The neural basis of flashback formation: the impact of viewing trauma

"Whenever I think about this, I feel like killing myself, because life has no meaning to me anymore": an exploration of the consequences of rape victimization for men

BACKGROUND AND PURPOSE

Rape is one of the most common human violations, with devastating consequences for the victims and their families. Although this scourge affects everyone, regardless of gender, studies on rape victimization have largely focused on women and children as the victims. Studies on rape victimization of men are therefore limited and little is known about the consequences of rape victimization for men. Accordingly, this study sought to fill this gap by exploring the consequences of rape victimization for men in the City of Tshwane Metropolitan Municipality, Gauteng Province, South Africa.

METHOD

A qualitative research approach underpinned by interpretative phenomenological analysis (IPA) was used to collect data from a purposive sample of eleven participants. Data was collected using semi-structured face-to-face individual interviews and analysed using the IPA framework. Trustworthiness and validity of study findings was ensured by following Lincoln and Guba criteria, and the study followed ethical principles outlined in the Declaration of Helsinki on conducting research with human participants.

RESULTS

Six superordinate themes emerged from the data as consequences of rape victimization for men, namely physical, psychological, emotional, social, spiritual and financial consequences.

CONCLUSION

The study provides a comprehensive description of the effects of rape on the overall well-being of men. The findings underscore the need for the development of holistic clinical care management guidelines and psychosocial interventions that are specifically tailored for men post-rape. Furthermore, longitudinal studies on the long-term impact of rape on men should be conducted.

Angiotensin receptor blockade modulates resting state functional connectivity in the memory network rather than fear network - implications for posttraumatic stress disorder

Population-based studies have shown that the intake of Angiotensin-II receptor blockers (ARBs), commonly used to treat high blood pressure, is associated with reduced post-traumatic stress disorder (PTSD) symptoms. However, the underlying neural mechanisms remain unclear. While PTSD development is characterized by maladaptive processing within brain networks associated with fear processing and memory formation during trauma exposure, there is increasing evidence that such aberrations manifest in altered resting state functional connectivity (rsFC) of brain regions in these networks. In this double-blind placebo-controlled study in 45 healthy volunteers with high trait-anxiety, we investigated whether the ARB losartan would affect rsFC in prominent seeds of the fear and memory network, counteracting effects seen in PTSD. Seed selection was informed by established rsFC aberrations seen in PTSD and consisted of the hippocampus and the parahippocampal gyrus (memory network), as well the amygdala and insula (fear network). Our results showed that a single dose of the ARB losartan decreased rsFC in the memory network from modulatory structures in the frontal cortex: losartan decreased rsFC (i) between the hippocampus and the inferior frontal gyrus involved in threat processing and memory intrusion development, and (ii) between the parahippocampal gyrus and the dorsolateral prefrontal cortex involved in top-down control. There were no drug effects on the fear network seeds. These findings may imply that ARB preserves adaptive memory function during trauma.

Digital Terror: Its Striking Impact on Public Mental Health

Digital terror refers to the use of digital technology to disseminate graphic images of acts of violence to frighten the public. On October 7, 2023, militants of the Palestinian organization Hamas launched a brutal attack on Israel and used digital terror to magnify their acts. Although the purposeful spreading of terror via digital means is not new, the Hamas attack was significant for the scope, immediacy, and widespread dissemination of its digital content. This column aims to describe and analyze the psychological significance of this new form of terror, the public mental health challenges raised, and the interventions needed to assist those exposed to digital terror.

Active contextualization reduces traumatic memory intrusions via memory integration

Traumatic memory intrusions, the involuntary retrieval of unwanted memories, significantly impact mental health. The dual representation theory proposes that the origin of intrusion lies in the overactivated sensory memory not being integrated with the corresponding contextual memory, highlighting the crucial associations between memory contextualization and intrusion. To test this, our study investigated whether enhancing memory contextualization could effectively reduce intrusion. After experiencing analogue trauma with the trauma film paradigm, 96 healthy participants were randomly allocated to three intervention groups: active contextualization (AC) in which participants actively retrieve and restructure film content, passive contextualization (PC) in which participants passively restudy content-matched pre-contextualized information, and working memory taxation (WM) in which participants performed a working memory dual-task. Diary recordings over the subsequent week revealed a significant reduction in intrusion frequency in the AC group compared to both the PC group and a no-intervention control group. Furthermore, comparing AC with WM, a well-established laboratory intervention on intrusion, established a superior efficacy of the AC intervention in reducing intrusions. Finally, analyses of the explicitly recollected film memories identified the critical element of active contextualization to be memory integration induced by active memory retrieval. Together, our findings suggest that active contextualization causally diminishes intrusions, providing novel insights into the regulation of the contextual memory system in intrusion intervention.

Does the media (also) keep the score? Media-based exposure to the Russian-Ukrainian war and mental health in Portugal

The Russian-Ukrainian war (RUW) is responsible for extensive individual suffering and a socio-economic impact on the world and is reshaping global affairs. Many studies have focused on direct exposure to conflict and several public health policies have been devised. Nonetheless, indirect exposure through media has received minimal attention and there is limited evidence that mental health symptoms and disorders may arise as a result. We explored the role of voluntary or involuntary media-based exposure to the RUW on individuals' mental health including stress symptoms, coping strategies, daily functioning, and worries across demographic variables. In our sample, subjects with involuntary and higher amount of exposure seem to have higher stress symptoms. Also, those who had previous ruminations on war issues could be at risk of developing more post-traumatic stress symptoms. Therefore, media appears to be a conduit that spreads negative consequences of community trauma beyond directly affected communities.

Neural processing of audiovisual and painful analogue trauma and its relationship with subsequent audiovisual and pain intrusions

Background: Posttraumatic stress disorder and medically unexplained pain frequently co-occur. While pain is common during traumatic events, the processing of pain during trauma and its relation to audiovisual and pain intrusions is poorly understood.Objective: Here we investigate neural activations during painful analogue trauma, focusing on areas that have been related to threat and pain processing, and how they predict intrusion formation. We also examine the moderating role of cumulative lifetime adversity.Methods: Sixty-five healthy women were assessed using functional magnetic resonance imaging. An analogue trauma was induced by an adaptation of the trauma-film paradigm extended by painful electrical stimulation in a 2 (film: aversive, neutral) x 2 (pain: pain, no-pain) design, followed by 7-day audiovisual and pain intrusion assessment using event-based ecological momentary assessment. Intrusions were fitted with Bayesian multilevel regression and a hurdle lognormal distribution.Results: Conjunction analysis confirmed a wide network including anterior insula (AI) and dorsal anterior cingulate cortex (dACC) being active both, during aversive films and pain. Pain resulted in activation in areas amongst posterior insula and deactivation in a network around ventromedial prefrontal cortex (VMPFC). Higher AI and dACC activity during aversive>neutral film predicted greater audiovisual intrusion probability over time and predicted greater audiovisual intrusion frequency particularly for participants with high lifetime adversity. Lower AI, dACC, hippocampus, and VMPFC activity during pain>no-pain predicted greater pain intrusion probability particularly for participants with high lifetime adversity. Weak regulatory VMPFC activation was associated with both increased audiovisual and pain intrusion frequency.Conclusions: Enhanced AI and dACC processing during aversive films, poor pain vs. no-pain discrimination in AI and dACC, as well as weak regulatory VMPFC processing may be driving factors for intrusion formation, particularly in combination with high lifetime adversity. Results shed light on a potential path for the etiology of PTSD and medically unexplained pain.

