pregnancy Childbirth 2018; 18:387. [PMID: 30285758 PMCID: PMC6167807 DOI: 10.1186/s12884-018-1988-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 08/20/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND About one-third of women report their childbirth as traumatic and up to 10% have severe traumatic stress responses to birth. The prevalence of Posttraumatic stress disorder following childbirth (PTSD FC) is estimated to 3%. Women with PTSD FC report the same symptoms as other patients with PTSD following other types of trauma. The effect of psychological treatment for women with PTSD FC has only been studied in a few trials. Similarly, studies on treatment needs for women not diagnosed as having PTSD FC but who nevertheless face psychological problems are lacking. METHODS/DESIGN Women who rate their overall birth experience as negative on a Likert scale, and/or had an immediate caesarean section and/or a major postpartum haemorrhage are randomized to either internet delivered cognitive behaviour therapy (iCBT) plus treatment as usual (TAU) or TAU. The iCBT is to be delivered in two steps. The first step consists of six weekly modules for both the woman and her partner (if they wish to participate) with minimal therapeutic support. Step 2 consists of eight weekly modules with extended therapeutic support and will be offered to participants whom after step 1 report PTSD FC. Assessments will be made at baseline, 6 weeks, 14 weeks, and at follow-ups at 1, 2, 3 and 4 years after baseline. The primary outcome measures are symptoms of posttraumatic stress and depression. Secondary outcomes are quality of life, parent-child bonding, marital satisfaction, coping strategies, experience regarding the quality of care received, health-related quality of life, number of re-visits to the clinic and number of appointments for counselling during the 4 years' period after the negative childbirth experience, time until the woman gets pregnant again, and the type of birth in the subsequent pregnancy. A health economic evaluation in the form of a cost utility analysis will be conducted. DISCUSSION This study protocol describes a randomized controlled trial that will provide information about the effectiveness of iCBT in women with negative experiences, posttraumatic stress, and PTSD FC. TRIAL REGISTRATION ISRCTN39318241 . Date for registration 12/01/2017, retrospectively registered.
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Affiliation(s)
- Josefin Sjömark
- Department of Women’s and Children’s Health, Uppsala University, Akademiska sjukhuset, SE-751 85 Uppsala, Sweden
| | - Thomas Parling
- Department of Women’s and Children’s Health, Uppsala University, Akademiska sjukhuset, SE-751 85 Uppsala, Sweden
- Centre for Psychotherapy Education & Research, Stockholm Health Care Services, Stockholm County Council & Department of Clinical Neuroscience, Karolinska Institutet, Liljeholmstorget 7B, SE-113 64 Stockholm, Sweden
| | - Maria Jonsson
- Department of Women’s and Children’s Health, Uppsala University, Akademiska sjukhuset, SE-751 85 Uppsala, Sweden
| | - Margareta Larsson
- Department of Women’s and Children’s Health, Uppsala University, Akademiska sjukhuset, SE-751 85 Uppsala, Sweden
| | - Agneta Skoog Svanberg
- Department of Women’s and Children’s Health, Uppsala University, Akademiska sjukhuset, SE-751 85 Uppsala, Sweden
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Lass-Hennemann J, Schäfer SK, Römer S, Holz E, Streb M, Michael T. Therapy Dogs as a Crisis Intervention After Traumatic Events? - An Experimental Study. Front Psychol 2018; 9:1627. [PMID: 30233464 PMCID: PMC6132135 DOI: 10.3389/fpsyg.2018.01627] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 08/14/2018] [Indexed: 11/15/2022] Open
Abstract
Animal-assisted therapy has been proposed as a treatment adjunct for traumatized patients. In animal-assisted crisis response, dogs are used directly after a traumatic event to reduce stress and anxiety. However, to date there are few controlled studies investigating the effects of therapy dogs on PTSD symptoms and to our knowledge there is no study investigating the effects of a therapy dog intervention directly after a traumatic event. In this study, 60 healthy female participants were randomly assigned to one of three groups: after exposure to a “traumatic” film clip (trauma-film paradigm), one group of participants interacted with a friendly dog for 15 min, another group of participants watched a film clip showing a person interacting with a friendly dog and the last group was instructed to relax. Participants who had interacted with the dog after the film reported lower anxiety levels, less negative affect, and more positive affect after the intervention as compared to the other two groups. However, the participants who interacted with the dog showed a smaller decrease in physiological arousal after the traumatic film clip compared to both other groups. There were no differences in intrusion symptoms between the three groups. Our results show that dogs are able to lessen subjectively experienced stress and anxiety after a “traumatic” stress situation.
