The Expression of Posttraumatic Stress Symptoms in Daily Life: A Review of Experience Sampling Methodology and Daily Diary Studies

Daily-level associations between posttraumatic stress disorder symptoms and reactions to retrieving positive autobiographical memories

Trauma survivors with posttraumatic stress disorder (PTSD) report difficulties accessing and describing positive memories. To understand these patterns, we examined daily-level relations of PTSD symptoms with affective, cognitive (dwelling/rumination; pushing memory out of one's mind; suppression; avoidance; distraction; thinking about something else; remembering negative or positive memories/events; negative or positive thoughts; accepting or disapproving memory; reinterpreting memory), and behavioral (using alcohol/drugs; smoking cigarettes; cravings for or seeking out cigarettes/alcohol/drugs; craving, seeking out, or consuming large amounts of food; dissociation; engaging in risky behaviors; sharing memories; interference with ongoing task; arousal) reactions to retrieving positive memories. Eighty-eight trauma survivors (Mage= 39.89 years; 59.1% female) completed 7 daily measures of PTSD and reactions to retrieving positive memories. Days with more PTSD severity were associated with higher odds of same-day suppression, avoidance, distraction, thinking about something else, smoking cigarettes, craving substances, craving, seeking out, or consuming large amounts of food, dissociation, remembering negative memories/events/thoughts, engaging in risky behaviors, interference with ongoing tasks, and arousal (ORs=1.10-1.22); and greater negative affect (β = 0.27). Supplemental lagged analyses indicated some associations between previous-day reactions to positive memory retrieval and next-day PTSD severity and vice versa. Trauma survivors with PTSD symptoms report negative and avoidance-oriented reactions to retrieving positive memories.

Beyond the mean: examining associations between intraindividual variability in posttraumatic stress disorder symptoms and posttrauma reckless behaviors

BACKGROUND/OBJECTIVES

Posttrauma reckless behaviors have been linked to the onset and exacerbation of posttraumatic stress disorder (PTSD) symptoms. However, PTSD symptoms fluctuate across time, triggered by environmental stimuli in daily life, referred to as (intraindividual) variability in PTSD symptoms.

DESIGN

We utilized experience sampling methods to investigate associations between engagement in posttrauma reckless behaviors and variability in PTSD symptoms and the moderating role of emotion dysregulation in this association.

METHODS

Data from 166 trauma-exposed university students (Mage = 21.43 ± 5.07, 85.4% women) were collected between January 2019 to August 2020. Participants completed baseline and follow-up surveys to assess engagement in posttrauma reckless behaviors and daily surveys (10-days) to assess variability in PTSD symptoms. Results. Analyzes indicated greater baseline engagement in posttrauma reckless behaviors was associated with greater 10-day variability in PTSD symptoms (β = 0.23, p = .031), and baseline emotion dysregulation moderated this association (β = -0.33, p = .003). Additionally, greater 10-day variability in PTSD symptoms was associated with greater follow-up engagement in posttrauma reckless behaviors (β = 0.14, p = .045).

CONCLUSIONS

Findings substantiate the interplay between engagement in posttrauma reckless behaviors and daily fluctuations in PTSD symptoms and support therapeutically targeting both engagement in posttrauma reckless behaviors and emotion dysregulation to impact PTSD symptoms.

Towards a more comprehensive understanding of PTSD and parenting

BACKGROUND

The impact of post-traumatic stress disorder (PTSD) on parenting and the parent-child relationship has been well-documented in the scientific literature. However, some conceptual and methodological challenges within this research field remain.

PROCEDURE

We reflect on a number of challenges that we identified while examining the literature in preparation of an individual participant data meta-analysis on the relationships between PTSD and parenting.

FINDINGS

We address 1) the presence of 'trauma-islands'; 2) the need for transdiagnostic theoretical frameworks for mechanisms between PTSD and parenting; 3) the lack of developmental perspectives; 4) the overuse of self-reported retrospective measures; 5) the need to study more diverse samples and cultural contexts; and 6) the lack of research on resilience and post-traumatic growth in parenting. Based on these reflections, we offer suggestions on strategies for responding to these challenges through: 1) welcoming open science; 2) working towards shared theoretical frameworks; 3) doing more longitudinal research 4) expanding the methodological palette; 5) centering lived experience; and 6) taking systemic inequality into account.