Posttraumatic Stress Disorder Symptom Clusters, Exposure to Potentially Morally Injurious Events, and Aggression Among Army Veterans

OBJECTIVE

Very few studies have examined the association between posttraumatic stress disorder (PTSD) symptom clusters and aggression since the change in PTSD diagnosis criteria a decade ago. Furthermore, these studies have used measures based on PTSD criteria of the DSM-IV. The current study therefore examines the association between PTSD symptom clusters, exposure to potentially morally injurious events (PMIEs), and various types of aggression following the change in PTSD criteria and in accordance with the criteria of the DSM-5-TR.

METHOD

A sample of 167 Israeli combat veterans completed validated self-report questionnaires tapping PTSD symptoms, exposure to PMIEs, and aggression levels.

RESULTS

Our analysis revealed a significant positive relationship between the number of court-martials, betrayal-based PMIEs, all PTSD symptom clusters, and aggression. We also found that the arousal cluster, as well as the number of court-martials and age, predicted aggression, whereas the re-experiencing cluster predicted lower aggression levels.

CONCLUSION

Besides an updated understanding of the association between all PTSD symptom clusters and various forms of aggression, these findings emphasize the importance of targeting arousal symptoms and especially anger in treatment of veterans with PTSD symptoms and those who report experiences of betrayal. The findings also suggest clinicians to consider arousal symptoms, age, and history of court-martials when conducting either clinical or actuarial risk assessments of veterans.

It matters what you see: Graphic media images of war and terror may amplify distress

Media exposure to graphic images of violence has proliferated in contemporary society, particularly with the advent of social media. Extensive exposure to media coverage immediately after the 9/11 attacks and the Boston Marathon bombings (BMB) was associated with more early traumatic stress symptoms; in fact, several hours of BMB-related daily media exposure was a stronger correlate of distress than being directly exposed to the bombings themselves. Researchers have replicated these findings across different traumatic events, extending this work to document that exposure to graphic images is independently and significantly associated with stress symptoms and poorer functioning. The media exposure-distress association also appears to be cyclical over time, with increased exposure predicting greater distress and greater distress predicting more media exposure following subsequent tragedies. The war in Israel and Gaza, which began on October 7, 2023, provides a current, real-time context to further explore these issues as journalists often share graphic images of death and destruction, making media-based graphic images once again ubiquitous and potentially challenging public well-being. For individuals sharing an identity with the victims or otherwise feeling emotionally connected to the Middle East, it may be difficult to avoid viewing these images. Through a review of research on the association between exposure to graphic images and public health, we discuss differing views on the societal implications of viewing such images and advocate for media literacy campaigns to educate the public to identify mis/disinformation and understand the risks of viewing and sharing graphic images with others.

Spatiotemporal dynamics of hippocampal-cortical networks underlying the unique phenomenological properties of trauma-related intrusive memories

Trauma-related intrusive memories (TR-IMs) possess unique phenomenological properties that contribute to adverse post-traumatic outcomes, positioning them as critical intervention targets. However, transdiagnostic treatments for TR-IMs are scarce, as their underlying mechanisms have been investigated separate from their unique phenomenological properties. Extant models of more general episodic memory highlight dynamic hippocampal-cortical interactions that vary along the anterior-posterior axis of the hippocampus (HPC) to support different cognitive-affective and sensory-perceptual features of memory. Extending this work into the unique properties of TR-IMs, we conducted a study of eighty-four trauma-exposed adults who completed daily ecological momentary assessments of TR-IM properties followed by resting-state functional magnetic resonance imaging (rs-fMRI). Spatiotemporal dynamics of anterior and posterior hippocampal (a/pHPC)-cortical networks were assessed using co-activation pattern analysis to investigate their associations with different properties of TR-IMs. Emotional intensity of TR-IMs was inversely associated with the frequency and persistence of an aHPC-default mode network co-activation pattern. Conversely, sensory features of TR-IMs were associated with more frequent co-activation of the HPC with sensory cortices and the ventral attention network, and the reliving of TR-IMs in the "here-and-now" was associated with more persistent co-activation of the pHPC and the visual cortex. Notably, no associations were found between HPC-cortical network dynamics and conventional symptom measures, including TR-IM frequency or retrospective recall, underscoring the utility of ecological assessments of memory properties in identifying their neural substrates. These findings provide novel insights into the neural correlates of the unique features of TR-IMs that are critical for the development of individualized, transdiagnostic treatments for this pervasive, difficult-to-treat symptom.

The impact of the left inferior frontal gyrus on fear extinction: A transcranial direct current stimulation study

INTRODUCTION

Fear extinction is a fundamental component of exposure-based therapies for anxiety-related disorders. The renewal of fear in a different context after extinction highlights the importance of contextual factors. In this study, we aimed to investigate the causal role of the left inferior frontal gyrus (LiFG) in the context-dependency of fear extinction learning via administration of transcranial direct current stimulation (tDCS) over this area.

METHODS

180 healthy subjects were assigned to 9 groups: 3 tDCS conditions (anodal, cathodal, and sham) × 3 context combinations (AAA, ABA, and ABB). The fear conditioning/extinction task was conducted over three consecutive days: acquisition, extinction learning, and extinction recall. tDCS (2 mA, 10min) was administered during the extinction learning phase over the LiFG via a 4-electrode montage. Skin conductance response (SCR) data and self-report assessments were collected.

RESULTS

During the extinction learning phase, groups with excitability-enhancing anodal tDCS showed a significantly higher fear response to the threat cues compared to cathodal and sham stimulation conditions, irrespective of contextual factors. This effect was stable until the extinction recall phase. Additionally, excitability-reducing cathodal tDCS caused a significant decrease of the response difference between the threat and safety cues during the extinction recall phase. The self-report assessments showed no significant differences between the conditions throughout the experiment.

CONCLUSION

Independent of the context, excitability enhancement of the LiFG did impair fear extinction, and led to preservation of fear memory. In contrast, excitability reduction of this area enhanced fear extinction retention. These findings imply that the LiFG plays a role in the fear extinction network, which seems to be however context-independent.

Functional locus coeruleus imaging to investigate an ageing noradrenergic system

The locus coeruleus (LC), our main source of norepinephrine (NE) in the brain, declines with age and is a potential epicentre of protein pathologies in neurodegenerative diseases (ND). In vivo measurements of LC integrity and function are potentially important biomarkers for healthy ageing and early ND onset. In the present study, high-resolution functional MRI (fMRI), a reversal reinforcement learning task, and dedicated post-processing approaches were used to visualise age differences in LC function (N = 50). Increased LC responses were observed during emotionally and task-related salient events, with subsequent accelerations and decelerations in reaction times, respectively, indicating context-specific adaptive engagement of the LC. Moreover, older adults exhibited increased LC activation compared to younger adults, indicating possible compensatory overactivation of a structurally declining LC in ageing. Our study shows that assessment of LC function is a promising biomarker of cognitive aging.

