Psychological dynamics affecting traumatic memories: implications in psychotherapy

The lived experiences of resilience among Syrian refugees in the UK: interpretative phenomenological analysis

AIMS AND METHOD

Refugees' mental health has attracted great interest from researchers recently, in view of increasing numbers of refugees settling in Europe. A deficit model, focusing on mental disorder, has often dominated the discourse on the subject, but a strength-based model is becoming more recognised and adopted. Through semi-structured interviews, and using interpretative phenomenological analysis as a data analysis tool, the current study sought to explore the lived experiences of Syrian refugees in the UK in relation to resilience factors.

RESULTS

Three main themes were identified reflecting interpersonal and family factors, factors related to religion, faith and belief systems, and personal qualities.

CLINICAL IMPLICATIONS

The study calls for perceiving refugees as resilient individuals with strengths and adaptive qualities. It also demonstrates that refugees' resilience is essentially an interpersonal process, advocating therefore for engagement and therapeutic approaches that are systemic, relational, and culturally and spiritually competent.

Psychotherapy and neuroscience: towards closer integration

The original aim of psychology was to study and understand the spirit-from the Latin spiritus, literally "breath." The limitations of scientific methods in the past favoured psychology's aloofness in terms of studying the "intangible," while medicine developed methods of examining the body (Latin corpus: essential part). Until 20 years ago, knowledge of the localization of brain functions was limited to inferences from clinical observation of brain-lesioned patients or parallel studies of primate brains. Current neuroscience, with its integrative approach, is bringing together research from molecular through cognitive levels, and psychotherapy has benefited from these findings. Functional neuroimaging studies may make specific and more far-reaching contributions in this respect, since cerebral dynamics may be observed in vivo and in controlled situations. Methods such as single photon emission tomography, positron emission tomography, and functional magnetic resonance imaging have been able to evaluate the neural correlates involved in psychotherapy for individuals with obsessive-compulsive disorder, major depression, social phobia, specific phobia, and post-traumatic disorder. Researchers have found that psychotherapy has the potential to modify dysfunctional neural circuits associated with these disorders. However, precautions are required in constructing feasible designs for neurofunctional investigations. This article reviews the 21 studies that have been published on the subject, and sets out the main advantages and limitations of the technologies used most frequently in protocols involving psychotherapies, and prerequisites for experimental designs. We also pose ways in which the findings from neuroimaging may produce knowledge to guide psychotherapeutic interventions by specifying what should be stimulated in these individuals in order to normalize deficient neural activities.

Should psychotherapy consider reincarnation?

There is increasing recognition of the need to take into account the cultural environment and belief systems of psychotherapy patients because these values reflect basic assumptions about man's nature and the cognitive references used to cope with psychological difficulties. Currently accepted psychotherapeutic approaches take no account of the belief in life after death held by most of the world's population. The World Values Survey (http://www.worldvaluessurvey.org) showed that there are large numbers of reincarnationists around the world, and whatever the reasons for believing in reincarnation, psychotherapeutic approaches should not ignore this significant group of people. Respect for patient opinions and subjective realities is a therapeutic need and an ethical duty, even though therapists may not share the same beliefs. Guidelines are suggested for professionals to develop collaborative models that help patients mobilize their intrinsic intelligence to find solutions to their complaints.

Health and social impacts of a flood disaster: responding to needs and implications for practice

Carlisle in northwest England suffered its worse floods for more than 180 years in 2005. A study, reported here, was undertaken to assess the health and social impacts of these floods via in-depth, taped individual and focus-group interviews with people whose homes had been flooded and with agency workers who helped them. Respondents spoke of physical health ailments, psychological stress, water health-and-safety issues related to the floods, and disputes with insurance and construction companies, which they felt had caused and exacerbated psychological health problems. Support workers also suffered from psychological stress. Furthermore, it was found that people had low expectations of a flood and were not prepared. The findings are presented in five sections covering flood risk awareness, water contamination issues, physical health, mental health, and impact on frontline support workers. The discussion focuses on the implications of the findings for policy and practice vis-à-vis psychological health provision, contamination issues, training and support for frontline support workers, matters relating to restoration, and preparation for flooding.

