Hostname: page-component-745bb68f8f-s22k5 Total loading time: 0 Render date: 2025-02-11T10:28:42.689Z Has data issue: false hasContentIssue false
  • English
  • Français

Maintenance of Intrusive Memories in Posttraumatic Stress Disorder: A Cognitive Approach

Published online by Cambridge University Press:  16 June 2009

Anke Ehlers  and
Regina Steil
Anke Ehlers
Affiliation:
University of Oxford
Regina Steil
Affiliation:
University of Göttingen, Germany
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Intrusive recollections are very common immediately after traumatic events and are considered necessary aspects of emotional processing. However, if these intrusive recollections persist over a long time, they are linked to long-term psychiatric disorder, especially Posttraumatic Stress Disorder (PTSD). This paper discusses the need to investigate factors involved in the maintenance of intrusive traumatic recollections. It is suggested that the idiosyncratic meaning of the intrusive recollections predicts the distress caused by them, and the degree to which the individual engages in strategies to control the intrusions. These control strategies maintain the intrusive recollections by preventing a change in the meaning of the trauma and of the traumatic memories. It is further suggested that what is needed is a comprehensive assessment of the processes that prevent change in meaning, going beyond the assessment of avoidance. In particular, safety behaviours, dissociation and numbing, suppression of memories and thoughts about trauma, rumination, activation of other emotions such as anger and guilt and corresponding cognitions, and selective information processing (attentional and memory biases) may be involved in the maintenance of intrusive recollections. Preliminary data supporting these suggestions from studies of individuals involved in road traffic accidents and survivors of child sexual abuse are described.

Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 23 , Issue 3 , July 1995 , pp. 217 - 249
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 1995

References

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4th Ed.) DSM-IV. Washington, DC: APA.Google Scholar
Baum, A., Cohen, L. and Hall, M. (1993). Control and intrusive memories as possible determinants of chronic stress. Psychosomatic Medicine 55, 274–286.CrossRefGoogle ScholarPubMed
Beck, A.T. (1976). Cognitive Therapy and the Emotional Disorders. New York: International Universities Press.Google Scholar
Blank, A.S. (1993). The longitudinal course of posttraumatic stress disorder. In Davidson, J.R.T. and Foa, E.B. (Eds). Posttraumatic Stress Disorder. DSM-IV and Beyond (pp. 3–22). Washington, DC: American Psychiatric Press.Google Scholar
Borkovec, T.D. (1985). The role of cognitive and somatic cues in anxiety and anxiety disorders: worry and relaxation-induced anxiety. In Tuma, A.H. and Maser, J.D. (Eds). Anxiety and the Anxiety Disorders (pp. 463–478). Hillsdale: Erlbaum.Google Scholar
Borkovec, T.D., Shadick, R. and Hopkins, M. (1990). The nature of normal and pathological worry. In Rapee, R. and Barlow, D.H. (Eds). Chronic Anxiety and Generalized Anxiety Disorder. New York: Plenum Press.Google Scholar
Breslau, N. and Davis, G.C. (1992). Posttraumatic stress disorder in an urban population of young adults: risk factors for chronicity. American Journal of Psychiatry 149, 671–675.Google Scholar
Brett, E.A. and Ostroff, R. (1985). Imagery and posttraumatic stress disorder: an overview. American Journal of Psychiatry 142, 417–424.Google ScholarPubMed
Burstein, A. (1989a). Intrusion and avoidance symptoms in PTSD. American Journal of Psychiatry 146, 15–18.Google ScholarPubMed
Burstein, A. (1989b). Posttraumatic stress disorder in victims of motor vehicle accidents. Hospital and Community Psychiatry 40, 295–297.Google ScholarPubMed
