Rumination in posttraumatic stress disorder

Instability of physical anxiety symptoms in daily life of patients with panic disorder and patients with posttraumatic stress disorder

The present study examined severity as well as degree and temporal pattern of instability of DSM-IV-based bodily symptoms of anxiety (BSA) in daily life of 26 panic disorder (PD) patients, 17 posttraumatic stress disorder (PTSD) patients, and 28 healthy controls (HC) during 1 week, using electronic diaries. The ecological momentary assessment around every 3h during wake times was accepted well by patients. Compared to HC, patient groups exhibited elevated instability of BSA. BSA instability was more pronounced in PTSD than PD (p<0.005), even after controlling for mean symptom level. Numbers of symptomatic episodes were comparable in PTSD and PD, but the duration of symptom-free episodes was shorter in PTSD than PD. Results indicate that PTSD patients are particularly burdened by fluctuations in somatic symptoms of anxiety, implying perceived unpredictability and uncontrollability. Electronic diaries can be applied in innovative ways to provide novel insights into the phenomenology of anxiety disorders that may not be captured well by retrospective interviews and questionnaires.

Autobiographical integration of trauma memories and repressive coping predict post-traumatic stress symptoms in undergraduate students

What differentiates those who are able to adapt well to adverse life events (i.e., persons who are resilient) from those who are not (e.g., persons who develop post-traumatic stress symptoms)? Previous work suggests that enhanced autobiographical integration of trauma memories is associated with more severe post-traumatic stress symptoms. Extending this line of work, the present study looked at whether the integration of trauma memories, repressive coping and cognitive reactivity are related to post-traumatic stress symptomatology following negative life events among otherwise healthy young adults (N = 213). Results show that while enhanced integration of trauma memories and high levels of dissociation are related to elevated levels of post-traumatic stress, people who generally engage in repressive coping report fewer post-traumatic stress symptoms.

Making meaning of traumatic events: youths' strategies for processing childhood sexual abuse are associated with psychosocial adjustment

The need to make meaning of childhood sexual abuse (CSA) is common and often persists long after the abuse ends. Although believed to be essential for healthy recovery, there is a paucity of research on how youth process their CSA experiences. The current study identified individual differences in the ways youth process their CSA and examined associations with psychosocial adjustment. A sample of 108 youth with confirmed abuse histories enrolled in the study within 8 weeks of abuse discovery, when they were between 8 and 15 years old. Six years later, they participated in interviews about their CSA experiences, reactions, and perceived effects. Using a coding system developed for this study, youths' CSA narratives were reliably classified with one of three processing strategies: Constructive (13.9%), Absorbed (50%), or Avoidant (36.1%). Absorbed youth reported the highest levels of psychopathological symptoms, sexual problems, and abuse-specific stigmatization, whereas Constructive youth tended to report the fewest problems. Avoidant youth showed significantly more problems than Constructive youth in some but not all areas. Interventions that build healthy processing skills may promote positive recovery by providing tools for constructing adaptive meanings of the abuse, both in its immediate aftermath and over time.

Eye tracking and visual attention to threating stimuli in veterans of the Iraq war

Theoretical and clinical characterizations of attention in PTSD acknowledge the possibility for both hypervigilance and avoidance of trauma-relevant stimuli. This study used eye tracking technology to investigate visual orientation and attention to traumatic and neutral stimuli in nineteen veterans of the Iraq war. Veterans saw slides in which half the screen had a negatively valenced image and half had a neutral image. Negatively valenced stimuli were further divided into stimuli that varied in trauma relevance (either Iraq war or civilian motor vehicle accidents). Veterans reporting relatively higher levels of PSTD symptoms had larger pupils to all negatively valenced pictures and spent more time looking at them than did veterans lower in PTSD symptoms. Veterans higher in PTSD symptoms also showed a trend towards looking first at Iraq images. The findings suggest that post-traumatic pathology is associated with vigilance rather than avoidance when visually processing negatively valenced and trauma-relevant stimuli.