CONCLUSION

With this commentary, we aim to open a discussion on next steps towards a more comprehensive understanding of the association between PTSD and parenting, and inspire collaborative research.

Ecological investigation of the co-occurrence of posttraumatic stress disorder symptoms and cannabis use among community women experiencing intimate partner violence

BACKGROUND

Women experiencing intimate partner violence (IPV) are at increased risk for developing hazardous patterns of cannabis use. Research suggests that women experiencing IPV use cannabis to cope with posttraumatic stress disorder (PTSD) symptoms. To advance research, we used experience sampling methods to explicate the within-day concurrent and proximal relations between PTSD symptom clusters and cannabis use among women experiencing IPV.

METHOD

Participants were 145 community women (M age = 40.66, 41.6% white, 31.4% Black, 10.9% Hispanic or Latina, 8% American Indian/Alaska Native, 5.8% Bi-/multi-racial) experiencing IPV and using substances who completed three surveys a day for 30 days.

RESULTS

Externalizing behavior (OR = 1.37, 95% CI [1.15, 1.65], p < 0.001) and dysphoric arousal (OR = 1.27, 95% CI [1.09, 1.49], p = 0.002) PTSD symptom clusters were associated with cannabis use reported in the same survey period. Results from the lagged models found no proximal associations between PTSD symptom clusters and cannabis use.

CONCLUSIONS

Results highlight the acute effects of externalizing behavior and dysphoric arousal PTSD symptoms on cannabis use among women experiencing IPV. These findings may inform prevention and intervention efforts for cannabis use in this population.

"I Know Myself Again, Which Makes Me Motivated for Life": Feasibility and Acceptability of Using Experience Sampling Methods With Trauma-Exposed Sexual Minority Women

Intensive longitudinal designs (e.g., experience sampling methods [ESMs]) hold promise for examining the dynamic interplay between daily adversity, coping strategies, and behavioral and mental health issues among marginalized populations. However, few studies have used intensive longitudinal designs with sexual minority women (SMW), an understudied and at-risk population. We assessed feasibility and acceptability of using once-daily, interval-contingent ESM with 161 trauma-exposed SMW (Mage = 29.1, SD = 7.57); 20.5% nonbinary; 32.3% queer; 52.2% people of color; 14.3% with annual incomes ≤$9,999; and 30.4% in Southern United States (U.S.). SMW completed one comprehensive online baseline assessment and once-daily brief online assessments for 14 days. Daily surveys assessed past-24-hour stressors, stress responses, and behavioral and mental health symptoms. At the end of the 14-day ESM period, SMW answered three open-ended questions about participating in this study and about research with SMW. Regarding feasibility, 151 participants (94.0%) initiated the post-baseline ESM study portion and 72 (45.0%) completed all 14 daily surveys. An average of 11.70 (median = 13, SD = 3.31) daily surveys (83.5%) were completed by those who initiated the ESM. ESM completion level varied by race/ethnicity and U.S. region. Qualitative acceptability data revealed several themes, namely that SMW (1) enjoyed participating and felt positively about the ESM experience, (2) felt supported to reflect on impacts of early and ongoing stressors, (3) appreciated the chance to self-reflect and challenge existing thought patterns and coping behaviors, (4) recognized their capacity to tolerate trauma-related distress, (5) recommended that researchers focus on SMW's diverse stressors and daily experiences, (6) wanted a rationale for providing sensitive information and more space to narrate their experiences, and (7) recognized the need for affirmative treatment and policies. Findings could inform modifications to ESM protocols to improve their feasibility and acceptability among trauma-exposed SMW and promote ongoing utility of this valuable method.

