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McDermott L, Hameed I, Lau-Zhu A. Cultural Adaptations, Efficacy, and Acceptability of Psychological Interventions for Mental Health in Adults with Refugees and Asylum-Seeker Status: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024:15248380241262262. [PMID: 39096106 DOI: 10.1177/15248380241262262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
People with refugees and asylum seeker status (R/AS) have been forced to leave their home and resettle in new countries due to political unrest, conflict, and violence. This review aimed to describe the nature and extent of cultural adaptations to psychological interventions for adults with R/AS experiencing clinically significant psychological distress, and the acceptability and efficacy of these interventions. A search was conducted in October 2023 and February 2024 across five electronic databases: PsycINFO, Medline, Embase, PubMed, and Cochrane. Eligible studies were randomized controlled trials of psychological interventions conducted in any geographic context. Studies reporting on interventions with minimal adaptations only to facilitate treatment access, with no clear evidence for cultural adaptation, were excluded. Eighteen studies were identified, and cultural adaptations were described in line with the Ecological Validity Model. Studies investigating transdiagnostic interventions, cognitive behavioral therapy (CBT) interventions, and other psychotherapies were synthesized. Analysis and reporting of acceptability were limited across intervention groups, highlighting a need for more robust research in this area. CBT interventions and other psychological therapies were found to be most efficacious with moderate to large effects across validated psychological measures. Small to moderate effect sizes were observed across transdiagnostic interventions. The evidence quality was generally of some concerns. While the evidence requires further developments, the current review provides a timely synthesis of culturally adapted interventions for adults with R/AS to inform intervention development and clinical practice. Strengths, limitations, and recommendations for future research are discussed.
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Affiliation(s)
| | - Ikra Hameed
- University of Oxford, UK
- Oxford Health NHS Foundation Trust, UK
| | - Alex Lau-Zhu
- University of Oxford, UK
- Oxford Health NHS Foundation Trust, UK
- Imperial College London, UK
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2
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Asselbergs J, Riper H, Engelhard IM, Mannes F, Sijbrandij M. The effectiveness of two novel approaches to prevent intrusions: A pilot study comparing Tetris_dualtask and imagery rescripting to control. J Behav Ther Exp Psychiatry 2024; 82:101920. [PMID: 37988886 DOI: 10.1016/j.jbtep.2023.101920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/08/2023] [Accepted: 10/25/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND AND OBJECTIVES Post-traumatic stress disorder (PTSD) is a global health problem. Although effective treatments for it exist, early interventions that prevent PTSD from developing are lacking. The aim of this pilot analogue trauma study was to compare the effects of two potential early intervention strategies, namely Tetris_dualtask and imagery rescripting (IR) to a no-intervention control group on intrusion frequency and the vividness and emotionality of aversive film memory. METHODS Sixty healthy students were subjected to the trauma film paradigm and randomly allocated to either: Tetris_dualtask, IR or no-intervention. Main outcomes were the number of film-related intrusions at one week and vividness and emotionality ratings of the most aversive film memory. Secondary outcomes were PTSD-like symptoms, intrusion intensity, and explicit film memory. RESULTS The Tetris_dualtask group reported significant fewer intrusions compared to the no-intervention group; whereas the IR group did not. No effect was found on vividness and emotionality ratings, PTSD-like symptoms, intrusion intensity, and explicit memory. LIMITATIONS The sample size was small, and analogue trauma in healthy individuals was examined, thus generalizability may be limited. Also, to increase comparability between interventions, the duration of Tetris_dualtask and IR was standardized. As a result, the IR intervention was shorter compared to other studies, which might have decreased its efficacy. CONCLUSIONS The results of this pilot study suggest that playing Tetris during retrieval of traumatic images, might hold potential as an early intervention strategy to reduce intrusions in the early aftermath of trauma and adversity. However, future large-scale replication research is needed.
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Affiliation(s)
- Joost Asselbergs
- Faculty of Behavioural and Movement Sciences, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands
| | - Heleen Riper
- Faculty of Behavioural and Movement Sciences, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands; GGZ inGeest, A.J. Ernststraat 1187, 1081 HL, Amsterdam, the Netherlands
| | | | - Fancy Mannes
- Faculty of Behavioural and Movement Sciences, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands
| | - Marit Sijbrandij
- Faculty of Behavioural and Movement Sciences, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.
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Stanek ML, Boaz KM, Cordes CN, Niese TD, Long KE, Risner MS, Blasco JG, Suzelis KN, Siereveld KM, Rorabaugh BR, Zoladz PR. Social evaluative stress enhances central detail memory, reduces false memory, and results in intrusive memories that last for days. Neurobiol Learn Mem 2024; 209:107906. [PMID: 38408534 DOI: 10.1016/j.nlm.2024.107906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/23/2024] [Accepted: 02/21/2024] [Indexed: 02/28/2024]
Abstract
Few studies have quantified what an individual remembers about a laboratory-controlled stressor. Here, we aimed to replicate previous work by using a modified version of the Trier Social Stress Test (TSST) to quantify participant memory for a stressful experience. We also aimed to extend this work by quantifying false and intrusive memories that ensued. One hundred and seven participants were exposed to the TSST (stress) or the friendly TSST (f-TSST; no stress). The TSST required participants to deliver a ten-minute speech in front of two laboratory panel members as part of a mock job interview; the f-TSST required participants to casually converse with the panel members about their interests. In both conditions, the panel members interacted with (central) or did not interact with (peripheral) several objects sitting on a desk in front of them. The next day, participants' memory for the objects was assessed with recall and recognition tests. We also quantified participants' intrusive memories on Days 2, 4, 6, and 8. Stressed participants recalled more central objects and exhibited greater recognition memory, particularly for central objects, than controls. Stress also led to less false recall and more intrusive memories on Days 2 and 4. Consistent with previous work, these findings suggest that participants exhibit enhanced memory for the central details of a stressful experience; they also extend prior work by showing that participants exposed to a stressor have less false memories and experience intrusive memories for several days following the event. The modified TSST paradigm used here may be useful for researchers studying not only what participants remember about a stressful event but also their susceptibility to intrusive memory formation.
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Affiliation(s)
- Mercedes L Stanek
- Psychology Program, The School of Health and Behavioral Sciences, Ohio Northern University, Ada, OH, USA
| | - Kayla M Boaz
- Psychology Program, The School of Health and Behavioral Sciences, Ohio Northern University, Ada, OH, USA
| | - Chloe N Cordes
- Psychology Program, The School of Health and Behavioral Sciences, Ohio Northern University, Ada, OH, USA
| | - Taylor D Niese
- Psychology Program, The School of Health and Behavioral Sciences, Ohio Northern University, Ada, OH, USA
| | - Kristen E Long
- Psychology Program, The School of Health and Behavioral Sciences, Ohio Northern University, Ada, OH, USA
| | - Matthew S Risner
- Psychology Program, The School of Health and Behavioral Sciences, Ohio Northern University, Ada, OH, USA
| | - John G Blasco
- Psychology Program, The School of Health and Behavioral Sciences, Ohio Northern University, Ada, OH, USA
| | - Koen N Suzelis
- Psychology Program, The School of Health and Behavioral Sciences, Ohio Northern University, Ada, OH, USA
| | - Kelsey M Siereveld
- Psychology Program, The School of Health and Behavioral Sciences, Ohio Northern University, Ada, OH, USA
| | - Boyd R Rorabaugh
- Department of Pharmaceutical Sciences, Marshall University School of Pharmacy, Huntington, WV, USA
| | - Phillip R Zoladz
- Psychology Program, The School of Health and Behavioral Sciences, Ohio Northern University, Ada, OH, USA.
