Intrusive cognitions, coping strategies and emotional responses in depression, post-traumatic stress disorder and a non-clinical population

Testing predictions from the memory and identity theory of ICD-11 complex posttraumatic stress disorder: Measurement development and initial findings

BACKGROUND

The 'Memory and Identity Theory' of ICD-11 Complex Posttraumatic Stress Disorder (CPTSD) was recently published but has not yet been subjected to empirical testing. The objective of this study was to evaluate newly developed measures of memory and identity disturbances and test hypothesized structural relations between these constructs and CPTSD symptoms.

METHODS

Self-report data were collected from a nationwide sample of adults living in Ukraine (N = 2050) in September 2023. Exploratory factor analysis was used to assess the latent structure of the newly developed measures, and structural equation modeling was used to test the associations between memory and identity disturbances and CPTSD symptoms.

RESULTS

90 % of participants experienced a lifetime trauma, and 9.2 % screened positive for ICD-11 CPTSD. Results indicated that the newly developed measures of memory and identity problems possessed satisfactory psychometric properties, and all but one of the model-implied structural associations were observed.

CONCLUSION

This study provides initial empirical support for the Memory and Identity theory of ICD-11 CPTSD, indicating that the basis of this disorder lies in distinct memory and identity processes. Several effects not predicted by the theory were observed, and these can provide the basis for further model testing and refinement.

Intrusive thoughts and memories in adolescents with major depressive disorder or post-traumatic stress disorder

OBJECTIVES

Research in adults suggests that intrusive memories and intrusive thoughts (often referred to as intrusive cognitions) are common in members of the general population and are often seen in clinical disorders. However, little is known about the experience of intrusive cognitions in adolescents, particularly in adolescents with major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). The present study sought to gather fundamental data on these phenomena (i.e., frequency, characteristics and appraisals of intrusive cognitions) in adolescents with MDD and PTSD.

METHODS

Adolescents aged 11-18 with MDD (n = 11), PTSD (n = 13) and a non-clinical control group (n = 25) completed structured interviews concerning their intrusive memories and thoughts.

RESULTS

Intrusive thoughts were common in all three groups but were particularly frequently experienced in the MDD group. Intrusive memories were expectedly very common in the PTSD group but also experienced by over half of the adolescents with MDD. Both clinical groups reported more negative emotions in response to their intrusive thoughts or memories and appraised these cognitions more negatively than the non-clinical group.

CONCLUSION

Intrusive memories and thoughts are common experiences in adolescents with MDD and PTSD. Emotions and appraisals relating to these cognitions may be targets for psychological intervention in this age group. However, small sample sizes limit the conclusions that can be drawn. Replication is needed with larger numbers of clinical participants.

Mental imagery of suicide and non-suicidal self-injury: A meta-analysis and systematic review

BACKGROUND

The vast majority of research on, and clinical assessment of, cognitions related to suicide and non-suicidal self-injury (NSSI) has focused on verbal thoughts. And yet, mental imagery is more realistic and emotionally arousing than verbal thoughts.

METHODS

We conducted a systematic review and meta-analysis documenting the prevalence of suicidal and NSSI mental imagery and describing the content and characteristics of suicidal and NSSI mental imagery, links between suicidal and NSSI mental imagery and suicidal and NSSI behavior, and how to intervene on suicidal and NSSI mental imagery. Studies published through December 17, 2022 were identified through a systematic search of MEDLINE and PsycINFO.

RESULTS

Twenty-three articles were included. Prevalence rates of suicidal (73.56%) and NSSI (84.33%) mental imagery were high among clinical samples. Self-harm mental imagery commonly depicts engagement in self-harm behavior and is experienced as vivid, realistic, and preoccupying. When experimentally induced, self-harm mental imagery reduces physiological and affective arousal. Preliminary evidence suggests that suicidal mental imagery is associated with suicidal behavior.

CONCLUSIONS

Suicidal and NSSI mental imagery are highly prevalent and may be associated with heightened risk for self-harm behavior. Assessments and interventions for self-harm should consider incorporating and addressing suicidal and NSSI mental imagery to mitigate risk.

How the body remembers: Examining the default mode and sensorimotor networks during moral injury autobiographical memory retrieval in PTSD

Neural representations of sensory percepts and motor responses constitute key elements of autobiographical memory. However, these representations may remain as unintegrated sensory and motor fragments in traumatic memory, thus contributing toward re-experiencing and reliving symptoms in trauma-related conditions such as post-traumatic stress disorder (PTSD). Here, we investigated the sensorimotor network (SMN) and posterior default mode network (pDMN) using a group independent component analysis (ICA) by examining their functional connectivity during a script-driven memory retrieval paradigm of (potentially) morally injurious events in individuals with PTSD and healthy controls. Moral injury (MI), where an individual acts or fails to act in a morally aligned manner, is examined given its inherent ties to disrupted motor planning and thus sensorimotor mechanisms. Our findings revealed significant differences in functional network connectivity across the SMN and pDMN during MI retrieval in participants with PTSD (n = 65) as compared to healthy controls (n = 25). No such significant group-wise differences emerged during retrieval of a neutral memory. PTSD-related alterations included hyperconnectivity between the SMN and pDMN, enhanced within-network connectivity of the SMN with premotor areas, and increased recruitment of the supramarginal gyrus into both the SMN and the pDMN during MI retrieval. In parallel with these neuroimaging findings, a positive correlation was found between PTSD severity and subjective re-experiencing intensity ratings after MI retrieval. These results suggest a neural basis for traumatic re-experiencing, where reliving and/or re-enacting a past morally injurious event in the form of sensory and motor fragments occurs in place of retrieving a complete, past-contextualized narrative as put forth by Brewin and colleagues (1996) and Conway and Pleydell-Pearce (2000). These findings have implications for bottom-up treatments targeting directly the sensory and motoric elements of traumatic experiences.