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Affiliation(s)
- Johanna Lass-Hennemann
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Sarah K Schäfer
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Sonja Römer
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Elena Holz
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Markus Streb
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Tanja Michael
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
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89
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Visser RM, Lau-Zhu A, Henson RN, Holmes EA. Multiple memory systems, multiple time points: how science can inform treatment to control the expression of unwanted emotional memories. Philos Trans R Soc Lond B Biol Sci 2018; 373:20170209. [PMID: 29352036 PMCID: PMC5790835 DOI: 10.1098/rstb.2017.0209] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2017] [Indexed: 01/04/2023] Open
Abstract
Memories that have strong emotions associated with them are particularly resilient to forgetting. This is not necessarily problematic, however some aspects of memory can be. In particular, the involuntary expression of those memories, e.g. intrusive memories after trauma, are core to certain psychological disorders. Since the beginning of this century, research using animal models shows that it is possible to change the underlying memory, for example by interfering with its consolidation or reconsolidation. While the idea of targeting maladaptive memories is promising for the treatment of stress and anxiety disorders, a direct application of the procedures used in non-human animals to humans in clinical settings is not straightforward. In translational research, more attention needs to be paid to specifying what aspect of memory (i) can be modified and (ii) should be modified. This requires a clear conceptualization of what aspect of memory is being targeted, and how different memory expressions may map onto clinical symptoms. Furthermore, memory processes are dynamic, so procedural details concerning timing are crucial when implementing a treatment and when assessing its effectiveness. To target emotional memory in its full complexity, including its malleability, science cannot rely on a single method, species or paradigm. Rather, a constructive dialogue is needed between multiple levels of research, all the way 'from mice to mental health'.This article is part of a discussion meeting issue 'Of mice and mental health: facilitating dialogue between basic and clinical neuroscientists'.
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Affiliation(s)
- Renée M Visser
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, UK
| | - Alex Lau-Zhu
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, UK
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Richard N Henson
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, UK
| | - Emily A Holmes
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, UK
- Karolinska Institutet, Division of Psychology, Department of Clinical Neuroscience, Stockholm, Sweden
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Holmes EA, Ghaderi A, Harmer CJ, Ramchandani PG, Cuijpers P, Morrison AP, Roiser JP, Bockting CLH, O'Connor RC, Shafran R, Moulds ML, Craske MG. The Lancet Psychiatry Commission on psychological treatments research in tomorrow's science. Lancet Psychiatry 2018; 5:237-286. [PMID: 29482764 DOI: 10.1016/s2215-0366(17)30513-8] [Citation(s) in RCA: 323] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 11/10/2017] [Accepted: 11/24/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Emily A Holmes
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Ata Ghaderi
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Catherine J Harmer
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Trust Foundation, Warneford Hospital, Oxford, UK
| | | | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Anthony P Morrison
- Psychosis Research Unit, Greater Manchester Mental Heath Trust, Manchester, UK; School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Jonathan P Roiser
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Claudi L H Bockting
- Academic Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, Netherlands
| | - Rory C O'Connor
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Roz Shafran
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Michelle L Moulds
- School of Psychology, The University of New South Wales, UNSW, Sydney, NSW, Australia
| | - Michelle G Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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91
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Lau-Zhu A, Holmes EA, Porcheret K. Intrusive Memories of Trauma in the Laboratory: Methodological Developments and Future Directions. Curr Behav Neurosci Rep 2018; 5:61-71. [PMID: 29577009 PMCID: PMC5857557 DOI: 10.1007/s40473-018-0141-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose of the Review Intrusive memories are those that spring to mind unbidden, e.g. sensory recollections of stressful/traumatic events. We review recent methods to monitor intrusions of a stressor (a trauma film) within the laboratory. Recent Findings Recent studies suggest three main methodologies after viewing a trauma film by which to monitor intrusions in the laboratory: during post-film rest periods, after exposure to trigger cues, and while performing an ongoing task. These approaches allow factors to be tested (e.g. psychological or pharmacological) that may influence the frequency of occurrence of intrusions. Summary We raise methodological considerations to guide trauma film studies using intrusion monitoring in the laboratory to complement monitoring approaches in daily life (e.g. diaries). Intrusion monitoring in the laboratory also confers greater experimental control and may open novel research avenues, to advance intervention development to mitigate problematic intrusive memory symptoms.