Calhoun, K.S. and Resick, P.A. (1993). Post-traumatic stress disorder. In Barlow, D.H. (Ed). clinical Handbook of Psychological Disorders (2nd ed) (pp. 48–98). New York: Guilford.Google Scholar
Cassidy, K.L., McNally, R.J. and Zeitlin, S.B. (1992). Cognitive processing of trauma cues in rape victims with post-traumatic stress disorder. Cognitive Therapy and Research 16, 283–295.CrossRefGoogle Scholar
Chemtob, C., Roitblat, H.L., Hamada, R.S., Carlson, J.G. and Twentyman, C.T. (1988). A cognitive action theory of post-traumatic stress disorder. Journal of Anxiety Disorders 2, 253–275.CrossRefGoogle Scholar
Clark, D.M. (1986). A cognitive approach to panic. Behaviour Research and Therapy 24, 461–470.CrossRefGoogle ScholarPubMed
Clark, D.M. (1989). Anxiety states. In Hawton, K., Salkovskis, P., Kirk, J. and Clark, D.M. (Eds). Cognitive Behaviour Therapy for Psychiatric Problems (pp. 52–96). Oxford: Oxford University Press.CrossRefGoogle Scholar
Creamer, M., Burgess, P. and Pattison, P. (1990). Cognitive processing in posttrauma reactions: some preliminary findings. Psychological Medicine 20, 597–604.CrossRefGoogle ScholarPubMed
Creamer, M., Burgess, P. and Pattison, P. (1992). Reaction to trauma: a cognitive processing model. Journal of Abnormal Psychology 101, 452–459.CrossRefGoogle ScholarPubMed
Davey, G.C.L. (1989). UCS revaluation and conditioning models of acquired fears. Behaviour Research and Therapy 27, 521–528.CrossRefGoogle ScholarPubMed
Davidson, J.R.T. and Foa, E.B. (1993). Epilogue. In Davidson, J.R.T. and Foa, E.B. (Eds). Posttraumatic Stress Disorder. DSM-IV and Beyond (pp. 229–235). Washington, DC: American Psychiatric Press.Google Scholar
Eberly, R.E., Harkness, A.R. and Engdahl, B.E. (1991). An adaptational view of trauma response as illustrated by the prisoner of war experience. Journal of Traumatic Stress 4, 363–380.CrossRefGoogle Scholar
Ehlers, A., Margraf, J. and Roth, W.T. (1988). Selective information processing, interoception, and panic attacks. In Hand, I. and Wittchen, H.U. (Eds). Panic and Phobias 2 (pp. 129–148). Berlin: Springer.CrossRefGoogle Scholar
Fairbank, J.A., Hansen, D.J. and Fitterling, J.M. (1991). Patterns of appraisal and coping across different stressor conditions among former prisoners of war with and without posttraumatic stress disorder. Journal of Consulting and Clinical Psychology 59, 274–281.CrossRefGoogle ScholarPubMed
Feinstein, A. and Dolan, R. (1991). Predictors of post-traumatic stress disorder following physical trauma: an examination of the stressor criterion. Psychological Medicine 21, 85–91.CrossRefGoogle ScholarPubMed
Flannery, R.B. (1990). Social support and psychological trauma: a methodological review. Journal of Traumatic Stress 3, 593–611.CrossRefGoogle Scholar
Foa, E.B. and Clark, D.M. (1994). Therapist guide for cognitive restructuring. Unpublished manuscript.Google Scholar
Foa, E.B., Feske, U., Murdock, T.B., Kozak, M.J. and McCarthy, P.R. (1991). Processing of threat-related information in rape victims. Journal of Abnormal Psychology 100, 156–162.CrossRefGoogle ScholarPubMed
Foa, E.B. and Hearst-Ikeda, D. (in press). Emotional dissociation in response to trauma: an information processing approach. In Michelson, L.K. and Ray, W.J. (Eds). Handbook of Dissociation: Theoretical, Empirical, and Research Perspectives. New York: Plenum Press.Google Scholar
Foa, E.B. and Kozak, M.J. (1986). Emotional processing of fear: exposure to corrective information. Psychological Bulletin 99, 20–35.CrossRefGoogle ScholarPubMed
Foa, E.B. and Riggs, D.S. (1993). Post-traumatic stress disorder in rape victims. American Psychiatric Press Review of Psychiatry 12 Washington DC: Author.Google Scholar
Foa, E.B., Riggs, D.S., Dancu, C.V. and Rothbaum, B.O. (1993). Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. Journal of Traumatic Stress 6, 459–473.Google Scholar