Flooded homes, broken bonds, the meaning of home, psychological processes and their impact on psychological health in a disaster

In 2005, Carlisle suffered severe flooding and 1600 houses were affected. A qualitative research project to study the social and health impacts was undertaken. People whose homes had been flooded and workers who had supported them were interviewed. The findings showed that there was severe disruption to people's lives and severe damage to their homes, and many suffered from psychological health issues. Phenomenological and transactional perspectives are utilised to analyse the psychological processes (identity, attachment, alienation and dialectics) underlying the meaning of home and their impact on psychological health. Proposals for policy and practice are made.

Traumatic memories: bridging the gap between functional neuroimaging and psychotherapy

OBJECTIVE

Neuroimaging studies have highlighted important issues related to structural and functional brain changes found in sufferers of psychological trauma that may influence their ability to synthesize, categorize, and integrate traumatic memories.

METHODS

Literature review and critical analysis and synthesis.

RESULTS

Traumatic memories are diagnostic symptoms of post-traumatic stress disorder (PTSD), and the dual representation theory posits separate memory systems subserving vivid re-experiencing (non-hippocampally dependent) versus declarative autobiographical memories of trauma (hippocampally dependent). But the psychopathological signs of trauma are not static over time, nor is the expression of traumatic memories. Multiple memory systems are activated simultaneously and in parallel on various occasions. Neural circuitry interaction is a crucial aspect in the development of a psychotherapeutic approach that may favour an integrative translation of the sensory fragments of the traumatic memory into a declarative memory system.

CONCLUSION

The relationship between neuroimaging findings and psychological approaches is discussed for greater efficacy in the treatment of psychologically traumatized patients.

Cerebral blood flow changes during retrieval of traumatic memories before and after psychotherapy: a SPECT study

BACKGROUND

Traumatic memory is a key symptom in psychological trauma victims and may remain vivid for several years. Psychotherapy has shown that neither the psychopathological signs of trauma nor the expression of traumatic memories are static over time. However, few studies have investigated the neural substrates of psychotherapy-related symptom changes.

METHOD

We studied 16 subthreshold post-traumatic stress disorder (PTSD) subjects by using a script-driven symptom provocation paradigm adapted for single photon emission computed tomography (SPECT) that was read aloud during traumatic memory retrieval both before and after exposure-based and cognitive restructuring therapy. Their neural activity levels were compared with a control group comprising 11 waiting-list subthreshold PTSD patients, who were age- and profile-matched with the psychotherapy group.

RESULTS

Significantly higher activity was observed in the parietal lobes, left hippocampus, thalamus and left prefrontal cortex during memory retrieval after psychotherapy. Positive correlations were found between activity changes in the left prefrontal cortex and left thalamus, and also between the left prefrontal cortex and left parietal lobe.

CONCLUSIONS

Neural mechanisms involved in subthreshold PTSD may share neural similarities with those underlying the fragmented and non-verbal nature of traumatic memories in full PTSD. Moreover, psychotherapy may influence the development of a narrative pattern overlaying the declarative memory neural substrates.

Impact of SARS on avian influenza preparedness in healthcare workers

BACKGROUND

SARS was an unprecedented outbreak which brought about 1,755 infections and 302 deaths in Hong Kong. The similarity of SARS and avian influenza prompted us to examine the relationship between SARS experience and preparedness on a potential avian influenza outbreak.

METHODS

A self-administered questionnaire was delivered to nurses in Hong Kong to assess their attitude towards avian influenza; risk perception, and their relationships with previous level of exposure to SARS patients.

RESULTS

Nine hundred and ninety-nine respondents were included in data analysis. About half of them perceived there would be an avian influenza outbreak in Hong Kong. The majority accepted a personal risk of infection in the course of their work (72.7%), and prepared to take care of patients infected with avian influenza (84.0%). Respondents were classified into two groups: high exposure (44.1%) and low exposure (55.9%) as defined by having worked in SARS ward or hospitals. High exposure nurses were less likely to avoid patients, less inclined to change their job if they were required to take care of infected patients, and had therefore a more positive attitude towards an impending avian influenza epidemic. About half of the nurses had frequent involuntary recalls of incidents relating to SARS, the frequency of which was positively correlated with knowing a person suffering from long-term complications of SARS.

CONCLUSION

Healthcare workers who had been actively involved in SARS work were more "positive" in responding to the impending avian influenza epidemic. Whether the level of preparedness can be sustained would need to be further explored.