Social problem solving and autobiographical memory in posttraumatic stress disorder

The Effects of the Processing of Positive Memories Technique on Posttrauma Affect and Cognitions Among Survivors of Trauma: Protocol for a Daily Diary Study

BACKGROUND

The Processing of Positive Memories Technique (PPMT) is a promising new treatment approach for posttraumatic stress disorder (PTSD), which involves detailed narration and processing of specific positive autobiographical memories. Indeed, preliminary case-series studies have found reductions in PTSD symptoms, negative affect, and negative cognitions among survivors of trauma who have received PPMT. However, PPMT's effects have not been investigated at the daily level. In this study, we describe the protocol for a study that will examine the daily-level impacts of PPMT in a trauma-exposed, nonclinical community sample.

OBJECTIVE

This study uses an innovative research protocol that combines case-series design and daily diary approaches to examine changes in daily affect, daily cognitions, and daily PTSD symptoms pre- and post-PPMT. We hypothesize that at the daily level, in comparison to their own pre-PPMT levels, following the PPMT intervention, participants will report (1) a lower count of endorsed daily PTSD symptoms, (2) increases in daily positive affect and decreases in daily negative affect, (3) increases in positive affect reactivity to daily positive events, and (4) decreases in daily posttrauma cognitions.

METHODS

We are currently recruiting participants (target n=70) from a metroplex in the southwest United States. Following a screening survey, eligible participants complete a preintervention baseline survey, followed by 21 daily surveys in their natural environments. Then, they receive 4 PPMT sessions on a weekly basis. After the conclusion of the PPMT intervention, participants complete a postintervention outcome survey and 21 daily surveys. To compare daily affect, daily cognitions, and daily PTSD symptoms before and after PPMT, we will use the daily diary report data and conduct multilevel random intercepts and slopes linear regression models.

RESULTS

Data collection was initiated in March 2022 and is expected to end by June 2024. As of November 28, 2023, a total of 515 participants had consented to the study in the screening phase. No analyses will be conducted until data collection has been completed.

CONCLUSIONS

Study findings could clarify whether deficits in positive autobiographical memory processes may also characterize PTSD alongside deficits in traumatic memory processes. Furthermore, PPMT could be an additional therapeutic tool for clinicians to help clients reduce posttraumatic distress in their everyday lives.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51838.

Atypical Interpersonal Problem-Solving and Resting-state Functional Connectivity in Adolescents with Maltreatment Experience

BACKGROUND

Childhood maltreatment is associated with altered neurocognitive functioning, which is thought to reflect, in part, adaptation to early adverse environmental experiences. However, we continue to lack a precise mechanistic understanding linking atypical neurocognitive processing with social functioning and psychiatric outcomes following early adversity.

OBJECTIVE

The present work investigated interpersonal problem-solving, resting-state functional connectivity (rsFC), and mental health symptoms in adolescents with documented maltreatment experience and explored whether altered neural function contributes in part to poorer social functioning.

METHODS

Forty adolescents (aged 12-17) with documented experiences of abuse or neglect and a carefully matched group of 42 non-maltreated peers participated in this study that measured task-based interpersonal problem-solving skills and rsFC.

RESULTS

Adolescents with maltreatment experience showed poorer interpersonal problem-solving performance, which partly accounted for their elevated mental health symptoms. Resting-state seed-based analyses revealed that adolescents with maltreatment experience showed a significant increase in rsFC between medial Default Mode Network (DMN) hubs, the medial prefrontal cortex (mPFC), with a posterior cluster, including the posterior cingulate cortex (PCC), precuneus (PCu), retrosplenial cortex (RSC), and lingual gyrus (LG). Moderation analyses revealed that maltreatment-related increased DMN rsFC partly accounted for poorer performance in interpersonal problem-solving.

CONCLUSION

Poorer interpersonal problem-solving, partly accounted for by atypical coupling between DMN medial hubs, was associated with maltreatment exposure. Interventions tailored to enhance interpersonal problem-solving represents a promising avenue to promote resilience and reduce the likelihood of mental health disorder following maltreatment experience.

Impacts of repeated retrieval of positive and neutral memories on posttrauma health: An investigative pilot study

BACKGROUND AND OBJECTIVES

Evidence indicates that positive memory processes play a role in the etiology and maintenance of posttraumatic stress symptoms (PTSS) and related posttrauma health indicators. To extend this research, the current pilot study examined if repeated retrieval of positive vs. neutral memories was associated with (1) less PTSS and depression severity; and (2) improved affect and cognitions (fewer posttrauma cognitions, more positively-valenced affect, less negatively-valenced affect, less negative affect interference, less anhedonia, retrieval of more positive specific memories, retrieval of fewer negative specific memories).

METHODS

Twenty-five trauma-exposed participants were randomly assigned to a positive or neutral memory task condition. They participated in four weekly experimental sessions facilitated by an experimenter virtually; each consecutive session was separated by 6-8 days. We conducted mixed between-within subjects ANOVAs to examine study hypotheses.

RESULTS

No interaction effects were significant. There were significant main effects of time on PTSS and depression severity, posttrauma cognitions, positively-valenced and negatively-valenced affect, and negative affect interference.

LIMITATIONS

We used self-report measures, small and non-clinical sample with limited demographic diversity, and virtual format; did not record memory narratives; and did not have a trauma memory condition.