Memory representation of aversive social experiences in Social Anxiety Disorder

Aversive social experiences are proposed to be a risk factor for developing Social Anxiety Disorder (SAD). Many patients with SAD report associated daily life symptoms, such as intrusive re-experiencing (e.g., negatively distorted images of oneself), avoidance, alterations in cognitions and mood, as well as hyperarousal, resembling symptom dimensions of Posttraumatic Stress Disorder (PTSD). These PTSD-like symptoms may result from maladaptive processing and representation of the aversive social experiences in memory. Emotional hyperreactivity during memory retrieval of aversive social experiences is another feature of SAD which was found in previous studies. This study aimed to further investigate PTSD-like symptoms and emotional reactivity associated with etiologically relevant aversive social experiences and shed more light on a potential relationship between both. Eighty-five patients with SAD and 85 healthy controls (HC) participated in this cross-sectional study. It comprised an imagination task with self-report and physiological measures to assess emotional reactivity during the cued recall of the aversive social experience and clinical interviews to assess PTSD-like symptoms. We expected increased emotional reactivity and more severe PTSD-like symptoms in response to the aversive social experience in patients with SAD compared to HC, as well as a positive correlation between emotional reactivity and PTSD-like symptoms in patients with SAD. Indeed, patients with SAD showed emotional hyperreactivity (self-report, physiology) during the cued recall of the aversive social experiences, also when compared to two control memory conditions (neutral, negative non-social) and HC. Patients with SAD furthermore reported more severe PTSD-like symptoms compared to HC and intrusive re-experiencing symptoms were positively correlated with distress during imagery of the social aversive event in patients with SAD. These results might point toward a maladaptive representation of aversive social experiences in memory. Similar to PTSD, this maladaptive memory representation might promote the development of PTSD-like symptoms such as intrusive re-experiencing (e.g., in the form of intrusive self-images in patients with SAD), which might finally lead to and maintain symptoms of SAD.

Posttraumatic stress, visual working memory, and visual imagery in military personnel

Posttraumatic stress disorder (PTSD) is characterized by disruptions to cognitive functioning. Two studies were conducted to examine the relevance of military-related PTSD to two cognitive functions - visual working memory and visual imagery. Participants were military personnel who reported their PTSD diagnosis history and completed a self-administered screening tool for PTSD, the PTSD Checklist - Military Version. In Study 1, 138 personnel also completed a memory span task and a 2-back task using colored words in which Stroop interference was introduced via the semantic content of the words. In Study 2, a separate group of 211 personnel completed measures of perceived imagery vividness and spontaneous use of visual imagery. Interference effects on working memory in PTSD-diagnosed military personnel were not replicated. However, ANCOVA and structural equation modelling revealed that PTSD-intrusions were associated with poorer working memory whereas PTSD-arousal was associated with spontaneous use of visual imagery. We interpret these results as evidence that intrusive flashbacks disrupt working memory performance not by limiting memory capacity nor by interfering directly with memory functions such as inhibition, but by adding internal noise in the form of task-irrelevant memories and emotions. Visual imagery appears to be unrelated to these flashbacks but with arousal symptoms of PTSD, perhaps in the form of flashforwards about feared/anticipated threats.

Longitudinal associations between pandemic post-traumatic stress symptoms and subsequent non-suicidal self-injury in adolescents: A multiple mediation model

BACKGROUNDS

PTSD is one of the most common conditions after people have experienced trauma. While previous studies have found a link between PTSD and non-suicidal self-injury, (NSSI), few studies have longitudinally explored this relationship and the underlying mechanisms.

AIMS

This study explored adolescent NSSI frequency after COVID-19 lockdown experiences, the relationship with early PTSD symptoms, and the mediating role of depression and sleep problems.

METHODS

A cohort of 1609 adolescents completed two surveys during and after the national lockdown in China; one month into the lockdown and six months later; which assessed demographic and pandemic-related exposure variables; PTSD, depression, sleep, and NSSI. Mediation analyses and hierarchical regression were employed to examine the relationships and the paths between these variables.

RESULTS

The NSSI rate was found to be 31.9 % after the three-month lockdown, with 20.6 % of adolescent participants reporting sleeping disorders, and 33.9 % indicating probable depression. Adolescents who had earlier PTSD symptoms, often smoked and/or drank, and had current depression and sleep disorders reported greater NSSI. Early PTSD symptoms were found to predict later NSSI and were mediated by sleep problems and depressive symptoms. Specifically, PTSD avoidance and numbing symptoms were significantly associated with NSSI above and beyond the depressive symptoms, sleeping problems, and the other covariables.

CONCLUSION

It is necessary to be vigilant about the increased risk of NSSI in adolescents who have experienced extended pandemic lockdowns. Preventing early adolescent PTSD symptoms, especially avoidance and numbness, and helping teenagers quit smoking and drinking could reduce the risk of sleep disorders, depression, and NSSI.

The amygdala mediates the facilitating influence of emotions on memory through multiple interacting mechanisms

Emotionally arousing experiences are better remembered than neutral ones, highlighting that memory consolidation differentially promotes retention of experiences depending on their survival value. This paper reviews evidence indicating that the basolateral amygdala (BLA) mediates the facilitating influence of emotions on memory through multiple mechanisms. Emotionally arousing events, in part by triggering the release of stress hormones, cause a long-lasting enhancement in the firing rate and synchrony of BLA neurons. BLA oscillations, particularly gamma, play an important role in synchronizing the activity of BLA neurons. In addition, BLA synapses are endowed with a unique property, an elevated post-synaptic expression of NMDA receptors. As a result, the synchronized gamma-related recruitment of BLA neurons facilitates synaptic plasticity at other inputs converging on the same target neurons. Given that emotional experiences are spontaneously remembered during wake and sleep, and that REM sleep is favorable to the consolidation of emotional memories, we propose a synthesis for the various lines of evidence mentioned above: gamma-related synchronized firing of BLA cells potentiates synapses between cortical neurons that were recruited during an emotional experience, either by tagging these cells for subsequent reactivation or by enhancing the effects of reactivation itself.

Presleep focusing on positive spontaneous thoughts enhanced the possibility of dreaming of them

Introduction

Dreaming is the subjective experience during sleep. A spontaneous thought is a thought that comes to one's mind involuntarily. This study investigated whether presleep focusing on a positive spontaneous thought enhanced the possibility of dreaming of the thought.

Methods

Ninety-seven participants were quasi-randomly assigned to an expression condition (focus on an spontaneous thought for 5-Min before sleeping; N = 45) and a control condition (think about anything for 5-Min before sleeping; N = 45). Participants completed a dream diary upon waking. Then, both participants themselves (the selfrating method) and external judges (the external-rating method) rated the correlation between the positive spontaneous thought and the dream.

Results

The result of the external-rating method indicated that presleep focusing on positive spontaneous thoughts enhanced the possibility of dreaming of the thoughts. In addition, the external-rating method found that presleep focusing on positive spontaneous thoughts enhanced the possibility of dreaming of thoughts that were related to the positive spontaneous thoughts but not the positive spontaneous thoughts themselves.

Discussion

These results supported the current concern theory which suggests that one's current concerns increase responses to cues related to the concerns implicitly. In addition, these results supported the continuity hypothesis which states that dreaming is in continuous with waking life, and thus the intensity of a daily concern may be related to the possibility of dreaming of the daily concern.