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Affiliation(s)
- Alex Lau-Zhu
- 1Medical Research Council Cognition and Brain Sciences Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK.,2Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emily A Holmes
- 3Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kate Porcheret
- 4Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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92
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Cook N, Ayers S, Horsch A. Maternal posttraumatic stress disorder during the perinatal period and child outcomes: A systematic review. J Affect Disord 2018; 225:18-31. [PMID: 28777972 DOI: 10.1016/j.jad.2017.07.045] [Citation(s) in RCA: 227] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/20/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Approximately 3.3% of women in pregnancy have posttraumatic stress disorder (PTSD) and 4% of women postpartum PTSD. The impact of maternal PTSD during the perinatal period (from conception until one year postpartum) on child outcomes has not been systematically examined. METHOD A systematic review was conducted to synthesize and critically evaluate quantitative research investigating the association between perinatal PTSD and child outcomes. Databases EMBASE, BNI, Medline, PsycInfo and CINAHL were searched using specific inclusion and exclusion criteria. RESULTS 26 papers reporting 21 studies were identified that examined associations between perinatal PTSD and postpartum birth outcomes, child development, and mother-infant relationship. Studies reviewed were heterogeneous, with poor-to-medium scores of methodological quality. Results showed that maternal postpartum PTSD is associated with low birth weight and lower rates of breastfeeding. Evidence for an association between maternal PTSD and preterm birth, fetal growth, head circumference, mother-infant interaction, the mother-infant relationship or child development is contradictory. Associations between maternal PTSD and infant salivary cortisol levels, and eating/sleeping difficulties are based on single studies, so require replication. LIMITATIONS Methodological weaknesses of the studies included insufficient sample size, use of invalidated measures, and limited external validity. CONCLUSION Findings suggest that perinatal PTSD is linked with some negative child outcomes. Early screening for PTSD during the perinatal period may be advisable and onward referral for effective treatment, if appropriate. Future research using larger sample sizes, validated and reliable clinical interviews to assess PTSD, and validated measures to assess a range of child outcomes, is needed.
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Affiliation(s)
- Natalie Cook
- The Oxford Institute of Clinical Psychology Training, Isis Education Centre, Warneford Hospital, Oxford OX3 7JX, United Kingdom.
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, United Kingdom.
| | - Antje Horsch
- Department Woman-Mother-Child, Lausanne University Hospital, Avenue Pierre-Decker 2, CH-1011 Lausanne, Switzerland.