Relations Between Posttraumatic Stress Disorder Symptoms and Positive Memory Characteristics Among Women Reporting Intimate Partner Violence: A Micro-Longitudinal Study

Evidence links posttraumatic stress disorder (PTSD) symptoms to positive autobiographical memory characteristics. To extend this research, we uniquely utilized micro-longitudinal data to examine (1) the trajectory of PTSD symptom count across 30 days; and (2) if more vividness and accessibility of retrieved positive memories at the daily level predicted decreases in the trajectory of PTSD symptom count across 30 days. The current study was a secondary data analysis of a larger study. The sample included 74 women who reported physical or sexual victimization in the past 30 days by their current male partner and reported the use of alcohol and/or drugs during that time (M_age = 39.68 years; 37.80% with diagnostic PTSD; 43.2% White; 37.8% Black or African American). They completed thrice daily measures of PTSD symptoms and positive memory characteristics (vividness and accessibility) across 30 days. Results of the random effects longitudinal multilevel model indicated that, on average, the relation between PTSD symptom count and positive memory vividness was positive and statistically significant (0.19, 95% Confidence Interval [CI] [0.2, 0.35]); and the relation between PTSD symptom count and positive memory accessibility was positive and statistically significant (0.31, 95% CI [0.15, 0.47]). The relationship between PTSD symptom count and positive memory vividness/accessibility (i.e., slopes) varied significantly across participants, with a wide range of positive and negative regression coefficients. Future research needs to investigate why and how positive memory vividness and accessibility may relate to trajectories of PTSD symptoms over time, with potential clinical implications for positive memory interventions addressing PTSD.

Do positive memory characteristics influence daily-level trajectories of posttraumatic stress disorder symptoms? an exploratory daily diary study

BACKGROUND AND OBJECTIVES

Evidence links posttraumatic stress disorder (PTSD) with positive memory characteristics. To extend this research, we utilized daily diary data to examine (1) concurrent/lagged associations between daily PTSD symptom severity and positive memory vividness/accessibility; and (2) associations between baseline-assessed positive memory characteristics and changes in PTSD symptom severity over time.

DESIGN AND METHODS

A sample of 238 trauma-exposed participants (Mage = 21.19 years; 86% women) completed baseline and 10 daily measures of PTSD symptoms and positive memory characteristics. Multilevel models covaried for gender, number of trauma types, and number of completed surveys.

RESULTS

Days with greater PTSD symptom severity than an individual's average associated with less vividness (b = -0.02, p < .001) and accessibility (b = -0.02, p < .001) of the positive memory on the same day. Days with greater positive memory vividness (b = -1.06, p < .001) and accessibility (b = -0.93, p < .001) than an individual's average associated with less PTSD symptom severity on the same day. There were no significant lagged associations between these constructs. There were significant interactions between baseline-assessed psychological distance and time (b = -0.04, p  = .042) and between baseline-assessed visual perspective and time (b = 0.05, p = .023) on PTSD symptom severity across days.

CONCLUSIONS

Findings inform positive memory intervention targets for PTSD and provide impetus for longitudinal investigations on their inter-relations.

Study protocol: development and randomized controlled trial of a preventive blended care parenting intervention for parents with PTSD

BACKGROUND

Children of parents with post-traumatic stress disorder (PTSD) are at increased risk of adverse psychological outcomes. An important risk mechanism is impaired parental functioning, including negative parenting behavior, perceived incompetence, and lack of social support. Several parenting interventions for trauma-exposed parents and parents with psychiatric disorders exist, but none have specifically targeted parents with PTSD. Our objective is to evaluate the effectiveness of a blended care preventive parenting intervention for parents with PTSD.

METHODS

The intervention was adapted from an existing online intervention, KopOpOuders Self-Help. In co-creation with parents with PTSD and partners, the intervention was adapted into KopOpOuders-PTSD, by adding PTSD-specific content and three in-person-sessions with a mental health prevention professional. Effectiveness will be tested in a randomized controlled trial among N = 142 parents being treated for PTSD at Arkin Mental Health Care (control condition: treatment as usual, n = 71; intervention condition: treatment as usual + intervention, n = 71). Online questionnaires at pretest, posttest, and three-month follow-up and ecological momentary assessment at pretest and posttest will be used. Intervention effects on primary (parenting behavior) and secondary outcomes (perceived parenting competence, parental social support, parenting stress, child overall psychological problems and PTSD symptoms) will be analyzed using generalized linear mixed modeling. We will also analyze possible moderation effects of parental PTSD symptoms at pretest on primary and secondary outcomes.