The effects of rumination on mood and intrusive memories after exposure to traumatic material: An experimental study

Correlational studies have shown that trauma-related rumination predicts chronic post-traumatic stress disorder (PTSD). This study aimed to experimentally test the hypothesis that rumination is causally involved in the development and maintenance of PTSD symptoms. A video depicting the aftermath of serious road traffic accidents was used as an analogue stressor. After having watched the video, N=101 healthy participants were randomly assigned to a guided thinking task designed to induce (a) rumination, (b) memory integration and (c) distraction. In line with the hypotheses, rumination led to less recovery from sad mood triggered by the video than the other two conditions. In addition, self-reported state levels of rumination during the guided thinking task predicted subsequent intrusive memories in the session. However, no significant main effect of the experimental manipulation on intrusive memories of the video was found. Results of exploratory analyses suggested possible sex differences in the way the processing manipulations were effective. Taken together, the results partially support the hypothesis that rumination is involved in the maintenance of negative mood and post-traumatic stress symptoms.

The effects of experimentally induced rumination versus distraction on analogue posttraumatic stress symptoms

Rumination has been suggested to be an important factor maintaining posttraumatic stress disorder (PTSD). Using an analogue design, this study aimed to experimentally test the hypothesis that trauma-related rumination maintains PTSD symptoms. Fifty-one participants were first asked to give a detailed narrative of a negative life event and were then randomly assigned to a rumination or distraction condition. In line with the hypotheses, rumination about the event resulted in the maintenance of negative mood and intrusive memories immediately after the manipulation whereas distraction resulted in symptom reduction. However, this effect was reversed during a subsequent symptom provocation task, in which distraction led to a greater increase in some of the symptoms than rumination. Results are in line with the idea that rumination is involved in the maintenance of PTSD but may suggest a complex relationship between rumination and posttraumatic stress symptoms.

A cognitive neuroscience hypothesis of mood and depression

Although mood has a direct impact on mental and physical health, our understanding of the mechanisms underlying mood regulation is limited. Here, I propose that there is a direct reciprocal relation between the cortical activation of associations and mood regulation, whereby positive mood promotes associative processing, and associative processing promotes positive mood. This relation might stem from an evolutionary pressure for learning and predicting. Along these lines, one can think of mood as a reward mechanism that guides individuals to use their brains in the most productive manner. The proposed framework has many implications, most notably for diagnosing and treating mood disorders such as depression; for elucidating the role of inhibition in the regulation of mood; for contextualizing adult hippocampal neurogenesis; and for a general, non-invasive improvement of well-being.

An experimental analogue study into the role of abstract thinking in trauma-related rumination

Trauma-related rumination has been shown to predict the maintenance of posttraumatic stress disorder (PTSD). However, it is still unclear how rumination can be distinguished from functional forms of thinking about traumatic events. The current study used an analogue design to experimentally test the hypothesis that the abstractness of thinking is responsible for the dysfunctional effects of trauma-related rumination. Eighty-three healthy university students first watched a distressing video and were then randomly assigned to abstract ruminative thinking, concrete thinking or distraction. Abstract thinking was found to lead to a significantly longer maintenance of negative mood and arousal than both concrete thinking and distraction. These results are in line with earlier findings in the context of excessive worry and depressive rumination and support the view that abstractness is a critical factor for the dysfunctional effects of trauma-related rumination. However, results regarding intrusive memories were not supportive of the hypotheses. Unexpectedly, the distraction group showed the highest number of intrusions, whereas the abstract and concrete conditions did not significantly differ. Implications for theoretical models of trauma-related rumination and possible clinical implications are discussed.

