Traumatic memories in acute stress disorder: An analysis of narratives before and after treatment

Randomized Trial on the Effects of a Group EMDR Intervention on Narrative Complexity and Specificity of Autobiographical Memories: A Path Analytic and Supervised Machine-Learning Study

Narratives of autobiographical memories may be impaired by adverse childhood experiences, generating narrative fragmentation and increased levels of perceived distress. Eye movement desensitization and reprocessing (EMDR) proved to be an effective treatment to overcome traumatic experiences and to promote coherent autobiographical narratives. However, the specific mechanisms by which EMDR promotes narrative coherence remains largely unknown. We conducted a randomized controlled pilot trial (ClinicalTrials.gov Identifier NCT05319002) in a non-clinical sample of 27 children recruited in a primary school. Participants were randomly assigned to the experimental and control groups. The experimental group underwent a three-week group EMDR intervention. Subjective unit of distress (SUD), validity of cognition (VoC), classification of autobiographical memories, narrative complexity and specificity were assessed before and after the group EMDR intervention. The group EMDR intervention was able to improve SUD and VoC scales, narrative complexity and specificity, and promoted the classification of autobiographical memories as relational. The path analysis showed that SUD was able to predict VoC and narrative specificity, which, in turn, was able to predict both narrative complexity and the classification of autobiographical memories as relational. Machine-learning analysis showed that random tree classifier outperformed all other models by achieving a 93.33% accuracy. Clinical implications are discussed.

A critical review of mechanisms of adaptation to trauma: Implications for early interventions for posttraumatic stress disorder

Although many attempts have been made to limit development of posttraumatic stress disorder (PTSD) by early intervention after trauma exposure, these attempts have achieved only modest success. This review critiques the biological and cognitive strategies used for early intervention and outlines the extent to which they have prevented PTSD. The major predictors of PTSD are reviewed, with an emphasis on potential mechanisms that may underpin the transition from acute stress reaction to development of PTSD. This review highlights that there is a wide range of biological and cognitive factors that have been shown to predict PTSD. Despite this, the major attempts at early intervention have focused on strategies that attempt to augment extinction processes or alter appraisals in the acute period. The documented predictors of PTSD indicate that a broader range of potential strategies could be explored to limit PTSD. The evidence that people follow different trajectories of stress response following trauma and there is a wide array of acute predictors of PTSD indicates that a flexible and tailored approach needs to be investigated to evaluate more effective early intervention strategies.

Do positive memory characteristics relate to reckless behaviours? an exploratory study in a treatment-seeking traumatised sample

Reckless and self-destructive behaviours (RSDBs), common among traumatised individuals, are associated with negative health consequences. Gaining a stronger understanding of factors associated with an increased likelihood of RSDBs among traumatised individuals offers potential new avenues for research and treatment. Mounting evidence indicates relations between traumatic experiences and deficits/disturbances in characteristics of positive memories; however, relations between RSDBs and positive memory characteristics has been understudied. Using hierarchical multiple regression, we examined relations between positive memory characteristics (Memory Experiences Questionnaire-Short Form; MEQ-SF) and RSDBs, controlling for PTSD and depression severity, among a sample of treatment-seeking trauma-exposed individuals (N = 77; Mage = 33.96; 57.10% female). Results indicated that MEQ-SF subscales of Accessibility, Coherence, Emotional Intensity, and Sensory Details were significantly associated with engagement in RSDBs, above and beyond PTSD and depressive severity. Those who easily accessed emotionally evocative positive memories tended to engage in elevated RSDBs; those with less coherence and fewer sensory details in their positive memories were also more likely to engage in RSDBs. Theories related to emotion dysregulation and cognitive deficits may explain these obtained relations.

Investigating linguistic coherence relations in child sexual abuse: A comparison of PTSD and non-PTSD children

Background

Language is the most common way to communicate internal states and emotions into a narrative form. Studies on the use of language provide a useful understanding of how people process an event and interpret it.

Objective

The aim of this study was to investigate the effects of PTSD on the narrative coherence of children's reports of sexual abuse.

Participants and setting

Narrative coherence was analyzed within a group of 89 allegations of children (M = 10; range: 4–16), who were victims of sexual abuse. Thirty-seven children presented the symptoms for a diagnosis of PTSD.