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Hemi A, Sopp MR, Perel A, Holmes EA, Levy-Gigi E. Cognitive flexibility moderates the efficacy of a visuospatial intervention following exposure to analog trauma. J Behav Ther Exp Psychiatry 2023; 81:101858. [PMID: 37075659 DOI: 10.1016/j.jbtep.2023.101858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 11/18/2022] [Accepted: 04/03/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND AND OBJECTIVES Intrusive memories are the hallmark feature of Post-Traumatic-Stress-Disorder (PTSD). Recent studies show that a visuospatial intervention after viewing traumatic films reduces intrusive memories in healthy individuals. However, many individuals still exhibit high levels of symptoms following such an intervention, warranting continued investigation into specific characteristics moderating intervention effect. One such candidate is cognitive-flexibility, defined as the ability to update behavior according to contextual demands. The present study examined the interactive effect of cognitive-flexibility and a visuospatial intervention on intrusive memories, predicting that higher flexibility would be associated with stronger intervention effects. METHODS Sixty participants (Mage = 29.07, SD = 4.23) completed a performance-based paradigm evaluating cognitive-flexibility, watched traumatic films, and were allocated to either an intervention or a no-task control group. Intrusions were assessed by means of laboratory and ambulatory assessment, and the intrusion subscale of the Impact-of-Events-Scale-Revised (IES-R). RESULTS Participants in the intervention group experienced fewer laboratory intrusions than the control group. However, this effect was moderated by cognitive-flexibility: Whereas individuals with below-average cognitive-flexibility did not benefit from the intervention, it was significantly beneficial for individuals with average and above-average cognitive-flexibility. No group differences emerged in the number of ambulatory intrusions or IES-R scores. However, cognitive-flexibility was negatively correlated with IES-R scores across both groups. LIMITATIONS The analog design may limit the extent of generalization to real-world traumatic events. CONCLUSIONS These results point to a potentially beneficial effect of cognitive-flexibility on intrusion development, particularly in the context of visuospatial interventions.
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Affiliation(s)
- Alla Hemi
- Faculty of Education, Bar Ilan University, Israel
| | | | - Ariel Perel
- Faculty of Education, Bar Ilan University, Israel
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Einat Levy-Gigi
- Faculty of Education, Bar Ilan University, Israel; The Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Israel.
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Pandzic I, Notebaert L, Basanovic J, MacLeod C. Examining the role of trait anxiety and attentional bias to negative information in intrusion vulnerability following an emotionally negative event. J Behav Ther Exp Psychiatry 2023; 81:101894. [PMID: 37499564 DOI: 10.1016/j.jbtep.2023.101894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 06/27/2023] [Accepted: 07/15/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND AND OBJECTIVES Research shows that individuals with heightened trait anxiety are more likely to experience intrusions; however, the mechanism that accounts for this relationship is unclear. Two alternative hypotheses were tested to determine the nature of the associations between trait anxiety, attentional bias to negative information, and intrusion vulnerability. METHODS Intrusions were elicited using the trauma film paradigm, and post-event attentional bias to negative information was assessed using the dot-probe task. Participants then completed a week-long intrusions diary. RESULTS Results showed that attentional bias to negative information mediated the effect of heightened trait anxiety on elevated intrusion frequency. It was also revealed that heightened trait anxiety was associated with elevated intrusion-related distress, though attentional bias to negative information did not mediate this relationship. LIMITATIONS Our sample was comprised of undergraduate students who were not selected based on a previous pathology. Replication in clinical samples is warranted. CONCLUSIONS These findings provide new insight regarding individual differences in the experience of intrusions and suggest that both the frequency and distress associated with intrusions could represent clinical targets.
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Affiliation(s)
- Ines Pandzic
- Centre for the Advancement of Reseach on Emotion, School of Psychological Science, University of Western Australia, M304, Perth, WA, 6009, Australia.
| | - Lies Notebaert
- Centre for the Advancement of Reseach on Emotion, School of Psychological Science, University of Western Australia, M304, Perth, WA, 6009, Australia
| | - Julian Basanovic
- Centre for the Advancement of Reseach on Emotion, School of Psychological Science, University of Western Australia, M304, Perth, WA, 6009, Australia; Department of Psychology, University of Exeter, United Kingdom
| | - Colin MacLeod
- Centre for the Advancement of Reseach on Emotion, School of Psychological Science, University of Western Australia, M304, Perth, WA, 6009, Australia
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Ganslmeier M, Ehring T, Wolkenstein L. Effects of imagery rescripting and imaginal exposure on voluntary memory. Behav Res Ther 2023; 170:104409. [PMID: 37925798 DOI: 10.1016/j.brat.2023.104409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/19/2023] [Accepted: 10/01/2023] [Indexed: 11/07/2023]
Abstract
Trauma-focused imagery-based interventions, such as Imagery Rescripting (ImRs) and Imaginal Exposure (ImE), are effective in reducing involuntary re-experiencing in PTSD. However, it has been suggested that they may impair voluntary memory. This study investigates whether ImRs and ImE distort voluntary memory of an analogue trauma. We presented a trauma film to N = 120 healthy participants (Session 1) and randomly allocated them to one of two intervention conditions (receiving one session of ImRs or ImE) or to a no-intervention control condition (NIC) afterwards (Session 2). Voluntary memory was assessed using a free recall (Sessions 2 and 3), and a cued recall as well as a recognition task (both Sessions 3 and 4). The ImRs and ImE groups did not differ from NIC in the cued recall task and the recognition task. However, ImE (compared to ImRs and NIC) led to an increase in correct reported details in the free recall. In sum, the current findings do not suggest that ImRs or ImE impair voluntary memory.
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Affiliation(s)
| | - Thomas Ehring
- Department of Psychology, Ludwig-Maximilians-Universität, München, Germany
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Zucker NL, Strauss GP, Smyth JM, Scherf KS, Brotman MA, Boyd RC, Choi J, Davila M, Ajilore OA, Gunning F, Schweitzer JB. Experimental Therapeutics: Opportunities and Challenges Stemming From the National Institute of Mental Health Workshop on Novel Target Discovery and Psychosocial Intervention Development. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2023:17456916231197980. [PMID: 37874961 PMCID: PMC11039571 DOI: 10.1177/17456916231197980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
There has been slow progress in the development of interventions that prevent and/or reduce mental-health morbidity and mortality. The National Institute of Mental Health (NIMH) launched an experimental-therapeutics initiative with the goal of accelerating the development of effective interventions. The emphasis is on interventions designed to engage a target mechanism. A target mechanism is a process (e.g., behavioral, neurobiological) proposed to underlie change in a defined clinical endpoint and through change in which an intervention exerts its effect. This article is based on discussions from an NIMH workshop conducted in February 2020 and subsequent conversations among researchers using this approach. We discuss the components of an experimental-therapeutics approach such as clinical-outcome selection, target definition and measurement, intervention design and selection, and implementation of a team-science strategy. We emphasize the important contributions of different constituencies (e.g., patients, caregivers, providers) in deriving hypotheses about novel target mechanisms. We highlight strategies for target-mechanism identification using published and hypothetical examples. We consider the decision-making dilemmas that arise with different patterns of results in purported mechanisms and clinical outcomes. We end with considerations of the practical challenges of this approach and the implications for future directions of this initiative.
