Relationships between memory inconsistency for traumatic events following 9/11 and PTSD in disaster restoration workers

Challenging memories reduces intrusive memories and the memory amplification effect

This study scrutinizes the influence of attenuating beliefs about the veracity of traumatic experiences on the manifestation of intrusive recollections and the memory amplification effect. Participants were exposed to distress-inducing visual stimuli, subsequently rating their emotional status pre and post exposure. They engaged in a recognition task, identifying scenarios within the stimuli. Participants' recall was contested, casting doubt about the occurrence of certain scenes. Subsequently, they maintained a daily log of intrusive memories over a week. A second session reiterated the same process. This method effectively diminished the certainty in the participants' traumatic memories. Scenes whose occurrence was contested demonstrated a significant decline in both intrusive memories and memory amplification when juxtaposed with uncontested ones. Interestingly, no significant correlation emerged between the diminished belief in traumatic incidents and reductions in intrusive memory or memory amplification. Thus, this study advocates that interrogating the veracity of traumatic recollections can mitigate the prevalence of intrusive memories and the memory amplification effect, suggesting a novel potential therapeutic approach for trauma-related disorders.

Performance and acceptability of the Stressful Life Events Screening Questionnaire in a chronic pain population: a mixed-methods study

Introduction

Pain-related fear, anxiety, and avoidance may play key roles in the chronification of pain and related disability. For practitioners, knowledge about the source or drivers of these fears, including patients' exposure to potentially traumatic events (PTEs) and related posttraumatic stress symptoms, could be particularly helpful in guiding their treatment approach.

Objectives

We aimed to investigate whether the use of a brief screening for PTEs could help inform chronic pain treatment.

Methods

The performance and acceptability of the Stressful Life Events Screening Questionnaire (SLESQ) was assessed among 567 adult patients (59% women, mean age 48.1 years) meeting at a hospital outpatient pain clinic. The sensitivity, specificity, and 20 months temporal stability of the SLESQ, assessing exposure to 14 specific trauma types followed by a 15th item capturing exposure to "other events," were assessed through digital administration and follow-up interviews with 55 participants. The qualitative responses of 158 participants reporting exposure to "other events" were reviewed and assessed based on fulfillment of the A Criterion for traumatic events in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The acceptability of the SLESQ was assessed in clinical interviews with 12 participants.

Results

The SLESQ demonstrated acceptable sensitivity (70.0%), high specificity (94.9%), and moderate temporal stability (κ = 0.66, P < 0.001). Participants' qualitative elaborations of "other events" were largely (76.3%) consistent with Criterion A events. The screening was well accepted and welcomed.

Conclusion

The results indicate that the use of a brief screening for potential trauma may be helpful to guide clinical practice in chronic pain settings.

Predictors of involuntary and voluntary emotional episodic memories of virtual reality scenarios in Veterans with and without PTSD

This study investigated predictors of involuntary and voluntary memories of stressful virtual reality scenarios. Thirty-two veterans of the two Persian Gulf Wars completed verbal memory tests and diagnostic assessments. They were randomly assigned to a Recounting (16) or a Suppression (16) condition. After immersion in the VR scenarios, the Recounting group described the scenarios and the Suppression group suppressed thoughts of the scenarios. One week later, participants completed surprise voluntary memory tests and another thought suppression task. The best predictors of voluntary memory were verbal memory ability, dissociation, and to a lesser extent, physiological arousal before and after scenarios. Dissociation and physiological stress responses selectively affected memory for neutral elements. Higher distress during scenarios impaired voluntary memory but increased the frequency of involuntary memories. Physiological stress responses promoted more frequent involuntary memories immediately after the scenarios. More frequent initial involuntary memories, tonic physiological arousal, and stronger emotional responses to dangerous events predicted difficulty inhibiting involuntary memories at follow-up. The effects of thought suppression were transient and weaker than those of other variables. The findings suggest that posttraumatic amnesia and involuntary memories of adverse events are more related to memory ability and emotional and physiological stress responses than to post-exposure suppression.

Serious life events and post-traumatic stress disorder in the Norwegian population

BACKGROUND

It has been suggested that countries with more resources and better healthcare have populations with a higher risk of post-traumatic stress disorder (PTSD). Norway is a high-income country with good public healthcare.

AIMS

To examine lifetime trauma exposure and the point prevalence of PTSD in the general Norwegian population.

METHOD

A survey was administered to a national probability sample of 5500 adults (aged ≥18 years). Of 4961 eligible individuals, 1792 responded (36%). Responders and non-responders did not differ significantly in age, gender or urban versus rural residence. Trauma exposure was measured using the Life Events Checklist for the DSM-5. PTSD was measured with the PTSD Checklist for the DSM-5. We used the DSM-5 diagnostic guidelines to categorise participants as fulfilling the PTSD symptom criteria or not.

RESULTS

At least one serious lifetime event was reported by 85% of men and 86% of women. The most common event categories were transportation accident and life-threatening illness or injury. The point prevalence of PTSD was 3.8% for men and 8.5% for women. The most common events causing PTSD were sexual and physical assaults, life-threatening illness or injury, and sudden violent deaths. Risk of PTSD increased proportionally with the number of event categories experienced.

CONCLUSIONS

High estimates of serious life events and correspondingly high rates of PTSD in the Norwegian population support the paradox that countries with more resources and better healthcare have higher risk of PTSD. Possible explanations are high expectations for a risk-free life and high attention to potential harmful mental health effects of serious life events.

