Repeated exposure to body-related memories in women with high body-related self-disgust: Impact on disgust, avoidance, and acceptance.

Disgust-based body image concerns can bias autobiographical memory towards the recall and avoidant processing of disgust-related memories of the own body. Repeated exposure to such memories may help breaking avoidance and promote the habituation of disgust, thereby lowering body concerns. Using a pre-post within-participant experimental design, we tested if repeatedly exposing women with high self-disgust (N = 61) to disgust-focused body memories vs. neutral memories led to changes in disgust, body acceptance, and reactive avoidance. Contrary to expectations, state disgust towards the body itself only decreased following exposure to neutral memories. Yet, disgust elicited by body-related memories decreased following both repeated exposure to neutral and body memories. Although acceptance was not found to significantly change in either exposure session, pre-post decreases in state disgust were associated with increases in acceptance following the disgust-focused exposure. In contrast to expectations, reactive avoidance increased from pre to post in the disgust-focused exposure. Overall, the results indicate that repeated exposure to disgust-focused body memories may help reduce disgust elicited by these memories and promote body acceptance. Yet, the effect of this repeated exposure to body memories did not extend to changing state disgust towards the body, possibly due to reactive avoidance.

Suppression-Induced Forgetting as a Model for Repression.

The Think/No-Think (T/NT) task was designed to test whether the deliberate avoidance of retrieving a memory (i.e., suppression) hinders the subsequent recall of that memory. Forgetting effects obtained with the T/NT-task (Suppression-Induced Forgetting) are thought to result from memory inhibition: the deactivation of the representation of the to-be-suppressed memory. Memory inhibition can be specifically inferred from decreased performance on a test using Independent Probes-cues that are unrelated to the initial study phase in the T/NT-procedure. The present contribution explores the evidence for the idea that Suppression-Induced Forgetting obtained with such Independent Probes may provide a viable model for repression. A review of the literature on Suppression-Induced Forgetting with Independent Probes (SIF-IP) suggests that reliable estimates of the overall effect size are unavailable, that the extent to which the literature suffers from publication bias is unknown and that reporting bias may obstruct a clear view of the percentage of studies that find a statistically significant effect. In addition, it is difficult to study SIF-IP in autobiographical memories, due to their complexity and idiosyncrasy. All in all, it seems questionable whether suppression-induced forgetting obtained with independent probes provides a viable model of repression.

Suppression-induced forgetting: a pre-registered replication of the think/no-think paradigm.

Post-traumatic stress disorder is characterised by recurring memories of a traumatic experience despite deliberate attempts to forget (i.e., suppression). The Think/No-Think (TNT) task has been used widely in the laboratory to study suppression-induced forgetting. During the task, participants learn a series of cue-target word pairs. Subsequently, they are presented with a subset of the cue words and are instructed to think (respond items) or not think about the corresponding target (suppression items). Baseline items are not shown during this phase. Successful suppression-induced forgetting is indicated by the reduced recall of suppression compared to baseline items in recall tests using either the same or different cues than originally studied (i.e., same- and independent-probe tests, respectively). The current replication was a pre-registered collaborative effort to evaluate an online experimenter-present version of the paradigm in 150 English-speaking healthy individuals (89 females; MAge = 31.14, SDAge = 7.73). Overall, we did not replicate the suppression-induced forgetting effect (same-probe: BF01 = 7.84; d = 0.03 [95% CI: -0.13; 0.20]; independent-probe: BF01 = 5.71; d = 0.06 [95% CI: -0.12; 0.24]). These null results should be considered in light of our online implementation of the paradigm. Nevertheless, our findings call into question the robustness of suppression-induced forgetting.

Negative body image and avoidant retrieval of body-related autobiographical memories.

People with a negative body image may be more likely to recall negative memories of their body, but also be motivated to avoid retrieving specific memories to prevent triggering aversive emotions (e.g., disgust). Such inclination to retain at a global level of memory recall may hamper the correction of their negative body image. In previous research using Autobiographical Memory Tests (AMTs) with minimal instructions, we failed to find an overgeneral memory bias specific to individuals with a negative body image but observed low specificity overall in response to body cue words. In the present study (N = 153), we included the traditional AMT next to a minimal instructions AMT and explored the idea that sensory reliving may be relevant to avoidance by assessing sensory reliving ratings next to memory specificity. A negative body image was associated with more negative body memories. In both AMTs, the findings failed to support our prediction that a more negative body image would be associated with lower specificity or sensory reliving. The findings are consistent with the view that autobiographical memories might be an important factor in defining one's body image, yet cast doubt on the relevance of avoidant retrieval of body-related memories in non-clinical samples.