CONCLUSIONS

Based on pilot data, our findings suggest that individuals who retrieve positive or neutral memories repeatedly may report less PTSS and depression severity, fewer posttrauma cognitions, and improved affect. Results provide an impetus to examine impacts of and mechanisms underlying memory interventions (beyond a sole focus on negatively-valenced memories) in trauma work.

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.

Attachment processes in posttraumatic stress disorder: A review of mechanisms to advance theories and treatments

Current conceptualisations of posttraumatic stress disorder (PTSD) are driven by biological, learning, and cognitive models that have shaped current treatments of the disorder. The strong influence of these models has resulted in a relative neglect of social mechanisms that can influence traumatic stress. There is abundant evidence from experimental, observational, and clinical studies that social factors can moderate many of the mechanisms articulated in prevailing models of PTSD. In this review it is proposed that attachment theory provides a useful framework to complement existing models of PTSD because it provides explanatory value for social factors can interact with biological, learning, and cognitive processes that shape traumatic stress response. The review provides an overview of attachment theory in the context of traumatic stress, outlines the evidence for how attachment factors can moderate stress responses and PTSD, and considers how harnessing attachment processes may augment recovery from and treatment of PTSD. This review emphasizes that rather than conceptualizing attachment theory as an independent theory of traumatic stress, there is much to gain by integrating attachment mechanisms into existing models of PTSD to accommodate the interactions between cognitive, biological, and attachment processes.

Autobiographical memory predicts postsurgical pain up to 12 months after major surgery

ABSTRACT

Recent cross-sectional studies have identified differences in autobiographical memory (AM) among individuals with chronic pain, but the temporal relationship between the 2 is unknown. Moreover, AM has yet to be studied in patients undergoing major surgery. This study addressed these gaps by conducting a prospective, longitudinal study of memory performance, postsurgical pain, and psychosocial factors in 97 adult participants scheduled for major surgery. Memories were evaluated using the Autobiographical Memory Test before and one month after surgery when participants were asked to recall personal events related to positive and pain-related word cues. Responses were coded for level of specificity, emotional valence, and surgery-related content. Questionnaires assessing presence/absence of pain and psychological functioning were administered before and at 1-, 3-, 6-, and 12-month follow-ups. Generalized estimating equations modelled pain at each postsurgical time point with memory variables as predictors. As hypothesized, higher numbers of specific pain memories recalled before surgery predicted lower odds of pain across all time points (OR = 0.58, 95% CI [0.37-0.91]). Participants who took longer to recall pain memories before surgery (OR = 2.65, 95% CI [1.31-5.37]) and those who produced more surgery-related content at the one-month assessment (OR = 1.31, 95% CI [1.02-1.68]) had greater odds of reporting postsurgical pain up to 12 months later. These findings indicate that presurgical AM biases are risk factors for development and maintenance of postsurgical pain. To the extent that these biases are causal, presurgical interventions that modify the quality and content of patients' memories may prove to be promising strategies in the prevention of chronic postsurgical pain.

Factors Related to Positive Memory Count Among Trauma-Exposed Individuals: A Scoping Review

To examine the existing knowledge base on trauma experiences and positive memories, we conducted a scoping review of trauma and post-trauma factors related to positive memory count. In July 2019, we searched PubMed, Medline, PsycINFO, Web of Science, Cumulative Index of Nursing and Allied Health Literature, Embase, and PTSDpubs for a combination of words related to "positive memories/experiences," "trauma/posttraumatic stress disorder (PTSD)," and "number/retrieval." Twenty-one articles met inclusion criteria (adult samples, original articles in English, peer-reviewed, included trauma-exposed group or variable of trauma exposure, trauma exposure examined with a trauma measure/methodology, assessed positive memory count, empirical experimental/non-experimental study designs). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, two authors reviewed abstracts, completed a secondary search, and independently extracted data. Our review indicated (1) that depression and PTSD were most researched; (2) no conclusive relationships of positive memory count with several psychopathology (depression, acute stress disorder, eating disorder, and anxiety), cognitive/affective, neurobiological, and demographic factors; (3) trends of potential relationships of positive memory count with PTSD and childhood interpersonal traumas (e.g., sexual and physical abuse); and (4) lower positive memory specificity as a potential counterpart to greater overgeneral positive memory bias. Given variations in sample characteristics and methodology as well as the limited longitudinal research, conclusions are tentative and worthy of further investigations.

Social thinning and stress generation after childhood maltreatment: a neurocognitive social transactional model of psychiatric vulnerability

Childhood maltreatment is associated with significant, enduring risk of psychiatric disorder. In this paper, we review how neurocognitive alterations after maltreatment might indirectly increase the risk of psychiatric disorder via their impact on social functioning. We propose a neurocognitive social transactional model, within which the neurocognitive sequelae of maltreatment are postulated to affect how an individual's social architecture is constructed across development, including the quality and quantity of relationships in an individual's social network. We review extant evidence in two areas in relation to maltreatment: stress generation (a process by which individuals are more likely to experience interpersonal stressor events) and social thinning (an attenuation in the number and quality of relationships over time). We consider how neurocognitive alterations could contribute to these interactive and autocatalytic social processes, which gradually impoverish an individual's actual or potential social environment and ultimately increase psychiatric risk. We conclude by considering the implications of this neurocognitive social transactional model for the prevention of psychiatric disorder after childhood maltreatment.