Preoccupation as psychopathological process and symptom in adjustment disorder: A scoping review

In the ICD‐11 diagnostic guidelines, preoccupation has been introduced as the new core symptom of adjustment disorder. Despite this essential innovation, preoccupation has so far largely been defined as rumination and worry and does not feature a distinct character as an independent symptom. In order to investigate the nature of preoccupation, various cognitive approaches are evaluated and linked to preoccupation. Furthermore, the aim of this review is to define preoccupation more precisely and to distinguish it from other symptoms in psychopathology. The evaluation of key features of cognitive dissonance theory, attention bias theory, memory theories, and other cognitive paradigms indicates that preoccupation is constituted by a complex interaction of cognitive–emotional mechanisms. In addition, this review implies that preoccupation in AjD can be defined as stressor‐related factual thinking, which is time‐consuming and often associated with negative emotions. It is assumed that rumination and dysfunctional worry serve as reactive processes to cope with preoccupation. For further distinction, this review presents similarities and differences of preoccupation and other symptoms, including negative automatic thoughts, flashbacks, and yearning. Finally, implications and suggestions for future research on preoccupation are offered. Overall, it is plausible that preoccupation is not only associated with adjustment disorder but also possesses a transdiagnostic character.

The Effects of Dissociation on Analogue Trauma Symptoms After Trauma Processing Among Women With Varying Histories of Lifespan Victimization

Research has identified two subtypes of posttraumatic stress disorder (PTSD); the traditional form that includes hyperarousal reactions, and the other involving ongoing dissociation. Dissociation has been reflected in the new diagnostic criteria for PTSD with the dissociative specification focused on the experience of high levels of depersonalization and/or derealization. PTSD that presents with ongoing dissociation appears to characterize complex cases of PTSD for individuals exposed to protracted trauma. Yet, our understanding of the role of dissociation in relation to PTSD symptoms is limited with inconsistent empirical findings. This study aims to elucidate the complex associations between trauma, dissociation, and trauma-relevant symptomatology. In total, 60 female interpersonal trauma survivors completed baseline measures of trauma and dissociation, and at least a week later, they completed self-report measures of state trauma intrusions, guilt, and anxiety before and after participating in a trauma recall task to examine dissociative tendencies on analogue trauma-related symptoms. After data collection, participants were categorized into two groups; individuals with multiple forms of lifetime interpersonal trauma versus individuals with trauma isolated to single-type trauma in childhood and/or adulthood. Results revealed trauma intrusions, guilt, and anxiety increased after trauma recall overall, though trauma groups differed in the manifestation of these outcomes. In addition, less depersonalization and greater derealization predicted increases in anxiety overall, though this only remained true for those exposed to multiple-type lifespan traumas. Results reveal dissociative tendencies may be most relevant in the processing of trauma-related material for those exposed to multiple types of trauma throughout the lifespan. Implications for treatment of trauma survivors with different clinical presentations are discussed.

A taxonomy of intrusive mental images in clinical disorders: what can "non-veridical" images tell us about the nature of human memory?

Intrusive mental images associated with autobiographical memories or depicting imagined scenes are common in psychological disorders. Although there is a growing body of literature on their contribution to psychopathology and their role in therapy, to date there have been limited attempts to categorise the different types of images that patients experience. In this article, we present a taxonomy which ranges from veridical to non-veridical intrusive images. We highlight the fact that many types of images consist of a blend of veridical and imagined details. After presenting some of the main explanations for the existence of blended and non-veridical images, we reflect on what the evidence on the content and origin of intrusive images tells us about the nature of human memory. We argue that it supports the idea of memory being constructive and briefly discuss what this means for clinical and non-clinical settings in which intrusive images have to be evaluated and used.

Decoding Nonconscious Thought Representations during Successful Thought Suppression

Controlling our thoughts is central to mental well-being, and its failure is at the crux of a number of mental disorders. Paradoxically, behavioral evidence shows that thought suppression often fails. Despite the broad importance of understanding the mechanisms of thought control, little is known about the fate of neural representations of suppressed thoughts. Using fMRI, we investigated the brain areas involved in controlling visual thoughts and tracked suppressed thought representations using multivoxel pattern analysis. Participants were asked to either visualize a vegetable/fruit or suppress any visual thoughts about those objects. Surprisingly, the content (object identity) of successfully suppressed thoughts was still decodable in visual areas with algorithms trained on imagery. This suggests that visual representations of suppressed thoughts are still present despite reports that they are not. Thought generation was associated with the left hemisphere, and thought suppression was associated with right hemisphere engagement. Furthermore, general linear model analyses showed that subjective success in thought suppression was correlated with engagement of executive areas, whereas thought-suppression failure was associated with engagement of visual and memory-related areas. These results suggest that the content of suppressed thoughts exists hidden from awareness, seemingly without an individual's knowledge, providing a compelling reason why thought suppression is so ineffective. These data inform models of unconscious thought production and could be used to develop new treatment approaches to disorders involving maladaptive thoughts.

The prevalence of intrusive memories in adult depression: A meta-analysis

BACKGROUND

Intrusive memories have typically been associated with post-traumatic stress disorder (PTSD) but some studies have suggested they can also occur in depression-alone.

OBJECTIVE

This meta-analysis aimed to estimate the prevalence of intrusive memories in adult depression and to explore methodological and other factors that may moderate this prevalence.

METHOD

The databases PsycINFO, PsycARTICLES, MedLine, PubMed, CINAHL and Embase were searched for relevant articles, published up to and including July 2016. Studies measuring point prevalence of intrusive memories in adults aged 18 years or above with depression were included and assessed for quality. Meta-analysis was completed under a random effects model.

RESULTS

Seven studies measuring point prevalence of intrusive memories in adult depression were included. The overall pooled prevalence estimate calculated was 76.0% (95% CI 59.4-89.4%), reducing to 66.0% (95% CI 51.0-79.5%) when restricted to intrusive memories experienced within the week prior to assessment. Heterogeneity was high. Between-groups analyses indicated that adults with depression are as likely to experience intrusive memories as adults with PTSD, and more likely to experience intrusive memories than healthy controls (risk ratio of 2.94, 95% CI 1.53-5.67).

LIMITATIONS

The strength of conclusions is limited by the small number of studies included. Consideration of the relationship between depression, intrusive memories and trauma exposure is required.

CONCLUSIONS

Intrusive memories are experienced by a large majority of adults with depression and may therefore be an important target for cognitive intervention. Larger scale measurement of clinical outcome is needed with identification of individual factors predicting treatment response.

