Reflective thinking and mental imagery: A perspective on the development of posttraumatic stress disorder

Mothers with a history of trauma and their children: a systematic review of treatment interventions

Introduction

Mothers with a history of trauma frequently face significant challenges in their relationships with their children. Therefore, it is crucial for trauma-exposed mothers and their young children to receive adequate trauma-informed treatment. This review aimed to examine the effects of trauma-informed interventions on improving the mother-child relationship among mothers with a history of trauma and their young children under 6 years old.

Methods

The study analyzed 15 articles that met the eligibility criteria, encompassing a sample size of 1,321 mothers. The systematic GRADE approach was used to rate the certainty of evidence in this systematic review.

Results

The study found that while some interventions demonstrated small to large effects, the quality of evidence was only moderate. The most promising interventions were Parent-Child Interaction Therapy (PCIT), Child-Parent Psychotherapy (CPP), and Maternal Empowerment Program (MEP), which all included elements of psychotherapy, psychoeducation, and skills training.

Discussion

The study underscores the importance of understanding the needs of mother-child dyads affected by trauma and tailoring interventions to meet those needs. Overall, the literature suggests that interventions combining psychotherapeutic, psychoeducational, and skills-training components are most effective in improving mother and child-related outcomes for mothers with a history of trauma and their young children. The review provides recommendations for future research and emphasizes the importance of considering the mother-child relationship in trauma-informed interventions.

A model for secondary traumatic stress following workplace exposure to traumatic material in analytical staff

Analytical professionals working in criminal justice and in social media companies are exposed to aversive details of traumatic events. Albeit indirect, exposure in these roles is repeated and can be extreme, including exposure to material containing lethal violence, sexual assault, and serious self-harm, leading to post-traumatic stress disorder and Secondary Traumatic Stress reactions. Incorporating relevant empirical research, this article considers the mechanisms that may contribute to post-exposure post-traumatic stress disorder and Secondary Traumatic Stress reactions in these roles. Building on the Ehlers and Clark model, subsequent extensions, and the authors' experience of working as, and conducting research with, law enforcement professionals, a new model is proposed to explain post-exposure post-traumatic stress disorder/Secondary Traumatic Stress reactions.

Associations between individual cognitive factors, mode of exposure and depression symptoms in practitioners working with aversive crime material

Background: There is extensive literature on front-line officers and investigators exposure to trauma and its negative impact on them. However, there are analytical practitioners in law enforcement who indirectly work with the traumatic experiences of other people daily, but are seldom the focus of academic research.Objective: Our goal was to conduct the first international study with these practitioners to identify the risk of depression symptoms and establish whether potentially modifiable risk factors (belief in a just world, mental imagery and thought suppression) and work-related characteristics (medium of exposure) are associated with depression.Method: 99 analysts and secondary investigators employed in police and law enforcement organizations from the UK, Europe and Canada participated in the study. The online survey was advertised to employees via their employers but hosted without employer access. Multiple regression was used to analyze the data.Results: After controlling for age, gender, ethnicity, previous exposure to trauma, and marital status, four potential risk factors were identified. Analytical practitioners with vivid mental imagery, those exposed to crime material via auditory and visual means, those who suppressed intrusive thoughts, and those who believed in a just world reported more depressive symptoms.Conclusions: The majority of our sample reported clinical levels of depressive symptoms. Four potential risk factors accounted for just under half of the variance in depression scores. We consider strategies that can be used to mitigate the potential negative influence of these factors and suggest that these are established as risk factors for depression symptoms via future longitudinal research.

Systems Medicine as a Strategy to Deal with Alzheimer's Disease

The traits of Alzheimer's disease (AD) include amyloid plaques made of Aβ1-40 and Aβ1-42, and neurofibrillary tangles by the hyperphosphorylation of tau protein. AD is a complex disorder that is heterogenous in genetical, neuropathological, and clinical contexts. Current available therapeutics are unable to cure AD. Systems medicine is a strategy by viewing the body as a whole system, taking into account each individual's unique health profile, provide treatment and associated nursing care clinically for the patient, aiming for precision. Since the onset of AD can lead towards cognitive impairment, it is vital to intervene and diagnose early and prevent further progressive loss of neurons. Moreover, as the individual's brain functions are impaired due to neurodegeneration in AD, it is essential to reconstruct the neurons or brain cells to enable normal brain functions. Although there are different subtypes of AD due to varied pathological lesions, in the majority cases of AD, neurodegeneration and severe brain atrophy develop at the chronic stage. Novel approaches including RNA based gene therapy, stem cell based technology, bioprinting technology, synthetic biology for brain tissue reconstruction are researched in recent decades in the hope to decrease neuroinflammation and restore normal brain function in individuals of AD. Systems medicine include the prevention of disease, diagnosis and treatment by viewing the individual's body as a whole system, along with systems medicine based nursing as a strategy against AD that should be researched further.