Brief inductions in episodic past or future thinking: effects on episodic detail and problem-solving

Episodic specificity inductions, involving brief training in recollecting episodic details, have been shown to improve subsequent performance on tasks involving remembering the past, imagining the future and problem solving. The current study examined if specificity inductions targeting self-referential past or future episodic thinking would have dissociable effects on generating past and future episodic detail and problem solving. Sixty-three participants were randomised to either a past self-referential or future self-referential episodic induction. All participants also completed a control task. Participants randomised to the self-referential future thinking induction generated more episodic details on past and future narrative tasks compared to a control task, whereas participants randomised to a self-referential past thinking induction showed similar performance to the control task. When examining within-group performance of participants randomised to the past or future induction, we found some evidence of dissociable effects of inductions on narrative generation tasks, but not on problem solving outcomes. Our findings suggest that self-referential inductions may be useful for increasing episodic specificity, but that the temporal distance and direction of the induction matters. We discuss our results in the context of the potential clinical utility of this approach for populations vulnerable to autobiographical memory disruption.

Autobiographical recall of a stressful negative event in veterans with PTSD

Posttraumatic stress disorder (PTSD) is characterised by alterations in autobiographical memory for traumatic and non-traumatic events. Studies that focus on event construction - the ability to search for and identify a specific event - have documented overgeneral memory in PTSD. However, the quality of autobiographical memory also depends on the ability to elaborate on an event once constructed by providing additional details. In a prior study, individuals with PTSD generated as many episodic (event-specific) details as trauma-exposed controls when demands on event construction were minimized, albeit the PTSD group generated more non-episodic details. The current study sought to further characterize PTSD-related alterations in event elaboration by asking participants to describe a stressful negative event specified by the experimenter, thus minimizing event construction demands. Narratives were scored for episodic and non-episodic details and relations with measures of executive function and self-reported avoidance were examined. Compared to controls, the PTSD group generated narratives with equivalent episodic detail but greater non-episodic detail, including semantic information and repeated or extended events. Non-episodic detail generation was associated with greater avoidance but not executive functions. Elaborated non-trauma memories may be perceived as overgeneral in PTSD due to greater generation of non-episodic details, rather than diminished episodic detail.

A critical review of mechanisms of adaptation to trauma: Implications for early interventions for posttraumatic stress disorder

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.

Examining relations of polytraumatization typologies with positive memory count and phenomenology

Background and Objectives: Most individuals experience multiple potentially traumatizing events (PTEs); hence, it is important to consider count and types of PTEs (polytraumatization) in relation to post-trauma health. Notably, no research has examined polytraumatization typologies in relation to positive memory count and phenomenology. We examined (1) latent subgroupings of individuals based on PTE endorsements; and (2) relation of the optimal latent class solution to positive memory count and phenomenology. Design: Participants were 203 trauma-exposed adults (Mage  = 35.40; 61.10% females); we used PTEs endorsed on the Life Events Checklist for DSM-5 as indicators for analyses. Results: Latent class analyses indicated a three-class solution differing in quantity and quality of PTE types: Low Experience, Predominant Interpersonal PTEs, and Predominant Non-Interpersonal PTEs. Further, more positive memories predicted membership in the Low Experience vs. other classes; greater sensory details of a positive memory predicted membership in the Low Experience vs. the Predominant Interpersonal PTEs Classes; and greater accessibility of a positive memory predicted membership in the Predominant Interpersonal PTEs vs. the Predominant Non-Interpersonal PTEs Classes. Conclusions: Results indicated three meaningful subgroups endorsing differing levels/types of PTEs; count, sensory details, and accessibility of positive memories, pending further investigation, may differentiate these subgroups.

Trauma, posttraumatic stress disorder severity, and positive memories

Positive memories play an important role in the aetiology and maintenance of posttraumatic stress disorder (PTSD). However, most trauma research/clinical work has focused solely on the role of traumatic memories. Thus, we examined the relationship between count of retrieved positive memories and PTSD severity, factors associated with count of retrieved positive memories (i.e., rumination, negative/positive emotion dysregulation, fear of positive emotions), and the relationship between positive memory phenomenological domains and PTSD severity. The sample included 185 trauma-exposed participants recruited through Amazon's Mechanical Turk (Mage = 35.69 years; 63.80% female). Results of linear/hierarchical regressions showed that (1) PTSD severity did not predict count of (specific) positive memories; (2) greater positive emotion dysregulation predicted fewer retrieved positive memories controlling for PTSD severity; and (3) greater PTSD severity predicted more negative valence, less vividness, less coherence, less accessibility, less clear time perspective, fewer sensory details, and greater distancing ratings of the retrieved positive memory, controlling for sleep quantity/quality. Findings add to the literature by informing PTSD theoretical perspectives; enhancing an understanding of positive memories in PTSD/trauma treatments; and highlighting potential clinical targets (e.g., positive emotion regulation), when integrating a focus on positive memories into PTSD intervention.

