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Distinguishing between rumination and intrusive memories in PTSD using a wearable self-tracking instrument: a proof-of-concept case study

Published online by Cambridge University Press:  03 May 2021

Ida-Marie T. P. Arendt Open the ORCID record for Ida-Marie T. P. Arendt [Opens in a new window] ,
Lisa H. G. Riisager ,
Jakob E. Larsen ,
Thomas B. Christiansen  and
Stine B. Moeller Open the ORCID record for Stine B. Moeller [Opens in a new window]
Ida-Marie T. P. Arendt*
Affiliation:
Psychotherapy Research Unit, Mental Health Centre Stolpegaard, Capital Region Psychiatry, Stolpegårdsvej 20, 2820 Gentofte, Denmark
Lisa H. G. Riisager
Affiliation:
Psychotherapy Research Unit, Mental Health Centre Stolpegaard, Capital Region Psychiatry, Stolpegårdsvej 20, 2820 Gentofte, Denmark University of Southern Denmark, Department of Psychology, Campusvej 55, 5230 Odense C, Denmark
Jakob E. Larsen
Affiliation:
Technical University of Denmark, Cognitive Systems Section, Anker Engelunds Vej 1, 2800 Kgs. Lyngby, Denmark
Thomas B. Christiansen
Affiliation:
Technical University of Denmark, Cognitive Systems Section, Anker Engelunds Vej 1, 2800 Kgs. Lyngby, Denmark
Stine B. Moeller
Affiliation:
Psychotherapy Research Unit, Mental Health Centre Stolpegaard, Capital Region Psychiatry, Stolpegårdsvej 20, 2820 Gentofte, Denmark University of Southern Denmark, Department of Psychology, Campusvej 55, 5230 Odense C, Denmark
*
*Corresponding author. Email: [email protected]
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Abstract

Rumination has been shown to play a part in post-traumatic stress disorder (PTSD), but its relation to the intrusions characteristic of PTSD has mainly been investigated experimentally. This proof-of-concept case study explored the occurrence, personal experiences, and possible relation between rumination and intrusions in two PTSD patients in their daily living using a mixed method approach. A novel wearable self-tracking instrument was employed which provided fine-grained temporal resolution of observation data and could eliminate recall bias. Furthermore, quantitative and qualitative data were collected on participants’ symptoms, rumination and experiences of using the self-tracking instrument. First, without distinguishing between the two phenomena, the participants tracked both for a week. After receiving psychoeducational training for distinguishing between rumination and intrusions, the differentiated phenomena were tracked for a week. Both participants reported being subjectively able to distinguish between rumination and intrusions and made observations with high adherence during the project. Data hinted at a possible temporal relation between the phenomena in line with theories posing rumination as a maladaptive coping strategy as well as an exacerbator of PTSD symptoms. However, relations to mood were inconclusive. Furthermore, by using the self-tracking instrument, participants gained a heightened awareness of the characteristics of rumination and intrusions and contextual cues for occurrence, as well as a greater sense of momentary agency. Results reveal promising prospects in using the wearable self-tracking instrument for further investigation of the relation between rumination and intrusions in the lived lives of PTSD patients, as well as potential for incorporating this method in clinical treatment.

Key learning aims

  1. (1) Self-tracking with the One Button Tracker is a novel symptom registration method, particularly suited for use in psychotherapeutic treatment and research.

  2. (2) Rumination and intrusions appear to the participants as distinct cognitive phenomena and treatment targets in PTSD.

  3. (3) Registering rumination and intrusions in real-time could reveal important temporal relations between them and the contexts in which they occur.

  4. (4) The data obtained with this self-tracking method can potentially be used as a tool in, and for the further development of psychotherapy for PTSD.

Keywords

cognitive behavioural therapyecological momentary assessmentintrusionsruminationstress and trauma related disorderswearable devices
Type
Original Research
Information
the Cognitive Behaviour Therapist , Volume 14 , 2021 , e15
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the British Association for Behavioural and Cognitive Psychotherapies

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References

Further reading

Ehlers, A., Hackmann, A., & Michael, T. (2004). Intrusive re-experiencing in post-traumatic stress disorder: phenomenology, theory, and therapy . Memory, 12, 403–415. https://doi.org/10.1080/09658210444000025CrossRefGoogle Scholar
Griffin, B., & Saunders, K. E. A. (2020). Smartphones and wearables as a method for understanding symptom mechanisms. Frontiers in Psychiatry, 10, 949. https://doi.org/10.3389/fpsyt.2019.00949CrossRefGoogle Scholar
Hackmann, A., Ehlers, A., Speckens, A., & Clark, D. M. (2004). Characteristics and content of intrusive memories in PTSD and their changes with treatment. Journal of Traumatic Stress, 17, 231–240. https://doi.org/10.1023/B:JOTS.0000029266.88369.fdCrossRefGoogle Scholar
Michael, T., Halligan, S. L., Clark, D. M., & Ehlers, A. (2007). Rumination in posttraumatic stress disorder Depression and Anxiety, 24, 307–317. https://doi.org/10.1002/da.20228 CrossRefGoogle ScholarPubMed
Pugach, C. P., Campbell, A. A., & Wisco, B. E. (2020). Emotion regulation in posttraumatic stress disorder (PTSD): rumination accounts for the association between emotion regulation difficulties and PTSD severity. Journal of Clinical Psychology, 76, 508–525. https://doi.org/10.1002/jclp.22879 CrossRefGoogle ScholarPubMed
Watkins, E. R., & Roberts, H. (2020). Reflecting on rumination: consequences, causes, mechanisms and treatment of rumination. Behaviour Research and Therapy, 127, 103573. https://doi.org/10.1016/j.brat.2020.103573 CrossRefGoogle ScholarPubMed

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