DISCUSSION

This study protocol describes the randomized controlled trial of KopOpOuders-PTSD, a blended care preventive parenting intervention for parents with PTSD. Findings can contribute to understanding of the effectiveness of parenting support in clinical practice for PTSD.

TRIAL REGISTRATION

This protocol (Version 1) was registered on 11-02-2022 at ClinicalTrials.gov under identification number NCT05237999.

Sustained threat and phasic fear in the laboratory and cognitive-emotional processes of anxiety in everyday life - An ambulatory assessment study

Fear is a phasic state of apprehension to an imminent threat, whereas anxiety is a more sustained state of expecting a potential threat leading to tension and worry. The NPU-threat test is a laboratory startle paradigm allowing a reliable and valid assessment of both, fear- and anxiety-potentiated reactions. It is suggested to differentiate between anxiety disorders, but little is known on associations with everyday life experiences of cognitive-emotional processes regarding anxiety in non-clinical samples. In the present project, the NPU-threat test was applied in three studies with (1) unselected healthy individuals, (2) participants with extreme manifestations of trait anxiety (low vs. high) and (3) individuals preparing for a high-stakes exam. Self-reported states of emotionality and worry were assessed during a four-day ambulatory assessment (AA). Overall, NPU-threat test measures did not significantly differ between studies, while the AA dependent measures were sufficiently sensitive to capture differences between groups. However, there was no significant association between psychophysiological measures of the NPU-threat test and AA state measures across participants. In participants recruited for low vs. high trait anxiety we found an association with AA worry and emotionality, but no interaction with potentiated startle. The present findings do not support the idea of a link between our laboratory biomarker and adaptive regulation of cognitive-emotional states in everyday life in healthy individuals. We speculate that an association between laboratory physiological measures and everyday experience of anxious states may be detectable in clinical samples.

Remembering the earthquake: intrusive memories of disaster in a rural Italian community

BACKGROUND

Disasters can have long-lasting impacts on mental health. Intrusive memories have been found to be common and persistent in the aftermath of earthquakes.

OBJECTIVE

To explore, using diaries, intrusive memories' presence, content, characteristics, and relationship with probable post-traumatic stress disorder (PTSD) in a small rural community exposed to mass destruction and loss of life.

METHODS

Survivors of the 2016-2017 Central Italy earthquakes (N = 104) were first interviewed to investigate the presence of intrusive memories of the disaster. Those that reported intrusive memories were subsequently asked to complete a 7-day paper-and-pen diary tracking their spontaneous memories of the earthquake events.

RESULTS

Twenty months after the earthquakes, 49% (n = 51) of the sample reported having experienced intrusive memories post-earthquake and 38% (n = 39) reported at least one intrusive memory in their diaries. Memories were rated as being distressing, vivid, and experienced as a mixture of images and thoughts. The content of intrusive memories generally focused on sensations and experiences during the earthquake. Other common categories of content were the material environment and physical objects as well as human loss & death. Several memories had a social focus. A minority of memories contained more positive content as well as content from before and after the earthquake. Some participants (28%) experienced repeated intrusive memories of the same content. Memories of participants with and without probable PTSD did not significantly differ on characteristics or content.

CONCLUSIONS

Intrusive memories can be common, distressing, and persistent occurrences following disasters, even in survivors not suffering from probable PTSD.

HIGHLIGHTS

Intrusive memories were common, distressing, and vivid more than 1-year post-disaster.They captured peri-earthquake sensations, material destruction, death, and social interactions.No difference in content or characteristics was found between participants with and without probable PTSD.