Better together: A systematic review of studies combining magnetic resonance imaging with ecological momentary assessment

Social neuroscientists often use magnetic resonance imaging (MRI) to understand the relationship between social experiences and their neural substrates. Although MRI is a powerful method, it has several limitations in the study of social experiences, first and foremost its low ecological validity. To address this limitation, researchers have conducted multimethod studies combining MRI with Ecological Momentary Assessment (EMA). However, there are no existing recommendations for best practices for conducting and reporting such studies. To address the absence of standards in the field, we conducted a systematic review of papers that combined the methods. A systematic search of peer-reviewed papers resulted in a pool of 11,558 articles. Inclusion criteria were studies in which participants completed (a) Structural or functional MRI and (b) an EMA protocol that included self-report. Seventy-one papers met inclusion criteria. The following review compares these studies based on several key parameters (e.g., sample size) with the aim of determining feasibility and current standards for design and reporting in the field. The review concludes with recommendations for future research. A special focus is given to the ways in which the two methods were combined analytically and suggestions for novel computational methods that could further advance the field of social neuroscience.

Trauma of the Shared Environment: A Qualitative Analysis of the Experiences of Survivors of College Campus Sexual Assault

Survivors of campus sexual assault are often tasked with healing while sharing an environment with their perpetrators. However, little is known about the effects of a shared environment on survivor well-being. A qualitative thematic analysis design was employed to address this gap. We conducted semi-structured interviews with nine female survivors who identified their perpetrators as fellow students at a large state university in the southeastern U.S. The five themes that emerged are situated within an ecological framework, which is also used to guide our recommendations for supporting survivors' well-being within higher education.

The memory trace of an intrusive trauma-analog episode

Intrusive memories are a core symptom of posttraumatic stress disorder. Compared with memories of everyday events, they are characterized by several seemingly contradictory features: intrusive memories contain distinct sensory and emotional details of the traumatic event and can be triggered by various perceptually similar cues, but they are poorly integrated into conceptual memory. Here, we conduct exploratory whole-brain analyses to investigate the neural representations of trauma-analog experiences and how they are reactivated during memory intrusions. We show that trauma-analog movies induce excessive processing and generalized representations in sensory areas but decreased blood-oxygen-level-dependent (BOLD) responses and highly distinct representations in conceptual/semantic areas. Intrusive memories activate generalized representations in sensory areas and reactivate memory traces specific to trauma-analog events in the anterior cingulate cortex. These findings provide the first evidence of how traumatic events could distort memory representations in the human brain, which may form the basis for future confirmatory research on the neural representations of traumatic experiences.

Prevalence and influencing factors of PTSD symptoms among healthcare workers: A multicenter cross-sectional study during the surge period of the COVID-19 pandemic since December 2022 in the Chinese mainland

BACKGROUND

China has experienced a surge period of COVID-19 pandemic since December 2022. Healthcare workers (HCWs) were exposed to huge workload under high risk of being infected, and significant levels of trauma, which might cause Post-traumatic Stress Disorders (PTSD) symptoms in HCWs.

OBJECTIVES

To identify the prevalence of PTSD symptoms among HCWs in the Chinese mainland during the surge period of the COVID-19 pandemic; to explore their psycho-social factors of PTSD symptoms.

METHODS

A multicenter cross-sectional study was conducted among HCWs in Chinese mainland from January 5 to February 9, 2023, covering seven geographical regions. 6552 participants were recruited by convenience sampling. Data were collected on demographic characteristics, work-related factors, and psychological factors by online questionnaires. Univariate analysis and binary logistic regression were used to determine the influencing factors of PTSD symptoms.

RESULTS

The prevalence of PTSD symptoms among HCWs was 37.49 %. A higher level of mindfulness, resilience, and perceived social support were protective factors. Female gender, nurses, higher educational attainment, married status, more working years, higher perceived risk of contracting COVID-19 due to work, and higher perceived work intensity were risk factors.

CONCLUSION

High prevalence of PTSD symptoms among HCWs necessitates psychological interventions. Tailored interventions, designed by professional psychiatrists, should be tailored to address the stressors. A comprehensive approach, incorporating mindfulness, resilience-building, and perceived social support enhancement, is vital to bolster the mental well-being of HCWs exposed to traumatic events, thus mitigating the impact of PTSD effectively. Additionally, it is essential to provide support to HCWs with other potential risk factors.

[Trauma and literality: psychodynamic reason in the spirit of neuroscientific traumatization]

Since its origin in the surgical medicine of the 17th century, trauma research has had multiple interpretations and has been associated either with visible injuries to organs and tissues, or with the influence of pathogenic psychic agents on memory, consciousness and personality. With the intensification of the role of classification systems since DSM-III, the phenomenon of trauma came to be incorporated into the psychiatric realm through Post-Traumatic Stress Disorder and destined finally to the constraints of neuroscientific research. Based on a narrative review, this article will address one of the fundamental epistemological premises for this transition, which informs how psychological trauma gained autonomy over anatomical descriptions to be reclassified, around a century later, as an essentially bodily phenomenon and incorporated into the jargon of neurosciences.

Psychometric properties of sum scores and factor scores differ even when their correlation is 0.98: A response to Widaman and Revelle

Commentary in Widaman and Revelle (2022) argued that sum scoring is justified as long as unidimensionality holds because sum score reliability is defined. My response begins with a review of the literature supporting the perspective we adopted in the original article. I then conduct simulation studies to assess the psychometric properties of sum scores created using Widaman and Revelle's justification relative to scores created by the weighted factor score approach in the original article. In my simulations, I generate data where sum and factor scores are correlated at 0.96 or 0.98 because high factor-sum score correlations are often used to support the contention that sum and factor scores have interchangeable psychometric properties. I explore (a) correlations between estimated scores and true scores, (b) classification accuracy of sum and factor scores, and (c) reliability of sum and factor scores. Results show that factor scores have (a) higher correlations with true scores (Δ = 0.02-0.04), (b) higher sensitivity (Δ = 4-8 percentage points), and (c) higher reliability (Δ = 0.04-0.07). Factor score performance metrics also have less sampling variability in most conditions. Psychometric properties of sum scores-even when highly correlated with factor scores-remain less desirable than those of factor scores. Additional considerations like models with multiple factors and measurement invariance are also discussed. Essentially, even if accepting Widaman and Revelle's justification for sum scoring, it is uncertain whether researchers generally would want to sum score after fitting a factor analysis unless sum and factor scores correlate at (and not merely close to) 1.00.

Differential symptom weighting in estimating empirical thresholds for underlying PTSD severity: Toward a "platinum" standard for diagnosis?

OBJECTIVE

Symptom counts as the basis for Post-Traumatic Stress Disorder (PTSD) diagnoses in the DSM presume each symptom is equally reflective of underlying disorder severity. However, the "equal weight" assumption fails to fit PTSD symptom data when tested. The present study developed an enhanced PTSD diagnosis based on (a) a conventional PTSD diagnosis from a clinical interview and (b) an empirical classification of full PTSD that reflected the relative clinical weights of each symptom.

METHOD

Baseline structured interview data from Project Harmony (N = 2658) was used. An enhanced diagnosis for full PTSD was estimated using an empirical threshold from moderated nonlinear factor analysis (MNLFA) latent PTSD scale scores, in combination with a full conventional PTSD diagnosis based on interview data.