Selectively Interfering With Intrusive but Not Voluntary Memories of a Trauma Film: Accounting for the Role of Associative Memory

Intrusive memories of a traumatic event can be reduced by a subsequent interference procedure, seemingly sparing voluntary memory for that event. This selective-interference effect has potential therapeutic benefits (e.g., for emotional disorders) and legal importance (e.g., for witness testimony). However, the measurements of intrusive memory and voluntary memory typically differ in the role of associations between a cue and the emotional memory "hotspots." To test this, we asked participants to watch a traumatic film followed by either an interference procedure (reminder plus Tetris) or control procedure (reminder only). Measurement of intrusions (using a laboratory task) and voluntary memory (recognition for film stills) were crossed with the presence or absence of associative cues. The reminder-plus-Tetris group exhibited fewer intrusions despite comparable recognition memory, replicating the results of prior studies. Note that this selective interference did not appear to depend on associative cues. This involuntary versus voluntary memory dissociation for emotional material further supports separate-trace memory theories and has applied advantages.

A novel virtual reality paradigm: Predictors for stress-related intrusions and avoidance behavior

BACKGROUND AND OBJECTIVES

Most people are exposed to a violent or life-threatening situation during their lives, but only a minority develops a stress-related disorder. To examine risk factors for the development of stress-related symptoms, such as intrusions and avoidance, analogue trauma studies are necessary. The often-used trauma film paradigm has proven to be valuable to examine intrusions, but inherently to its technique is less suitable for assessing behavioral avoidance, a core symptom of stress-related disorders. The aim of the present study was twofold, first to further develop an analogue that explicitly addresses behavioral avoidance and second, to link previously-established risk factors for the development of stress-related symptoms.

METHOD

Eighty-two healthy participants were subjected to a trauma induction using virtual reality (VR). At follow-up, participants were placed in a similar VR environment and could approach or avoid the trauma-scene, a trauma-related scene or a neutral, unrelated scene. Several pre- and peri-trauma risk factors were measured.

RESULTS

The VR paradigm increased negative mood and heart rate, decreased positive mood and heart rate variability, and resulted in stress-related symptoms as trauma-related thoughts and beliefs, intrusions and avoidance behavior. The most prominent risk factors that contributed to the stress-related symptoms were negative emotions during the trauma induction, trait anxiety, and avoidant coping strategies.

LIMITATIONS

The stress-related symptoms were mild, resulting in a vast amount of participants without intrusions and limited avoidance behavior.

CONCLUSION

The current VR paradigm can elicit stress-related symptoms, including avoidance; risk factors contributing to these symptoms were similar to those observed in clinical research, indicating the potential of the general set up.

Strengthening the Healthy Adult Self in Art Therapy: Using Schema Therapy as a Positive Psychological Intervention for People Diagnosed With Personality Disorders

This article reviews recent theoretical contributions and studies about art therapy that attempt to capture aspects of healthy ego functioning and presents an inventory of art therapy interventions to strengthen the Healthy Adult. It discusses how art therapy can offer interventions that focus specifically and directly on the integration and growth of the whole person, and which interventions are suitable for this purpose in the treatment of people diagnosed with severe personality disorders. A link is made between the Healthy Adult as a familiar concept from Schema Therapy, and Positive Psychology, with its focus on well-being, strength and positive affect. On the basis of our present knowledge, available studies and experiences, art therapy seems promising in contributing to the development of Healthy Adult functioning. Art therapy addresses the different areas of healthy adult functioning. Specific art therapy interventions are discussed on a concrete level. Art therapy appears to offer ways to strengthen the Healthy Adult and helps people to free themselves from destructive patterns and to work on satisfying their basic needs as independent and responsibly functioning individuals in a positive connectedness with themselves and their surroundings. The strength of art therapy may be the experiential level and the appeal to the capacity to play, to flexibility, and to be creative. This makes experiences easier to reach, and developing from there into a Healthy Adult mode is possible in a manner that is more felt than thought. Creativity can be regarded as the ability of the Healthy Adult to be flexible and to find different solutions to a problem. This appeal of art therapy fits well the therapeutic goal of empowerment and well-being, which is at the heart of positive psychology. More research is needed to verify the effects and working mechanisms of art therapy interventions.