Ecological momentary assessment of self-rated health, daily strategies and self-management app use among trauma-exposed adults

Background: The process whereby trauma-exposed people benefit from self-management apps to increase health is poorly understood. Objective: We investigated whether access to a self-management smartphone app for posttraumatic stress (PTSD Coach) improved momentary self-rated health (SRH) and if use of a self-management app or specific strategies related to SRH. Method: Participants were 179 adults in Sweden with trauma exposure in the past 2 years who were enrolled in a randomized trial of PTSD Coach versus waitlist. Ecological momentary assessments (EMA) were collected twice daily during 21 consecutive days from participants in both groups, with questions about momentary SRH as well as self-management app use and use of strategies (social support, distress management, monitoring of discomfort and seeking information) in the preceding 12 hours. Results: Overall, neither access to PTSD Coach nor reported use of an app in the preceding hours was related to SRH. Even so, people with access to PTSD Coach reported using more social support over time. Socializing and use of social support predicted greater SRH. Use of other strategies was associated with worse short-term SRH. Conclusions: Momentarily improved health relates to utilization of social support. However, the directionality of the day-to-day associations is unclear; uncertainty remains around the timing for assessing these relationships.

Bayesian Time-Series Models in Single Case Experimental Designs: A Tutorial for Trauma Researchers

Single-case experimental designs (SCEDs) involve obtaining repeated measures from one or a few participants before, during, and, sometimes, after treatment implementation. Because they are cost-, time-, and resource-efficient and can provide robust causal evidence for more large-scale research, SCEDs are gaining popularity in trauma treatment research. However, sophisticated techniques to analyze SCED data remain underutilized. Herein, we discuss the utility of SCED data for trauma research, provide recommendations for addressing challenges specific to SCED approaches, and introduce a tutorial for two Bayesian models-the Bayesian interrupted time-series (BITS) model and the Bayesian unknown change-point (BUCP) model-that can be used to analyze the typically small sample, autocorrelated, SCED data. Software codes are provided for the ease of guiding readers in estimating these models. Analyses of a dataset from a published article as well as a trauma-specific simulated dataset are used to illustrate the models and demonstrate the interpretation of the results. We further discuss the implications of using such small-sample data-analytic techniques for SCEDs specific to trauma research.

Drinking Motives as Moderators of In-the-Moment Drinking Risks in Response to Trauma-Related Distress

BACKGROUND

Trauma exposure and posttraumatic stress disorder (PTSD) symptomatology are linked to increased risk for problematic drinking, yet the factors that increase such risk remain largely unknown. Theoretical models suggest that affectively oriented drinking motives may be central to trauma-related drinking. Specifically, individual-level motivations to drink to regulate affect may be important for moderating drinking urges that occur acutely in response to trauma cues. Further, elevated distress associated with PTSD symptomatology may increase any affectively motivated, momentary drinking risks. However, research has yet to examine these dynamic affective processes. In a large experimental sample, the current study tested whether affective (i.e., coping and enhancement) drinking motives and PTSD symptomatology moderated individuals' drinking urge in response to a trauma cue in a laboratory cue reactivity paradigm.

METHODS

College drinkers (n = 611, 53% female) were recruited and selected across levels of trauma exposure and PTSD symptomatology by a structured clinical interview. Participants were randomized to a personalized trauma or neutral cue, reporting on their urge to drink alcohol before and after cue exposure. Drinking motives were assessed at the end of the experimental session.

RESULTS

Trauma cue associations with drinking urge were moderated by coping, but not enhancement, motives. Specifically, stronger coping motives were associated with increases in urge to drink alcohol following exposure to a trauma but not neutral cue. PTSD classification did not significantly moderate these associations.

CONCLUSIONS

Coping motives may increase drinking urge immediately following exposure to trauma cues and may differentiate individuals most at risk for problematic drinking during trauma-associated distress. Findings support momentary negative affect processes driving dynamic, immediate trauma-related drinking risks.

