Elsevier

Clinical Psychology Review

Volume 18, Issue 8, December 1998, Pages 971-982
Clinical Psychology Review

Experimental approaches to cognitive abnormality in posttraumatic stress disorder

https://doi.org/10.1016/S0272-7358(98)00036-1Get rights and content

Abstract

During the past decade, experimental psychopathologists have increasingly applied the concepts and methods of cognitive psychology to elucidate information-processing abnormalities in people with posttraumatic stress disorder (PTSD). These studies have shown that individuals with PTSD: (a) selectively process trauma-relevant material in the emotional Stroop paradigm; (b) exhibit enhanced memory for material related to trauma in explicit and perhaps implicit tests; (c) exhibit difficulty forgetting trauma words during directed forgetting; and (d) exhibit problems retrieving specific autobiographical memories in response to cue words, instead recalling “overgeneral” memories. These studies suggest that experimental methods can complement traditional, self-report methods for studying cognitive disturbances in PTSD.

Section snippets

Involuntary retrieval of traumatic information

Reexperiencing symptoms are characterized by intrusion into consciousness of horrific autobiographical memories. If information about trauma is characterized by involuntary access to working memory, PTSD patients ought to exhibit delayed color-naming of trauma words in the emotional Stroop paradigm. Furthermore, the magnitude of delay (i.e., Stroop interference) should be related to other indices of intrusive cognition.

In this paradigm, the investigator asks participants to view words of

Explicit and implicit memory for traumatic material

Emotional Stroop studies indicate that trauma concepts are readily activated and difficult to suppress in people with PTSD. Other attempts to study enhanced accessibility of trauma-relevant information have involved explicit and implicit laboratory tests. Explicit memory tests require conscious recollection of previous experiences, whereas implicit memory tests reflect prior experiences without requiring conscious recollection of these experiences.

If trauma-related material is characterized by

Directed forgetting and childhood sexual abuse

Some therapists believe that sexually abused children acquire an avoidant (or dissociative) encoding style that enables them to disengage attention from terrifying stimuli during abuse episodes and to redirect it elsewhere (e.g., Gelinas 1983, Terr 1991). An ability to attend preferentially to innocuous cues (e.g., wallpaper patterns) may attenuate an otherwise very frightening experience (Herman & Schatzow, 1987). Although probably adaptive under the circumstances of chronic abuse, this

Autobiographical memory disturbance

While investigating mood and memory in depressed and suicidal patients, Williams and his colleagues discovered that these individuals had great difficulty recalling specific personal memories in response to cue words (e.g., Williams & Broadbent 1986, Williams & Dritschel 1988). Unlike nondepressed participants, these patients tended to retrieve “overgeneral” memories, especially in response to positive cue words. Thus, in response to words like happy, control participants easily remembered

Summary and clinical implications

Cognitive research on PTSD has captured information-processing abnormalities in the laboratory that may figure in the genesis of certain symptoms of the disorder. Words related to traumatic events disproportionately command attention in Stroop tasks. The meanings of such words, once activated, are difficult for PTSD patients to suppress. These studies imply that enhanced accessibility and failure of inhibition are candidates for the mechanism underlying the phenomenon of intrusive recollection.

Acknowledgements

Preparation of this article was supported, in part, by NIMH Grant 51927 awarded to the author.

References (58)

  • J.A. Bargh

    Conditional automaticityVarieties of automatic influence in social perception and cognition

  • Basden, B. H., Basden, D. R., & Gargano, G. J. (1993). Directed forgetting in implicit and explicit memory tests: A...
  • D. Berntsen

    Involuntary autobiographical memories

    Applied Cognitive Psychology

    (1996)
  • B.P. Bradley et al.

    Selective processing of negative informationEffects of clinical anxiety, concurrent depression, and awareness

    Journal of Abnormal Psychology

    (1995)
  • J.D. Bremner et al.

    MRI-based measurement of hippocampal volume in combat-related posttraumatic stress disorder

    American Journal of Psychiatry

    (1995)
  • A.D. Brittlebank et al.

    Autobiographical memory in depressionState or trait marker?

    British Journal of Psychiatry

    (1993)
  • R.A. Bryant et al.

    Processing of threatening information in posttraumatic stress disorder

    Journal of Abnormal Psychology

    (1995)
  • K.L. Cassiday et al.

    Cognitive processing of trauma cues in rape victims with post-traumatic stress disorder

    Cognitive Therapy and Research

    (1992)
  • J. Evans et al.

    Autobiographical memory and problem-solving strategies of parasuicide patients

    Psychological Medicine

    (1992)
  • E.B. Foa et al.

    Processing of threat-related information in rape victims

    Journal of Abnormal Psychology

    (1991)
  • D.J. Gelinas

    The persisting negative effects of incest

    Psychiatry

    (1983)
  • D. Goleman

    Emotional intelligence

    (1995)
  • A.G. Harvey et al.

    Preconscious processing of threat in posttraumatic stress disorder

    Cognitive Therapy and Research

    (1996)
  • J.L. Herman et al.

    Recovery and verification of memories of childhood sexual trauma

    Psychoanalytic Psychology

    (1987)
  • M.J. Horowitz

    Stress response syndromes

    (1986)
  • M. Horowitz et al.

    The Impact of Events ScaleA measure of subjective stress

    Psychosomatic Medicine

    (1979)
  • Jacoby, L. L., Allan, L. G., Collins, J. C., & Larwill, L. K. (1988). Memory influences subjective experience: Noise...
  • R. Janoff-Bulman

    Assumptive worlds and the stress of traumatic eventsApplication of the schema construct

    Social Cognition

    (1989)
  • H.M. Johnson

    Processes of successful intentional forgetting

    Psychological Bulletin

    (1994)
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