Reduced Autobiographical Memory Specificity Predicts Depression and Posttraumatic Stress Disorder After Recent Trauma

In this prospective longitudinal study, the authors examined the relationship between reduced specificity in autobiographical memory retrieval and the development of depression, posttraumatic stress disorder (PTSD), and specific phobia after injury in an assault. Assault survivors (N = 203) completed the Autobiographical Memory Test (J. M. G. Williams & K. Broadbent, 1986) at 2 weeks after the trauma as well as structured clinical interviews at 2 weeks and 6 months. Participants with acute stress disorder or major depression at 2 weeks, but not those with phobia, retrieved fewer specific autobiographical memories than those without the respective disorder. Reduced memory specificity at 2 weeks also predicted subsequent PTSD and major depression at 6 months over and above what could be predicted from initial diagnoses and symptom severity. Moderator analyses showed that low memory specificity predicted later depression in participants with prior episodes of major depression but not in those without prior depression. Mediation analyses suggested that rumination partly mediated and perceived permanent change fully mediated the effects of low memory specificity on posttrauma psychopathology at follow-up

Posttraumatic Stress Disorder

The chapter begins by describing how PTSD is diagnosed, contrasting the ‘broad’, inclusive DSM formulations with the ‘narrow’ formulation focusing on core symptoms introduced in ICD-11. The ICD-11 distinction between PTSD and Complex PTSD is also described. We go on to consider why PTSD has been regarded as a disorder of memory, and the two signature changes consisting of vivid re-experiencing of the traumatic event in the present coupled with impaired voluntary recall of the event. Other aspects of memory affected in PTSD that are unrelated to the traumatic event include a general bias toward recalling negative rather than positive stimuli, verbal memory deficits, and difficulties in retrieving specific memories and suppressing unwanted memories. We discuss three prominent controversies, whether traumatic memories are ‘special’, whether traumatic events can be forgotten, and whether there is evidence for delayed onset PTSD. Contemporary theories of PTSD are then described including fear conditioning, neo-conditioning theories, the Ehlers and Clark cognitive model, and dual representation theory, all of which identify deficits in memory for context as central to the disorder. In the final section we discuss how traumatic memory changes with successful treatment and the likely mechanisms involved in psychological therapy for PTSD: Habituation/extinction, updating/reconsolidation, and metacognitive change

Enhanced Priming for Trauma-Related Words Predicts Posttraumatic Stress Disorder

There is preliminary evidence that enhanced priming for trauma-related cues plays a role in posttraumatic stress disorder (PTSD). A prospective study of 119 motor vehicle accident survivors investigated whether priming for trauma-related stimuli predicts PTSD. Participants completed a modified word-stem completion test comprising accident-related, traffic-related, general threat, and neutral words at 2 weeks post-trauma. Priming for accident-related words predicted PTSD at 6 months follow-up, even when initial symptom levels of PTSD and depression and priming for other words were controlled. The results are in line with the hypothesis that enhanced priming for traumatic material contributes to the development of chronic PTSD

The Depressive Attributions Questionnaire (DAQ): Development of a Short Self-Report Measure of Depressogenic Attributions

A depressogenic attributional style, i.e., internal, stable and global causal interpretations of negative events, is a stable vulnerability factor for depression. Current measures of pessimistic attributional style can be time-consuming to complete, and some are designed for specific use with student populations. We developed and validated a new short questionnaire suitable for the measurement of depressogenic attributions in clinical settings, the Depressive Attributions Questionnaire (DAQ). The 16-item DAQ, and measures of depression and related cognitive concepts were completed by three samples of depressed patients and matched controls, or depressed and non-depressed participants who had been exposed to a recent uncontrollable stressful life event (total N = 375). The DAQ had high (i) internal reliability, (ii) test-retest reliability, (iii) convergent, discriminant and construct validity. It predicted a diagnosis of major depression at 6months after an uncontrollable stressor, over and above what could be predicted from initial depression severity. Depressed patients rated the scale as acceptable. The DAQ may be a useful short measure of depressogenic attributions, which is easy to administer, and predicts concurrent and future depression. It has possible applications as a screening measure for risk of depression, or as a treatment process measur

Do Cognitive Models Help in Predicting the Severity of Posttraumatic Stress Disorder, Phobia, and Depression After Motor Vehicle Accidents? A Prospective Longitudinal Study