Posttraumatic stress and autobiographical memory in chronic pain patients

Background and aims Posttraumatic stress disorder (PTSD) is related to more severe pain among chronic pain patients. PTSD is also related to dysfunctions or biases in several cognitive processes, including autobiographical memory. The autobiographical memories are our memories of specific personal events taking place over a limited amount of time on a specific occasion. We investigated how two biases in autobiographical memory, overgeneral memory style and negative emotional bias were related to pain, PTSD and trauma exposure in chronic pain patients. Methods Forty-three patients with diverse chronic pain conditions were recruited from a specialist pain clinic. The patients were evaluated for psychiatric diagnosis, with a diagnostic interview Mini-International Neuropsychiatric Interview (M.I.N.I) and for exposure to the most common types of traumatic events with the Life Event Checklist (LEC). The patients were tested with the 15-cue-words version of the Autobiographical Memory Test (AMT). In this test the participants are presented verbally to five positive, five neutral and five negative cue words and asked to respond with a personal, episodic memory associated with the cue word. The participant's responses were coded according to level of specificity and emotional valence. Pain intensity was assessed on a Visual Analogy Scale (VAS) and extent of pain by marking affected body parts on a pre-drawn body figure. Comparisons on autobiographical memory were made between PTSD and non-PTSD groups, and correlations were computed between pain intensity and extent of pain, trauma exposure and autobiographical memory. Results PTSD and extent of pain were significantly related to more negatively emotionally valenced memory responses to positive and negative cue words. There were no significant difference in response to neutral cue words. PTSD status and pain intensity were unrelated to overgeneral autobiographical memory style. Conclusions A memory bias towards negatively emotionally valenced memories is associated with PTSD and extent of pain. This bias may sustain negative mood and thereby intensify pain perception, or pain may also cause this memory bias. Contrary to our expectations, pain, trauma exposure and PTSD were not significantly related to an overgeneral memory style. Implications Cognitive therapies that have an ingredient focusing on amending memory biases in persons with comorbid pain and PTSD might be helpful for this patient population. Further investigations of negative personal memories and techniques to improve the control over these memories could potentially be useful for chronic pain treatment.

Perceptions of HIV-related trauma in people living with HIV in Zimbabwe's Friendship Bench Program: A qualitative analysis of counselors' and clients' experiences

This study investigated the experience of lay health workers (LHWs) delivering problem-solving therapy (PST) for common mental disorders (CMD) as well as clients' views of the PST program referred to as the Friendship Bench (FB). Semi-structured interviews were conducted with LHWs (n = 5) and clients living with HIV (PLWH) (n = 10). Data were analyzed using thematic content analysis. LHWs described a severe form of CMD amongst PLWH with a history of trauma, naming it kufungisisa kwe njodzi (excessive thinking due to trauma), a local cultural equivalent of PTSD. The term kufungisisa (thinking too much) has been used as the local equivalent for CMD. Trauma or njodzi was seen both as a circumscribed event and as linked to ongoing pervasive experiences such as living with HIV, stigma, and poverty. Although LHWs recognized symptoms of PTSD such as intrusion, avoidance, and hyper-arousal, they did not know how to address these specifically and chose to address them as a severe form of kufungisisa. There is a need to integrate aspects of PTSD management within care packages for CMD delivered by LHWs.

Relation between PTSD symptom clusters and positive memory characteristics: A network perspective

Positive memory characteristics relate to posttraumatic stress disorder (PTSD) severity. We utilized a network approach to examine relations between PTSD clusters (intrusions, avoidance, negative alterations in cognitions and mood [NACM], alterations in arousal and reactivity [AAR]) and positive memory characteristics (count, accessibility, valence, vividness, coherence, time perspective, sensory details). We identified differential relations between PTSD clusters and positive memory characteristics, and central/bridging symptoms. Participants were an Amazon Mechanical Turk-recruited sample of 206 individuals (M_age = 35.36; 61.20% females). We estimated a regularized Gaussian Graphic Model comprising four nodes representing the PTSD clusters and six nodes representing positive memory characteristics. Regarding cross-community relations, AAR (highest node strength) was negatively associated with positive memory count, valence, coherence, and accessibility; avoidance was positively and negatively associated with positive memory vividness and count respectively. The NACM-AAR and intrusion-avoidance edges were significantly stronger than most edges. From the PTSD community, AAR and avoidance had the highest bridge strength and bridge expected influence respectively; from the positive memory community, coherence and vividness had the highest bridge strength and bridge expected influence respectively. Results indicate the potential pivotal role of AAR, avoidance, coherence, and vividness in the PTSD-positive memory relation, which renders them assessment/treatment targets pending further investigation.

Efficacy of online Memory Specificity Training in adults with a history of depression, using a multiple baseline across participants design

BACKGROUND AND OBJECTIVES

Memory Specificity Training (MeST), a group training protocol, is effective in improving autobiographical memory specificity (AMS), and in so doing, reducing emotional disorder symptoms amongst clinical groups. We examined MeST's effectiveness when the core component (memory specificity trials) is offered online and individually (c-MeST).

METHODS

A multiple-baseline across-participants design with a randomization-to-baseline length (14 to 33 days) was used. Participants were twenty adults (16 female; M age  = 50, SD = 12) experiencing reduced AMS, at least one lifetime depressive episode and who currently reported at least minimal depressive symptoms. During baseline, the training phase (nine sessions across 17 days) and a three-month follow-up assessment, AMS, depressive symptoms and related processes were measured.

RESULTS

AMS improved significantly by three months follow-up. Session-to-session scores indicated that AMS improved most from baseline to the first online session, with no further improvement thereafter. In contrast to studies with clinical participants, no significant change in symptoms or secondary processes such as rumination was found.

CONCLUSIONS

Translating MeST into an online, individual version is a feasible, low-cost intervention for reduced AMS. Future research should examine c-MeST's potential for preventing increases in symptoms in at-risk samples with longer follow-ups as well as its potential for reducing symptoms in clinical groups.