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Affiliation(s)
- Nancy L Zucker
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Gregory P Strauss
- Department of Psychology and Neuroscience, University of Georgia, Athens, Georgia
| | - Joshua M Smyth
- Department of Psychology, The Ohio State University, Columbus, OH
| | - K Suzanne Scherf
- Department of Psychology, Pennsylvania State University, University Park, Pennsylvania
| | | | - Rhonda C Boyd
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jimmy Choi
- Olin Neuropsychiatry Research Center, Hartford Healthcare Behavioral Health Network, Hartford, Connecticut
| | - Maria Davila
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, Chicago, Illinois
| | - Olusola A Ajilore
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
- University of Illinois Center for Depression and Resilience, Chicago, Illinois
| | - Faith Gunning
- Department of Psychiatry, Weill Cornell Medicine, New York, New York
| | - Julie B Schweitzer
- Department of Psychiatry and Behavioral Sciences and the MIND Institute, University of California, Davis, Sacramento, California
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Espinosa L, Singh L, Eimer T, Olsson A, Holmes EA. Reading others' social appraisals after viewing an aversive film online impacts mood but not intrusive memories. J Anxiety Disord 2023; 99:102763. [PMID: 37657150 DOI: 10.1016/j.janxdis.2023.102763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 07/26/2023] [Accepted: 08/10/2023] [Indexed: 09/03/2023]
Abstract
Exposure to aversive footage online can affect our well-being, but to what extent does reading others' appraisals of this content modulate our affective responses? In a pre-registered online study (N = 170), we used a digital trauma film paradigm as an analogue for the naturalistic exposure to aversive visual content online. We investigated whether online social reappraisal about the film influenced acute affective responses and subsequent intrusive memories. First, we examined whether the digital trauma film paradigm induced similar affective responses as in-lab experiments (within-subjects; change in negative mood and intrusive memories of the film during seven days). Participants reported a negative mood change and experienced intrusive memories of the film, extending findings from in-lab experiments. Next, we tested a social reappraisal manipulation that provides written comments from (fictitious) previous participants (between-subjects; reading positive, negative, or no comments) modulated participants' affective responses. As predicted, relative to controls and negative comments, reading positive comments decreased negative mood. However, reading negative comments did not increase negative mood. Contrary to predictions, the social reappraisal manipulation did not modulate the number of intrusive memories. Findings suggest the benefit of positive social reappraisal for mitigating negative mood, but not intrusive memories following aversive film content online.
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Affiliation(s)
- Lisa Espinosa
- Karolinska Institutet, Department of Clinical Neuroscience, Nobels väg 9, 171 65 Solna, Sweden.
| | - Laura Singh
- Uppsala University, Department of Psychology, Von Kraemers allé 1A, 752 37 Uppsala, Sweden
| | - Tabea Eimer
- KU Leuven, Faculty of Psychology and Educational Sciences, Tiensestraat 102, 3000 Leuven, Belgium
| | - Andreas Olsson
- Karolinska Institutet, Department of Clinical Neuroscience, Nobels väg 9, 171 65 Solna, Sweden
| | - Emily A Holmes
- Karolinska Institutet, Department of Clinical Neuroscience, Nobels väg 9, 171 65 Solna, Sweden; Uppsala University, Department of Psychology, Von Kraemers allé 1A, 752 37 Uppsala, Sweden
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Ramineni V, Millroth P, Iyadurai L, Jaki T, Kingslake J, Highfield J, Summers C, Bonsall MB, Holmes EA. Treating intrusive memories after trauma in healthcare workers: a Bayesian adaptive randomised trial developing an imagery-competing task intervention. Mol Psychiatry 2023; 28:2985-2994. [PMID: 37100869 PMCID: PMC10131522 DOI: 10.1038/s41380-023-02062-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 04/28/2023]
Abstract
Intensive care unit (ICU) staff continue to face recurrent work-related traumatic events throughout the COVID-19 pandemic. Intrusive memories (IMs) of such traumatic events comprise sensory image-based memories. Harnessing research on preventing IMs with a novel behavioural intervention on the day of trauma, here we take critical next steps in developing this approach as a treatment for ICU staff who are already experiencing IMs days, weeks, or months post-trauma. To address the urgent need to develop novel mental health interventions, we used Bayesian statistical approaches to optimise a brief imagery-competing task intervention to reduce the number of IMs. We evaluated a digitised version of the intervention for remote, scalable delivery. We conducted a two-arm, parallel-group, randomised, adaptive Bayesian optimisation trial. Eligible participants worked clinically in a UK NHS ICU during the pandemic, experienced at least one work-related traumatic event, and at least three IMs in the week prior to recruitment. Participants were randomised to receive immediate or delayed (after 4 weeks) access to the intervention. Primary outcome was the number of IMs of trauma during week 4, controlling for baseline week. Analyses were conducted on an intention-to-treat basis as a between-group comparison. Prior to final analysis, sequential Bayesian analyses were conducted (n = 20, 23, 29, 37, 41, 45) to inform early stopping of the trial prior to the planned maximum recruitment (n = 150). Final analysis (n = 75) showed strong evidence for a positive treatment effect (Bayes factor, BF = 1.25 × 106): the immediate arm reported fewer IMs (median = 1, IQR = 0-3) than the delayed arm (median = 10, IQR = 6-16.5). With further digital enhancements, the intervention (n = 28) also showed a positive treatment effect (BF = 7.31). Sequential Bayesian analyses provided evidence for reducing IMs of work-related trauma for healthcare workers. This methodology also allowed us to rule out negative effects early, reduced the planned maximum sample size, and allowed evaluation of enhancements. Trial Registration NCT04992390 ( www.clinicaltrials.gov ).
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Affiliation(s)
- Varsha Ramineni
- Department of Psychology, Uppsala University, Uppsala, Uppsala County, Sweden
- P1vital Products Ltd, Wallingford, Oxfordshire, UK
| | - Philip Millroth
- Department of Psychology, Uppsala University, Uppsala, Uppsala County, Sweden
| | | | - Thomas Jaki
- MRC Biostatistics Unit, University of Cambridge, Cambridge, Cambridgeshire, UK
- University of Regensburg, Regensburg, Bavaria, Germany
| | | | | | - Charlotte Summers
- Department of Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Michael B Bonsall
- Department of Biology, University of Oxford, Oxford, Oxfordshire, UK
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Uppsala County, Sweden.
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10
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Xu Z, Hu J, Wang Y. Bilateral eye movements disrupt the involuntary perceptual representation of trauma-related memories. Behav Res Ther 2023; 165:104311. [PMID: 37037182 DOI: 10.1016/j.brat.2023.104311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/29/2023] [Accepted: 04/07/2023] [Indexed: 04/12/2023]
Abstract
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.
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Affiliation(s)
- Zhenjie Xu
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, 310028, Zhejiang, China
| | - Jie Hu
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, 310028, Zhejiang, China
| | - Yingying Wang
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, 310028, Zhejiang, China.
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11
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Lau-Zhu A, Williams F, Steel C. Attachment patterns and autobiographical episodic memory functioning: A systemic review of adult studies to advance clinical psychological science. Clin Psychol Rev 2023; 101:102254. [PMID: 36804184 DOI: 10.1016/j.cpr.2023.102254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
Patterns of insecure attachment are associated with psychopathology but the mechanisms involved remain poorly understood. Cognitive science proposes that attachment patterns are influenced by the autobiographical memory system and in turn influence its ongoing functioning. Disturbances in autobiographical memory represent cognitive risks for later emotional difficulties. We systemically reviewed 33 studies (in 28 articles) examining the association between attachment patterns and autobiographical episodic memory (AEM) in individuals from the age of 16 (i.e., from young to older adulthood). Attachment patterns were associated with key areas of AEM phenomenology, including intensity and arousal; detail, specificity, and vividness; coherence and fragmentation; and accuracy and latency. These associations appeared to be moderated by contextual and individual factors; mediated by emotional regulation and schema-based processing; linked to mental health outcomes. Attachment patterns may also influence the impact of certain AEM-based manipulations. We conclude by providing a critical discussion and a research agenda for bringing together attachment, memory, and emotion, with a view to promote mechanism-driven treatment innovation in clinical psychology.