Method

Linguistic Inquiry Word Count (LIWC) was employed and narrative coherence was analyzed through some linguistic markers (first-person singular pronouns, conjunctions, and cognitive words).

Results

Results illustrated the effects of PTSD on the narrative coherence, in terms of first-person singular pronouns, conjunctions, and cognitive processes. Indeed, compared with traumatic narratives of children without PTSD, traumatic narratives of children with PTSD contained a greater number of first-person singular pronouns (M_PTSD = 1.45 versus M_no-PTSD = 1.12) and a smaller number of conjunctions (M_PTSD = .37 versus M_non-PTSD = .67), cognitive (M_PTSD = 2.93 versus M_non-PTSD = 3.76) and insight words (M_PTSD = 2.29 versus M_non-PTSD = 3.09). Regression analyses were used to examine if age and PTSD were predictors of the narrative coherence, suggesting the effects of PTSD in predicting the use of the first-person singular pronouns and the conjunctions.

Conclusion

This study could underline the importance of considering the PTSD in legal testimony of children who have been sexually abused.

The effects of state anxiety on analogue peritraumatic encoding and event memory: introducing the stressful event segmentation paradigm

Cognitive theories of PTSD argue that poor recall of trauma memories results from a stress-induced shift toward perceptual processing during encoding. The present study assessed the extent to which self-reported state anxiety affects event segmentation and its subsequent impact on memory performance (recall and recognition). Event segmentation is the cognitive process of condensing continuous streams of spatiotemporal information into discrete elements. In this study, undergraduates without PTSD used a computer programme to segment a stressful film and a non-stressful film and then they completed memory tasks for each film. For the stressful film, low memory performance was associated with high segmentation performance. A meditational analysis revealed high segmentation performance mediated a negative relationship between state anxiety and memory performance. Additionally, ad-hoc analyses suggest perceptual processing primarily drives segmentation of the stressful film and conceptual processing primarily drives segmentation of the non-stressful film.

Narrative fragmentation in child sexual abuse: The role of age and post-traumatic stress disorder

The present study aimed to assess the effects of age and PTSD on the narrative fragmentation in memories for child sexual abuse. Lexical complexity, cohesion and coherence were analyzed within a group of 86 allegations of children (M=10years; SD=3.7; range: 4-17) who were victims of sexual abuse. Results illustrated that age played an important role in establishing narrative coherence and predicted the level of orientation, the sequence of events and the level of evaluation of the event. Instead, PTSD was related to narrative coherence and cohesion. Therefore, in children, the narrative fragmentation could be an effective diagnostic tool for understanding the effects of PTSD. Moreover in a legal setting the traumatic effects of PTSD on the narrative coherence and cohesion could be significant indices in the evaluation of child testimony.

Is Trauma Memory Special? Trauma Narrative Fragmentation in PTSD: Effects of Treatment and Response

Seminal theories posit that fragmented trauma memories are critical to posttraumatic stress disorder (PTSD; van der Kolk & Fisler, 1995; Brewin, 2014) and that elaboration of the trauma narrative is necessary for recovery (e.g., Foa, Huppert, & Cahill, 2006). According to fragmentation theories, trauma narrative changes, particularly for those receiving trauma-focused treatment, should accompany symptom reduction. Trauma and control narratives in 77 men and women with chronic PTSD were examined pre- and post-treatment, comparing prolonged exposure (PE) and sertraline. Utilizing self-report, rater coding, and objective coding of narrative content, fragmentation was compared across narrative types (trauma, negative, positive) by treatment modality and response, controlling for potential confounds. Although sensory components increased with PE (d = 0.23 - 0.44), there were no consistent differences in fragmentation from pre- to post-treatment between PE and sertraline or treatment responders and non-responders. Contrary to theories, changes in fragmentation may not be a crucial mechanism underlying PTSD therapeutic recovery.

Trauma memory characteristics and the development of acute stress disorder and post-traumatic stress disorder in youth

BACKGROUND & OBJECTIVES

The present study addresses gaps in knowledge regarding the association between trauma memory processes and posttraumatic stress responses in youth. Our primary goal was to explore the relative contribution of perceptions of trauma memory quality versus narrative trauma memory characteristics to explain overall adjustment.