Time series analysis of intensive longitudinal data in psychosomatic research: A methodological overview

Time series analysis of intensive longitudinal data provides the psychological literature with a powerful tool for assessing how psychological processes evolve through time. Recent applications in the field of psychosomatic research have provided insights into the dynamical nature of the relationship between somatic symptoms, physiological measures, and emotional states. These promising results highlight the intrinsic value of employing time series analysis, although application comes with some important challenges. This paper aims to present an approachable, non-technical overview of the state of the art on these challenges and the solutions that have been proposed, with emphasis on application towards psychosomatic hypotheses. Specifically, we elaborate on issues related to measurement intervals, the number and nature of the variables used in the analysis, modeling stable and changing processes, concurrent relationships, and extending time series analysis to incorporate the data of multiple individuals. We also briefly discuss some general modeling issues, such as lag-specification, sample size and time series length, and the role of measurement errors. We hope to arm applied researchers with an overview from which to select appropriate techniques from the ever growing variety of time series analysis approaches.

Dynamic Network Analysis of Negative Emotions and DSM-5 Posttraumatic Stress Disorder Symptom Clusters During Conflict

Investigating dynamic associations between specific negative emotions and PTSD symptom clusters may provide novel insights into the ways in which PTSD symptoms interact with, emerge from, or are reinforced by negative emotions. The present study estimated the associations among negative emotions and the four DSM-5 PTSD symptom clusters (intrusions, avoidance, negative alterations in cognitions and mood [NACM], and arousal) in a sample of Israeli civilians (n = 96) during the Israel-Gaza War of July-August 2014. Data were collected using experience sampling methodology, with participants queried via smartphone about PTSD symptoms and negative emotions twice a day for 30 days. We used a multilevel vector auto-regression model to estimate temporal and contemporaneous temporal networks. Contrary to our hypothesis, in the temporal network, PTSD symptom clusters were more predictive of negative emotions than vice versa, with arousal emerging as the strongest predictor that negative emotions would be reported at the next measurement point; fear and sadness were also strong predictors of PTSD symptom clusters. In the contemporaneous network, negative emotions exhibited the strongest associations with the NACM and arousal PTSD symptom clusters. The negative emotions of sadness, stress, fear, and loneliness had the strongest associations to the PTSD symptom clusters. Our findings suggest that arousal has strong associations to both PTSD symptoms and negative emotions during ongoing trauma and highlights the potentially relevant role of arousal for future investigations in primary or early interventions.

Studying the "sexuality-health-technology nexus": a new materialist visual methodology

A school of critical sexual health scholars argues that biomedical and digital technologies need to be understood not as mere objects of use, but as having the agentic capacity to effect new senses of the self and transform social/sexual health relations and outcomes. Such a call to grapple with the multidimensionality of technologies, their affects and effects poses a challenge to current methodological frameworks. To address this challenge, we introduce a novel visual methodology called "embodied mapping" that builds on the arts-based method of body mapping. Drawing from new materialism scholarship, embodied mapping extends the scope of inquiry of sexual-health research and conventional qualitative methods. It does so by interrogating the capacities and properties of sexual agents, technologies and readily available discourses on sexual health and HIV prevention as co-constitutive within the sexual-health-technologies nexus itself. Embodied mapping's research process is collaborative and emergent; researchers, together with an artist and research participants co-create a visual collage tracing the thick moments of sexual/health encounters. Embodied mapping's methodological and analytical capacity to approach sexual health phenomena as performative and immanent to the research process could open new sight lines for comprehending and intervening in this globalised era marked by an increasing technologising of sexual health care.

Dynamic networks of PTSD symptoms during conflict

BACKGROUND

Conceptualizing posttraumatic stress disorder (PTSD) symptoms as a dynamic system of causal elements could provide valuable insights into the way that PTSD develops and is maintained in traumatized individuals. We present the first study to apply a multilevel network model to produce an exploratory empirical conceptualization of dynamic networks of PTSD symptoms, using data collected during a period of conflict.

METHODS

Intensive longitudinal assessment data were collected during the Israel-Gaza War in July-August 2014. The final sample (n = 96) comprised a general population sample of Israeli adult civilians exposed to rocket fire. Participants completed twice-daily reports of PTSD symptoms via smartphone for 30 days. We used a multilevel vector auto-regression model to produce contemporaneous and temporal networks, and a partial correlation network model to obtain a between-subjects network.