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Affiliation(s)
- A Lau-Zhu
- Oxford Institute of Clinical Psychology Training and Research, Medical Sciences Division, University of Oxford, Oxford, United Kingdom; Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, United Kingdom.
| | - F Williams
- Oxford Institute of Clinical Psychology Training and Research, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - C Steel
- Oxford Institute of Clinical Psychology Training and Research, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
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12
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Jiang C, Chen W, Tao L, Wang J, Cheng K, Zhang Y, Qi Z, Zheng X. Game-matching background music has an add-on effect for reducing emotionality of traumatic memories during reconsolidation intervention. Front Psychiatry 2023; 14:1090290. [PMID: 36873205 PMCID: PMC9974640 DOI: 10.3389/fpsyt.2023.1090290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION Hospital is a stressful place of employment, and a high proportion of healthcare workers, especially the ICU (Intensive Care Unit) nurses were found to be at risk of PTSD. Previous studies showed that taxing working memory through visuospatial tasks during the reconsolidation process of aversive memories can reduce the number of intrusions afterwards. However, the finds could not be replicated by some researches, indicating there may be some boundary conditions that are subtle and complex. METHODS We performed a randomized controlled trial (ChiCTR2200055921; URL: www.chictr.org.cn). In our study, a series of ICU nurses or probationers who performed a cardiopulmonary resuscitation (CPR) were enrolled and instructed to play a visuospatial music tapping game ("Ceaseless Music Note", CMN; Beijing Muyuan Technology Co., Ltd., Beijing, China) at the fourth day after CPR. The numbers of intrusions each day were recorded from the first to the seventh days (24 h×6 day), and the vividness and emotionality of CPR memories were rated at the 4th and 7th days. These parameters were compared between different groups (game with background sound; game with sound off; sound only; none). RESULTS The game-matching background music can have an add-on effect for single tapping game with no sound in reducing the emotionality of previous aversive memories. DISCUSSION We proposed that flow experience (the subjective experience of effortless attention, reduced self-awareness, and enjoyment, and may be induced by optimal skill-demands compatibility in challenging tasks) as a key boundary condition for successful reconsolidation intervention. CLINICAL TRIAL REGISTRATION www.chictr.org.cn, identifier: ChiCTR2200055921.
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Affiliation(s)
- Che Jiang
- School of Psychology, South China Normal University, Guangzhou, China.,Department of Neurosurgery, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Wei Chen
- School of Psychology, South China Normal University, Guangzhou, China
| | - Ling Tao
- Computer Engineering Technical College, Guangdong Polytechnic of Science and Technology, Guangzhou, China
| | - Jiajia Wang
- Department of Neurosurgery, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Kuihong Cheng
- Department of Neurosurgery, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Yibo Zhang
- Department of Neurosurgery, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Zijuan Qi
- Department of Neurology, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Xifu Zheng
- School of Psychology, South China Normal University, Guangzhou, China
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13
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Singh L, Rathbone CJ, Moulds ML, Holmes EA. Future self-imagery of young people in Sweden during the COVID-19 pandemic: an exploratory mixed methods analysis. CURRENT PSYCHOLOGY 2022; 43:1-15. [PMID: 36570058 PMCID: PMC9765368 DOI: 10.1007/s12144-022-04100-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
Global restrictions imposed during the COVID-19 pandemic significantly limited the capacity to plan for the future. Little is known about young people's future self-images and the impact the COVID-19 pandemic may have had upon them. Given evidence that the ability to imagine a positive future can be protective for mental health, research into the impact of the pandemic on future self-imagery is needed. In two studies, we therefore explored the consequences of the COVID-19 pandemic for future self-imagery in an unselected sample of young people in Sweden, specifically: (a) how content and characteristics of future self-images changed from before to during the pandemic, and (b) how such change was related to trauma history, intrusive memories of COVID-19 media footage, past time perspective and optimism (assessed with questionnaires/intrusive memory diary). Future self-images before and during the pandemic were assessed using the 'I Will Be' task (N Study1=74; N Study2=99). A mixed methods design, combining quantitative analysis, qualitative content coding and thematic analysis was used. Exploratory results of Study 1 indicated that future images were rated as less positive during than before the pandemic and that this reduction was less pronounced in people with higher optimism. Results were replicated in an independent sample (Study 2, collected later during the pandemic). In conclusion, whilst the findings are preliminary and emerged from an unselected sample, they prompt the suggestion that brief, novel interventions which aim to bolster positive future imagery may hold promise as a scalable means by which to enhance mental health for young people in the context of the COVID-19 pandemic. Supplementary information The online version contains supplementary material available at 10.1007/s12144-022-04100-z.
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Affiliation(s)
- Laura Singh
- Department of Psychology, Uppsala University, Box 1225, 751 42 Uppsala, Sweden
- Swedish Collegium for Advanced Study, Uppsala, Sweden
| | - Clare J Rathbone
- Centre for Psychological Research, Oxford Brookes University, Oxford, UK
| | - Michelle L. Moulds
- School of Psychology, The University of New South Wales, UNSW Sydney, Kensington, Australia
| | - Emily A. Holmes
- Department of Psychology, Uppsala University, Box 1225, 751 42 Uppsala, Sweden
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14
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Visser RM, Henson RN, Holmes EA. A Naturalistic Paradigm to Investigate Postencoding Neural Activation Patterns in Relation to Subsequent Voluntary and Intrusive Recall of Distressing Events. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:960-969. [PMID: 34454167 DOI: 10.1016/j.bpsc.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/20/2021] [Accepted: 08/11/2021] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Renée M Visser
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.
| | - Richard N Henson
- Medical Research Council Cognition and Brain Sciences Unit and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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15
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Espinosa L, Bonsall MB, Becker N, Holmes EA, Olsson A. Pavlovian threat conditioning can generate intrusive memories that persist over time. Behav Res Ther 2022; 157:104161. [DOI: 10.1016/j.brat.2022.104161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 06/27/2022] [Accepted: 07/08/2022] [Indexed: 11/02/2022]
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16
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Hilberdink CE, de Rooij SR, Olff M, Bosch JA, van Zuiden M. Acute stress reactivity and intrusive memory development: a randomized trial using an adjusted trauma film paradigm. Psychoneuroendocrinology 2022; 139:105686. [PMID: 35193044 DOI: 10.1016/j.psyneuen.2022.105686] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/08/2022] [Accepted: 02/08/2022] [Indexed: 12/14/2022]
Abstract
Understanding the neurobiological and cognitive processes underlying the development of posttraumatic stress disorder (PTSD) and its specific symptoms may facilitate preventive intervention development. Severe traumatic stress and resulting biological stress system activations can alter contextual memory processes. This may provide a neurobiological explanation for the occurrence of intrusive memories following trauma. Investigating the associations between temporal aspects and individual variation in peri- and post-traumatic hypothalamic pituitary adrenal (HPA) axis and sympathetic nervous system (SNS) stress reactivity and memory processing may increase our understanding of intrusive symptom development. The experimental trauma film paradigm is commonly used for this purpose but lacks robust SNS and HPA axis activation. Here, we performed an RCT to investigate the effect of an adjusted trauma film paradigm containing an added brief psychosocial stressor on HPA and SNS stress reactivity throughout the experiment and intrusive memory frequency in the following week in healthy males (N = 63, mean age = 22.3). Secondary, we investigated effects on film-related declarative memory accuracy and intrusion-related characteristics, and associations between acute HPA and SNS stress reactivity, film-related memory, glucocorticoid receptor functioning and intrusion frequency and characteristics. Participants were randomized to the socially-evaluated cold pressor test (seCPT n = 29) or control condition (warm water n = 34) immediately prior to a trauma film. Linear Mixed Models revealed increased acute SNS and cortisol reactivity, lower recognition memory accuracy and more intrusions that were more vivid and distressing during the following week in the seCPT compared to control condition. Linear regression models revealed initial associations between cortisol and alpha amylase reactivity during the experimental assessment and subsequent intrusions, but these effects did not survive multiple comparison corrections. Thus, with this adjustment, we increased the translational value of the trauma film paradigm as it appears to elicit a stronger stress response that is likely more comparable to real-life trauma. The adapted paradigm may be useful to investigate individual variation in biological and cognitive processes underlying early post-trauma PTSD symptoms and could advance potential preventive interventions.