Spontaneous cognition in dysphoria: reduced positive bias in imagining the future

Anomalies in future-oriented cognition are implicated in the maintenance of emotional disturbance within cognitive models of depression. Thinking about the future can involve mental imagery or verbal-linguistic mental representations. Research suggests that future thinking involving imagery representations may disproportionately impact on-going emotional experience in daily life relative to future thinking not involving imagery (verbal-linguistic representation only). However, while higher depression symptoms (dysphoria) are associated with impaired ability to deliberately generate positive relatively to negative imagery representations of the future (when instructed to do so), it is unclear whether dysphoria is associated with impairments in the tendency to do so spontaneously (when not instructed to deliberately generate task unrelated cognition of any kind). The present study investigated dysphoria-linked individual differences in the tendency to experience spontaneous future-oriented cognition as a function of emotional valence and representational format. Individuals varying in dysphoria level reported the occurrence of task unrelated thoughts (TUTs) in real time while completing a sustained attention go/no-go task, during exposure to auditory cues. Results indicate higher levels of dysphoria were associated with lower levels of positive bias in the number of imagery-based future TUTs reported, reflecting higher negative imagery-based future TUT generation (medium to large effect size), and lower positive imagery-based TUT generation (small to medium effect size). Further, this dysphoria-linked bias appeared to be specific in temporal orientation (future, not past) and representational format (imagery, not non-imagery). Reduced tendency to engage in positive relative to negative imagery-based future thinking appears to be implicated in dysphoria.

Novelty exposure hinders aversive memory generalization and depends on hippocampal protein synthesis

Fear generalization is defined as the transferring of fear experienced during a traumatic event to safe conditions resembling or not the traumatic event. It has been related to several psychological disorders. Here we set out to determine whether novelty exposure can be effective to avoid fear generalization. We evaluated the effect of a novelty exposure on fear memory generalization using an aversive memory task, the inhibitory avoidance (IA). Male Wistar rats were trained in IA (day 1) and 24 h after (day 2) they were exposed to a new context similar to the original (modified IA - MIA), with some rats being exposed to a novelty just before the exposure to the MIA, while others were not (controls). On day 3, retention tests for IA and MIA contexts were performed. The control rats generalized the memory, expressing aversive behavioral in both contexts whereas rats exposed to novelty only expressed aversion on IA. Furthermore, both anisomycin, an inhibitor of ribosomal protein synthesis, and rapamycin, an inhibitor of mTOR-mediated protein synthesis, injected in the CA1 region of dorsal hippocampus blocked the novelty effect, promoting memory generalization. We conclude that novelty exposure hinders aversive memory generalization depending on hippocampal protein synthesis.

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.

Predator-based psychosocial stress model of PTSD differentially influences voluntary ethanol consumption depending on methodology

Post-traumatic stress disorder (PTSD) is a debilitating psychological disorder typified by diagnostic symptom clusters including hyperarousal, avoidance, negative cognitions and mood, and intrusive re-experiencing of the traumatic event. Patients with PTSD have been reported to self-medicate with alcohol to ameliorate hyperarousal symptoms associated with the disorder. Research utilizing rodent models of PTSD to emulate this behavioral phenomenon has thus far yielded inconsistent results. In the present study, we examined the effects of a predator-based psychosocial stress model of PTSD on voluntary ethanol consumption. In the first of two experiments, following exposure to a 31-day stress or control paradigm, rats were singly housed during the dark cycle with free access to 1% sucrose solution or 10% ethanol, which was also sweetened with 1% sucrose. Over the course of a 20-day period of ethanol access, stressed rats consumed significantly less ethanol than non-stressed rats. These counterintuitive results prompted the completion of a second experiment which was identical to the first, except rats were also exposed to the two-bottle paradigm for 20 days before the stress or control paradigm. In the second experiment, after the stress manipulation, stressed rats exhibited significantly greater ethanol preference than non-stressed rats. These findings suggest that prior exposure to ethanol influences the subsequent effect of stress on ethanol intake. They also validate the use of the present model of PTSD to examine potential mechanisms underlying stress-related changes in ethanol-seeking behavior.

The Centrality of Events Scale for Italian Adolescents: Integrating Traumatic Experience Into One's Identity and Its Relation to Posttraumatic Stress Disorder Symptomatology

Adolescents could develop areas of vulnerability, especially if they have had to deal with highly stressful and traumatic life events. Stressful experiences can work as traumatic memories that become central to one's life and core topics for one's identity and for the attribution of meaning to life experience. The present work evaluates (a) the internal structures of the 20-item Centrality of Event Scale in the Italian context and (b) the impact of stressful and traumatic experience during adolescence. The present work includes a convenience sample of 872 Italian adolescents -528 males, 344 females- aged between 11 and 21 years (M = 15.85; SD = 2.09). We performed a confirmatory factor analysis that confirmed a three-factor solution. Moreover, the perception of stressful event as central in the participants' lives was significantly correlated with the presence of PTSD symptomatology, as measured by the Impact of Event Scale Revised. We found that participants with PTSD symptoms had significantly higher CES scores. These data show the validity of the CES with adolescent samples, emphasizing the sensitivity of this instrument in detecting the impact of negative life experiences even in a sample of adolescents.

Can't get it out of my mind: A systematic review of predictors of intrusive memories of distressing events

Intrusive memories, when persistent and distressing, are theorized to underlie a range of transdiagnostic psychological symptoms and associated impairment. However, little is known about factors predicting the development and persistence of intrusive memories. The aim of this systematic review is to evaluate the literature on pre-event, event-based, and post-event predictors of intrusive memories. A systematic review was conducted, searching for studies that examined intrusive, event-based memories. One hundred and six articles were identified from PsycInfo, PubMed, and Medline databases. Experimental and prospective studies with clinical (N = 14) and nonclinical (N = 92) samples were critically reviewed, provided the inclusion of an analogue stressor with nonclinical samples, and that intrusive memories frequency and/or distress were assessed as primary dependent variables. Pre-existing psychopathology and pre-event appraisal style appear to predict intrusive memories (small to medium effects), whereas trait dissociation did not predict intrusive memories. Of studies examining event-based predictors, higher data-driven processing appears to predict intrusive memories with generally large effects. Post-event negative appraisals consistently predicted intrusive memories (medium to large effects), and preliminary evidence suggests higher post-event conceptual processing predicting fewer intrusive memories. This review synthesizes findings regarding a broad range of pre-event, event-based, and post-event factors that may influence the development of intrusive memories. Methodological issues of current paradigms and the lack of emphasis on memory retrieval processes limit our understanding of what predicts intrusive memory persistence. These limitations are particularly important given that individuals typically seek treatment for distressing intrusive memories once a memory has been fully consolidated, where retrieval processes are of utmost importance. (PsycINFO Database Record

Neural responses to emotional involuntary memories in posttraumatic stress disorder: Differences in timing and activity

Background

Involuntary memories are a hallmark symptom of posttraumatic stress disorder (PTSD), but studies of the neural basis of involuntary memory retrieval in posttraumatic stress disorder (PTSD) are sparse. The study of the neural correlates of involuntary memories of stressful events in PTSD focuses on the voluntary retrieval of memories that are sometimes recalled as intrusive involuntary memories, not on involuntary retrieval while being scanned. Involuntary memory retrieval in controls has been shown to elicit activity in the parahippocampal gyrus, precuneus, inferior parietal cortex, and posterior midline regions. However, it is unknown whether involuntary memories are supported by the same mechanisms in PTSD. Because previous work has shown that both behavioral and neural responsivity is slowed in PTSD, we examined the spatiotemporal dynamics of the neural activity underlying negative and neutral involuntary memory retrieval.