Escaping from revulsion - disgust and escape in response to body-relevant autobiographical memories.

The term Repulsive Body Image (RBI) refers to a schematic construct combining body-directed self-disgust and other negative body image features, that is assumed to bias information processing, including autobiographical memory retrieval. When specific memories about the own body are retrieved, intense self-disgust may arise and trigger urges to escape from those memories. We asked 133 women with high (HRBI; n = 63) and low (LRBI; n = 70) levels of habitual body-directed self-disgust to recall autobiographical memories in response to 11 concrete body-related cue words in a minimal instructions Autobiographical Memory Test (AMT). Despite an overall low level of memory specificity, we found that RBI levels were associated with stronger disgust reactions and stronger motivations to escape from body-related memories. In addition, disgust reactions to body-related memories accounted for the association between habitual levels of self-disgust and urges to escape from these memories. Thus, the findings indicated that women with body image concerns showed disgust-based urges to escape from body-related memories. This disgust-based urge to avert from body-related autobiographical memories might counteract the correction of an RBI, thereby contributing to the persistence of body image concerns and associated psychopathology.

Individual differences in avoiding feelings of disgust: Development and construct validity of the disgust avoidance questionnaire.

We developed and examined the construct validity of the Disgust Avoidance Questionnaire (DAQ) as a measure of people's inclination to prevent experiencing disgust (disgust prevention) and to escape from the experience of disgust (disgust escape). In a stepwise item-reduction (Study 1; N = 417) using Exploratory Factor Analysis (EFA) based on a 4-subscale distinction (behavioral prevention, cognitive prevention, behavioral escape, cognitive escape), we selected 17 items from a pool of potential items. In order to incorporate the conceptual overlap between dimensions of disgust avoidance, focus (prevention vs. escape), and strategy (behavioral avoidance vs. cognitive avoidance), we specified an adapted model. In this model, we allowed each item to load on one type of dimension and one type of strategy, resulting in four overlapping factors (prevention, escape, behavioral avoidance, cognitive avoidance). Evaluation of this overlapping 4-factor model (Study 2; N = 513) using Exploratory Structural Equation Modeling (ESEM) and Confirmatory Factor Analysis (CFA) showed promising model fit indices, factor loadings, factor correlations, and reliability estimates for three of the four factors (prevention, behavioral avoidance, cognitive avoidance). Those three subscales also showed good convergent validity. In contrast, the results related to the escape factor may call the suitability of self-report to assess disgust escape into question. In light of the exploratory nature of the project, future examinations of the DAQ's validity and applicability to more diverse samples are essential. A critical next step for future research would be to examine the DAQ's criterion validity and the distinctive roles of the DAQ subscales in (clinical) psychological constructs and processes.

A multiverse analysis of early attempts to replicate memory suppression with the Think/No-think Task.

In 2001, Anderson and Green [2001. Suppressing unwanted memories by executive control. Nature, 410(6826), 366-369] showed memory suppression using a novel Think/No-think (TNT) task. When participants attempted to prevent studied words from entering awareness, they reported fewer of those words than baseline words in subsequent cued recall (i.e., suppression effect). The TNT literature contains predominantly positive findings and few null-results. Therefore we report unpublished replications conducted in the 2000s (N = 49; N = 36). As the features of the data obtained with the TNT task call for a variety of plausible solutions, we report parallel "universes" of data-analyses (i.e., multiverse analysis) testing the suppression effect. Two published studies (Wessel et al., 2005. Dissociation and memory suppression: A comparison of high and low dissociative individuals' performance on the Think-No think Task. Personality and Individual Differences, 39(8), 1461-1470, N = 68; Wessel et al., 2010. Cognitive control and suppression of memories of an emotional film. Journal of Behavior Therapy and Experimental Psychiatry, 41(2), 83-89. https://doi.org/10.1016/j.jbtep.2009.10.005, N = 80) were reanalysed in a similar fashion. For recall probed with studied cues (Same Probes, SP), some tests (sample 3) or all (samples 2 and 4) showed statistically significant suppression effects, whereas in sample 1, only one test showed significance. Recall probed with novel cues (Independent Probes, IP) predominantly rendered non-significant results. The absence of statistically significant IP suppression effects raises problems for inhibition theory and its implication that repression is a viable mechanism of forgetting. The pre-registration, materials, data, and code are publicly available (https://osf.io/qgcy5/).