Foa, E.B., Riggs, D.S., Massie, E.D. and Yarczower, M. (in press). The impact of fear activation and anger on the efficacy of exposure treatment for PTSD. Behavior Therapy.Google Scholar
Foa, E.B., Rothbaum, B.O., Riggs, D.S. and Murdock, T.B. (1991). Treatment of posttraumatic stress disorder in rape victims: a comparison between cognitive-behavioral procedures and counselling. Journal of Consulting and Clinical Psychology 59, 715–723.CrossRefGoogle Scholar
Foa, E.B., Steketee, G. and Rothbaum, B.O. (1989). Behavioral/cognitive conceptualizations of post-traumatic stress disorder. Behavior Therapy 20, 155–176.CrossRefGoogle Scholar
Foa, E.B., Zinbarg, R. and Rothbaum, B.O. (1992). Uncontrollability and unpredictability in post-traumatic stress disorder: an animal model. Psychological Bulletin 112, 218–238.CrossRefGoogle ScholarPubMed
Freedy, J.R., Shaw, D.L., Jarrell, M.P. and Masters, C.R. (1992). Towards an understanding of the psychological impact of natural disasters: an application of the conservation resources stress model. Journal of Traumatic Stress 5, 441–454.CrossRefGoogle Scholar
Glover, H. (1992). Emotional numbing: a possible endorphine-mediated phenomenon associated with post-traumatic stress disorders and other allied psychopathologic states. Journal of Traumatic Stress 5, 643–675.Google Scholar
Goldstein, A.J. and Chambless, D.L. (1978). A reanalysis of agoraphobia. Behavior Therapy 9, 47–59.CrossRefGoogle Scholar
Green, B.L. (1993). Disasters and posttraumatic stress disorder. In Davidson, J.R.T. and Foa, E.B. (Eds). Posttraumatic Stress Disorder. DSM-IV and Beyond (pp. 75–97). Washington, DC: American Psychiatric Press.Google Scholar
Horowitz, M.J. (1976). Stress Response Syndromes. New York: Aronson.Google Scholar
Horowitz, M., Wilner, N. and Alvarez, W. (1979). Impact of Event Scale: a measure of subjective stress. Psychosomatic Medicine 41, 209–218.CrossRefGoogle Scholar
Janoff-Bulman, R. (1985). The aftermath of victimization: rebuilding shattered assumptions. In Figley, C. R. (Ed). Trauma and its Wake: The Study and Treatment of Posttraumatic Stress Disorder (pp. 15–35). New York: Brunner & Mazel.Google Scholar
Janoff-Bulman, R. and Frieze, I.H. (1983). A theoretical perspective for understanding reactions to victimization. Journal of Social Issues 37, 105–122.Google Scholar
Jones, J.C. and Barlow, D.H. (1990). The etiology of posttraumatic stress disorder. Clinical Psychology Review 10, 299–328.CrossRefGoogle Scholar
Joseph, S., Yule, W. and Williams, R. (1993). Post-traumatic stress: attributional aspects. Journal of Traumatic Stress 6, 501–513.Google Scholar
Kilpatrick, D.G. and Resnick, H.S. (1993). Posttraumatic stress disorder associated with exposure to criminal victimization in clinical and community populations. In Davidson, J.R.T. and Foa, E.B. (Eds). Posttraumatic Stress Disorder. DSM-IV and Beyond (pp. 113–143). Washington, DC: American Psychiatric Press.Google Scholar
Kilpatrick, D.G., Saunders, B.E., Amick-McMullan, A., Best, C.L., Veronen, L. and Resick, H. (1989). Victim and crime factors associated with the development of post-traumatic stress disorder. Behavior Therapy 20, 199–214.CrossRefGoogle Scholar
Lang, P.M. (1977). Imagery in therapy: an information processing analysis of fear. Behavior Therapy 8, 862–886.CrossRefGoogle Scholar
Litz, B.T. and Keane, T.M. (1989). Information processing in anxiety disorders: application to the understanding of posttraumatic stress disorder. Clinical Psychology Review 9, 243–257.CrossRefGoogle Scholar
Mathews, M. (1990). Why worry? The cognitive function of anxiety. Behavior Research and Therapy 28, 455–468.CrossRefGoogle ScholarPubMed