Methods

Twenty-one individuals with PTSD and 21 non-PTSD, trauma-exposed controls performed an involuntary memory task, while undergoing a functional magnetic resonance imaging scan. Environmental sounds served as cues for well-associated pictures of negative and neutral scenes. We used a finite impulse response model to analyze temporal differences between groups in neural responses.

Results

Compared with controls, participants with PTSD reported more involuntary memories, which were more emotional and more vivid, but which activated a similar network of regions. However, compared to controls, individuals with PTSD showed delayed neural responsivity in this network and increased vmPFC/ACC activity for negative > neutral stimuli.

Conclusions

The similarity between PTSD and controls in neural substrates underlying involuntary memories suggests that, unlike voluntary memories, involuntary memories elicit similar activity in regions critical for memory retrieval. Further, the delayed neural responsivity for involuntary memories in PTSD suggests that factors affecting cognition in PTSD, like increased fatigue, or avoidance behaviors could do so by delaying activity in regions necessary for cognitive processing. Finally, compared to neutral memories, negative involuntary memories elicit hyperactivity in the vmPFC, whereas the vmPFC is typically shown to be hypoactive in PTSD during voluntary memory retrieval. These patterns suggest that considering both the temporal dynamics of cognitive processes as well as involuntary cognitive processes would improve existing neurobiological models of PTSD.

The M-Maze task: An automated method for studying fear memory in rats exposed to protracted aversive conditioning

BACKGROUND

Fear conditioning (FC) in rodents is the most used animal model to investigate the neurobiology of posttraumatic stress disorder (PTSD). Although research using FC has generated a better understanding of fear memories, studies often rely on mild or moderate FC training and behavioral analysis generally focuses on measuring freezing responses within few test sessions.

NEW METHOD

We introduce the M-Maze task, a system that measures extinction of conditioned fear using suppression of operant behavior. The apparatus consists of an M-shaped maze where rats are trained to alternate nose poking at two pellet dispensers. Proximity sensors measure the animal's locomotion, as well as the latencies and number of operant behaviors. Here we also describe the protracted aversive conditioning (PAC), a rat model of severe fear that induces resistant extinction following a 4-day conditioning protocol that combines delay, unpredictable, and short- and long-trace conditioning.

RESULTS

An intense one-day auditory FC protocol induced a sharp elevation in transit time and suppression of nose pokes by conditioned cues, but in contrast to what is found in PTSD patients, fear extinction was rapidly observed. On the other hand, PAC alone or in combination with exposure to single prolonged stress induced persistent extinction impairments in M-Maze tests, as well as enhanced anxiety, and social withdrawal.

COMPARISON WITH OTHER EXISTING METHODS

The M-Maze task is fully automated and allows multiple animals to be tested simultaneously in long-term experiments. Moreover, PAC training can be an alternative approach to study extinction-resistant fear.

CONCLUSIONS

The M-Maze task allows rapid and unbiased measurements of fear-induced suppression. We suggest that long-term assessment of extinction impairments would lead to a better understanding of the neurobiology of persistent fear and the screening for new therapies.

Treatment of Intrusive Suicidal Imagery Using Eye Movements

Suicide and suicidal behavior are major public health concerns, and affect 3–9% of the population worldwide. Despite increased efforts for national suicide prevention strategies, there are still few effective interventions available for reducing suicide risk. In this article, we describe various theoretical approaches for suicide ideation and behavior, and propose to examine the possible effectiveness of a new and innovative preventive strategy. A model of suicidal intrusion (mental imagery related to suicide, also referred to as suicidal flash-forwards) is presented describing one of the assumed mechanisms in the etiology of suicide and the mechanism of therapeutic change. We provide a brief rationale for an Eye Movement Dual Task (EMDT) treatment for suicidal intrusions, describing techniques that can be used to target these suicidal mental images and thoughts to reduce overall behavior. Based on the available empirical evidence for the mechanisms of suicidal intrusions, this approach appears to be a promising new treatment to prevent suicidal behavior as it potentially targets one of the linking pins between suicidal ideation and suicidal actions.

Sometimes Less is More: Establishing the Core Symptoms of PTSD

Historically, the symptoms of posttraumatic stress disorder (PTSD) have garnered attention and controversy due to symptom overlap with other disorders. To improve diagnostic specificity, researchers have proposed to reformulate PTSD symptoms into a parsimonious set of core criteria. The core symptoms consisted of recurrent distressing dreams or flashbacks; internal or external avoidance; and hypervigilance or exaggerated startle. The purpose of this study was to examine a previously proposed set of "core" PTSD criteria in identifying cases of PTSD within a veteran sample. Veterans (N = 383) presenting to a Veterans Affairs (VA) Medical Center PTSD clinic for psychological services were assessed using the Clinician Administered PTSD Scale for DSM-5 (CAPS-5). A logistic regression analysis revealed that the core criteria accurately identified 79% of veterans with PTSD (OR = 11.57). Findings support a parsimonious set of core criteria in the assessment and diagnosis of PTSD. Future studies should replicate these findings in diverse, nonveteran samples.

Predictive Validity of ICD-11 PTSD as Measured by the Impact of Event Scale-Revised: A 15-Year Prospective Study of Political Prisoners

The 11^th edition of the International Classification of Diseases (ICD-11; World Health Organization, 2017) proposes a model of posttraumatic stress disorder (PTSD) that includes 6 symptoms. This study assessed the ability of a classification-independent measure of posttraumatic stress symptoms, the Impact of Event Scale-Revised (Weiss & Marmar, 1996), to capture the ICD-11 model of PTSD. The current study also provided the first assessment of the predictive validity of ICD-11 PTSD. Former East German political prisoners were assessed in 1994 (N = 144) and in 2008-2009 (N = 88) on numerous psychological variables using self-report measures. Of the participants, 48.2% and 36.8% met probable diagnosis for ICD-11 PTSD at the first and second assessments, respectively. Confirmatory factor analysis supported the factorial validity of the 3-factor ICD-11 model of PTSD, as represented by items selected from the Impact of Event Scale-Revised. Hierarchical multiple regression analysis demonstrated that, controlling for sex, the symptom clusters of ICD-11 PTSD (reexperiencing, avoidance, and sense of threat) significantly contributed to the explanation of depression (R² = .17), quality of life (R² = .21), internalized anger (R² = .10), externalized anger (R² = .12), hatred of perpetrators (R² = .15), dysfunctional disclosure (R² = .27), and social acknowledgment as a victim (R² = .12) across the 15-year study period. Current findings add support for the factorial and predictive validity of ICD-11 PTSD within a unique cohort of political prisoners.