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93
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Furuta M, Horsch A, Ng ESW, Bick D, Spain D, Sin J. Effectiveness of Trauma-Focused Psychological Therapies for Treating Post-traumatic Stress Disorder Symptoms in Women Following Childbirth: A Systematic Review and Meta-Analysis. Front Psychiatry 2018; 9:591. [PMID: 30515108 PMCID: PMC6255986 DOI: 10.3389/fpsyt.2018.00591] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 10/25/2018] [Indexed: 12/13/2022] Open
Abstract
Background: Approximately 3% of women in community samples develop posttraumatic stress disorder (PTSD) after childbirth. Higher prevalence rates are reported for high risk samples. Postpartum PTSD can adversely affect women's wellbeing, mother-infant relationships and child development. This study aims to examine the effectiveness of trauma-focused psychological interventions (TFPT), for postnatal women. Methods: We conducted a systematic review and meta-analysis including all clinical trials which reported post-traumatic stress symptoms for both the intervention and control groups or at least two time-points, pre- and post-intervention. We searched four databases: CENTRAL, MEDLINE, PsycINFO, and OpenGrey. Screening of search results, data extraction, and risk of bias assessment were undertaken independently by two reviewers. Results: Eleven studies, reported in 12 papers, involving 2,677 postnatal women were included. All were RCTs, bar one case series. Interventions varied in modality, duration and intensity, and included exposure therapy, trauma-focused cognitive behavioral therapy, eye movement desensitization and reprocessing and other psychological approaches. Participants had experienced uncomplicated births, emergency cesarean sections and/or preterm births. Results suggest that TFPT are effective for reducing PTSD symptoms in the short term (up to 3 months postpartum [4 RCTs, n = 301, SMD = -0.50, 95% CI = -0.73 to -0.27]), and medium term (i.e., 3-6 months postpartum [2 RCTs, n = 174, SMD = -1.87, 95% CI = -2.60 to -1.13]). However, there is no robust evidence to suggest whether TFPT can also improve women's recovery from clinically significant PTSD symptoms. Conclusion: Further larger studies, distinguishing between low and high risk groups, and with adequate follow-up, are needed to establish which TFPT are most effective and acceptable for treating postnatal PTSD.
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Affiliation(s)
- Marie Furuta
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Antje Horsch
- Institute of Higher Education in Healthcare Research, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland.,Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Edmond S W Ng
- Director's Office, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Debra Bick
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Debbie Spain
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Jacqueline Sin
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, United Kingdom.,Berkshire Traumatic Stress Service, Berkshire Healthcare NHS Foundation Trust, Bracknell, United Kingdom
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94
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Andersson E, Holmes EA, Kavanagh D. Innovations in digital interventions for psychological trauma: harnessing advances in cognitive science. Mhealth 2018; 4:47. [PMID: 30505845 PMCID: PMC6232069 DOI: 10.21037/mhealth.2018.09.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 09/27/2018] [Indexed: 11/06/2022] Open
Abstract
A range of digital psychological interventions have demonstrated a positive impact on trauma-related problems in controlled trials, but there is room for further improvements in their form, reach and impact. Most to date have been adaptions of established face-to-face treatments. In this paper, we highlight a complementary emerging route to their development, which draws on advances in cognitive science theory and research and applies them to clinical contexts. Three examples are given regarding laboratory research with potential applications to digital interventions for trauma-related mental health problems: a digital game to reduce intrusive memories of trauma, novel cognitive techniques for worry, and digitally supported mental imagery to enhance motivation for functional behavior change. Much of this research is still at an early stage, meriting a balance of optimism and caution. However, even if only a few digital applications of cognitive science constitute substantial improvements to complement current treatments, their potential for large-scale use at low unit cost may provide significant benefits across populations.
