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Anxiety and Related Disorder () Summary of ALL LITERATURE of week 8: Posttraumatic Stress Disorder
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Week 8: Posttraumatic Stress disorderEngelhard et al. (2019) – Retrieving and modifying traumatic memories: recent
research relevant to three controversies
How people encode, recall, and modify memories of trauma has repeatedly been a flashpoint, most
notably during the bitter dispute over the authenticity of reports of repressed and recovered memories of
childhood sexual abuse.
Although belief in repressed memories has declined among practicing clinical psychologists since the
1990s, a substantial minority (24.1%) agrees that people often repress their memories of trauma.
Aim of the study
Review recent research that is relevant to three controversies concerning memory for trauma:
1. An interpretation of recovered memories that doesn’t rely on repression of false memory.
2. The claim that trauma memories typically lack narrative structures and that this fragmentation
fosters the emergence of PTSD.
3. The utility of eye movements In EMDR therapy.
A non-repression account of recovered memories
There are two different perspectives concerning the memories of child sexual abuse
Repression perspective
According to this perspective, people become incapable of recalling memories of childhood
sexual abuse because these memories are so emotionally traumatic.
Support for this view comes from studies that reported that many survivors encode trauma
memories yet become incapable of recalling them, except under special circumstances such as
hypnosis. However, in these studies they often misconstrued other memory phenomena as
confirming repression (e.g., ordinary forgetfulness as an inability to recall trauma). Therefore
theirs is not much evidence that survivors had forgotten, or repressed their trauma.
False-memory perspective
According to this perspective, people who report recovering memories of childhood sexual
abuse are likely mistaken, especially if these memories surface during recovered-memory
therapy. However, although there are many instances of false memories of trauma, not all
recovered memories are false or previously repressed. Some adults report having recalled
childhood sexual abuse after many years of not having it come to mind. Accordingly, victims
may fail to think about their childhood sexual abuse for years because they did not experience it
as terrifying when it occurred despite its moral reprehensibility.
Are traumatic memories fragmented and incoherent?
Some theorists hold that memories of trauma, especially among people with PTSD, are fragmented,
incomplete, and lack narrative coherence. They claim that patients must emotionally process intrusive,
sensory flashbacks, integrating them into a coherent narrative to achieve recovery. However, studies
indicate that trauma memories were as coherent as very positive and very important memories, and
participants with PTSD had no less coherent memories than did trauma-exposed participants without
,PTSD. Therefore, these data counter the claim that trauma memories are characterized by a lack of
narrative coherence, especially in individuals with PTSD.
The importance of the narrative fragmentation of trauma memories is their presumptive effect on the
maintenance of PTSD. Presumably, these memories must become integrated and coherent for recovery
to occur. However, a study (with PTSD patients receiving either prolonged exposure or sertraline)
showed that memory fragmentation did not reliably change throughout the course of treatment. Neither
treatment type nor response to treatment was related to a change in narrative fragmentation.
Are eye movements in EMDR therapy effective?
A crucial part of standard EMDR therapy is that patients recall a traumatic memory while visually
tracking the therapist’s fingers as they move back and forth in front of the patient’s eyes. However,
controversy has been whether (and how) eye movements in EMDR possess added benefit to its
therapeutically established imaginal exposure component.
Some argue that the eye movements are not effective, however a more recent study indicated that
lateral eye movements enhance the efficacy of (desensitizing) exposure to traumatic/distressing
memories. Other lab experiment found that lateral eye movements, compared with no eye
movements, typically reduce memory-vividness and emotional-intensity ratings after the intervention.
Working mechanism of EMDR
But how do these lateral eye movements modify how a memory is experienced? presumably, they
limit the working memory (WM) resources needed for memory retrieval. When people vividly recall a
memory, it can become more distinctive (= imagination inflation). When distraction diminishes the
capacity for retrieval, imagination deflation occurs.
This hypothesis has been tested and resulted in the finding that other dual tasks that compete with
memory retrieval also work, including vertical eye movements, counting backward, attentional breathing,
and playing the computer game Tetris. However, passive dual tasks, such as listening to beeps or finger
tapping, barely tax working memory and do not attenuate memory vividness or emotionality as active
tasks do. Moreover, eye movements are less taxing and effective if they are slow rather than fast and do
not work if they precede memory retrieval or are combined with a different memory than the one rated in
the pre- or post-test.
Another finding was that the eye-movement task is more effective for visual memories, whereas an
auditory dual task is more effective for auditory memories.
The last finding was that the eye-movement intervention attenuates not only distressing memories but
also imagined future threats, positive memories, including sexual fantasies, and substance-related
imagery.
The exact mechanism mediating the effects of lateral eye movements on memory remains unknown.
Suggestions
All in all, this study suggests that:
Some children can experience childhood sexual abuse without understanding it as abuse and
without experiencing the terror characteristic of encountering canonical traumatic stressors
(e.g., combat, rape, torture). Yet recalling it through the eyes of an adult many years later, they
can suffer symptoms of PTSD.
Memories of trauma are not especially fragmented, and when they are, fragmentation is
unrelated to recovery from trauma.
, Eye movements in EMDR add benefit to its therapeutically established imaginal exposure
component, and a working memory account seems to explain this apparent efficacy.
Ehlers & Clark (2000) – A cognitive model of posttraumatic stress disorder
Posttraumatic stress disorder (PTSD) is a common reaction to traumatic events such as assault,
disaster, or severe accidents. The symptoms include repeated and unwanted reexperiencing of the
event, hyperarousal, emotional numbing, and avoidance of stimuli (including thoughts) which could
serve as reminders for the event.
Aim of the study
Introduce a cognitive model to explain the persistence of PTSD and provide a framework for the
cognitive-behavioural treatment of PTSD.
Cognitive model of PTSD
It is proposed that persistent PTSD occurs only if individuals process the traumatic event and/or its
sequelae in a way which produces a sense of a serious current threat. The model proposes that two key
processes lead to a sense of current threat:
1. Individual difference in the appraisal of the trauma and/or its sequelae.
2. Individual differences in the nature of the memory for the event and its link to other
autobiographical memories.
Once activated, the perception of current threat is accompanied by intrusions and other reexperiencing
symptoms, symptoms of arousal, anxiety, and other emotional responses. The perceived threat also
motivates a series of behavioural and cognitive responses that are intended to reduce perceived threat
and distress in the short-term, but have the consequence of preventing cognitive change and therefore
maintaining the disorder (figure below).
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