Do meta-cognitive beliefs affect meta-awareness of intrusive thoughts about trauma?

BACKGROUND AND OBJECTIVES

People exposed to trauma often experience intrusive thoughts and memories about that event. Research examining people's responses to trauma assumes that people can accurately notice the occurrence of symptoms. However, we know from the broader cognitive literature on 'mind-wandering' that people are not always aware of their current focus of attention. That lack of awareness has implications for our theoretical and practical understanding of how trauma survivors recover from their experience. In the current study we investigated whether people's meta-cognitive beliefs about controlling trauma-related intrusions influenced the occurrence and meta-awareness of those intrusions.

METHODS

We recruited participants who scored high (strong beliefs) or low (weak beliefs) on beliefs regarding the importance of controlling intrusive thoughts. Participants viewed a trauma film then-during a subsequent reading task-reported any film-related intrusions they noticed. We also intermittently asked half the participants to report what they were thinking at that particular moment, to "catch" intrusions without meta-awareness.

RESULTS

People are not always aware of their trauma intrusions, and importantly, people with strong beliefs are more likely to notice trauma related intrusions both with and without meta-awareness than people with weak beliefs.

LIMITATIONS

We used an analogue trauma, and focused on a particular metacognitive belief, both of which somewhat limit generalizability. We also cannot definitively rule out demand effects.

CONCLUSIONS

Our data add to existing research showing people may lack meta-awareness of trauma-related thoughts, and suggest that survivors with particular metacognitive characteristics may be more vulnerable to 'mind-wandering' about trauma without awareness.

Posttraumatic Stress Disorder and Autobiographical Memories in Everyday Life

Evidence from self-reports and laboratory studies suggests that recall of nontrauma autobiographical memories may be disturbed in posttraumatic stress disorder (PTSD), but investigations in everyday life are sparse. This study investigated unintentional nontrauma and trauma memories in trauma survivors with and without PTSD (N = 52), who kept an autobiographical memory diary for a week. We investigated whether unintentional nontrauma memories show an overgeneral memory bias and further memory abnormalities in people with PTSD, and whether unintentional trauma memories show distinct features. Compared to the no-PTSD group, the PTSD group recorded fewer nontrauma memories, which were more overgeneral, more often from before the trauma or related to the trauma, were perceived as distant, and led to greater dwelling. Trauma memories were more vivid, recurrent, and present and led to greater suppression and dwelling. Within the PTSD group, the same features distinguished trauma and nontrauma memories. Results are discussed regarding theories of autobiographical memory and PTSD.

Is remembering less specifically part of an avoidant coping style? Associations between memory specificity, avoidant coping, and stress

Individuals higher on avoidant coping may remember fewer specific autobiographical memories and more nonspecific memories on the Autobiographical Memory Test (AMT) in order to protect themselves from the painful emotions accompanying some specific memories. Habitually remembering this way (overgeneral memory) may be a risk factor for depression. In Studies 1 and 2 (nondepressed samples), avoidant coping was associated with more specific memories and fewer overgeneral memories, at odds with the functional avoidance view. In Study 3 (depressed sample), there were no significant relationships between AMT indices and avoidant coping. Results are discussed in light of ironic process theory.

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.

Intrusive Cognitive Content and Postdeployment Distress

Although intrusive cognitions (ICs) are common posttrauma, little is known about trauma-related IC content, or associations between IC content and posttraumatic adjustment. A mixed-method cross-sectional approach was used in a secondary analysis of IC content and postdeployment distress. Participants were 1,521 U.S. Army soldiers 3-12 months postdeployment reporting their most distressing postdeployment ICs (mean number of ICs reported was 1.20). ICs were transcribed and content was categorized by 13 emergent themes. The most commonly reported ICs were of injury or death (48.2%) and combat (43.5%), and soldiers with probable posttraumatic stress disorder (PTSD; n = 187) were more likely to report the presence of these ICs, χ(2) s(1) = 35.27, ps < .001, φs < .16 than those without probable PTSD (n = 1,331). Other domains also emerged frequently, including ICs about friends (31.0%), family (15.8%), and leadership concerns (13.8%). IC content was a small, but significant correlate of distress after adjusting for combat exposure (ΔR(2) ≥ .02, ps ≤ .001). The presence of ICs of injury or death, combat, military sexual trauma, health, leadership, and family (βs > .06, ps < .02) were unique correlates of distress. Results suggested that ICs about a wide range of topics should be addressed in postdeployment interventions.

Genetic and environmental modulation of neurodevelopmental disorders: Translational insights from labs to beds

Neurodevelopmental disorders (NDDs) are a heterogeneous group of prevalent neuropsychiatric illnesses with various degrees of social, cognitive, motor, language and affective deficits. NDDs are caused by aberrant brain development due to genetic and environmental perturbations. Common NDDs include autism spectrum disorder (ASD), intellectual disability, communication/speech disorders, motor/tic disorders and attention deficit hyperactivity disorder. Genetic and epigenetic/environmental factors play a key role in these NDDs with significant societal impact. Given the lack of their efficient therapies, it is important to gain further translational insights into the pathobiology of NDDs. To address these challenges, the International Stress and Behavior Society (ISBS) has established the Strategic Task Force on NDDs. Summarizing the Panel's findings, here we discuss the neurobiological mechanisms of selected common NDDs and a wider NDD+ spectrum of associated neuropsychiatric disorders with developmental trajectories. We also outline the utility of existing preclinical (animal) models for building translational and cross-diagnostic bridges to improve our understanding of various NDDs.

Re-experiencing phenomena following a disaster: The long-term predictive role of intrusion symptoms in the development of post-trauma depression and anxiety

BACKGROUND

Contention in the literature regarding the diagnostic utility of intrusion symptoms highlights that they have high sensitivity but low specificity in predicting PTSD. They are highly prevalent following a range of traumatic events, and across a range of disorders. The prevalence of intrusion symptoms in the absence of PTSD suggests their relevance to the development of other psychopathology. Therefore, the predictive role of intrusion symptoms for other post-trauma psychopathology was examined using data from an epidemiological, longitudinal sample of adults recruited in childhood.