METHODS

Children (N = 67) were interviewed within four weeks (T1) of an injury leading to hospital treatment and then again eight weeks later (T2). In each interview, the child told a trauma narrative (which were later coded), and answered the Trauma Memory Quality Questionnaire (Meiser-Stedman, Smith, Yule, & Dalgleish, 2007a), a self-report measure indexing the sensory, fragmented, and disorganised characteristics of trauma memory. They then completed measures of Acute Stress Disorder (ASD) symptoms and associated psychopathology at T1 and measures of Posttraumatic Stress (PTS) symptoms and associated psychopathology at T2.

RESULTS

Self-reported trauma memory characteristics predicted ASD symptoms cross-sectionally at T1 and PTS symptoms prospectively over time. At both time points, self-reported trauma memory characteristics accounted for all of the unique variance in symptoms initially explained by narrative characteristics. A reduction in self-report ratings, but not the hypothesised narrative features (e.g., disorganised or lexical elements of the narrative), significantly predicted a reduction in PTS symptoms over time.

LIMITATIONS

The small sample size and the absence of a within-subjects narrative control were the main limitations of the study.

CONCLUSIONS

These findings underscore the importance of self-reported trauma memory characteristics to the aetiology of PTSD.

Dissociation and memory fragmentation in post-traumatic stress disorder: an evaluation of the dissociative encoding hypothesis

Several prominent theories of post-traumatic stress disorder (PTSD) posit that peritraumatic dissociation results in insufficient encoding of the trauma memory and that persistent dissociation prevents memory elaboration, resulting in memory fragmentation and PTSD. In this review we summarise the empirical literature on peritraumatic and trait dissociation and trauma narrative fragmentation as measured by meta-memory and rater/objective coding. Across 16 studies to date, the association between dissociation and fragmentation was most prominent when examining peritraumatic dissociation and patient's own ratings of memory fragmentation. This relationship did not hold when examining trait dissociation or rater-coded or computer-generated measures of fragmentation. Thus initial evidence points more towards a strong self-reported association between constructs that is not supported on more objective fragmentation coding. Measurement overlap, construct ambiguity, and exclusion of potential confounds may underlie lack of a strong association between dissociation and objective-rated fragmentation.

Metacognition, memory disorganization and rumination in posttraumatic stress symptoms

The present study aimed to assess the relative contribution of memory disorganization and beliefs about trauma memory in the prediction of posttraumatic stress symptoms. A sample of 95 student nurses and midwives narrated their memory of the most distressing placement related event they had experienced. Several questionnaires were administered, including the Beliefs about Memory Questionnaire (BAMQ), which was devised for the study. Pearson's correlations, hierarchical analyses and mediation analyses were performed on the data. The reliability and validity of the BAMQ gained preliminary support. Beliefs about the trauma memory, but not memory disorganization within the trauma narrative, predicted a significant proportion of the variance in posttraumatic stress symptoms after control variables were accounted for. Consistent with the metacognitive model of PTSD, the use of rumination mediated the relationship between beliefs about the trauma memory and PTSD symptoms. The findings provide preliminary support for the role of meta-memory in the maintenance of PTSD symptoms and question the importance of memory disorganization.

[Narration as a means of restoring self-coherency: Thoughts on processing traumatic experiences]

OBJECTIVE

Traumatic memories are characterized by not being accessible to intentional recall nor being integrated into the matrix of autobiographical memory. Based on this description, the authors discuss the process of narration as a central means of regaining a sense of self-coherence after traumatic experiences. Formally correct narratives are characterized by three functions: orientation, reference and evaluation. Through so-called "memory talk" with socio-culturally competent partners, children learn how to reconstruct memories and to represent experience by narration. It is therefore suggested that narratives are the basic ingredient of autobiographical memory. The process of re-establishing a sense of coherence after trauma relies on the capacity for coherent narration. The latter is often not possible with traumatic experiences.

METHOD AND RESULT

We conducted a literature search in multiple databases for linguistic analyses of trauma narratives empirically correlating narrative style and posttraumatic psychopathology.

DISCUSSION

It is recommended that research in psychopathology and psychotherapy should take issues of language into account more systematically.