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Affiliation(s)
- C E Hilberdink
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - S R de Rooij
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - M Olff
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; ARQ, National Psychotrauma Centre, Diemen, The Netherlands.
| | - J A Bosch
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - M van Zuiden
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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17
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Qualitative analysis of hotspots and intrusive memories after viewing an aversive film highlights their sensory and spatial features. Sci Rep 2022; 12:7049. [PMID: 35487945 PMCID: PMC9052176 DOI: 10.1038/s41598-022-10579-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 04/08/2022] [Indexed: 11/08/2022] Open
Abstract
Intrusive memories of trauma are recurrent distressing sensory-perceptual impressions of the traumatic event that enter consciousness spontaneously and unwanted. They often contain the worst moment/s ('hotspots') of the trauma memory and have primarily been studied in clinical populations after real trauma. Intrusive memories can also be studied using analogue trauma as an 'experimental psychology model'. Little is known about the features of analogue trauma hotspots. Here we report an ancillary analysis of data from a randomized controlled trial. Seventy non-clinical participants viewed a trauma film containing COVID-19 related footage. Features of hotspots/intrusive memories of the film were explored using linguistic analysis and qualitative content coding. Participants reported on average five hotspots (M = 9.5 words/hotspot). Akin to hotspots soon after real trauma, analogue hotspots/intrusions primarily contained words related to space. Most contained sensory features, yet few cognitions and emotions. Results indicate that features of analogue trauma hotspots mirror those of hotspots soon after real trauma, speaking to the clinical validity of this 'experimental psychology model'.ClinicalTrials.gov ID: NCT04608097, registered on 29/10/2020.
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18
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Varma MM, Hu X. Prosocial behaviour reduces unwanted intrusions of experimental traumatic memories. Behav Res Ther 2021; 148:103998. [PMID: 34864480 DOI: 10.1016/j.brat.2021.103998] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 10/07/2021] [Accepted: 11/11/2021] [Indexed: 11/25/2022]
Abstract
Following trauma exposure, people often experience involuntary intrusions of traumatic memories, i.e., flashbacks. How to reduce such unwanted intrusions attracts attention from basic and translational memory research, with a goal to safeguard mental well-being and promote resilience. Here, based on prosocial behaviour's well-documented psychological benefits, we hypothesized that post-trauma prosocial behaviour would causally reduce trauma-related symptoms, including involuntary intrusions. To test this novel hypothesis, we conducted two pre-registered lab studies (N = 180) using trauma films to induce lab-analogue trauma exposure. Following trauma exposure, participants were randomly assigned to prosocial or non-prosocial conditions. Specifically, in the prosocial condition, participants donated money to their preferred charities. In the non-prosocial conditions, participants completed either a neutral, number judgement task (Experiment 1) or a proself task (Experiment 2). Participants completed a 1-week intrusion diary and Impact of Event Scale-Revised (IES-R), to assess frequencies of traumatic intrusions and post-trauma stress disorder symptoms, respectively. Results showed that compared to non-prosocial behaviour, prosocial engagement (i.e. performing charitable donations) reduced involuntary traumatic intrusions in both lab settings and in their daily life as evidenced by 1-week intrusion diaries. While exploratory mediation analyses suggested that intrusion reduction was partly driven by enhanced positive affect afforded by prosocial behaviour, future studies are required to illuminate the underlying mechanisms. To the extent that post-trauma prosociality alleviated trauma-related symptoms, future research is warranted to investigate how various forms of prosocial behaviour in naturalistic setting could promote resilience following trauma exposure.
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Affiliation(s)
- Mohith M Varma
- Department of Psychology, The University of Hong Kong, Hong Kong, China
| | - Xiaoqing Hu
- Department of Psychology, The University of Hong Kong, Hong Kong, China; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China; HKU-Shenzhen Institute of Research and Innovation, Shenzhen, China.
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19
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Lau-Zhu A, Henson RN, Holmes EA. Selectively Interfering With Intrusive but Not Voluntary Memories of a Trauma Film: Accounting for the Role of Associative Memory. Clin Psychol Sci 2021; 9:1128-1143. [PMID: 34777922 PMCID: PMC8579330 DOI: 10.1177/2167702621998315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/01/2021] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Alex Lau-Zhu
- Medical Research Council Cognition and Brain Sciences Unit, Department of Psychiatry, University of Cambridge
- Oxford Institute of Clinical Psychology Training and Research, Division of Medical Sciences, University of Oxford
- Centre for Psychiatry, Department of Brain Sciences, Imperial College London
- Oxford Health NHS Foundation Trust, Oxford, England
| | - Richard N. Henson
- Medical Research Council Cognition and Brain Sciences Unit, Department of Psychiatry, University of Cambridge
| | - Emily A. Holmes
- Medical Research Council Cognition and Brain Sciences Unit, Department of Psychiatry, University of Cambridge
- Department of Psychology, Uppsala University
- Department for Clinical Neuroscience, Karolinska Institutet
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20
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Herz N, Bar-Haim Y, Tavor I, Tik N, Sharon H, Holmes EA, Censor N. Neuromodulation of Visual Cortex Reduces the Intensity of Intrusive Memories. Cereb Cortex 2021; 32:408-417. [PMID: 34265849 PMCID: PMC8754386 DOI: 10.1093/cercor/bhab217] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 12/24/2022] Open
Abstract
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.