Mayou, R., Bryant, B. and Duthie, R. (1993). Psychiatric consequences of road traffic accidents. British Medical Journal. 307, 647–651.CrossRefGoogle ScholarPubMed
McCann, I.L. and Pearlman, L.A. (1990). Psychological Trauma and the Adult Survivor: Theory, Therapy, and Transformation. New York: Brunner and Mazel.Google Scholar
McFarlane, A.C. (1988). The phenomenology of posttraumatic stress disorders following a natural disaster. Journal of Nervous and Mental Disease 176, 22–29.CrossRefGoogle ScholarPubMed
McFarlane, A.C. (1992a). Avoidance and intrusion in posttraumatic stress disorder. Journal of Nervous and Mental Disease 180, 439–445.CrossRefGoogle ScholarPubMed
McFarlane, A.C. (1992b). Commentary. Posttraumatic stress disorder among injured survivors of a terrorist attack: predictive value of early intrusion and avoidance symptoms. The Journal of Nervous and Mental Disease 180, 599–560.CrossRefGoogle ScholarPubMed
McNally, R.J., Kaspi, S.P., Riemann, B.C. and Zeitlin, S.B. (1990). Selective processing of threat cues in posttraumatic stress disorder. Journal of Abnormal Psychology 99, 398–402.CrossRefGoogle ScholarPubMed
McNally, R.J., Litz, B.T., Prassas, A., Shin, L.M. and Weathers, F.W. (1994). Emotional priming of autobiographical memory in post-traumatic stress disorder. Cognition and Emotion 8, 351–367.CrossRefGoogle Scholar
Mowrer, O.H. (1960). Learning Theory and Behavior. New York: Wiley.CrossRefGoogle Scholar
Parkinson, L. and Rachman, S. (1981). Part II. The nature of intrusive thoughts. Advances in Behaviour Research and Therapy 3, 101–110.CrossRefGoogle Scholar
Pennebaker, J.W. (1989). Confession, inhibition, and disease. Advances in Experimental Social Psychology 22, 211–244.CrossRefGoogle Scholar
Perry, S., Difede, J., Musngi, G., Frances, A.J. and Jacobsberg, L. (1992). Predictors of posttraumatic stress disorder after burn injury. American Journal of Psychiatry 149, 931–935.Google ScholarPubMed
Rachman, S.J. (1990). Fear and Courage (2nd ed.). New York: Freeman.Google Scholar
Rachman, S.J. and de Silva, P. (1978). Abnormal and normal obsessions. Behaviour Research and Therapy 16, 101–110.CrossRefGoogle ScholarPubMed
Resick, P.A. and Schicke, M.K. (1993). Cognitive Processing Therapy for Rape Victims. Newbury Park, California: Sage.Google Scholar
Riggs, D., Foa, E.B., Rothbaum, B.O. and Murdock, T. (1991). Post-traumatic stress disorder following rape and non-sexual assault: a predictive model. Unpublished manuscript.Google Scholar
Riggs, D.S., Dancu, C.V., Gershuny, B.S., Greenberg, D. and Foa, E.B. (1992). Anger and post-traumatic stress disorder in female crime victims. Journal of Traumatic Stress 5, 613–625.Google Scholar
Rothbaum, B.O. and Foa, E.B. (1993). Subtypes of posttraumatic stress disorder and duration of symptoms. In Davidson, J.R.T. and Foa, E.B. (Eds). Posttraumatic Stress Disorder. DSM-IV and Beyond (pp. 23–35). Washington, DC: American Psychiatric Press.Google Scholar
Rothbaum, B.O., Foa, E.B., Riggs, D.S., Murdock, T. and Walsh, W. (1992). A prospective examination of post-traumatic stress disorder in rape victims. Journal of Traumatic Stress 5, 455–475.Google Scholar
Salkovskis, P.M. (1985). Obsessional-compulsive problems: a cognitive-behavioural analysis. Behaviour Research and Therapy 23, 571–583.CrossRefGoogle ScholarPubMed
Salkovskis, P.M., Richards, H.C. and Forrester, E. (1995). The relationship between obsessional problems and intrusive thoughts. Behavioural and Cognitive Psychotherapy 23, 281–299.CrossRefGoogle Scholar
Salkovskis, P.M. and Campbell, P. (1994). Thought suppression induces intrusion in naturally occurring negative thoughts. Behaviour Research and Therapy 32, 1–8.CrossRefGoogle Scholar
Schwartz, L.S. (1990). A biopsychosocial treatment approach to post-traumatic stress disorder. Journal of Traumatic Stress 3, 221–238.Google Scholar
