Metacognitive appraisal of memory inconsistency for traumatic events in Dutch veterans

The role of belief in memory amplification for trauma events

BACKGROUND AND OBJECTIVES

Trauma survivors often report trauma events inconsistently over time. Many studies, for example, have found that people report having experienced trauma events that they initially failed to report or remember, a phenomenon called "memory amplification." Other studies have found the opposite: people report experiencing fewer events over time. Nahleen, Nixon, and Takarangi (2019) asked participants at two time-points, with a six-month delay, whether they had experienced 19 sexual assault events on a yes/no scale. Participants reported fewer events over time, that is, memory for sexual assault did not amplify overall. In the current study, we assessed whether inconsistency in reports of trauma exposure over time may be attributed to changes in participants' belief that certain events were experienced.

METHODS

We replicated Nahleen et al. (2019), but rather than respond to a yes/no trauma exposure scale, participants were required to rate the likelihood that each trauma event occurred on an 8-point scale (1 = definitely did not happen; 8 = definitely did happen).

RESULTS

We found that participants believed that they were less likely to have experienced the sexual assault events at follow-up compared to initial assessment.

LIMITATIONS

We could not corroborate trauma experiences or determine causality with our design. Further, not all of our findings were consistent with Nahleen et al. (2019).

CONCLUSIONS

Sexual assault memories did not amplify over time, perhaps because, compared to other types of trauma, the idea of experiencing additional sexual assault events that were not actually experienced is less believable.

Prevalence and course of posttraumatic stress disorder symptoms in partners of burn survivors

Background: Partners of burn survivors may develop posttraumatic stress disorder (PTSD) symptoms in response to the potential life threatening nature of the burn event and the burn survivor's medical treatment. Objective: This longitudinal study examined the prevalence, course and potential predictors of partners' PTSD symptoms up to 18 months post-burn. Methods: Participants were 111 partners of adult burn survivors. In a multi-centre study, PTSD symptoms were assessed with the Impact of Event Scale-Revised during the acute phase and subsequently at 3, 6, 12 and 18 months post-burn. Partners' appraisal of life threat, anger, guilt and level of rumination were assessed as potential predictors of PTSD symptoms in an exploratory piecewise latent growth model. Results: Acute PTSD symptoms in the clinical range were reported by 30% of the partners, which decreased to 4% at 18 months post-burn. Higher acute PTSD symptoms were related to perceived life threat and higher levels of anger, guilt, and rumination. Over time, mean symptom levels decreased, especially in partners with high levels of acute PTSD symptoms, perceived life threat and rumination. From three months onward, PTSD symptoms decreased less in partners of more severely burned survivors. At 18 months post-burn, higher levels of PTSD symptoms were related to higher acute PTSD symptoms and more severe burns. Conclusions: One in three partners reported clinical levels of acute PTSD symptoms, of which the majority recovered over time. Perceived life threat, feelings of anger and guilt, and rumination may indicate the presence of acute PTSD symptoms, whereas more severe burns predict long-term PTSD symptom levels. The results highlight the need to screen for acute PTSD symptoms and offer psychological help to partners to alleviate acute elevated stress levels if indicated.

Mothers' emotions after pediatric burn injury: Longitudinal associations with posttraumatic stress and depressive symptoms 18 months postburn

BACKGROUND

Various emotions are implicated in posttraumatic stress disorder (PTSD). Longitudinal studies examining temporal associations between emotions and posttraumatic stress may reveal who is at risk of chronic psychological problems. This study examined the longitudinal relationships of mothers' trauma-related emotions with posttraumatic stress and depressive symptoms after pediatric burn injury.

METHODS

Data from two cohort studies were used (n = 296). Mothers reported the intensity of burn-related emotions within the first month (T1) and 12 months postburn (T2). The Impact of Event Scale (IES) and the Hospital and Anxiety Depression Scale (HADS-D; depression subscale) were administered at T1 and 18 months postburn (T3).

RESULTS

Based on two exploratory factor analyses, emotion variables were combined into acute and long-term basic emotions (fear, sadness, horror, anger) and self-conscious emotions (guilt, shame). The path model showed a positive relationship between acute and long-term basic emotions. Higher long-term basic emotions were related to persistence of posttraumatic stress and depressive symptoms. Acute self-conscious emotions showed associations with posttraumatic stress and depressive symptoms at T1 and were longitudinally related to depressive, but not posttraumatic stress, symptoms.

LIMITATIONS

The posttraumatic stress measure was not based on DSM-5 PTSD criteria and results require replication using these criteria.

CONCLUSIONS

This study suggests that mothers' acute self-conscious and long-term basic emotions in relation to their child's burn injury are involved in the development of posttraumatic stress and depressive symptoms. Clinically, assessing and monitoring parents' early posttraumatic stress, depressive symptoms and burn-related emotions may be useful to identify parents at risk.

Current PTSD symptomatology distorts memory for past symptoms

Clinicians often rely on clients' retrospective reports of past symptoms to diagnose and treat Posttraumatic Stress Disorder (PTSD). However, there is limited research investigating memory for past PTSD symptoms. We asked sexual assault survivors to report their PTSD symptoms and then recall them 6 months later. Overall, symptom recall was consistent with initial reports. However, after dividing participants into PTSD-positive and negative groups, we found that people who were PTSD-negative at follow-up underestimated past PTSD symptom severity while people who were PTSD-positive overestimated past symptoms. For example, 2.8% of PTSD-negative participants versus 15.9% of PTSD-positive participants recalled experiencing 20+ more points on the PCL-5 at follow-up than at initial assessment. Further, people who adjusted over time greatly underestimated past symptoms unlike those who remained PTSD-positive. Our findings have important theoretical and clinical implications because they show that current symptom severity may influence the memory reconstruction of prior levels of adjustment.

A virtual reality paradigm as an analogue to real-life trauma: its effectiveness compared with the trauma film paradigm

Background: The trauma film paradigm (TFP) is a well-established method to study the effects of analogue psychological trauma under controlled laboratory settings. It has been used to examine pre-, peri-, and post-trauma processes, and to create and test interventions. A possible drawback is that watching films is a somewhat passive endeavour that lacks active behavioural engagement. Virtual reality (VR) may provide a better alternative. Like the TFP, VR allows for experimental control. In addition, it can induce a greater 'feeling of presence' and allows interaction with the environment, enabling research on action-reaction associations. Objective: We aimed to validate the utility of a VR paradigm as an experimental model to study psychological trauma by comparing its effectiveness with the TFP. Method: One group of participants (N = 25) was shown an aversive film, and another group (N = 25) moved through a VR scene. Main outcome measures were intrusion frequency assessed with a 7-day diary and self-rated vividness and emotionality of recalled memories related to the film or VR scene. Results: The results indicate that the film and VR scene were equally effective in inducing vivid and intrusive memories. However, self-reported emotional intensity appeared to be higher for memories related to the film than for memories related to the VR scene. Conclusions: Perhaps the film was more effective in inducing emotional memories than the VR scene due to its more aversive content. However, the VR scene seemed equally effective in inducing vivid and intrusive memories, and merits further exploration in light of ethical considerations (less aversive content) and other presumably beneficial qualities (e.g. inducing a greater feeling of presence and allowing interaction with the environment).