RESULTS

Multilevel network analysis found strong positive contemporaneous associations between hypervigilance and startle response, avoidance of thoughts and avoidance of reminders, and between flashbacks and emotional reactivity. The temporal network indicated the central role of startle response as a predictor of future PTSD symptomatology, together with restricted affect, blame, negative emotions, and avoidance of thoughts. There were some notable differences between the temporal and contemporaneous networks, including the presence of a number of negative associations, particularly from blame. The between-person network indicated flashbacks and emotional reactivity to be the most central symptoms.

CONCLUSIONS

This study suggests various symptoms that could potentially be driving the development of PTSD. We discuss clinical implications such as identifying particular symptoms as targets for interventions.

"Just Take a Moment and Breathe and Think": Young Women with Depression Talk about the Development of an Ecological Momentary Intervention to Reduce Their Sexual Risk

STUDY OBJECTIVE

Depressed young women are at increased risk for adverse outcomes related to sexual behavior, including unintended pregnancy, HIV, and other sexually transmitted infections. Brief sexual risk reduction interventions have not targeted depressed young women's specific needs for affect management and impulse control. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We interviewed depressed young women ages 15-23 years engaging in sexual risk behavior about a proposed intervention approach. The approach was described as in-person counseling and cognitive-behavioral skills training, followed by an ecological momentary intervention (EMI) delivered via smartphone application for 4 weeks. The EMI would include reporting multiple times a day on affective states, self-efficacy for safer sex behavior, and sexual behavior, and receiving responsive messages to provide support and prompt use of cognitive-behavioral skills. Participants provided their perspectives on comfort, usability, burden, confidentiality, and potential efficacy of the EMI and recommended message content. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis.

RESULTS

Thematic saturation was reached with 16 interviews. Participants expressed positive opinions about the EMI. They believed that reporting at random times would help them to recognize their feelings, receiving the messages would be reassuring, and overall the smartphone application would be experienced as therapeutic. They desired a high degree of personalization of the message quality, style, and voice, and provided a wide variety of message content.

CONCLUSION

Depressed young women believed that a flexible, personalized approach to mobile momentary intervention for addressing the link between their symptoms and behavior would be acceptable, supportive, and effective in reducing sexual risk.

Trauma-related memories in PTSD after interpersonal violence: an ambulatory assessment study

Background: Ambulatory assessment (AA) is increasingly recommended for assessing symptoms of posttraumatic stress disorder (PTSD). Previous AA studies provided new insights into the phenomenology of trauma-related memories, but also divergent findings. Notably, the range of trauma-related memories (a major target of psychotherapeutic interventions) reported in AA studies was as wide as 7.3 to 74.5 per week which might result from different methods used in these studies. Objective: We aimed at assessing the frequency of trauma-related memories in PTSD related to interpersonal violence and investigated whether this frequency is dependent upon the method. Method: For each patient trauma-related memories were assessed using two variants of smartphone-based AA: (1) Event-based sampling (EBS), i.e. participants entered data on each intrusive memory as it occurred; (2) Time-based sampling (TBS), i.e. participants reported the number of trauma-related memories they had experienced during the last two hours after they had been alerted by the smartphone. The numbers reported during the TBS-block were either analysed as reported by the participants or restricted to one per hour (rTBS). The impact of smartphone-assessments on trauma-related memories was assessed during a post-monitoring questionnaire. Results: While trauma-related memories were frequent across assessments, the methodology had a huge impact on the numbers: EBS (median = 7) and rTBS (median = 6) yielded significantly lower weekly numbers of intrusive trauma-related memories than TBS (median = 49). Accordingly, the possibility to report unrestricted numbers of trauma-related memories clearly impacted the results. The post-monitoring questionnaire identified another source for the divergent findings: while feeling disrupted by the smartphone-assessments was unrelated to the numbers reported during EBS, feeling disrupted was related to an increase of trauma-related memories during TBS and rTBS. Conclusions: The method clearly impacts the recorded number of trauma-related memories. Future research should clarify whether other variables (e.g. the subjective stress related to intrusive memories) are less dependent on the methodology.