Social problem solving in social anxiety disorder

Successful social problem solving requires both an adaptive orientation toward the problem and the necessary skills to generate relevant and effective solutions. Surprisingly few studies have examined social problem solving in the context of social anxiety. We examined social problem solving in 38 participants with social anxiety disorder (SAD) in comparison to 30 healthy control (HC) participants with no history of anxiety problems. Participants rated their problem solving attitudes and abilities (i.e., problem orientation) and then generated solutions to hypothetical interpersonal problems from both their own perspective and that of an objective other. These solutions were coded for effectiveness and relevance, as well as the degree to which the solution was active versus passive. Participants with SAD exhibited a more negative problem orientation than HC participants. Furthermore, although SAD and HC participants demonstrated no overall differences in generating relevant and effective solutions to interpersonal problems, utilizing a personal perspective facilitated the generation of more active solutions for HC participants, but less active solutions for those with SAD. Findings illuminate new research directions regarding social problem solving in social anxiety, with potential implications for applied intervention.

Relation of positive memory recall count and accessibility with post-trauma mental health

Positive memory encoding and retrieval deficits have an empirical relation with several post-trauma outcomes. Drawing from the Contractor et al. model, we examined relations between positive memory characteristics and post-trauma mental health indicators. A trauma-exposed community sample of 203 participants (Mage = 35.40 years; 61.10% female) was recruited via Amazon's Mechanical Turk. Participants completed measures of posttraumatic stress disorder (PTSD; PTSD Checklist for DSM-5), depression (Patient Health Questionnaire-9), posttraumatic cognitions (Posttraumatic Cognitions Inventory), affect (Positive and Negative Affect Schedule), count/number of recalled specific positive memories (Autobiographical Memory Test) and accessibility of a specific positive memory (i.e., subjective ease of recalling details of a memory; Memory Experiences Questionnaire-Short Form). Linear regression results indicated that PTSD intrusion severity, PTSD negative alterations in cognitions and mood (NACM) severity, PTSD alterations in arousal and reactivity (AAR) severity, self-blame, and positive affect significantly and negatively predicted the count of specific positive memories. Further, PTSD NACM severity, PTSD AAR severity, negative cognitions about the self, and negative affect significantly and negatively predicted accessibility of a specific positive memory. Thus, count/accessibility of specific positive memories was associated with several post-trauma mental health indicators; this highlights the relevance and potential impact of integrating positive memories into trauma treatment.

Reduced autobiographical memory specificity affects general distress through poor social support

Sharing specific autobiographical events is likely to influence the support people give us; a person who shares little detail of their lives may be unlikely to attract social support and this may in turn contribute towards anxious and depressive symptoms. Participants (N = 142) reported memories evoked by negative and positive cue words and these memories were coded for whether or not they referred to a specific event lasting less than 24 h. At this time (T1) and one year later (T2), participants also completed the UCLA Life Stress Interview (LSI), which includes a measure of social support, and measures of depression and anxiety comprising a general distress latent construct. The tendency to recall fewer specific memories was associated with lower social support given by friends and romantic partners and this was in turn associated with elevated general distress at T2, even when accounting for T1 social support and general distress. Our findings contribute to the literature regarding the social function of memory and suggest another route via which reduced specificity contributes to emotional disorders.

Cannabis-associated impairments in the fading affect bias and autobiographical memory specificity

We investigated potential relationships between cannabis use and 2 phenomena associated with autobiographical remembering: the fading affect bias (FAB) and memory specificity. The FAB is an emotional affect regulation mechanism that is observed when the intensity of affect associated with experiencing negative memories fades faster than the intensity of affect associated with experiencing positive memories. Memory specificity refers to the level of detail with which events are recalled. No studies have examined the relationships between cannabis use, the FAB, and memory specificity simultaneously. Chronic cannabis users (N = 47) and non-users (N = 52) recalled and described positive and negative autobiographical events and rated the affective intensity for the events at the time of occurrence and at time of test. Participants retrieved additional memories using a sentence-completion recall task, which were coded for specificity. Cannabis users showed reduced fading affect for unpleasant events and reduced memory specificity compared to non-users.

The Association Between Posttraumatic Negative Self-Conscious Cognitions and Emotions and Maladaptive Behaviors: Does Time Since Trauma Exposure Matter?

Negative beliefs about the self, self-blame, guilt, and shame have been consistently linked to emotional problems, such as posttraumatic stress disorder and depression, following trauma exposure. To expand understanding of the potential role of negative self-conscious cognitions and emotions in other forms of posttrauma maladjustments, such as maladaptive behaviors, the current study examined the associations between these cognitions and emotions with dissociation, alcohol use, and avoidant problem-solving. As a secondary goal, the influence of time since trauma exposure was considered given recent data suggesting that some posttraumatic responses require lengthier time following trauma to become salient. Multiple-group analysis was conducted in two groups of female survivors of intimate partner violence (IPV): women whose IPV experiences occurred within 3 months prior to assessment (early posttrauma phase [EPP]; n = 67) and those whose experiences occurred 12 months or more prior to assessment (chronic posttrauma phase [CPP]; n = 145). The results suggested model invariance. Posttraumatic negative self-conscious cognitions and emotions were significantly correlated with dissociation (EPP group: β = .61, p < .001 and CPP group: β = .48, p < .001), alcohol use (EPP group: β = .31, p = .014 and CPP group: β = .30, p < .001), and avoidant problem-solving (EPP group: β = .58, p < .001 and CPP group: β = .56, p < .001). The findings highlight the importance of negative self-conscious cognitions and emotions in posttrauma maladjustment and support intervening in these domains shortly after trauma exposure.