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Affiliation(s)
- Noa Herz
- School of Psychological Sciences, Tel Aviv University, Tel Aviv 69978, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 69978, Israel
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University, Tel Aviv 69978, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ido Tavor
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 69978, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
| | - Niv Tik
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 69978, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
| | - Haggai Sharon
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel.,Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala 75142, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Solna 17177, Sweden
| | - Nitzan Censor
- School of Psychological Sciences, Tel Aviv University, Tel Aviv 69978, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 69978, Israel
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21
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Kanstrup M, Singh L, Göransson KE, Widoff J, Taylor RS, Gamble B, Iyadurai L, Moulds ML, Holmes EA. Reducing intrusive memories after trauma via a brief cognitive task intervention in the hospital emergency department: an exploratory pilot randomised controlled trial. Transl Psychiatry 2021; 11:30. [PMID: 33431807 PMCID: PMC7798383 DOI: 10.1038/s41398-020-01124-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/10/2020] [Accepted: 11/23/2020] [Indexed: 02/06/2023] Open
Abstract
Intrusive memories are common after trauma, and can cause significant distress. Interventions to prevent/reduce the occurrence of this core clinical feature of posttraumatic stress disorder are needed; they should be easy to deliver, readily disseminated and scalable. A novel one-session intervention by Iyadurai et al. 2018, Molecular Psychiatry, resulted in intrusion reduction over the subsequent week. Its feasibility in a different setting and longer-term effects (>1 month) need investigation. We conducted an exploratory open-label pilot randomised controlled trial (RCT) to investigate the feasibility and effects of a brief behavioural intervention to reduce intrusive memories in trauma-exposed patients in a Swedish hospital emergency department (ED). Participants (final N = 41) were randomly allocated to either intervention (including memory reminder cue then visuospatial cognitive task "Tetris" with mental rotation instructions) or active control (podcast) condition within 72 h of presenting to the ED (both conditions using their smartphone). Findings were examined descriptively. We estimated between-group effect sizes for the number of intrusive memories post-intervention at week 1 (primary outcome) and week 5 (secondary outcome). Compared to the control condition, participants in the intervention condition reported fewer intrusive memories of trauma, both at week 1 and week 5. Findings extend the previous evaluation in the UK. The intervention was readily implemented in a different international context, with a mixed trauma sample, with treatment gains maintained at 1 month and associated with some functional improvements. Findings inform future trials to evaluate the capacity of the cognitive task intervention to reduce the occurrence of intrusive memories after traumatic events.
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Affiliation(s)
- Marie Kanstrup
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Functional Area Medical Psychology, Karolinska University Hospital, Stockholm, Sweden.
| | - Laura Singh
- Department of Psychology, Uppsala University, Uppsala, Sweden.
| | - Katarina E Göransson
- Emergency and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Julia Widoff
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - Beau Gamble
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | | | - Michelle L Moulds
- School of Psychology, The University of New South Wales, UNSW Sydney, Sydney, Australia
| | - Emily A Holmes
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Uppsala University, Uppsala, Sweden
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22
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Rackham LA, Lau-Zhu A. Taxing working memory to modulate mental imagery of the 9/11 terrorist attacks following media exposure during childhood: a pilot study in young adult UK residents. ANXIETY STRESS AND COPING 2021; 34:423-436. [PMID: 33412932 DOI: 10.1080/10615806.2020.1870107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Media trauma in civilians is linked to intrusive imagery-based memory symptoms. We investigated whether mental imagery of the 9/11 terrorist attacks following media exposure is dampened by taxing working memory (WM). METHODS Forty-five young adult UK residents, who were exposed to the 9/11 terrorist attacks as children via the media, identified a personally-relevant mental image of the attacks. They were then randomly allocated to: (1) recall + Tetris, (2) recall + eye movements (EMs), or (3) recall-only. Ratings on imagery vividness and emotionality were provided at three time points: pre-, post-manipulations, and at 24-hr follow-up. RESULTS Repeated measures ANOVAs revealed that recall + Tetris and recall + EMs (relative to recall-only) significantly reduced imagery vividness and emotionality from pre- to post-manipulations, but not to follow-up. LIMITATIONS A passive control group is needed to fully rule out the role of natural memory decay; the follow-up was exploratory and took place outside the laboratory with reduced experimental control. CONCLUSIONS Aversive memory imagery from media trauma in civilians can be dampened by taxing WM, at least temporarily, which could be therapeutically useful. The use of such cognitive techniques may also hold relevance for public health approaches to address the impact of collective trauma.
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Affiliation(s)
- Libby A Rackham
- School of Psychology, Cognitive Institute, Plymouth University, Plymouth, UK
| | - Alex Lau-Zhu
- Oxford Institute of Clinical Psychology Training and Research, Medical Sciences Division, University of Oxford, Oxford, UK.,Centre for Psychiatry, Division of Brain Sciences, Imperial College London, London, UK
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23
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Herz N, Bar-Haim Y, Holmes EA, Censor N. Intrusive memories: A mechanistic signature for emotional memory persistence. Behav Res Ther 2020; 135:103752. [DOI: 10.1016/j.brat.2020.103752] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/03/2020] [Accepted: 10/04/2020] [Indexed: 01/25/2023]
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24
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Experimental Psychopathology at the Crossroads: Reflections on Past, Present, and Future Contributions to Cognitive Behavioural Therapy. Int J Cogn Ther 2020. [DOI: 10.1007/s41811-020-00093-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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25
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Zeng S, Lau EYY, Li SX, Hu X. Sleep differentially impacts involuntary intrusions and voluntary recognitions of lab-analogue traumatic memories. J Sleep Res 2020; 30:e13208. [PMID: 33107163 DOI: 10.1111/jsr.13208] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 11/29/2022]
Abstract
Despite the critical role of sleep in memory and emotion processing, large remains unknown regarding how sleep influences trauma-related symptoms arising from maladaptive memory/emotional processes, such as those among patients with post-traumatic stress disorder. Employing a trauma film paradigm, we investigated how post-trauma sleep versus sleep deprivation influenced involuntary intrusions and voluntary recognition of traumatic memories. Sixty participants were randomly assigned to sleep or total sleep deprivation group following experimental trauma induction. Participants were assessed with: (a) lab-based and 7-day diary-based involuntary intrusions; (b) voluntary recognitions of traumatic memories 12-hr and 7-day post-trauma induction; and (c) post-traumatic stress disorder-like symptoms measured by the Impact of Event Scale-Revised. We found that compared with sleep deprivation, slept participants experienced fewer traumatic intrusions across 7 days, reported lower emotional hyperarousal, and showed more accurate recognition of trauma-related stimuli. Moreover, higher subjective sleep quality was associated with fewer intrusions only in the sleep group, while a reversed pattern emerged in the sleep deprivation group. These results provide novel evidence supporting the therapeutic benefits of sleep in protecting mental well-being from trauma exposure. To the extent that sleep modulates trauma-related symptoms, sleep can be conceived as the potential target for early interventions among trauma victims.
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Affiliation(s)
- Shengzi Zeng
- Department of Psychology, The University of Hong Kong, Hong Kong, China
| | - Esther Yuet Ying Lau
- Sleep Laboratory, Department of Psychology, The Education University of Hong Kong, Hong Kong, China.,Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong, China
| | - Shirley Xin Li
- Department of Psychology, The University of Hong Kong, Hong Kong, China.,The State Key Laboratory of Brian and Cognitive Sciences, The University of Hong Kong, Hong Kong, China.,HKU-Shenzhen Institute of Research and Innovation, Shenzhen, China
| | - Xiaoqing Hu
- Department of Psychology, The University of Hong Kong, Hong Kong, China.,The State Key Laboratory of Brian and Cognitive Sciences, The University of Hong Kong, Hong Kong, China.,HKU-Shenzhen Institute of Research and Innovation, Shenzhen, China
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Blackwell SE, Dooley D, Würtz F, Woud ML, Margraf J. Inducing positive involuntary mental imagery in everyday life: an experimental investigation. Memory 2020; 28:1157-1172. [PMID: 32985372 DOI: 10.1080/09658211.2020.1822413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Positive involuntary mental imagery occurs frequently in daily life but evidence as to its functions and importance is largely indirect. The current study investigated a method to induce positive involuntary imagery in daily life, which would allow direct testing of its impact. An unselected student sample (N = 80) completed a single session of a positive imagery cognitive bias modification (CBM) paradigm, which involved listening to and imagining brief positive imagery scripts. Participants then recorded any involuntary memories of the imagined training scenarios in a three-day diary before returning to the lab for a follow-up assessment. Participants were randomised to imagine the scenarios in either an emotionally involved or emotionally detached manner, providing a test of the role of emotion in the subsequent experience of involuntary memories. Participants reported experiencing involuntary memories of the training scenarios in their daily life, but the number recorded did not differ between the experimental conditions. Exploratory analyses suggested that more vivid imagery and recall testing were associated with a greater number of involuntary memories. The study highlights the potential of the imagery CBM paradigm to further our understanding of the functions and potential importance of positive involuntary mental imagery in daily life.