RESULTS

One in 4 patients in the sample had a PTSD diagnosis that was inconsistent with their empirical PTSD grouping, such that the enhanced diagnostic standard reduced the diagnostic discrepancy rate by 20%. Veterans, and in particular female Veterans, were at greatest odds for discrepancy between their underlying PTSD severity and DSM diagnosis.

CONCLUSION

Psychometric methodologies that differentially weight symptoms can complement DSM criteria and may serve as a platform for symptom prioritization for diagnoses in future editions of DSM.

Psychological experience of home-quarantined older women with COVID-19 in Hong Kong: A qualitative study

BACKGROUND

The surge of positive COVID-19 cases taxed the local health care system and left many older adults initiating home self-care practices. The study aimed to explore the psychological experiences of home-quarantined older women diagnosed with COVID-19 in Hong Kong.

METHODS

Ten semi-structured telephone interviews were held among older women from March to April 2022. Inductive thematic analysis was used to analyse the data.

RESULTS

Older women experienced psychological distress, anxiety and depression after being infected with COVID-19. The source of their psychological difficulties included fear of losing control over one's health and dignity, feeling a burden to one's family, conflict in balancing risks and responsibilities, and being overwhelmed by the tragic news reported in media. Meanwhile, the participants demonstrated resilience following the infection and found meaning in their experiences, and grew mentally.

CONCLUSIONS

The older women in this study have identified the negative impact having a diagnosis and being home-quarantine means to them and their family. Yet, they were also able to take some positives from this. Importantly, the older women report being able to build greater resilience, optimism and wisdom towards COVID-19 in general and feel better prepared for the potential of future positive diagnoses.

A prolonged stress rat model recapitulates some PTSD-like changes in sleep and neuronal connectivity

Chronic post-traumatic stress disorder (PTSD) exhibits psychological abnormalities during fear memory processing in rodent models. To simulate long-term impaired fear extinction in PTSD patients, we constructed a seven-day model with multiple prolonged stress (MPS) by modifying manipulation repetitions, intensity, and unpredictability of stressors. Behavioral and neural changes following MPS conveyed longitudinal PTSD-like effects in rats for 6 weeks. Extended fear memory was estimated through fear retrieval induced-freezing behavior and increased long-term serum corticosterone concentrations after MPS manipulation. Additionally, memory retrieval and behavioral anxiety tasks continued enhancing theta oscillation activity in the prefrontal cortex-basal lateral amygdala-ventral hippocampus pathway for an extended period. Moreover, MPS and remote fear retrieval stimuli disrupted sleep-wake activities to consolidate fear memory. Our prolonged fear memory, neuronal connectivity, anxiety, and sleep alteration results demonstrated integrated chronic PTSD symptoms in an MPS-induced rodent model.

Effect of sleep manipulations on intrusive memories after exposure to an experimental analogue trauma: A meta-analytic review

Sleep plays an important role in memory processing and is disrupted in individuals with post-traumatic stress disorder (PTSD). A growing body of research has experimentally investigated how sleep - or lack thereof - in the early aftermath of a traumatic experience contributes to intrusive memory formation. The aim of this meta-analytic review was to examine the effects of various experimental sleep manipulations (e.g., sleep deprivation, daytime naps) on intrusive memories following exposure to an experimentally induced analogue traumatic event. Eight eligible studies were systematically identified through PsycInfo and PubMed and provided sufficient data to contribute to a meta-analysis of the effects of sleep versus wakefulness on intrusive memory frequency. Sleep was found to reduce intrusive memory frequency when compared to wakefulness at a small but significant effect size (Hedge's g = 0.29). There was no evidence of publication bias and heterogeneity of effect sizes across studies was moderate. Results suggest that sleep plays a protective role in the aftermath of exposure to a traumatic event with implications for early post-trauma intervention efforts.

Bilateral eye movements disrupt the involuntary perceptual representation of trauma-related memories

Bilateral eye movement (EM) is a critical component in eye movement desensitization and reprocessing (EMDR), an effective treatment for post-traumatic stress disorder. However, the role of bilateral EM in alleviating trauma-related symptoms is unclear. Here we hypothesize that bilateral EM selectively disrupts the perceptual representation of traumatic memories. We used the trauma film paradigm as an analog for trauma experience. Nonclinical participants viewed trauma films followed by a bilateral EM intervention or a static Fixation period as a control. Perceptual and semantic memories for the film were assessed with different measures. Results showed a significant decrease in perceptual memory recognition shortly after the EM intervention and subsequently in the frequency and vividness of film-related memory intrusions across one week, relative to the Fixation condition. The EM intervention did not affect the explicit recognition of semantic memories, suggesting a dissociation between perceptual and semantic memory disruption. Furthermore, the EM intervention effectively reduced psychophysiological affective responses, including the skin conductance response and pupil size, to film scenes and subjective affective ratings of film-related intrusions. Together, bilateral EMs effectively reduce the perceptual representation and affective response of trauma-related memories. Further theoretical developments are needed to elucidate the mechanism of bilateral EMs in trauma treatment.

Workplace Trauma in a Digital Age: The Impact of Video Evidence of Violent Crime on Criminal Justice Professionals

High-quality video and audio recordings of violent crimes, captured using now ubiquitous digital technologies, play an increasingly important role in the administration of justice. However, the effects of exposure to gruesome material presented in this form on criminal justice professionals who analyze, evaluate, and use this potentially traumatic content in the context of their work, are largely unknown. Using long interviews and constructivist grounded theory, this qualitative study sought to explore experiences of exposure to video evidence of violent crime among Canadian criminal justice professionals. Sixteen individuals including police, lawyers, judges, psychiatrists, law clerks, and court reporters volunteered to participate in qualitative long interviews asking about workplace exposures to violent videos. Themes identified address the ubiquity of video evidence of violent crime; proximity to violence through video; being blindsided through lack of preparedness for violent content; repeated exposures through multiple and protracted viewings; insufficient customary methods for self-protection; and the enduring impact of exposure to videoed violence. We determine that criminal justice professionals are increasingly and repeatedly presented with deeply disturbing imagery that was once imperceptible or unknowable and thus previously held at a greater distance. Elements of what is newly visible and audible in video evidence of violent crime create a new emotional proximity to violence that potentially increases the risks of secondary trauma and underscores the need for improved safety measures.

Longitudinal assessment of amygdala activity in mice susceptible to trauma

Resilience to consequences of trauma exposure contains relevant information about the processes that contribute to the maintenance of mental health in the face of adversity; information that is essential to improve treatment success of stress-related mental diseases. Prior literature has implicated aberrant amygdala (re)activity as potential factor contributing to trauma susceptibility. However, it remains to be resolved which amygdalar subregions and neuronal subclasses are involved, and when - i.e., pre-, peri- or post-trauma exposure - and under what conditions changes in amygdala (re)activity manifest themselves. Here, we implemented a preclinical rodent model for PTSD that entailed exposure to a traumatic event (severe, unpredictable foot shock) followed by a trigger (mild, predictable foot shock). Using behavioral phenotyping, trauma susceptible vs. resilient mice were identified and pre-, peri- or post-trauma amygdala activity was compared. Neuronal activity was tagged in living mice by the use of the ArcTRAP transgenic mouse line, labeling all activated (i.e., Arc-expressing) neurons by a systemic injection of tamoxifen. Furthermore, we assessed amygdala responses during fear memory recall, induced by either (re-)exposure to the trauma, trigger, or a novel, yet similar context, and analyzed behavioral fear responses under these conditions, as well as basal anxiety in the mice. Results revealed no major differences dissociating susceptible vs. resilient mice prior to trauma exposure, but exaggerated activity in specifically the basolateral amygdala (BLA) peri-trauma that predicted susceptibility to later PTSD-like symptoms. Post-trauma, susceptible mice did not display altered basal amygdala activity, but BLA hyperreactivity in response to trigger context re-exposure, and BLA hyporesponsivity in response to the trauma context. Exposure to the novel, similar context evoked a differential temporal pattern of freezing behavior in susceptible mice and an increased activity of amygdalar somatostatin-expressing neurons specifically. As such, these results for the first time show that deviant BLA activity during fear learning predicts susceptibility to its long-term consequences and that aberrant subsequent BLA responses to stressful contexts depend on the exact context.