DECLARATION OF INTEREST

None.

Imagining trauma: Memory amplification and the role of elaborative cognitions

BACKGROUND AND OBJECTIVES

Trauma victims, such as war veterans, often remember additional traumatic events over time: the "memory amplification effect". This effect is associated with the re-experiencing symptoms of post-traumatic stress disorder (PTSD), including frequent and intrusive images of the trauma. One explanation for memory amplification is that people gradually incorporate new, imagined information about the trauma with what they actually experienced, leading to an amplified memory for what actually happened. We investigated this proposal here.

METHODS

Participants viewed highly negative and graphic photographs and recorded their intrusions. Critically, we instructed some participants to elaborate on their intrusions-that is, we asked them to imagine details about the trauma beyond what they actually witnessed. We assessed memory for the traumatic photos twice, 24-h apart.

RESULTS

The elaboration condition experienced fewer intrusions about the photos compared to the control condition. Furthermore, the elaboration condition were less susceptible to memory amplification compared to controls.

LIMITATIONS

The use of negative photos allowed experimental control, however does not permit generalization of our findings to real-world traumatic experiences.

CONCLUSIONS

Our findings suggest that effortful imagination of new trauma-related details leads to a reduction in intrusions and an increased tendency to not endorse trauma exposure over time. One explanation for this finding is that elaboration enhanced conceptual processing of the trauma analogue, therefore reducing intrusions. Critically, this reduction in intrusions affected participants' tendency to endorse trauma exposure, which is consistent with the reality-monitoring explanation for memory amplification.

Memory amplification for trauma: Investigating the role of analogue PTSD symptoms in the laboratory

Victims of trauma often remember their experience as being more traumatic later, compared to immediately after, the event took place. This finding-the "memory amplification effect"-is associated with increased re-experiencing symptoms. However, the effect has been found almost exclusively in field-based studies. We examined whether the effect could be replicated in the laboratory. In two studies, we exposed participants to negative photographs and assessed their memory for the photographs and analogue PTSD symptoms on two occasions. In Study 1, analogue symptoms at follow-up were positively associated with remembering more negative photos over time. In Study 2, we focused on "memory amplifiers": people whose memory of the photos amplified over time. Consistent with field research, analogue re-experiencing symptoms were associated with memory amplification. Overall, our findings confirm that analogue PTSD symptoms are also associated with an amplified memory for a trauma analogue.

Encoding disorganized memories for an analogue trauma does not increase memory distortion or analogue symptoms of PTSD

BACKGROUND AND OBJECTIVES

Empirical studies with objective measures and control conditions have failed to demonstrate disorganization; yet people tend to self-report disorganization in their trauma narratives, which may have other effects. Thus, we investigated whether a disorganized trauma memory produces more analogue PTSD symptoms and memory distortion, compared to an organized memory.

METHODS

Participants watched a traumatic film with missing scenes. Some saw the scenes in their correct temporal sequence; others saw a random sequence; thus for some participants we implanted a disorganized memory. We also told some participants to focus on the meaning of the event (conceptual), some on the sensory details (data-driven), and some received no instruction (control). Participants recorded their intrusions for a week. Then, they reported analogue symptoms and we tested their memory for the film and their confidence in what they remembered.

RESULTS

Analogue symptoms and number of reported intrusions did not differ across conditions, nor did the degree of memory distortion or confidence in those memories. However, participants who self-reported feeling more memory disorganization reported more avoidance symptoms and more memory distortion.

LIMITATIONS

We did not measure memory for real trauma, nor did we assess for a history of PTSD. Our results may also be restricted to temporal disorganization.

CONCLUSIONS

Although objective assessments of disorganization do not appear important, people's feelings regarding the disorganization of their memories not only affect their assessment of the severity of their PTSD symptoms, but also the kinds of memory errors they make.

Investigating the variability of memory distortion for an analogue trauma

In this paper, we examine whether source monitoring (SM) errors might be one mechanism that accounts for traumatic memory distortion. Participants watched a traumatic film with some critical (crux) and non-critical (non-crux) scenes removed. Twenty-four hours later, they completed a memory test. To increase the likelihood participants would notice the film's gaps, we inserted visual static for the length of each missing scene. We then added manipulations designed to affect people's SM behaviour. To encourage systematic SM, before watching the film, we warned half the participants that we had removed some scenes. To encourage heuristic SM some participants also saw labels describing the missing scenes. Adding static highlighting, the missing scenes did not affect false recognition of those missing scenes. However, a warning decreased, while labels increased, participants' false recognition rates. We conclude that manipulations designed to affect SM behaviour also affect the degree of memory distortion in our paradigm.

Metacognitive appraisal of memory inconsistency for traumatic events in Dutch veterans

Although memories of traumatic events are often remembered vividly, these memories are subject to change over time. In our previous study, we found that Dutch infantry veterans who had served in Iraq often reported stressful events at a second assessment point that they had not reported during a prior assessment point and vice versa. In the present exploratory study, we recontacted subjects from this previous study and asked how they explained the discrepancy in their memory reports between post-deployment assessment points 1 and 2. Common explanations were: interpreting the item differently, having forgotten the incident initially, repression and having accidentally incorporated someone else's experience into their own memory. Although such reports are not necessarily revelatory of the mechanisms driving discrepancies in memory reports over time, our study illuminates the metacognitive variables involved.