The study investigated the power of theoretically derived cognitive variables to predict posttraumatic stress disorder (PTSD), travel phobia, and depression following injury in a motor vehicle accident (MVA). MVA survivors (N = 147) were assessed at the emergency department on the day of their accident and 2 weeks, 1 month, 3 months, and 6 months later. Diagnoses were established with the Structured Clinical Interview for DSM–IV. Predictors included initial symptom severities; variables established as predictors of PTSD in E. J. Ozer, S. R. Best, T. L. Lipsey, and D. S. Weiss's (2003) meta-analysis; and variables derived from cognitive models of PTSD, phobia, and depression. Results of nonparametric multiple regression analyses showed that the cognitive variables predicted subsequent PTSD and depression severities over and above what could be predicted from initial symptom levels. They also showed greater predictive power than the established predictors, although the latter showed similar effect sizes as in the meta-analysis. In addition, the predictors derived from cognitive models of PTSD and depression were disorder-specific. The results support the role of cognitive factors in the maintenance of emotional disorders following trauma

Early predictors of chronic post-traumatic stress disorder in assault survivors

ABSTRACTBackgroundSome studies suggest that early psychological treatment is effective in preventing chronic post-traumatic stress disorder (PTSD), but it is as yet unclear how best to identify trauma survivors who need such intervention. This prospective longitudinal study investigated the prognostic validity of acute stress disorder (ASD), of variables derived from a meta-analysis of risk factors for PTSD, and of candidate cognitive and biological variables in predicting chronic PTSD following assault.MethodAssault survivors who had been treated for their injuries at a metropolitan Accident and Emergency (A&E) Department were assessed with structured clinical interviews to establish diagnoses of ASD at 2 weeks (n=222) and PTSD at 6 months (n=205) after the assault. Candidate predictors were assessed at 2 weeks.ResultsMost predictors significantly predicted PTSD status at follow-up. Multivariate logistic regressions showed that a set of four theory-derived cognitive variables predicted PTSD best (Nagelkerke R$^{2}$=0·50), followed by the variables from the meta-analysis (Nagelkerke R$^{2}$=0·37) and ASD (Nagelkerke R$^{2}$=0·25). When all predictors were considered simultaneously, mental defeat, rumination and prior problems with anxiety or depression were chosen as the best combination of predictors (Nagelkerke R$^{2}$=0·47).ConclusionQuestionnaires measuring mental defeat, rumination and pre-trauma psychological problems may help to identify assault survivors at risk of chronic PTSD

Are Trauma Memories Disjointed from other Autobiographical Memories in Posttraumatic Stress Disorder? An Experimental Investigation

This study tested the hypothesis that trauma memories are disjointed from other autobiographical material in posttraumatic stress disorder (PTSD). Assault survivors with (n = 25) and without PTSD (n = 49) completed an autobiographical memory retrieval task during script-driven imagery of (a) the assault and (b) an unrelated negative event. When listening to a taped imagery script of the worst moment of their assault, survivors with PTSD took longer to retrieve unrelated non-traumatic autobiographical information than those without PTSD, but not when listening to a taped script of the worst moment of another negative life event. The groups also did not differ in general retrieval latencies, neither at baseline nor after the imagery tasks. The findings are in line with suggestions that traumatic memories are less integrated with other autobiographical information in trauma survivors with PTSD than in those without PTSD

Are Trauma Memories Disjointed from other Autobiographical Memories in Posttraumatic Stress Disorder? An Experimental Investigation

This study tested the hypothesis that trauma memories are disjointed from other autobiographical material in posttraumatic stress disorder (PTSD). Assault survivors with (n = 25) and without PTSD (n = 49) completed an autobiographical memory retrieval task during script-driven imagery of (a) the assault and (b) an unrelated negative event. When listening to a taped imagery script of the worst moment of their assault, survivors with PTSD took longer to retrieve unrelated non-traumatic autobiographical information than those without PTSD, but not when listening to a taped script of the worst moment of another negative life event. The groups also did not differ in general retrieval latencies, neither at baseline nor after the imagery tasks. The findings are in line with suggestions that traumatic memories are less integrated with other autobiographical information in trauma survivors with PTSD than in those without PTSD

Capturing intrusive re-experiencing in trauma survivors’ daily lives using ecological momentary assessment

Intrusive memories are common following traumatic events and among the hallmark symptoms of posttraumatic stress disorder (PTSD). Most studies assess summarized accounts of intrusions retrospectively. We used an ecological momentary approach and index intrusive memories in trauma survivors with and without PTSD using electronic diaries. Forty-six trauma survivors completed daily diaries for 7 consecutive days recording a total of 294 intrusions. Participants with PTSD experienced only marginally more intrusions than those without PTSD, but experienced them with more “here and now quality,” and responded with more fear, helplessness, anger, and shame than those without PTSD. Most frequent intrusion triggers were stimuli that were perceptually similar to stimuli from the trauma. Individuals with PTSD experienced diary-prompted voluntary trauma memories with the same sense of nowness and vividness as involuntary intrusive trauma memories. The findings contribute to a better understanding of everyday experiences of intrusive reexperiencing in trauma survivors with PTSD and offer clinical treatment implications