Not to worry: Episodic retrieval impacts emotion regulation in older adults

Interventions that increase the specificity of episodic memory and future-oriented problem solving have been shown to help both young adults and clinical populations regulate their emotions toward potential stressors. However, little is known about how episodic specificity impacts anxiety levels in older adults, who show reduced specificity of episodic memory, future simulation, and problem-solving performance. Although emotion regulation generally improves with age, older adults still experience worries pertaining to their health and interpersonal relationships. The current studies test how episodic specificity affects emotion regulation in older adults. In Experiment 1, participants received an episodic specificity induction (ESI)-brief training in recollecting details of past experiences-prior to generating steps to solve worrisome problems. Older adults provided more relevant steps and episodic details after the specificity induction relative to a control induction, but we found no difference in emotion regulation ratings between induction conditions. In Experiment 2, we contrasted performance on a personal problem-solving task (i.e., generating steps to solve one's own problems) intended to draw on episodic retrieval with an advice task focused on semantic processing (i.e., listing general advice for an acquaintance worried about similar problems). Participants provided more relevant steps and episodic details in the personal problem-solving task relative to the advice task, and boosts in detail were related to larger reductions in anxiety toward the target worrisome events. These results indicate that solving worrisome problems with greater levels of episodic detail can positively influence emotion regulation in older adults. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The transportability of Memory Specificity Training (MeST): adapting an intervention derived from experimental psychology to routine clinical practices

Background

Accumulating evidence shows that a cognitive factor associated with a worsening of depressive symptoms amongst people with and without diagnoses of depression – reduced Autobiographical Memory (rAMS) – can be ameliorated by a group cognitive training protocol referred to as Memory Specificity Training (MeST). When transporting interventions such as MeST from research to routine clinical practices (RCPs), modifications are inevitable, with potentially a decrease in effectiveness, so called voltage drop. We examined the transportability of MeST to RCPs as an add-on to treatment as usual with depressed in- and out- patients.

Methods

We examined whether 1) MeST was adaptable to local needs of RCPs by implementing MeST in a joint decision-making process in seven Belgian RCPs 2) without losing its effect on rAMS. The effectiveness of MeST was measured by pre- and post- intervention measurements of memory specificity.

Results

Adaptations were made to the MeST protocol to optimize the fit with RCPs. Local needs of RCPs were met by dismantling MeST into different subparts. By dismantling it in this way, we were able to address several challenges raised by clinicians. In particular, multidisciplinary teams could divide the workload across different team members and, for the open version of MeST, the intervention could be offered continuously with tailored dosing per patient. Both closed and open versions of MeST, with or without peripheral components, and delivered by health professionals with different backgrounds, resulted in a significant increase in memory specificity for depressed in- and out- patients in RCPs.

Conclusions

MeST is shown to be a transportable and adaptable add-on intervention which effectively maintains its core mechanism when delivered in RCPs.

Trial registration

ISRCTN registry, IDISRCTN10144349, registered on January 22, 2019. Retrospectively registered.

Electronic supplementary material

The online version of this article (10.1186/s40359-019-0279-y) contains supplementary material, which is available to authorized users.

Posttraumatic stress disorder and positive memories: Clinical considerations

Encoding and retrieval difficulties, and avoidance of both traumatic and positive memories, are associated with posttraumatic stress disorder (PTSD) symptoms. However, most PTSD research and clinical work has solely examined the role of traumatic memories in the maintenance/resolution of PTSD symptoms. This review provides a comprehensive discussion of the literature on positive memories and PTSD. First, we review theories and evidence on the relations between trauma, PTSD, and memory processes (particularly positive memories). Next, we propose a conceptual model that integrates evidence from experimental and positive/memory-based intervention research and highlights hypothesized mechanisms underlying the potential effectiveness of targeting positive memories in PTSD interventions. Specifically, we discuss how targeting positive memories could (1) increase positive affect and reduce negative affect, (2) correct negative cognitions, (3) increase specificity of retrieving autobiographical memories, and (4) be effectively integrated/sequenced with and enhance the effects of trauma-focused interventions. Lastly, we suggest clinical research avenues for investigating the relations between positive memories and PTSD, to possibly alter the current PTSD intervention paradigm focused only on traumatic memories. Overall, our proposed model drawing from experimental and intervention research, and outlining potential effects of targeting positive memories to reduce PTSD severity, needs further empirical investigation.

Emerging Directions in Emotional Episodic Memory

Building upon the existing literature on emotional memory, the present review examines emerging evidence from brain imaging investigations regarding four research directions: (1) Social Emotional Memory, (2) The Role of Emotion Regulation in the Impact of Emotion on Memory, (3) The Impact of Emotion on Associative or Relational Memory, and (4) The Role of Individual Differences in Emotional Memory. Across these four domains, available evidence demonstrates that emotion- and memory-related medial temporal lobe brain regions (amygdala and hippocampus, respectively), together with prefrontal cortical regions, play a pivotal role during both encoding and retrieval of emotional episodic memories. This evidence sheds light on the neural mechanisms of emotional memories in healthy functioning, and has important implications for understanding clinical conditions that are associated with negative affective biases in encoding and retrieving emotional memories.

Peritraumatic Assessment of Autobiographical Memory After Exposure to a Traumatic Event

Posttraumatic stress disorder (PTSD) is commonly acknowledged to be associated with reduced specificity of autobiographical memory (AM). However, very few studies have assessed AM in the peritraumatic phase. The aim of the present study was to examine whether the AM impairment reported in PTSD is present a few days after a traumatic event. We assessed AM in 41 participants who had recently been exposed to trauma, and 34 controls who had never experienced a traumatic situation. The trauma-exposed participants also completed the Impact of Event Scale-R (IES-R), the Inventory of Peritraumatic Distress, and the Peritraumatic Dissociative Experiences Questionnaire. Results showed that autobiographical memories cued by negative words were significantly less specific in the group of trauma-exposed participants than in the control group (p = .008; d = 0.40). Thus, mild AM impairment was already present three days after trauma exposure, long before acute PTSD set in.