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Affiliation(s)
- Simon E Blackwell
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Daniela Dooley
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Felix Würtz
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Marcella L Woud
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
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27
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Singh L, Espinosa L, Ji JL, Moulds ML, Holmes EA. Developing thinking around mental health science: the example of intrusive, emotional mental imagery after psychological trauma. Cogn Neuropsychiatry 2020; 25:348-363. [PMID: 32847486 DOI: 10.1080/13546805.2020.1804845] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION One route to advancing psychological treatments is to harness mental health science, a multidisciplinary approach including individuals with lived experience and end users (e.g., Holmes, E. A., Craske, M. G., & Graybiel, A. M. (2014). Psychological treatments: A call for mental-health science. Nature, 511(7509), 287-289. doi:10.1038/511287a). While early days, we here illustrate a line of research explored by our group-intrusive imagery-based memories after trauma. METHOD/RESULTS We illustrate three possible approaches through which mental health science may stimulate thinking around psychological treatment innovation. First, focusing on single/specific target symptoms rather than full, multifaceted psychiatric diagnoses (e.g., intrusive trauma memories rather than all of posttraumatic stress disorder). Second, investigating mechanisms that can be modified in treatment (treatment mechanisms), rather than those which cannot (e.g., processes only linked to aetiology). Finally, exploring novel ways of delivering psychological treatment (peer-/self-administration), given the prevalence of mental health problems globally, and the corresponding need for effective interventions that can be delivered at scale and remotely for example at times of crisis (e.g., current COVID-19 pandemic). CONCLUSIONS These three approaches suggest options for potential innovative avenues through which mental health science may be harnessed to recouple basic and applied research and transform treatment development.
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Affiliation(s)
- Laura Singh
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Lisa Espinosa
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Julie L Ji
- School of Psychological Science, The University of Western Australia, UWA Perth, Australia
| | - Michelle L Moulds
- School of Psychology, The University of New South Wales, UNSW Sydney, Australia
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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28
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Porcheret K, Iyadurai L, Bonsall MB, Goodwin GM, Beer SA, Darwent M, Holmes EA. Sleep and intrusive memories immediately after a traumatic event in emergency department patients. Sleep 2020; 43:zsaa033. [PMID: 32133531 PMCID: PMC7420515 DOI: 10.1093/sleep/zsaa033] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 02/11/2020] [Indexed: 12/24/2022] Open
Abstract
STUDY OBJECTIVES Intrusive memories of psychological trauma are a core clinical feature of posttraumatic stress disorder (PTSD), and in the early period post-trauma may be a potential target for early intervention. Disrupted sleep in the weeks post-trauma is associated with later PTSD. The impact of sleep and intrusive memories immediately post-trauma, and their relation to later PTSD, is unknown. This study assessed the relationship between sleep duration on the first night following a real-life traumatic event and intrusive memories in the subsequent week, and how these might relate to PTSD symptoms at 2 months. METHODS Patients (n = 87) recruited in the emergency department completed a sleep and intrusive memory diary from the day of their trauma and for the subsequent week, with optional actigraphy. PTSD, anxiety, and depression symptoms were assessed at 1 week and 2 months. RESULTS A U-shaped relationship was observed between sleep duration on the first night and intrusive memories over the subsequent week: sleeping "too little" or "too much" was associated with more intrusive memories. Individuals who met Clinician-Administered PTSD Scale (CAPS) criteria for PTSD at 2 months had three times more intrusive memories in the first week immediately post-trauma than those who did not (M = 28.20 vs 9.96). Post hoc analysis showed that the absence of intrusive memories in the first week post-trauma was only observed in those who did not meet CAPS criteria for PTSD at 2 months. CONCLUSIONS Monitoring intrusive memories and sleep in the first week post-trauma, using a simple diary, may help identify individuals more vulnerable to later psychopathology.
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Affiliation(s)
- Kate Porcheret
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Lalitha Iyadurai
- Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK
- Emergency Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Michael B Bonsall
- Department of Zoology and St. Peter’s College, University of Oxford, Oxford, UK
| | - Guy M Goodwin
- Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK
| | - Sally A Beer
- Emergency Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Melanie Darwent
- Emergency Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Emily A Holmes
- Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Department of Clinical Neurosciences, Karolinska Institutet, Uppsala, Sweden
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29
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Kanstrup M, Kontio E, Geranmayeh A, Olofsdotter Lauri K, Moulds ML, Holmes EA. A single case series using visuospatial task interference to reduce the number of visual intrusive memories of trauma with refugees. Clin Psychol Psychother 2020; 28:109-123. [PMID: 32525244 DOI: 10.1002/cpp.2489] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 11/07/2022]
Abstract
The current worldwide so-called "refugee crisis" has led to an unprecedented increase in migration globally. Because of stigma and language barriers, mental health care for refugees is limited. There is a need for novel, scalable psychological interventions. We investigated whether a brief behavioural intervention involving a memory reminder cue and Tetris gameplay on a smartphone reduces intrusive memories in refugees using a single case (N = 4) ABAB withdrawal design. The baseline phase (A) included a no-intervention week; the intervention phase (B) included an in-person session with the researchers, comprised of the behavioural intervention followed by self-guided use in daily life the following week. All participants reported a decrease in intrusive memories after the intervention, as well as functional improvements (e.g., in concentration). Importantly, participants rated the intervention as feasible and acceptable. As one in-person session was effective in persistent intrusion reduction, ABAB proved not to be the optimal design as intrusions did not rebound in the withdrawal phase. Findings are promising and highlight the need for further evaluation of novel interventions for mental health problems in refugees.
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Affiliation(s)
- Marie Kanstrup
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Evelina Kontio
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Anahita Geranmayeh
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Klara Olofsdotter Lauri
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Michelle L Moulds
- Department of Psychology, Uppsala University, Uppsala, Sweden.,School of Psychology, The University of New South Wales, UNSW, Sydney, New South Wales, Australia
| | - Emily A Holmes
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, Stockholm, Sweden.,Department of Psychology, Uppsala University, Uppsala, Sweden
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30
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Bisby JA, Burgess N, Brewin CR. Reduced Memory Coherence for Negative Events and Its Relationship to Posttraumatic Stress Disorder. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2020; 29:267-272. [PMID: 33214741 PMCID: PMC7643751 DOI: 10.1177/0963721420917691] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Posttraumatic stress disorder (PTSD) is characterized by disruptions in memory, including vivid sensory images of the trauma that are involuntarily reexperienced. However, the extent and nature of disruptions to deliberate memory for trauma remain controversial. A unitary account posits that all aspects of memory for a traumatic event are strengthened. In contrast, a dual-representation account proposes up-modulation of sensory and affective representations of the negative content and down-modulation of hippocampal representations of the context in which the event occurred. We take a neuroscientific approach and review the literature concerning the mechanisms required to produce coherent episodic memories and how they are affected in experiments involving negative content. We find, in healthy volunteers, that negative content can reduce associative binding and the coherence of episodic memories. Finally, we bring these findings together with the literature on PTSD to highlight how similar associative mechanisms are affected in patients, consistent with hippocampal impairment, supporting a dual-representation view of disrupted memory coherence.