A Naturalistic Paradigm to Investigate Postencoding Neural Activation Patterns in Relation to Subsequent Voluntary and Intrusive Recall of Distressing Events

BACKGROUND

While neuroimaging has provided insights into the formation of episodic memories in relation to voluntary memory recall, less is known about neural mechanisms that cause memories to occur involuntarily, for example, as intrusive memories of trauma. Here, we investigated brain activity shortly after viewing distressing events as a function of whether memories for those events later intruded involuntarily. The postencoding period is particularly important because it is a period when clinical interventions could be applied.

METHODS

A total of 32 healthy volunteers underwent functional magnetic resonance imaging while viewing distressing film clips, interspersed with 5 minutes of awake (postencoding) rest. Voluntary memories of the films were assessed using free recall and verbal and visual recognition tests after a week, while intrusive (involuntary) memories were recorded in a diary throughout that week.

RESULTS

When analyzing functional magnetic resonance imaging responses related to watching the films, we replicated findings that those "hotspots" (salient moments within the films) that would later become intrusive memories elicited higher activation in parts of the brain's salience network. Surprisingly, while the postencoding persistence of multivoxel correlation structures associated with entire film clips predicted subsequent voluntary recall, there was no evidence that they predicted subsequent intrusions.

CONCLUSIONS

Results replicate findings regarding the formation of intrusive memories during encoding and extend findings regarding the consolidation of information in postencoding rest in relation to voluntary memory. While we provided a first step using a naturalistic paradigm, further research is needed to elucidate the role of postencoding neural processes in the development of intrusive memories.

Multilayer Network Analysis of Dynamic Network Reconfiguration in Adults With Posttraumatic Stress Disorder

BACKGROUND

Brain functional network abnormalities are reported in posttraumatic stress disorder (PTSD). Most resting-state functional magnetic resonance imaging studies have assumed that the functional networks remain static during the scans. How these might change dynamically in PTSD remains unclear.

METHODS

Resting-state functional magnetic resonance imaging data were collected from 71 noncomorbid, treatment-naïve patients with PTSD and 70 demographically matched, trauma-exposed non-PTSD control subjects. Network switching rate was used to characterize dynamic changes of individual resting-state functional networks. Results were analyzed by comparing switching rates between the PTSD and trauma-exposed non-PTSD groups, testing for diagnosis × sex interactions, and examining correlations with PTSD symptom severity.

RESULTS

At the global level, the PTSD group showed significantly lower network switching rates than the trauma-exposed non-PTSD group. These were observed mainly in the frontoparietal, default mode, and limbic networks at the subnetwork level and in the frontal and temporal regions at the nodal level. These network switching rate alterations were correlated with PTSD symptom severity. There were no significant effects of sex.

CONCLUSIONS

These disruptions of dynamic functional network stability, reflected by lower network switching rates in the resting state, are a feature of PTSD and suggest that the frontoparietal, default mode, and limbic networks may play a critical role in the underlying neural mechanisms.

Visual phenomenology in schizophrenia and post-traumatic stress disorder: an exploratory study

BACKGROUND

Visual experiences such as hallucinations are commonly reported by people with psychosis, psychological trauma and dissociative states, although questions remain about their similarities and differences. For diagnostic and therapeutic purposes, clinical research must better delineate and compare the characteristics of these experiences in post-traumatic stress disorder (PTSD) and in schizophrenia.

AIMS

To compare visual phenomena and dissociation in participants with a primary psychotic illness and those with a trauma diagnosis.

METHOD

A quantitative group design study comparing visual phenomena in three participant groups who also have a history of hearing voices: schizophrenia and no trauma history (n = 19), PTSD with dissociation (n = 17) and comorbid schizophrenia and PTSD (n = 20). Validated clinical measures included the North-East Visual Hallucination Interview, PTSD Symptoms Scale Interview, Clinician Administered Dissociative States Scale, Psychotic Symptoms Rating Scales and Positive and Negative Syndrome Scale.

RESULTS

There was a remarkable similarity in visual experiences, including rates of complex visual hallucinations, between the three diagnostic groups. There were no significant differences in the severity or components of distress surrounding the visual experiences. Dissociation predicted visual hallucination severity for the comorbid schizophrenia and PTSD group, but not for PTSD or schizophrenia alone.

CONCLUSIONS

Visual experiences in PTSD can include visual hallucinations that are indistinguishable from those experienced in schizophrenia. Multimodal hallucinations are frequently observed in both schizophrenia and PTSD. A model for visual hallucinations in PTSD is suggested, following two separate neurobiological pathways based on distinct responses to trauma.

Media exposure, risk perceptions, and fear: Americans' behavioral responses to the Ebola public health crisis

We examined media exposure, psychological fear and worry, perceptions of risk, and health protective behaviors surrounding the 2014 Ebola virus outbreak in a probability-based, representative, national sample of Americans (N = 3447). Structural equation models examined relationships between amount (hours/day) and content (e.g., graphic images of dead bodies) of media exposure and counts of self-reported health protective behaviors that participants performed or would perform if Ebola spread to their community. Ebola-related risk perceptions and fear and worry were potential mediators. Greater total hours and more graphic media exposure positively correlated with more fear and worry; greater total hours of media exposure also positively correlated with higher perceived risk. Higher risk perceptions were associated with more health protective behaviors performed and intended. Greater fear and worry were associated with more behaviors performed. Amount and content of media exposure exhibited indirect effects on behaviors performed; amount of media exposure had indirect effects on intentions. Media may help promote health protective behaviors during public health threats; the amount and content should be congruent with threat to minimize distress and maximize resources.

Estimating posttraumatic stress disorder severity in the presence of differential item functioning across populations, comorbidities, and interview measures: Introduction to Project Harmony

Multiple factor analytic and item response theory studies have shown that items/symptoms vary in their relative clinical weights in structured interview measures for posttraumatic stress disorder (PTSD). Despite these findings, the use of total scores, which treat symptoms as though they are equally weighted, predominates in practice, with the consequence of undermining the precision of clinical decision-making. We conducted an integrative data analysis (IDA) study to harmonize PTSD structured interview data (i.e., recoding of items to a common symptom metric) from 25 studies (total N = 2,568). We aimed to identify (a) measurement noninvariance/differential item functioning (MNI/DIF) across multiple populations, psychiatric comorbidities, and interview measures simultaneously and (b) differences in inferences regarding underlying PTSD severity between scale scores estimated using moderated nonlinear factor analysis (MNLFA) and a total score analog model (TSA). Several predictors of MNI/DIF impacted effect size differences in underlying severity across scale scoring methods. Notably, we observed MNI/DIF substantial enough to bias inferences on underlying PTSD severity for two groups: African Americans and incarcerated women. The findings highlight two issues raised elsewhere in the PTSD psychometrics literature: (a) bias in characterizing underlying PTSD severity and individual-level treatment outcomes when the psychometric model underlying total scores fails to fit the data and (b) higher latent severity scores, on average, when using DSM-5 (net of MNI/DIF) criteria, by which multiple factors (e.g., Criterion A discordance across DSM editions, changes to the number/type of symptom clusters, changes to the symptoms themselves) may have impacted severity scoring for some patients.