Cognitive behavioural therapy and mindfulness for relatives of missing persons: a pilot study.

OBJECTIVES: Relatives of long-term missing persons need to deal with uncertainties related to the disappearance. These uncertainties may give rise to ruminative thinking about the causes and consequences of the loss. Focusing on tolerating uncertainties in treatment of relatives of missing persons might foster recovery. Adding mindfulness to cognitive behavioural therapy might serve this aim. The feasibility and potential effectiveness of cognitive behavioural therapy with mindfulness were evaluated in a pilot study. We aimed to detect changes in symptom levels and mindfulness from pre-treatment to 1 week, 12 weeks, and 24 weeks post-treatment. METHOD: Dutch adults who experienced the disappearance of a significant other more than 3 months earlier and scored above clinical thresholds for psychological distress were eligible to participate. Participants were recruited from January 2015 to July 2016. Participants in the immediate treatment group started treatment after 1 week after randomization, whereas waiting list controls started the treatment after 12 weeks of waiting. Data from self-report measures as well as clinical diagnostic interviews (tapping persistent complex bereavement disorder, major depressive disorder, and posttraumatic stress disorder) were gathered among 17 relatives of missing persons with elevated symptom levels. RESULTS: The response rate (31.7%) was low, and dropout rate (47.1%) high. Cognitive behavioural therapy with mindfulness coincided with changes in psychopathology levels (Hedges' g 0.35-1.09) and mindfulness (Hedges' g - 0.10-0.41). Participants completing the treatment were satisfied with treatment quality and reported high treatment compliance. CONCLUSIONS: Because of the limited research about effective treatments for relatives of missing persons and promising results of small and/or uncontrolled trials examining the effect of mindfulness-based treatment to target grief-related complaints, it seems valuable to continue investigating the effects of cognitive behavioural therapy with mindfulness on reducing post-loss psychopathology in future research. However, in order to increase the feasibility of future trials among relatives of missing persons, we recommend collaborating internationally and/or extending duration of recruitment phase, to maximize the sample size. TRIAL REGISTRATION: The Netherlands National Trial Register, NTR4732.

Manipulating the reported age in earliest memories in a Dutch community sample.

BACKGROUND: Childhood amnesia in adults can be defined as the relative paucity of autobiographical memories from the first years of life. An earlier study by Wessel, Schweig and Huntjens demonstrated that 'how' we ask for an earliest memory may bias adults' estimations of when the earliest childhood memory actually happened. They suggested that snapshot memories (i.e., mental pictures) were less sensitive to an age manipulation than event memories (i.e. narratives). We aimed at replicating and extending these findings using a Dutch community sample stratified for age, gender and educational level. METHOD: Participants (N = 619) were randomized into one of three experimental conditions. Prior to recalling their earliest memory, participants in the early and late conditions were presented with examples referring to memories from age 1-2 or 5-6, respectively. The example memories in the control group did not contain any age cues. Participants reported the estimated age in their earliest memory and their strategy for arriving at this estimate. They also rated their memory's phenomenology (e.g. vividness). Independent judges rated memory type (e.g., snapshot memories). RESULTS: Compared to the control group, participants in the early condition estimated the age in their memory to be significantly earlier. The difference between the late and control conditions was too small to be of interest. We did not observe a statistically significant interaction between memory type and condition. Snapshot memories were from a younger age than event memories and showed differences with respect to phenomenology (e.g., emotional intensity). CONCLUSION: The results of this community study replicate earlier findings that instructions including age cues influence estimates of age in earliest memories. Although snapshot and event memories seem to be qualitatively different, the idea that they respond differently to an age manipulation could not be corroborated.

The role of event relevance and congruence to social groups in flashbulb memory formation.