Intrusive memories of trauma: A target for research bridging cognitive science and its clinical application

Intrusive memories of a traumatic event can be distressing and disruptive, and comprise a core clinical feature of post-traumatic stress disorder (PTSD). Intrusive memories involve mental imagery-based impressions that intrude into mind involuntarily, and are emotional. Here we consider how recent advances in cognitive science have fueled our understanding of the development and possible treatment of intrusive memories of trauma. We conducted a systematic literature search in PubMed, selecting articles published from 2008 to 2018 that used the terms "trauma" AND ("intrusive memories" OR "involuntary memories") in their abstract or title. First, we discuss studies that investigated internal (neural, hormonal, psychophysiological, and cognitive) processes that contribute to intrusive memory development. Second, we discuss studies that targeted these processes using behavioural/pharmacological interventions to reduce intrusive memories. Third, we consider possible clinical implications of this work and highlight some emerging research avenues for treatment and prevention, supplemented by new data to examine some unanswered questions. In conclusion, we raise the possibility that intrusive memories comprise an alternative, possibly more focused, target in translational research endeavours, rather than only targeting overall symptoms of disorders such as PTSD. If so, relatively simple approaches could help to address the need for easy-to-deliver, widely-scalable trauma interventions.

Attachment Representation and Sensitivity: The Moderating Role of Posttraumatic Stress Disorder in a Refugee Sample

It has been hypothesized that adult attachment representations guide caregiving behavior and influence parental sensitivity, and thus affect the child's socio-emotional development. Several studies have shown a link between posttraumatic stress disorder (PTSD) and reduced parental sensitivity, so it is possible that PTSD moderates the relationship between insecure attachment representations and insensitivity. In this study symptoms of PTSD (Harvard Trauma Questionnaire), parental sensitivity (Emotional Availability Scales), and attachment representations (Attachment Script Assessment) were assessed in 53 parents who were asylum seekers or refugees. Results showed that when parents were less able to draw on secure attachment representations, symptoms of PTSD increased the risk of insensitive parenting. These findings suggest that parental sensitivity is affected not just by attachment representations, but by a conjunction of risk factors including symptoms of PTSD and insecure attachment representations. These parents should therefore be supported to establish or confirm secure models of attachment experiences, to facilitate their ability interact sensitively and form a secure relationship with their children.

Semantic and emotional content of imagined representations in human occipitotemporal cortex

Mental imagery is a critical cognitive function, clinically important, but poorly understood. When visual objects are perceived, many of their sensory, semantic and emotional properties are represented in occipitotemporal cortex. Visual imagery has been found to activate some of the same brain regions, but it was not known what properties are re-created in these regions during imagery. We therefore examined the representation during imagery for two stimuli in depth, by comparing the pattern of fMRI response to the patterns evoked by the perception of 200 diverse objects chosen to de-correlate their properties. Real-time, adaptive stimulus selection allowed efficient sampling of this broad stimulus space. Our experiments show that occipitotemporal cortex, which encoded sensory, semantic and emotional properties during perception, can robustly represent semantic and emotional properties during imagery, but that these representations depend on the object being imagined and on individual differences in style and reported vividness of imagery.

Mental imagery, emotion and psychopathology across child and adolescent development

Mental imagery-based interventions are receiving increasing interest for the treatment of psychological disorders in adults. This is based on evidence that mental imagery potently influences the experience of emotion in non-clinical samples, and that a number of psychological disorders are marked by syndrome-specific, distressing abnormalities in mental imagery. During childhood and adolescence, neurocognitive development impacting mental imagery processes may moderate its relationship with clinically-relevant emotional symptoms at a number of potential loci. Crucially, these changes could impact vulnerability to distressing mental imagery and the efficacy of mental imagery-based clinical interventions. This review synthesises evidence pertaining to developmental changes in the role and content of mental imagery, and in the cognitive sub-processes required to generate and sustain mental images. Subsequently, we discuss implications for understanding the developmental relationship between mental imagery, emotion and psychopathology. Translational cognitive neuroscience research investigating the content, emotional impact and neurocognitive substrates of mental imagery across development may reveal insights into trajectories of vulnerability to symptoms of a number of psychological disorders. If proper consideration is given to developmental factors, techniques based on mental imagery may be valuable as part of a treatment armoury for child and adolescent clinical populations and those at risk of emotional disorders.