METHOD

From 5 phases of data collection for this sample, these analyses focused on the 20 year and 28 year follow-ups (n=583). Lifetime exposure to trauma was assessed using a modified set of 10 Criterion-A events from the Composite International Diagnostic Interview (CIDI), with PTSD assessed in reference to a self-nominated worst lifetime event, and other DSM-IV disorder also assessed using the CIDI.

RESULTS

Results showed that the presence of intrusion symptoms without PTSD at the 20 year follow-up was predictive of increased risk at 28 years for depressive but not anxiety disorders.

LIMITATIONS

There was limited psychopathology in the sample, reducing the power to examine many individual disorders. Furthermore, trauma history and psychiatric symptoms were retrospectively reported, introducing the possibility of recall bias.

CONCLUSION

Together the findings suggest that intrusion symptoms may play an aetiological role in the development and/or maintenance of disorders other than PTSD.

Re-experiencing traumatic events in PTSD: new avenues in research on intrusive memories and flashbacks

Posttraumatic flashbacks, consisting of the intrusive re-experiencing of traumatic experiences in the present, have been more clearly defined for the first time in DSM-5 and have been identified as a unique symptom of posttraumatic stress disorder in the proposed ICD-11 diagnostic criteria. Relatively little research into flashbacks has been conducted, however, and new research efforts are required to understand the cognitive and biological basis of this important symptom. In addition, there is considerable scope for research into how flashbacks should be assessed and into flashbacks occurring in different contexts, such as psychosis or intensive care.

Understanding HIV-related posttraumatic stress disorder in South Africa: a review and conceptual framework

A number of epidemiological studies have attempted to measure the prevalence of HIV-related posttraumatic stress disorder (PTSD) in sub-Saharan Africa. A systematic review of the literature identified eight relevant studies that put current estimates of the prevalence of HIV-related PTSD between 4.2% and 40%. Even the lower estimates suggest that PTSD in response to the trauma of being diagnosed and living with HIV is a significant mental health burden. However, a conceptual framework to advance our understanding of the prevalence and phenomenology of HIV-related PTSD is lacking. This article argues that the Ehlers & Clark (2000) cognitive model of PTSD provides a useful conceptual framework for understanding HIV-related PTSD in South Africa. The model emphasises the role of trauma appraisals in the development and maintenance of PTSD, which can also be usefully applied to some of the other psychological disorders associated with HIV infection. The model appears to fit some of the important research findings, and it offers insights into the relationships between HIV-related PTSD and other psychological disorders, HIV stigma, the high prevalence of non-HIV traumatic events, occasional problems with the delivery of antiretroviral drugs in the South African public health service, the unpredictable course of HIV illness, and the quality of HIV testing and counselling. Implications for individual treatment strategies and broader public health interventions are briefly discussed.

Visual mental imagery in psychopathology--implications for the maintenance and treatment of depression

Negative mental images are a common feature in a range of mental disorders as well as in healthy subjects. Intrusive negative mental images have only recently become a focus of attention in clinical research on depression. Research so far indicates that they can be an important factor regarding the onset and chronicity of affective disorders. This article is the first to provide an extensive overview of the current state of research in the field of visual mental images in depression. It aims to investigate disorder-specific characteristics, as well as the role of imagery as a maintaining factor. A detailed definition and description of empirical results about mental images in depressive disorders is followed by a presentation and analysis of treatment studies using imagery techniques in depressed samples. Additionally, methodological issues like small sample sizes and the lack of control groups are pointed out and implications for future research are discussed. Case vignettes are included in the appendix to exemplify the importance of negative mental images in patients suffering from depression.

Emotionsregulation bei Depression

Die Anzahl der Studien, die sich mit dem Zusammenhang zwischen Emotionsregulation (ER) und depressiven Störungen befassen, steigt. In diesem Review werden Studien zusammengefasst und metaanalytisch ausgewertet, die den Zusammenhang zwischen ER und Depression mittels Fragebögen bzw. Ecological Momentary Assessment (EMA) erfassen. Dabei zeigt sich ein ER-Profil welches durch die vermehrte Nutzung von Rumination, Suppression und Vermeidung bei gleichzeitig seltenerem Einsatz von Neubewertung und Problemlösen gekennzeichnet ist. Mit mittleren bis großen Effekten, ist der Zusammenhang zwischen Depression und maladaptiven Strategien besser belegt als bei den adaptiven Formen, wo die Effekte eher moderat ausfielen. EMA-Messungen bestätigen dieses Profil. Da EMA-Studien neben der Häufigkeit des Strategieeinsatzes auch die Erfassung anderer ER-Parameter wie Effektivität und Flexibilität ermöglichen, sollten solche Designs in der ER-Forschung zukünftig vermehrt Einsatz finden.

Recurrent involuntary imagery in people who stutter and people who do not stutter

OBJECTIVE

To compare intrusive memories in groups of people who do (PWS), and who do not (PWNS), stutter.

METHOD

Twenty-one participants who stuttered and 21 matched controls were given a semi-structured interview which explored imagery in speaking situations. The data were analyzed using a Content Analysis approach. Other outcome measures were the Beck Anxiety Inventory, the Beck Depression Inventory, the Post Traumatic Stress Disorder, PTSD, Symptom Scale: Self-Report Version.

RESULTS

Significantly more stuttering participants than control participants indicated both recurrent imagery and associated memories. Content Analysis revealed themes of disfluency, anxiety, negative social evaluation, self-focus and pressure to speak that were common to both groups' reports. Additional themes of helplessness, shame, sadness and frustration were found only in the images and memories of the stuttering group. No group differences were evident for the number of sensory modalities involved in images and memories, or for ratings of their vividness or strength of associated emotions, or on self-reports of depression, anxiety and trauma.

CONCLUSIONS

Recurrent imagery about events in childhood is a potent factor in the memories of PWS. It is worth modifying interventions that have been successfully applied for treating social anxiety for use with people who stutter.

EDUCATIONAL OBJECTIVES

After reading this article, participants will be able to: (a) identify the role of intrusive memories in psychiatric disorders and stuttering; (b) investigate how DSM criteria can be employed with people who stutter; (c) employ anxiety instruments used for assessing psychiatric disorders for stuttering; (d) distinguish between the intrusive memories experienced by people who stutter, and people who do not stutter; (e) apply treatments for intrusive memories in psychiatric disorders to work with people who stutter.

Health-related quality of life in kidney transplant patients with diabetes

OBJECTIVE

We sought to assess the disutility associated with diabetes in the kidney transplant population.