Autobiographical memory: a candidate latent vulnerability mechanism for psychiatric disorder following childhood maltreatment

BackgroundAltered autobiographical memory (ABM) functioning has been implicated in the pathogenesis of depression and post-traumatic stress disorder and may represent one mechanism by which childhood maltreatment elevates psychiatric risk.AimsTo investigate the impact of childhood maltreatment on ABM functioning.MethodThirty-four children with documented maltreatment and 33 matched controls recalled specific ABMs in response to emotionally valenced cue words during functional magnetic resonance imaging.ResultsChildren with maltreatment experience showed reduced hippocampal and increased middle temporal and parahippocampal activation during positive ABM recall compared with peers. During negative ABM recall they exhibited increased amygdala activation, and greater amygdala connectivity with the salience network.ConclusionsChildhood maltreatment is associated with altered ABM functioning, specifically reduced activation in areas encoding specification of positive memories, and greater activation of the salience network for negative memories. This pattern may confer latent vulnerability to future depression and post-traumatic stress disorder.

Enhancing self-efficacy improves episodic future thinking and social-decision making in combat veterans with posttraumatic stress disorder

Posttraumatic Stress Disorder (PTSD) is associated with maladaptive changes in self-identity, including impoverished perceived self-efficacy. This study examined if enhancing perceptions of self-efficacy in combat veterans with and without symptoms of PTSD promotes cognitive strategies associated with positive mental health outcomes. Prior to completing a future thinking and social problem-solving task, sixty-two OEF/OIF veterans with and without symptoms of PTSD were randomized to either a high self-efficacy (HSE) induction in which they were asked to recall three autobiographical memories demonstrating self-efficacy or a control condition in which they recalled any three autobiographical events. An interaction between HSE and PTSD revealed that individuals with symptoms of PTSD in the HSE condition generated future events with more self-efficacious statements than those with PTSD in the control condition, whereas those without PTSD did not differ in self-efficacy content across the conditions. In addition, individuals in the HSE condition exhibited better social problem solving than those in the control condition. Increasing perceptions of self-efficacy may promote future thinking and problem solving in ways that are relevant to overcoming trauma and adversity.

Autobiographical Memory in the Angry Self

The impact of anger on autobiographical recall was examined in two studies. In Experiment 1, 76 participants differing in trait anger completed an autobiographical memory task (AMT). In Experiment 2, 50 participants with elevated trait anger were either provoked or not provoked and subsequently completed an AMT. Across both studies, participants with high dispositional anger reported more anger-related memories, describing themselves as the primary agent of anger. In Experiment 2, provoked participants reported more memories describing themselves as the target of anger. These findings highlight the distinct patterns of memory recall associated with trait versus state anger. Findings are discussed in terms of retrieval biases operating in angry individuals and proposals stemming from self-memory system models of autobiographical memory.

Worrying about the future: An episodic specificity induction impacts problem solving, reappraisal, and well-being

Previous research has demonstrated that an episodic specificity induction--brief training in recollecting details of a recent experience--enhances performance on various subsequent tasks thought to draw upon episodic memory processes. Existing work has also shown that mental simulation can be beneficial for emotion regulation and coping with stressors. Here we focus on understanding how episodic detail can affect problem solving, reappraisal, and psychological well-being regarding worrisome future events. In Experiment 1, an episodic specificity induction significantly improved participants' performance on a subsequent means-end problem solving task (i.e., more relevant steps) and an episodic reappraisal task (i.e., more episodic details) involving personally worrisome future events compared with a control induction not focused on episodic specificity. Imagining constructive behaviors with increased episodic detail via the specificity induction was also related to significantly larger decreases in anxiety, perceived likelihood of a bad outcome, and perceived difficulty to cope with a bad outcome, as well as larger increases in perceived likelihood of a good outcome and indicated use of active coping behaviors compared with the control. In Experiment 2, we extended these findings using a more stringent control induction, and found preliminary evidence that the specificity induction was related to an increase in positive affect and decrease in negative affect compared with the control. Our findings support the idea that episodic memory processes are involved in means-end problem solving and episodic reappraisal, and that increasing the episodic specificity of imagining constructive behaviors regarding worrisome events may be related to improved psychological well-being.

Memory Flexibility training (MemFlex) to reduce depressive symptomatology in individuals with major depressive disorder: study protocol for a randomised controlled trial

Background

Major depressive disorder (MDD) is associated with chronic biases in the allocation of attention and recollection of personal memories. Impaired flexibility in attention and autobiographical memory retrieval is seen to both maintain current symptoms and predict future depression. Development of innovative interventions to reduce maladaptive cognitive patterns and improve cognitive flexibility in the domain of memory may therefore advance current treatment approaches for depression. Memory specificity training and cognitive bias modification techniques have both shown some promise in improving cognitive flexibility. Here we outline plans for a trial of an innovative memory flexibility training programme, MemFlex, which advances current training techniques with the aim of improving flexibility of autobiographical memory retrieval. This trial seeks to estimate the efficacy of MemFlex, provide data on feasibility, and begin to explore mechanisms of change.