Vividness of general mental imagery is associated with the occurrence of intrusive memories

BACKGROUND AND OBJECTIVES

Intrusive memories of traumatic events constitute a core feature of post-traumatic stress disorder. However, the association of pre-traumatic factors with post-traumatic intrusive memories is still only poorly understood. The current study investigated the extent to which vividness of general mental imagery prior to an analogue stressor is positively associated with occurrence of intrusive images following such a stressor.

METHODS

Sixty-seven participants were exposed to video material depicting the aftermath of serious road traffic accidents. Additionally, participants filled in questionnaires on mental imagery, affect, peri-traumatic processing style, and intrusive memories.

RESULTS

Vividness of mental imagery before the analogue stressor correlated positively with the amount, vividness, and emotional distress due to intrusive images shortly after the analogue stressor and on the subsequently five days. Importantly, mental imagery assessed pre-stressor was associated with intrusive memories independently of trait anxiety and depression as well as participants' emotional response to the video. Peri-traumatic data-driven processing was also related to intrusive memories but not to the vividness of pre-stressor mental imagery.

LIMITATIONS

An analogue design was used. Results need to be replicated in a prospective design with survivors of traumatic events according to DSM-IV criteria.

CONCLUSIONS

The findings indicate that high levels of vividness of general mental imagery may contribute to the development of intrusive imaginal memories following exposure to traumatic events.

Using mental imagery to improve memory in patients with Alzheimer disease: trouble generating or remembering the mind's eye?

This study was conducted to understand whether patients with mild Alzheimer disease (AD) could use general or self-referential mental imagery to improve their recognition of visually presented words. Experiment 1 showed that, unlike healthy controls, patients generally did not benefit from either type of imagery. To help determine whether the patients' inability to benefit from mental imagery at encoding was due to poor memory or due to an impairment in mental imagery, participants performed 4 imagery tasks with varying imagery and cognitive demands. Experiment 2 showed that patients successfully performed basic visual imagery, but degraded semantic memory, coupled with visuospatial and executive functioning deficits, impaired their ability to perform more complex types of imagery. Given that patients with AD can perform basic mental imagery, our results suggest that episodic memory deficits likely prevent AD patients from storing or retrieving general mental images generated during encoding. Overall, the results of both experiments suggest that neurocognitive deficits do not allow patients with AD to perform complex mental imagery, which may be most beneficial to improving memory. However, our data also suggest that intact basic mental imagery and rehearsal could possibly be helpful if used in a rehabilitation multisession intervention approach.

Intrusive Memories and Modality-Specific Mental Imagery in Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is characterized by vivid intrusive memories of the trauma. Among these, visual sensations of the trauma are most commonly reported. However, intrusions may involve other senses as well (e.g., acoustic, olfactory, or bodily sensations). It has been proposed that enhanced mental imagery may predispose individuals with traumatic experiences to intrusions and ultimately to PTSD. A total of 58 victims of interpersonal violence with current (n = 20), past (n = 19), and no lifetime PTSD (n = 19) as well as non-traumatized controls (n = 23) were assessed with the Vividness of Visual Imagery Questionnaire (VVIQ) and a modality-specific imagery questionnaire. Moreover, the sensory quality of the traumatic intrusions was assessed in traumatized participants. Participants with recovered PTSD displayed less overall mental imagery than the other three groups who were indistinguishable. No relation was found between the modality-specific mental imagery and the sensory quality of the intrusions. The impact of mental imagery on intrusive memories in PTSD is complex. Less mental imagery appears beneficial in the recovery process, but does not prevent the development of intrusive symptoms in the first place. Further investigation of perceptual and memory vividness as well imagery control (i.e., to sustain, modify, or terminate an image) also including trauma-related material may be important for trauma-specific interventions.