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Affiliation(s)
- Erik Andersson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska institute, Stockholm, Sweden
| | - Emily A. Holmes
- Department of Clinical Neuroscience, Division of Psychology, Karolinska institute, Stockholm, Sweden
| | - David Kavanagh
- Centre for Children’s Health Research, Institute of Health and Biomedical Innovation, and School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
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95
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Asselbergs J, Sijbrandij M, Hoogendoorn E, Cuijpers P, Olie L, Oved K, Merkies J, Plooijer T, Eltink S, Riper H. Development and testing of TraumaGameplay: an iterative experimental approach using the trauma film paradigm. Eur J Psychotraumatol 2018; 9:1424447. [PMID: 29441151 PMCID: PMC5804785 DOI: 10.1080/20008198.2018.1424447] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 12/21/2017] [Indexed: 11/29/2022] Open
Abstract
Background: Vivid trauma-related intrusions are a hallmark symptom of posttraumatic stress disorder (PTSD), and may be involved in its onset. Effective interventions to reduce intrusions and to potentially prevent the onset of subsequent PTSD are scarce. Studies suggest that playing the videogame Tetris, shortly after watching aversive film clips, reduces subsequent intrusions. Other studies have shown that taxing working memory (WM) while retrieving an emotional memory reduces the memory's vividness and emotionality. Objective: We developed TraumaGameplay (TGP), a gaming app designed to reduce intrusions. This paper describes two successive experiments to determine whether playing TGP without memory retrieval (regular TGP) or TGP with memory retrieval (dual-task TGP) reduces intrusion frequency at one week compared to a no-game control. Method: For both experiments, healthy university students were recruited. Experiment 1: 92 participants were exposed to a trauma film and randomized to (1) regular TGP1 (n = 31), (2) dual-task TGP1 (n = 31) or (3) control (n = 30). In experiment 2, 120 healthy students were exposed to a trauma film and randomized to (1) regular TGP2 (n = 30), (2) dual-task TGP2 (n = 29), (3) recall only (n = 31) or (4) control (n = 30). Results: We found no significant difference between conditions on the number of intrusions for either playing regular TGP or dual-task TGP in both experiment 1 and experiment 2. Conclusion: Our results could not replicate earlier promising findings from preceding experimental research. Several reasons may underpin this difference ranging from the visuospatial videogame used in our experiments to the method of the experiment to the difficulties of replicability in general.
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Affiliation(s)
- Joost Asselbergs
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,The Netherlands and EMGO Institute for Health Care and Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,The Netherlands and EMGO Institute for Health Care and Research, VU University Medical Centre, Amsterdam, The Netherlands
| | | | - Pim Cuijpers
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lara Olie
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Kfir Oved
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Job Merkies
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tessa Plooijer
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Simone Eltink
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Heleen Riper
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,The Netherlands and EMGO Institute for Health Care and Research, VU University Medical Centre, Amsterdam, The Netherlands.,GGZ inGeest, Amsterdam, The Netherlands.,Health and Life Sciences Faculty, Telepsychiatry Unit, Southern Denmark University, Odense, Denmark
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96
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Treatment of Intrusive Suicidal Imagery Using Eye Movements. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14070714. [PMID: 28665329 PMCID: PMC5551152 DOI: 10.3390/ijerph14070714] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/19/2017] [Accepted: 06/26/2017] [Indexed: 12/18/2022]
Abstract
Suicide and suicidal behavior are major public health concerns, and affect 3–9% of the population worldwide. Despite increased efforts for national suicide prevention strategies, there are still few effective interventions available for reducing suicide risk. In this article, we describe various theoretical approaches for suicide ideation and behavior, and propose to examine the possible effectiveness of a new and innovative preventive strategy. A model of suicidal intrusion (mental imagery related to suicide, also referred to as suicidal flash-forwards) is presented describing one of the assumed mechanisms in the etiology of suicide and the mechanism of therapeutic change. We provide a brief rationale for an Eye Movement Dual Task (EMDT) treatment for suicidal intrusions, describing techniques that can be used to target these suicidal mental images and thoughts to reduce overall behavior. Based on the available empirical evidence for the mechanisms of suicidal intrusions, this approach appears to be a promising new treatment to prevent suicidal behavior as it potentially targets one of the linking pins between suicidal ideation and suicidal actions.
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