Schwarz, N. and Clore, G.L. (1983). Mood, misattribution, and judgements of well-being: informative and directive functions of affective states. Journal of Personality and Social Psychology 45, 513–523.CrossRefGoogle Scholar
Schwarz, E.D., Kowalski, J.M. and McNally, R.J. (1993). Malignant memories: post-traumatic changes in memory in adults after a school shooting. Journal of Traumatic Stress 6, 545–553.Google Scholar
Seligman, M.E.P. and Johnston, J.C. (1973). A cognitive theory of avoidance learning. In McGuigan, F.J. and Lumsden, D.B. (Eds). Contemporary Approaches to Conditioning and Learning. New York: Wiley.Google Scholar
Shalev, A.Y. (1992). Posttraumatic stress disorder among injured survivors of a terrorist attack. Predictive value of early intrusion and avoidance symptoms. Journal of Nervous and Mental Disease 180, 505–509.CrossRefGoogle ScholarPubMed
Shalev, A.Y., Schreiber, S. and Galai, T. (1993). Early psychological responses to traumatic injury. Journal of Traumatic Stress 6, 441–450.CrossRefGoogle Scholar
Solomon, Z., Mikulincer, M. and Avitzur, E. (1988). Coping, locus of control, social support, and combat-related posttraumatic stress disorder: a prospective study. Journal of Personality and Social Psychology 55, 279–285.CrossRefGoogle ScholarPubMed
Solomon, Z., Mikulincer, M. and Flum, H. (1988). Negative life events, coping responses, and combat-related psychopathology: a prospective study. Journal of Abnormal Psychology 97, 302–307.CrossRefGoogle ScholarPubMed
Spiegel, D. (1991). Dissociation and trauma. In Tasman, A. and Goldfinger, S.M. (Eds). Review of Psychiatry (Vol. 10, pp. 261–275). Washington DC: American Psychiatric Press.Google Scholar
Steil, R. and Ehlers, A. (in preparation). Cognitive correlates of intrusive memories after road traffic accidents.Google Scholar
Teasdale, J.D. and Barnard, P.J. (1993). Affect, Cognition, and Change. Hillsdale, NJ: Lawrence Erlbaum.Google Scholar
Tennen, H. and Affleck, G. (1990). Blaming others for threatening events. Psychological Bulletin 108, 209–232.CrossRefGoogle Scholar
Trinder, H. and Salkovskis, P.M. (1994). Personally relevant intrusions outside the laboratory: long-term suppression increases intrusion. Behaviour Research and Therapy 32, 833–842.CrossRefGoogle ScholarPubMed
Van Der Kolk, B.A. and Saporta, J. (1991). The biological response to psychic trauma: mechanisms and treatment of intrusion and numbing. Anxiety Research 4, 199–212.CrossRefGoogle Scholar
Vaughan, K. and Tarrier, N. (1992). The use of image habituation training with posttraumatic stress disorder. British Journal of Psychiatry 161, 658–664.CrossRefGoogle Scholar
Wegner, D.M. (1989). White Bears and Other Unwanted Thoughts: Suppression, Obsession, and the Psychology of Mental Control. New York: Viking.Google Scholar
Wells, A. (1994). Attention and the control of worry. In Davey, G.C.L. and Tallis, F. (Eds). Worrying: Pespectives on Theory, Assessment, and Treatment (pp. 91–114). New York: Wiley.Google Scholar
Wells, A. and Matthews, G. (1994). Attention and Emotion: A Clinical Perspective. Hove, UK: Lawrence Erlbaum.Google Scholar
Wells, A. and Papageorgiou, C. (submitted). Worry and the incubation of intrusive images following stress.Google Scholar
Wenninger, K. and Ehlers, A. (submitted). Dysfunctional cognitions and adult functioning in child sexual abuse survivors.Google Scholar
Wenninger, K. and Ehlers, A. (in preparation). Nature of intrusive recollections in child sexual abuse survivors.Google Scholar
Williams, J.M.G., Watts, F.N., MacLeod, C. and Mathews, A. (1988). Cognitive Psychology and Emotional Disorders. Chichester: Wiley.Google Scholar
Winter, H. and Ehlers, A. (in preparation). Predictors of posttraumatic stress disorder after road traffic accidents.Google Scholar
Submit a response

Comments

No Comments have been published for this article.