Flashbulb memories are vivid, confidently held, long-lasting memories for the personal circumstances of learning about an important event. Importance is determined, in part, by social group membership. Events that are relevant to one's social group, and furthermore, are congruent with the prior beliefs of that group, should be more likely to be retained as flashbulb memories. The Fukushima nuclear disaster was relevant to ongoing political conversations in both Germany and the Netherlands, but, while the disaster was congruent with German beliefs about the dangers of nuclear energy, it was incongruent with Dutch support for nuclear power. Danish participants would not have found the disaster to be particularly relevant. Partially consistent with this prediction, across two samples (N = 265 and N = 518), German participants were most likely to have flashbulb memories for the Fukushima disaster. Furthermore, event features thought to be related to flashbulb memory formation (e.g. ratings of importance and consequentiality) also differed as a function of nationality. Spontaneously generated flashbulb memories for events other than Fukushima also suggested that participants reported events that were relevant to national identity (e.g. the Munich attacks for Germans, the Utøya massacre for Danes, and Malaysian Airlines flight MH-17 for Dutch participants).

We need to change our attitude, and journals can help: Reflections in response to Spiller & Olff (2018).

Adopting Registered Reports is an important step for the European Journal of Psychotraumatology to promote open science practices in the field of psychotrauma research. However, adopting these practices requires us as individual researchers to change our perspective fundamentally. We need to put fears of being scooped aside, adopt a permissive stance towards making mistakes and accept that null-results should be part of the scientific record. This is difficult because the culture in academia is competitive. Incentives are on publishing novel and positive results in high impact journals. A change in journal policies, such that openness and transparency are reinforced, can facilitate an attitude change in individual researchers.

La adopción de Reportes Registrados es un paso importante para la Revista Europea de Psicotraumatología para promover las prácticas de la ciencia abierta en el campo de la investigación en psicotrauma. Sin embargo, la adopción de esta práctica requiere de nosotros como investigadores individuales de cambiar fundamentalmente nuestra perspectiva. Necesitamos poner a un lado nuestros temores de ser apartados, adoptar una postura permisiva para cometer errores y aceptar que los resultados nulos deben formar parte del registro científico. Esto es difícil porque la cultura en la academia es competitiva. Los incentivos están en la publicación de resultados novedosos y positivos en revistas con impacto alto. Un cambio en las políticas de las revistas, tales como la apertura y transparencia se refuerzan, pueden facilitar una actitud de cambio en los investigadores individuales.

Toward a Better Understanding of Psychological Symptoms in People Confronted With the Disappearance of a Loved One: A Systematic Review.

OBJECTIVE: The disappearance of a loved one is claimed to be the most stressful type of loss. The present review explores the empirical evidence relating to this claim. Specifically, it summarizes studies exploring the prevalence and correlates of psychological symptoms in relatives of missing persons as well as studies comparing levels of psychopathology in relatives of the disappeared and the deceased. METHOD: Two independent reviewers performed a systematic search in PsychINFO, Web of Science, and Medline, which resulted in 15 studies meeting predefined inclusion criteria. Eligible studies included quantitative peer-reviewed articles and dissertations that assessed psychopathology in relatives of missing person. RESULTS: All reviewed studies were focused on disappearances due to war or state terrorism. Prevalence rates of psychopathology were mainly described in terms of post-traumatic stress disorder and depression and varied considerably among the studies. Number of experienced traumatic events and kinship to the missing person were identified as correlates of psychopathology. Comparative studies showed that psychopathology levels did not differ between relatives of missing and deceased persons. CONCLUSIONS: The small number of studies and the heterogeneity of the studies limit the understanding of psychopathology in those left behind. More knowledge about psychopathology postdisappearance could be gained by expanding the focus of research beyond disappearances due to war or state terrorism.

Manipulating the reported age in earliest memories.

Previous work suggests that the estimated age in adults' earliest autobiographical memories depends on age information implied by the experimental context [e.g., Kingo, O. S., Bohn, A., & Krøjgaard, P. (2013). Warm-up questions on early childhood memories affect the reported age of earliest memories in late adolescence. Memory, 21(2), 280-284. doi: 10.1080/09658211.2012.729598 ] and that the age in decontextualised snippets of memory is younger than in more complete accounts (i.e., event memories [Bruce, D., Wilcox-O'Hearn, L. A., Robinson, J. A., Phillips-Grant, K., Francis, L., & Smith, M. C. (2005). Fragment memories mark the end of childhood amnesia. Memory & Cognition, 33(4), 567-576. doi: 10.3758/BF03195324 ]). We examined the malleability of the estimated age in undergraduates' earliest memories and its relation with memory quality. In Study 1 (n = 141), vignettes referring to events happening at age 2 rendered earlier reported ages than examples referring to age 6. Exploratory analyses suggested that event memories were more sensitive to the age manipulation than memories representing a single, isolated scene (i.e., snapshots). In Study 2 (n = 162), asking self-relevant and public-event knowledge questions about participants' preschool years prior to retrieval yielded comparable average estimated ages. Both types of semantic knowledge questions rendered earlier memories than a no-age control task. Overall, the reported age in snapshots was younger than in event memories. However, age-differences between memory types across conditions were not statistically significant. Together, the results add to the growing literature indicating that the average age in earliest memories is not as fixed as previously thought.