Lonely in the Dark: Trauma Memory and Sex-Specific Dysregulation of Amygdala Reactivity to Fear Signals

Loneliness exacerbates psychological distress and increases the risk of psychopathology after trauma exposure. However, it is still unclear whether a lack of social connectedness affects trauma-related intrusions and the neural processing of fear signals. Moreover, it is uncertain, whether loneliness plays a different role in women and men. A prestratification strategy is used and n = 47 (n = 20 women) healthy lonely individuals and n = 35 controls (n = 18 women) are recruited. Participants are exposed to an experimental trauma and evoked intrusive thoughts in daily life are monitored for three consecutive days. Functional magnetic resonance imaging is used to assess neural habituation to fearful faces and fear learning (conditioning and extinction) prior to trauma exposure. The results reveal a significant interaction between loneliness and sex such that loneliness is associated with more intrusions in men, but not in women. A similar pattern emerges at the neural level, with both reduced amygdala habituation to repeated fearful faces and amygdala hyperreactivity during the conditioning of fear signals in lonely men. The findings indicate that loneliness may confer vulnerability to intrusive memories after trauma exposure in healthy men and that this phenotype relates to altered limbic processing of fear signals.

Neurobiological Changes in Posttraumatic Stress Disorder and Their Reversibility by Psychotherapy

Abstract. Background: Posttraumatic stress disorder (PTSD) is a debilitating illness associated with distressing symptoms and a high societal burden. Objective: To investigate the neurobiological underpinnings of PTSD to improve our understanding of this disorder and its treatment. Methods: This article reviews currently researched mechanisms that can explain the development of PTSD symptoms. It presents key findings on neural (i. e., brain functioning and brain structure), neuroendocrine (i. e., noradrenergic and hypothalamic-pituitary-adrenal axis activity), and related (epi)‌genetic changes in individuals with PTSD. Furthermore, it presents preliminary research examining the reversibility of these alterations during psychotherapeutic treatment. Results: PTSD is characterized by specific neurobiological alterations, with preliminary findings indicating that at least some of these may normalize during psychotherapy. Discussion: A multidimensional perspective on the development, maintenance, and treatment of PTSD has the potential to improve our understanding of the causal processes underlying the disorder and may ultimately inform the conception of novel treatments.

Visual hallucinations in psychiatry - what aren't we seeing?

OBJECTIVE

To increase awareness of practising clinicians and researchers to the phenomenological distinctions between visual hallucinations and trauma-based, dissociative, visual re-experiencing phenomena seen in psychiatric disease.

CONCLUSIONS

The experience of visual hallucinations is not exclusive to psychotic disorders in psychiatry. Different forms of experiences that resemble visual hallucinations may occur in patients with a trauma background and may potentially affect diagnosis. Given the paucity of literature around the subject, it is imperative that further research aims to characterise the distinction between visual hallucinations in psychosis and visual phenomena associated with trauma.

Post-traumatic Stress and Growth Among the Children and Adolescents in the Aftermath of COVID-19

The coronavirus disease 2019 (COVID-19) pandemic has enkindled many mental health problems across the globe. Prominent among them is the prevalence of post-traumatic stress (PTS) with hosts of its precipitating factors being present in the surrounding. With India witnessing severe impact of the second wave of COVID-19, marked by a large number of hospitalizations, deaths, unemployment, imposition of lockdowns, etc., its repercussions on children and adolescents demand particular attention. This study aims to examine the direct and the indirect exposure of COVID-19-related experiences on children and adolescents and its subsequent relationship with PTS and post-traumatic growth (PTG). The direct exposure was operationalized in terms of death or hospitalization in the family, while the indirect exposure was gauged in terms of exposure to media reports of the COVID situation. Data from 412 children and adolescents aged 9–20 years, collected online, revealed 68.9% of them with PTS. Interestingly, 39.8% of those reporting PTS were also experiencing PTG. Arousal appeared to be the most frequently reported characteristics of trauma. The multivariate analysis of variance (MANOVA) endorses significant difference between those with direct and indirect exposures to hospitalization. Those with direct exposure to hospitalization reported higher PTS. The indirect exposure of COVID-19-related news through electronic media was also significantly associated with higher PTS. Exposure through print media did not lead to significant difference in PTS, but those reading only magazines reported significantly higher PTG than not reading magazines. The findings are analyzed in the light of unfolding of events during the second wave of COVID-19 in India.

Post-traumatic Stress and Growth Among the Children and Adolescents in the Aftermath of COVID-19

The coronavirus disease 2019 (COVID-19) pandemic has enkindled many mental health problems across the globe. Prominent among them is the prevalence of post-traumatic stress (PTS) with hosts of its precipitating factors being present in the surrounding. With India witnessing severe impact of the second wave of COVID-19, marked by a large number of hospitalizations, deaths, unemployment, imposition of lockdowns, etc., its repercussions on children and adolescents demand particular attention. This study aims to examine the direct and the indirect exposure of COVID-19-related experiences on children and adolescents and its subsequent relationship with PTS and post-traumatic growth (PTG). The direct exposure was operationalized in terms of death or hospitalization in the family, while the indirect exposure was gauged in terms of exposure to media reports of the COVID situation. Data from 412 children and adolescents aged 9–20 years, collected online, revealed 68.9% of them with PTS. Interestingly, 39.8% of those reporting PTS were also experiencing PTG. Arousal appeared to be the most frequently reported characteristics of trauma. The multivariate analysis of variance (MANOVA) endorses significant difference between those with direct and indirect exposures to hospitalization. Those with direct exposure to hospitalization reported higher PTS. The indirect exposure of COVID-19-related news through electronic media was also significantly associated with higher PTS. Exposure through print media did not lead to significant difference in PTS, but those reading only magazines reported significantly higher PTG than not reading magazines. The findings are analyzed in the light of unfolding of events during the second wave of COVID-19 in India.

Narrative imagery: Emotional modulation in the default mode network

The default mode network (DMN) is activated when constructing and imagining narrative events, with functional brain activity in the medial-prefrontal cortex hypothesized to be modulated during emotional processing by adding value (or pleasure) to the episodic representation. However, since enhanced reactivity during emotional, compared to neutral, content is a more frequent finding in both the brain and body in physiological, neural, and behavioral measures, the current study directly assesses the effects of pleasure and emotion during narrative imagery in the DMN by using a within-subject design to first identify the DMN during resting state and then assess activation during pleasant, neutral, or unpleasant imagery. Replicating previous findings, enhanced functional activity in the medial prefrontal cortex was found when imagining pleasant, compared to unpleasant, events. On the other hand, emotion-related activation was found when imagining either pleasant or unpleasant, compared to neutral, events in other nodes of the DMN including the posterior cingulate cortex (PCC), angular gyrus, anterior hippocampus, lateral temporal cortex, temporal pole, dorsomedial prefrontal cortex (dmPFC), and ventrolateral prefrontal cortex (vlPFC). Pervasive emotional modulation in the DMN is consistent with the view that a primary function of event retrieval and construction is to remember, recreate, and imagine motivationally relevant events important for planning adaptive behavior.