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Affiliation(s)
- James A Bisby
- Division of Psychiatry, University College London.,Institute of Cognitive Neuroscience, University College London
| | - Neil Burgess
- Institute of Cognitive Neuroscience, University College London.,Institute of Neurology, University College London
| | - Chris R Brewin
- Department of Clinical, Educational and Health Psychology, University College London
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31
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Kube T, Berg M, Kleim B, Herzog P. Rethinking post-traumatic stress disorder - A predictive processing perspective. Neurosci Biobehav Rev 2020; 113:448-460. [PMID: 32315695 DOI: 10.1016/j.neubiorev.2020.04.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 12/15/2022]
Abstract
Predictive processing has become a popular framework in neuroscience and computational psychiatry, where it has provided a new understanding of various mental disorders. Here, we apply the predictive processing account to post-traumatic stress disorder (PTSD). We argue that the experience of a traumatic event in Bayesian terms can be understood as a perceptual hypothesis that is subsequently given a very high a-priori likelihood due to its (life-) threatening significance; thus, this hypothesis is re-selected although it does not fit the actual sensory input. Based on this account, we re-conceptualise the symptom clusters of PTSD through the lens of a predictive processing model. We particularly focus on re-experiencing symptoms as the hallmark symptoms of PTSD, and discuss the occurrence of flashbacks in terms of perceptual and interoceptive inference. This account provides not only a new understanding of the clinical profile of PTSD, but also a unifying framework for the corresponding pathologies at the neurobiological level. Finally, we derive directions for future research and discuss implications for psychological and pharmacological interventions.
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Affiliation(s)
- Tobias Kube
- Harvard Medical School, Program in Placebo Studies, Beth Israel Deaconess Medical Center, Brookline Avenue 330, Boston, MA, 02115, USA; University of Koblenz-Landau, Pain and Psychotherapy Research Lab, Ostbahnstr. 10, 76829 Landau, Germany.
| | - Max Berg
- Philipps-University of Marburg, Department of Psychology, Division of Clinical Psychology and Psychological Treatment Gutenbergstraße 18, D-35032, Marburg, Germany
| | - Birgit Kleim
- University of Zurich, Department of Psychology, Binzmühlestrasse 14, Box 8, CH-8050, Zurich, Switzerland; Psychiatric University Hospital (PUK), Lenggstrasse 31, CH-8032, Zurich, Switzerland
| | - Philipp Herzog
- Philipps-University of Marburg, Department of Psychology, Division of Clinical Psychology and Psychological Treatment Gutenbergstraße 18, D-35032, Marburg, Germany; University of Greifswald, Department of Psychology, Clinical Psychology and Psychotherapy, Franz-Mehring-Straße 47, D-17489, Greifswald, Germany; Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, D-23562, Lübeck, Germany
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32
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Arresting visuospatial stimulation is insufficient to disrupt analogue traumatic intrusions. PLoS One 2020; 15:e0228416. [PMID: 32012193 PMCID: PMC6999047 DOI: 10.1371/journal.pone.0228416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/14/2020] [Indexed: 11/19/2022] Open
Abstract
Intrusive memories are a core symptom of Post-Traumatic Stress Disorder (PTSD). A growing body of analogue studies using trauma films suggest that carrying out specific demanding tasks (e.g., playing the video game Tetris, pattern tapping) after the analogue trauma can reduce intrusive memories. To examine the mechanism behind this effect, we tested whether mere engagement with attention-grabbing and interesting visual stimuli disrupts intrusive memories, and whether this depends on working memory resources and/or the concurrent activation of trauma film memories. In a total sample of 234 healthy participants, we compared no-task control conditions to a perceptual rating task with visually arresting video clips (i.e., non-emotional, complex, moving displays), to a less arresting task with non-moving, blurred pictures (Study 1), and to more demanding imagery tasks with and without repetitive reminders of the trauma film (Study 2). Generally, we found moderate to strong evidence that none of the conditions lead to differences in intrusion frequency. Moreover, our data suggest that intrusive memories were neither related to individual differences in working memory capacity (i.e., operation span performance; Study 1), nor to the degree of engagement with a visuospatial task (i.e., one-week recognition performance; Study 2). Taken together, our findings suggest that the boundary conditions for successful interference with traumatic intrusions may be more complex and subtle than assumed. Future studies may want to test the role of prediction errors during (re-)consolidation, deliberate efforts to suppress thoughts, or the compatibility of the task demands with the individual's skills.
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33
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Di Simplicio M, Lau-Zhu A, Meluken I, Taylor P, Kessing LV, Vinberg M, Holmes EA, Miskowiak KW. Emotional Mental Imagery Abnormalities in Monozygotic Twins With, at High-Risk of, and Without Affective Disorders: Present in Affected Twins in Remission but Absent in High-Risk Twins. Front Psychiatry 2019; 10:801. [PMID: 31780967 PMCID: PMC6856790 DOI: 10.3389/fpsyt.2019.00801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 10/07/2019] [Indexed: 12/31/2022] Open
Abstract
Background: Mental imagery abnormalities feature across affective disorders including bipolar disorder (BD) and unipolar depression (UD). Maladaptive emotional imagery has been proposed as a maintenance factor for affective symptomatology and a target for mechanism-driven psychological treatment developments. Where imagery abnormalities feature beyond acute affective episodes, further opportunities for innovation arise beyond treatments, such as for tertiary/relapse prevention (e.g., in remitted individuals) or primary prevention (e.g., in non-affected but at-risk individuals). The aim of our study was to investigate for the first time the presence of possible mental imagery abnormalities in affected individuals in remission and at-risk individuals for affective disorders using a familial risk design. Methods: A population-based cohort of monozygotic twins was recruited through linkage between the Danish national registries (N=204). Participants were grouped as: affected (remitted BD/UD; n = 115); high-risk (co-twin with history of BD/UD; n = 49), or low-risk (no co-twin history of BD/UD; n = 40). Twins completed mental imagery measures spanning key subjective domains (spontaneous imagery use and emotional imagery) and cognitive domains (imagery inspection and imagery manipulation). Results: Affected twins in remission reported enhanced emotional mental imagery compared to both low- and high-risk twins. This was characterized by greater impact of i) intrusive prospective imagery (Impact of Future Events Scale) and ii) deliberately-generated prospective imagery of negative scenarios (Prospective Imagery Task). There were no significant differences in these key measures between affected BD and UD twins in remission. Additionally, low- and high-risk twins did not significantly differ on these emotional imagery measures. There were also no significant differences between the three groups on non-emotional measures including spontaneous imagery use and cognitive stages of imagery. Conclusions: Abnormalities in emotional prospective imagery are present in monozygotic twins with affective disorders in remission-despite preserved cognitive stages of imagery-but absent in unaffected high-risk twins, and thus do not appear to index familial risk (i.e., unlikely to qualify as "endophenotypes"). Elevated emotional prospective imagery represents a promising treatment/prevention target in affective disorders.
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Affiliation(s)
- Martina Di Simplicio
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Alex Lau-Zhu
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, United Kingdom.,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Medical Sciences Division, Oxford Institute of Clinical Psychology Training, University of Oxford, Oxford, United Kingdom
| | - Iselin Meluken
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Patrick Taylor
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Maj Vinberg
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Emily Alexandra Holmes
- Division of Psychology, Department for Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Kamilla Woznica Miskowiak
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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