Methods/design

We plan a single-blind, randomised, controlled, patient-level trial in which 50 individuals with MDD will complete either psychoeducation (n = 25) or MemFlex (n = 25). After completing pre-treatment measures and an orientation session, participants complete eight workbook-based sessions at home. Participants will then be assessed at post-treatment and at 3 month follow-up. The co-primary outcomes are depressive symptoms and diagnostic status at 3 month follow-up. The secondary outcomes are memory flexibility at post-treatment and number of depression free days at 3 month follow-up. Other process outcomes and mediators of any treatment effects will also be explored.

Discussion

This trial will establish the efficacy of MemFlex in improving memory flexibility, and reducing depressive symptoms. Any effects on process measures related to relapse may also indicate whether MemFlex may be helpful in reducing vulnerability to future depressive episodes. The low-intensity and workbook-based format of the programme may improve access to psychological therapies, and, if encouraging, the results of this study will provide a platform for later-phase trials.

Trial registration

NCT02371291 (ClinicalTrials.gov), registered 9 February 2015.

Overgeneral autobiographical memory predicts higher prospective levels of depressive symptoms and intrusions in borderline patients

Overgeneral memory (OGM), the tendency to retrieve categories of events from autobiographical memory instead of single events, is found to be a reliable predictor for future mood disturbances and post-traumatic symptom severity. Patients with borderline personality disorder (BPD) often report co-morbid episodes of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). Therefore, we investigated whether OGM would predict depression severity and (post-traumatic) stress symptoms in BPD patients. At admission (N = 54) and at six-month follow-up (N ≥ 31), BPD patients completed the Structured Clinical Interview for DSM-IV Disorders, the Assessment of DSM-IV Personality Disorders, the Autobiographical Memory Test, the Beck Depression Inventory-2nd edition (BDI-II), and the Impact of Event Scale. OGM at baseline predicted (a) higher levels of depressive symptoms at follow-up and (b) more intrusions related to a stressful event over and above baseline levels of borderline symptoms, depressive symptoms, and intrusions, respectively. No association was found between memory specificity and event-related avoidance at follow-up. Despite previous findings suggesting that OGM in BPD is less robust than in MDD and PTSD, our results suggest that memory specificity in BPD patients may have some relevance for the course of depressive and stress symptomatology in BPD.

Social problem solving strategies and posttraumatic stress disorder in the aftermath of intimate partner violence

Social factors are often associated with the development or maintenance of posttraumatic stress disorder (PTSD) in the aftermath of interpersonal traumas. However, social problem solving strategies have received little attention. The current study explored the role of social problem solving styles (i.e., rational approaches, impulsive/careless strategies, or avoidance strategies) as intermediary variables between abuse exposure and PTSD severity among intimate partner violence survivors. Avoidance problem solving served as an intermediating variable for the relationship between three types of abuse and PTSD severity. Rational and impulsive/careless strategies were not associated with abuse exposure. These findings extend the current understanding of social problem solving among interpersonal trauma survivors and are consistent with more general avoidance coping research. Future research might examine whether avoidance problem solving tends to evolve in the aftermath of trauma or whether it represents a longstanding risk factor for PTSD development.

Treatment of post traumatic stress disorder symptoms in emotionally distressed individuals

Older individuals with emotional distress and a history of psychologic trauma are at risk for post traumatic stress disorder (PTSD) and major depression. This study was an exploratory, secondary analysis of data from the study "Prevention of Depression in Older African Americans". It examined whether Problem Solving Therapy-Primary Care (PST-PC) would lead to improvement in PTSD symptoms in patients with subsyndromal depression and a history of psychologic trauma. The control condition was dietary education (DIET). Participants (n=60) were age 50 or older with scores on the Center for Epidemiologic Studies-Depression scale of 11 or greater and history of psychologic trauma. Exclusions stipulated no major depression and substance dependence within a year. Participants were randomized to 6-8 sessions of either PST-PC or DIET and followed 2 years with booster sessions every 6 months; 29 participants were in the PST-PC group and 31 were in the DIET group. Mixed effects models showed that improvement of PTSD Check List scores was significantly greater in the DIET group over two years than in the PST-PC group (based on a group time interaction). We observed no intervention⁎time interactions in Beck Depression Inventory or Brief Symptom Inventory-Anxiety subscale scores.

An episodic specificity induction enhances means-end problem solving in young and older adults

Episodic memory plays an important role not only in remembering past experiences, but also in constructing simulations of future experiences and solving means-end social problems. We recently found that an episodic specificity induction-brief training in recollecting details of past experiences-enhances performance of young and older adults on memory and imagination tasks. Here we tested the hypothesis that this specificity induction would also positively impact a means-end problem-solving task on which age-related changes have been linked to impaired episodic memory. Young and older adults received the specificity induction or a control induction before completing a means-end problem-solving task, as well as memory and imagination tasks. Consistent with previous findings, older adults provided fewer relevant steps on problem solving than did young adults, and their responses also contained fewer internal (i.e., episodic) details across the 3 tasks. There was no difference in the number of other (e.g., irrelevant) steps on problem solving or external (i.e., semantic) details generated on the 3 tasks as a function of age. Critically, the specificity induction increased the number of relevant steps and internal details (but not other steps or external details) that both young and older adults generated in problem solving compared with the control induction, as well as the number of internal details (but not external details) generated for memory and imagination. Our findings support the idea that episodic retrieval processes are involved in means-end problem solving, extend the range of tasks on which a specificity induction targets these processes, and show that the problem-solving performance of older adults can benefit from a specificity induction as much as that of young adults.