Dysconnectivity of the amygdala and dorsal anterior cingulate cortex in drug-naive post-traumatic stress disorder

Convergent studies have highlighted the amygdala-based and dorsal anterior cingulate cortex (dACC)-based circuit or network dysfunction in post-traumatic stress disorder (PTSD). However, previous studies are often complicated by various traumatic types, psychiatric comorbidities, chronic illness duration, and medication effect on brain function. Besides, little is known whether the functional integration with amygdala-dACC interaction disrupted or not in PTSD. Here, we investigated effective connectivity (EC) between the amygdala-dACC and rest of the cortex by applying psycho-physiological interaction (PPI) approach to resting-state functional magnetic resonance imaging data of 63 drug-naive PTSD patients and 74 matched trauma-exposed non-PTSD controls. Pearson correlation analysis was performed between EC values extracted from regions with between-group difference and clinical profiles in PTSD patients. We observed distinct amygdala-dACC interaction pattern between PTSD group and the control group, which is composed primarily by positive EC in the former and negative in the latter. In addition, compared with non-PTSD controls, PTSD patients showed increased EC between amygdala-dACC and the prefrontal cortex, left inferior parietal lobule, and bilateral ventral occipital cortex, and decreased EC between amygdala-dACC and the left fusiform gyrus. The EC increase between amygdala-dACC and the right middle frontal gyrus was negatively correlated with the clinician-administered PTSD scale scores in PTSD patients. Aberrent communication between amgydala-dACC and brain regions involved in central executive network and visual systems might be associated with the pathophysiology of PTSD. Further, these findings suggested that dysconnectivity of the amygdala and dACC could be adapted as a relatively early course diagnostic biomarker of PTSD.

Connection between the COVID-19 pandemic, war trauma reminders, perceived stress, loneliness, and PTSD in Bosnia and Herzegovina

In order to gain a better understanding of what happens during the COVID-19 pandemic to those who were previously traumatized, this study investigated perceived stress and severity of PTSD symptoms during the COVID-19 pandemic in people who experienced the 1992-1995 war in Bosnia and Herzegovina. It was also examined how reminders of past trauma and loneliness instigated by the COVID-19 crisis relate to current stress and PTSD symptoms. The sample consisted of 123 participants (74.8% women). Participants responded to assessments of sociodemographic characteristics, exposure to COVID-related information, concerns over disease, severity of exposure to war, frequency and intensity of war trauma reminders, loneliness, stress, and severity of PTSD symptoms. Data was collected as part of the COVIDiSTRESS Global Survey. Results showed that in a population previously exposed to the effects of war, severity of PTSD symptoms was positively related to perceived stress, and loneliness during the pandemic significantly mediated this relationship. Intensity of exposure to war trauma reminders was associated with higher levels of PTSD symptom severity. Higher severity of PTSD symptoms was related to forced displacement during the war. Moreover, higher stress was related to increased concerns over disease. To conclude, those exposed to war may be more affected by the global COVID-19 pandemic and preventive measures that accompany it, while loneliness mediates the effects of PTSD and perceived stress in this population.

Increased occurrence of PTSD symptoms in adolescents with major depressive disorder soon after the start of the COVID-19 outbreak in China: a cross-sectional survey

BACKGROUND

The Coronavirus Disease 2019 (COVID-19) pandemic continues to threaten the physical and mental health of people across the world. This study aimed to understand the psychological impact of this disease on adolescents with major depressive disorder (MDD) at 1 month after the start of the outbreak in China.

METHODS

Using the Children's Impact of Event Scale (CRIES-13) questionnaire, we investigated the occurrence of posttraumatic stress disorder (PTSD) in two groups of adolescents: MDD patients who were in continuous antidepressant therapy and healthy controls. Total scores and factor subscores were compared between the two groups and subgroups stratified by sex and school grade. Logistic regression was used to identify variables associated with high total CRIES-13 scores.

RESULTS

Compared to controls (n = 107), the MDD group (n = 90) had higher total CRIES-13 scores and a higher proportion with a total score ≥ 30. They also had a lower intrusion subscore and a higher arousal subscore. In the MDD group, males and females did not differ significantly in total CRIES-13 scores or factor subscores, but junior high school students had higher avoidance subscores than senior high school students. Logistic regression showed high total CRIES-13 scores to be associated with MDD and the experience of "flashbacks" or avoidance of traumatic memories associated with COVID-19.

CONCLUSIONS

It is crucial to understand the psychological impact of COVID-19 on adolescents with MDD in China, especially females and junior high school students. Long-term monitoring of adolescents with a history of mental illness is required to further understand these impacts.

TRIAL REGISTRATION

ChiCTR, ChiCTR2000033402 , Registered 31 May 2020.

The neural basis of Tetris gameplay: implicating the role of visuospatial processing

Tetris is not only a widely used entertaining computer game, but has been used as a component in emerging psychological interventions targeting dysfunctional mental imagery, e.g., intrusive memories and imagery-based cravings. However, little is known about the neurobiological mechanisms underlying these interventions. Tetris gameplay has been hypothesized to disrupt dysfunctional mental imagery (e.g., imagery-based intrusive memories of adverse events) and cravings (e.g., substance use) by taxing visuospatial working memory. In line with this, the present study aimed to characterize brain areas involved in the visuospatial aspects of Tetris gameplay, by controlling for motor activity (button presses) and using gameplay instructions emphasizing mental rotation. Participants (N = 28) received mental rotation instructions and thereafter either played Tetris, or only pressed buttons as if playing Tetris (motor activity), while undergoing functional magnetic resonance imaging. Tetris gameplay (when using mental rotation instructions and controlling for motor activity) robustly activated brain areas located in the ventral and dorsal stream, with maximum peak activation in the inferior and mid temporal gyrus. To the best of our knowledge, this is the first study to characterize brain areas specifically associated with the visuospatial aspects of Tetris gameplay, by controlling for motor activity and when using mental rotation instructions. Results demonstrate that engaging in Tetris gameplay recruits an extensive brain circuitry previously tied to visuospatial processing. Thus, findings are consistent with the use of Tetris as an imagery-competing task as one of several components of emerging interventions targeting dysfunctional mental imagery.

Neuromodulation of Visual Cortex Reduces the Intensity of Intrusive Memories

Aversive events can be reexperienced as involuntary and spontaneous mental images of the event. Given that the vividness of retrieved mental images is coupled with elevated visual activation, we tested whether neuromodulation of the visual cortex would reduce the frequency and negative emotional intensity of intrusive memories. Intrusive memories of a viewed trauma film and their accompanied emotional intensity were recorded throughout 5 days. Functional connectivity, measured with resting-state functional magnetic resonance imaging prior to film viewing, was used as predictive marker for intrusions-related negative emotional intensity. Results indicated that an interaction between the visual network and emotion processing areas predicted intrusions’ emotional intensity. To test the causal influence of early visual cortex activity on intrusions’ emotional intensity, participants’ memory of the film was reactivated by brief reminders 1 day following film viewing, followed by inhibitory 1 Hz repetitive transcranial magnetic stimulation (rTMS) over early visual cortex. Results showed that visual cortex inhibitory stimulation reduced the emotional intensity of later intrusions, while leaving intrusion frequency and explicit visual memory intact. Current findings suggest that early visual areas constitute a central node influencing the emotional intensity of intrusive memories for negative events. Potential neuroscience-driven intervention targets designed to downregulate the emotional intensity of intrusive memories are discussed.