METHODS

We enrolled 233 kidney transplant recipients age 18-74 from a Midwestern hospital outpatient department. Recipients with multiple or multi-organ transplants, those with laboratory evidence that suggests acute cellular damage (creatinine-kinase > 200 U/L), or a diagnosis of acute renal failure or acute rejection were excluded from the analysis (n = 33). Participants health-related quality of life (HRQOL) were evaluated using the Euro-QoL-5 Dimension (EQ-5D), Health Utility Index Mark III (HUI-III), and the Short Form-6D (SF-6D), which was calculated from the generic section (SF-12) of the Kidney Disease Quality of Life 36 (KDQOL-36). We estimated health utilities associated with diabetes using general linear modeling after adjusting for demographic, socioeconomic, and clinical characteristics.

RESULTS

The adjusted health disutilities associated with diabetes were clinically and statistically significant: EQ-5D (Δ = 0.05; p < 0.01), HUI-III (Δ = 0.09; p < 0.01), and SF-6D (Δ = 0.04, p < 0.01). There was no difference between diabetic patients with good glycemic control (mean serum glucose <126 mg/dL in the three months prior to enrollment) and patients with poor glycemic control.

CONCLUSIONS

Among kidney transplant patients between the ages of 18-74, non-diabetics have significantly higher HRQOL scores on the EQ-5D, HUI-III, and SF-6D compared with patients with diabetes.

Differential effectiveness of tianeptine, clonidine and amitriptyline in blocking traumatic memory expression, anxiety and hypertension in an animal model of PTSD

Individuals exposed to life-threatening trauma are at risk for developing post-traumatic stress disorder (PTSD), a debilitating condition that involves persistent anxiety, intrusive memories and several physiological disturbances. Current pharmacotherapies for PTSD manage only a subset of these symptoms and typically have adverse side effects which limit their overall effectiveness. We evaluated the effectiveness of three different pharmacological agents to ameliorate a broad range of PTSD-like symptoms in our established predator-based animal model of PTSD. Adult male Sprague-Dawley rats were given 1-h cat exposures on two occasions that were separated by 10 days, in conjunction with chronic social instability. Beginning 24 h after the first cat exposure, rats received daily injections of amitriptyline, clonidine, tianeptine or vehicle. Three weeks after the second cat exposure, all rats underwent a battery of behavioral and physiological tests. The vehicle-treated, psychosocially stressed rats demonstrated a robust fear memory for the two cat exposures, as well as increased anxiety expressed on the elevated plus maze, an exaggerated startle response, elevated heart rate and blood pressure, reduced growth rate and increased adrenal gland weight, relative to the vehicle-treated, non-stressed (control) rats. Neither amitriptyline nor clonidine was effective at blocking the entire cluster of stress-induced sequelae, and each agent produced adverse side effects in control subjects. Only the antidepressant tianeptine completely blocked the effects of psychosocial stress on all of the physiological and behavioral measures that were examined. These findings illustrate the differential effectiveness of these three treatments to block components of PTSD-like symptoms in rats, and in particular, reveal the profile of tianeptine as the most effective of all three agents.

A comparison of the quality of intrusive memories in post-traumatic stress disorder and depression

As in post-traumatic stress disorder (PTSD), intrusive memories (IMs) also play an important role in depression. Evidence about the comparative quality of IMs in PTSD and depression is limited and inconsistent. A total of 28 adults with PTSD, 29 with depression, and 30 controls identified intrusive and voluntary segments of narrative memories of key events. Self-report and language measures of memory quality were obtained. Depressed and PTSD participants reported higher frequency of IMs and higher IM-related interference than controls. IMs in PTSD participants were distinguished from depressed and control participants by higher self-rated distress, higher self-rated sensory quality, and a higher proportion of sensory words in the narrative. The depressed and control groups did not differ on IM quality. PTSD IM segments had more sensory content than voluntary segments and fewer temporal markers. The IM segments of the depressed and control groups had fewer temporal markers than the voluntary segments. Depression severity predicted fewer sensory words in the IM after considering peri-event dissociation and arousal but did not add to the prediction of other IM qualities. A strong sensory quality is a distinctive feature of IMs in PTSD but not in depression. Basic sensory processes contribute to the intrusiveness of remembering in PTSD but not in depression.

Identification of a narrow post-ovulatory window of vulnerability to distressing involuntary memories in healthy women

Psychological disorders characterised by intrusive memories are more prevalent in women than men. The biological, social and cognitive processes underlying this gender-difference have yet to be fully elucidated. Some evidence suggests that (fluctuations in) ovarian hormone levels are responsible for altered sensitivity to emotional stimuli during certain phases in the menstrual-cycle and this may form the basis of a specific vulnerability to psychological disorders in women. The post-ovulatory (luteal) phase has been identified as a period of particular vulnerability to the development of post-traumatic stress disorder (PTSD). Using an experimental model of PTSD, we examine whether differences are detectable between discrete phases in the menstrual-cycle in the experience of intrusive memories. Women (18-35 years-old) in one of three tightly-defined periods within the menstrual cycle--mid-follicular (n=15), early-luteal (n=15) and late-luteal (n=11)--provided saliva samples for ovarian-hormone assay and watched a distressing film. Subsequent intrusive memories, assessed using a daily online-diary, occurred significantly more frequently in the early-luteal group compared to mid-follicular and late-luteal groups. Intrusion frequency was negatively correlated with the estradiol-to-progesterone ratio, but not estradiol or progesterone alone, suggesting that the interactive effect of low estradiol and high progesterone at encoding contributes to the observed effect. Our results support the need for further research in a clinical context with naturally-cycling women who experience a traumatic event, since assessment of days-since-last-menses and ovarian hormone levels may help to identify those at greatest risk of developing re-experiencing symptoms akin to those seen in psychological disorder such as depression and PTSD.

Current status on behavioral and biological markers of PTSD: a search for clarity in a conflicting literature

Extensive research has identified stereotypic behavioral and biological abnormalities in post-traumatic stress disorder (PTSD), such as heightened autonomic activity, an exaggerated startle response, reduced basal cortisol levels and cognitive impairments. We have reviewed primary research in this area, noting that factors involved in the susceptibility and expression of PTSD symptoms are more complex and heterogeneous than is commonly stated, with extensive findings which are inconsistent with the stereotypic behavioral and biological profile of the PTSD patient. A thorough assessment of the literature indicates that interactions among myriad susceptibility factors, including social support, early life stress, sex, age, peri- and post-traumatic dissociation, cognitive appraisal of trauma, neuroendocrine abnormalities and gene polymorphisms, in conjunction with the inconsistent expression of the disorder across studies, confounds attempts to characterize PTSD as a monolithic disorder. Overall, our assessment of the literature addresses the great challenge in developing a behavioral and biomarker-based diagnosis of PTSD.