A roadmap to rumination: a review of the definition, assessment, and conceptualization of this multifaceted construct

Rumination has been widely studied and is a crucial component in the study of cognitive vulnerabilities to depression. However, rumination means different things in the context of different theories, and has not been uniformly defined or measured. This article aims to review models of rumination, as well as the various ways in which it is assessed. The models are compared and contrasted with respect to several important dimensions of rumination. Guidelines to consider in the selection of a model and measure of rumination are presented, and suggestions for the conceptualization of rumination are offered. In addition, rumination's relation to other similar constructs is evaluated. Finally, future directions for the study of ruminative phenomena are presented. It is hoped that this article will be a useful guide to those interested in studying the multi-faceted construct of rumination.

Information Processing Bias in Post-traumatic Stress Disorder

This review considers theory and evidence for abnormal information processing in post-traumatic stress disorder (PTSD). Cognitive studies have indicated sensitivity in PTSD for traumatic information, more so than general emotional information. These findings were supported by neuroimaging studies that identify increased brain activity during traumatic cognition, especially in affective networks (including the amygdala, orbitofrontal and anterior cingulate cortex). In theory, it is proposed that traumatic cognition may interfere with neutral cognition and there is evidence of abnormal neutral stimulus processing in PTSD. Firstly, PTSD patients perform poorly on a variety of neuropsychology tasks that involve attention and memory for neutral information. The evidence from event-related potentials and functional neuroimaging also indicates abnormal results in PTSD during neutral stimulus processing. The research evidence generally provides support for theories of trauma sensitivity and abnormal neutral stimulus processing in PTSD. However, there is only tentative evidence that trauma cognition concurrently interferes with neutral cognition. There is even some evidence that traumatic or novelty arousal processes can increase the capacity for attentive processing, thereby enhancing cognition for neutral stimulus information. Research on this topic has not yet fully explored the mechanisms of interaction between traumatic and neutral content in the cognitive dynamics of PTSD.

Acute predator stress impairs the consolidation and retrieval of hippocampus-dependent memory in male and female rats

We have studied the effects of an acute predator stress experience on spatial learning and memory in adult male and female Sprague-Dawley rats. All rats were trained to learn the location of a hidden escape platform in the radial-arm water maze (RAWM), a hippocampus-dependent spatial memory task. In the control (non-stress) condition, female rats were superior to the males in the accuracy and consistency of their spatial memory performance tested over multiple days of training. In the stress condition, rats were exposed to the cat for 30 min immediately before or after learning, or before the 24-h memory test. Predator stress dramatically increased corticosterone levels in males and females, with females exhibiting greater baseline and stress-evoked responses than males. Despite these sex differences in the overall magnitudes of corticosterone levels, there were significant sex-independent correlations involving basal and stress-evoked corticosterone levels, and memory performance. Most importantly, predator stress impaired short-term memory, as well as processes involved in memory consolidation and retrieval, in male and female rats. Overall, we have found that an intense, ethologically relevant stressor produced a largely equivalent impairment of memory in male and female rats, and sex-independent corticosterone-memory correlations. These findings may provide insight into commonalities in how traumatic stress affects the brain and memory in men and women.

The Role of Rumination and Reduced Concreteness in the Maintenance of Posttraumatic Stress Disorder and Depression Following Trauma

Rumination has been linked to posttraumatic stress disorder (PTSD) and depression following trauma. A cross-sectional (N = 101) and a prospective longitudinal study (N = 147) of road traffic accident survivors assessed rumination, PTSD and depression with self-report measures and structured interviews. We tested the hypotheses that (1) rumination predicts the maintenance of PTSD and depression and (2) reduced concreteness of ruminative thinking may be a maintaining factor. Rumination significantly predicted PTSD and depression at 6 months over and above what could be predicted from initial symptom levels. In contrast to the second hypothesis, reduced concreteness in an iterative rumination task was not significantly correlated with self-reported rumination frequency, and did not consistently correlate with symptom severity measures. However, multiple regression analyses showed that the combination of reduced concreteness and self-reported frequency of rumination predicted subsequent PTSD better than rumination frequency alone. The results support the view that rumination is an important maintaining factor of trauma-related emotional disorders.