Centrally acting anticholinergic drug trihexyphenidyl is highly effective in reducing nightmares associated with post-traumatic stress disorder

INTRODUCTION

Following a case study on scopolamine butyl bromide, an anticholinergic drug, we studied the effect of a central anticholinergic drug on post-traumatic stress disorder (PTSD)-related flashbacks and nightmares.

METHODS

We administered trihexyphenidyl (TP) to 34 patients with refractory PTSD-related nightmares and flashbacks (open-label trial [n = 22]; single-blind trial [n = 12]), who had previously received psychiatric treatment for approximately 2-15 years, without therapeutic benefits. The effect of TP was determined using the Clinician-Administered PTSD Scale (CAPS) and the Impact of Event Scale-Revised (IES-R).

RESULTS

Overall, most patients reported an improvement to none or mild on the CAPS for nightmares (88%) and flashbacks (79%).

CONCLUSION

This study is the first to demonstrate the potential efficacy of TP in the treatment of refractory PTSD-related nightmares and flashbacks. Further double-blind, randomized control trials are needed to explore the potential clinical benefits of TP in PTSD.

Reflex memory theory of acquired involuntary motor and sensory disorders

Background

Explicit and implicit memories are conserved but flexible biological tools that nature uses to regulate the daily behaviors of human beings. An aberrant form of the implicit memory is presumed to exist and may be contributory to the pathophysiology of disorders such as tardive syndromes, phantom phenomena, flashback, posttraumatic stress disorders (PTSD), and related disorders. These disorders have posed significant clinical problems for both patients and physicians for centuries. All extant pathophysiological theories of these disorders have failed to provide basis for effective treatment.

Objective

The objective of this article is to propose an alternative pathophysiological theory that will hopefully lead to new treatment approaches.

Methods

The author sourced over 60 journal articles that treated topics on memory, and involuntary motor and sensory disorders, from open access journals using Google Scholar, and reviewed them and this helped in the formulation of this theory.

Results

From the reviews, the author thinks physical or chemical insult to the nervous system can cause defective circuit remodeling, leading to generation of a variant of implicit (automatic) memory, herein called “reflex memory” and this is encoded interoceptively to contribute to these phenomena states.

Conclusion

Acquired involuntary motor and sensory disorders are caused by defective circuit remodeling involving multiple neural mechanisms. Dysregulation of excitatory neurotransmitters, calcium overload, homeostatic failure, and neurotoxicity are implicated in the process. Sustained effects of these defective mechanisms are encoded interoceptively as abnormal memory in the neurons and the conscious manifestations are these disorders. Extant theories failed to recognize this possibility.

Media exposure predicts acute stress and probable acute stress disorder during the early COVID-19 outbreak in China

Background

The COVID-19 has led to unprecedented psychological stress on the general public. However, the associations between media exposure to COVID-19 and acute stress responses have not been explored during the early COVID-19 outbreak in China.

Methods

An online survey was conducted to investigate the relationships between media exposure to COVID-19 and acute stress responses, and to recognize associated predictors of acute stress responses on a sample of 1,450 Chinese citizens from February 3 to February 10, 2020. Media exposure questionnaire related to COVID-19 was developed to assess media exposure time, media exposure forms and media exposure content. The Stanford Acute Stress Reaction Questionnaire (SASRQ) was used to measure acute stress responses, including continuous acute stress symptom scores and the risk of probable acute stress disorder (ASD). A series of regression analyses were conducted.

Results

Longer media exposure time and social media use were associated with higher acute stress and probable ASD. Viewing the situation of infected patients was associated with higher acute stress, whereas viewing the latest news about pandemic data was associated with lower odds of probable ASD. Being females, living in Hubei Province, someone close to them diagnosed with COVID-19, history of mental illness, recent adverse life events and previous collective trauma exposure were risk factors for acute stress responses.

Conclusions

These findings confirmed the associations between indirect media exposure to pandemic events and acute stress responses. The governments should be aware of the negative impacts of disaster-related media exposure and implement appropriate interventions to promote psychological well-being following pandemic events.

Media Exposure Related to the PTSS During COVID-19 Pandemic: The Mediating Role of Risk Perception

Objectives: The objectives of this study are to assess the relationship between media exposure and post-traumatic stress symptoms (PTSS) and to highlight the underlying mechanisms mediated by risk perception. Methods: This survey was conducted online in China from February 1st to February 10th, 2020. A total of 2,858 Chinese citizens aged ≥18 years from 31 provinces and autonomous regions were recruited to participate in a cross-sectional study. Self-report questionnaires were used to assess media exposure, PTSS, and risk perception. Results: The prevalence of respondents with heightened PTSS scores was 22.2%. After controlling for covariates, media exposure (more than five times a day) was significantly and positively associated with a high level of PTSS (B = 4.11, p < 0.001), and risk perception (worry and severity) significantly mediated the relationship between media exposure and PTSS (all 95% CIs did not include 0). Conclusions: Based on these findings, the frequency of media exposure was associated with PTSS. Risk perception (worry and severity) mediated the relationship between media exposure and PTSS. The mental health, particularly PTSS, of the general population should be closely monitored and "infodemics" should be combatted while addressing the COVID-19 outbreak; cognitive interventions may be promising.

Media Exposure to COVID-19 Predicted Acute Stress: A Moderated Mediation Model of Intolerance of Uncertainty and Perceived Social Support

Background: Previous studies have found that disaster-related media exposure could predict acute stress responses. However, few studies have investigated the relationship between media exposure to COVID-19 and acute stress, and less is known about the mechanisms that translate media exposure to COVID-19 into acute stress. The current study explored the impact of media exposure to COVID-19 on acute stress, and examined the mediating role of intolerance of uncertainty (IU) and the moderating role of perceived social support (PSS). Methods: A total of 1,483 Chinese participants (M age = 27.93 years, SD = 8.45) completed anonymous online questionnaires regarding media exposure to COVID-19, IU, PSS, and acute stress during the COVID-19 outbreak in China. Results: Media exposure to COVID-19 was positively related to acute stress, and IU partially mediated this relationship. The direct effect of media exposure to COVID-19 on acute stress, and the relationship between IU and acute stress, were both moderated by PSS. The impacts of both media exposure to COVID-19 and IU on acute stress were stronger for individuals with low PSS. Limitations: This study collected data in a shorter timeframe, and no assessments occurred during the follow-up, which may prevent us from detecting the changes of the relationships between variables over time. Meanwhile, the self-report method limited the validity of the data due to subjective reporting bias. Conclusions: These findings contribute to a better understanding of how and when pandemic-related media exposure affects acute stress, and provide new perspectives for the prevention to reduce psychological problems following traumatic events.