Negative body image: Relationships with heightened disgust propensity, disgust sensitivity, and self-directed disgust.

Consistent with the view that disgust might be involved in persistent body dissatisfaction, there is preliminary evidence showing a positive correlation between measures of negative body image and indices of both trait disgust and self-directed disgust. In two correlational studies among undergraduates (N = 577 and N = 346, respectively) we aimed at replicating and extending these findings by testing a series of critical relationships, which follow from our hypotheses that 1) trait disgust propensity would increase the risk of developing a negative body image by increasing the likelihood of feeling self-disgust, and 2) trait disgust sensitivity would heighten the impact of self-disgust on the development of persistent negative body appraisals. Replicating previous research, both studies showed that negative body image was positively related to self-disgust, disgust propensity and disgust sensitivity. Mediation analyses showed that, in line with our model, self-disgust partly accounted for the association between disgust propensity and negative body image. Although disgust sensitivity showed an independent relationship with body image, disgust sensitivity did not moderate the association between self-disgust and negative body image. All in all, findings are consistent with the view that self-disgust-induced avoidance may contribute to persistent negative body appraisals.

Exploration of the Associations Between Responses to Affective States and Psychopathology in Two Samples of People Confronted With the Loss of a Loved One.

Adaptive regulation of positive and negative affect after the loss of a loved one may foster recovery. In two studies, using similar methods but different samples, we explored the association between positive (i.e., dampening and enhancing) and negative (i.e., rumination) affect regulation strategies and symptoms levels of postloss psychopathology. Study 1 used data from 187 people confronted with the death of a loved one. In study 2, the sample consisted of 134 relatives of long-term missing persons. Participants completed self-reports tapping prolonged grief, depression, posttraumatic stress symptoms, and affect regulation strategies. Hierarchical regression analyses showed that both negative and positive affect regulation strategies explained significant amounts of variance symptom levels in both samples. In line with previous work, our results suggest that negative and positive affect regulation strategies relate to postloss psychopathology. Future research should explore how both affect regulation strategies may adequately be addressed in treatment.

Collaboration enhances later individual memory for emotional material.

Research on collaborative remembering suggests that collaboration hampers group memory (i.e., collaborative inhibition), yet enhances later individual memory. Studies examining collaborative effects on memory for emotional stimuli are scarce, especially concerning later individual memory. In the present study, female undergraduates watched an emotional movie and recalled it either collaboratively (n = 60) or individually (n = 60), followed by an individual free recall test and a recognition test. We replicated the standard collaborative inhibition effect. Further, in line with the literature, the collaborative condition displayed better post-collaborative individual memory. More importantly, in post-collaborative free recall, the centrality of the information to the movie plot did not play an important role. Recognition rendered slightly different results. Although collaboration rendered more correct recognition for more central details, it did not enhance recognition of background details. Secondly, the collaborative and individual conditions did not differ with respect to overlap of unique correct items in free recall. Yet, during recognition former collaborators more unanimously endorsed correct answers, as well as errors. Finally, extraversion, neuroticism, social anxiety, and depressive symptoms did not moderate the influence of collaboration on memory. Implications for the fields of forensic and clinical psychology are discussed.

Prolonged grief and post-traumatic stress among relatives of missing persons and homicidally bereaved individuals: A comparative study.

BACKGROUND: Traumatic loss (e.g., homicide) is associated with elevated prolonged grief disorder (PGD) and posttraumatic stress disorder (PTSD). Several studies comparing relatives of missing persons with homicidally bereaved individuals showed inconsistent results about the difference in PGD- and PTSD-levels between the groups. These studies were conducted in the context of armed conflict, which may confound the results. The current study aims to compare PGD- and PTSD-levels between the groups outside the context of armed conflict. METHODS: Relatives of long-term missing persons (n=134) and homicidally bereaved individuals (n=331) completed self-report measures of PGD and PTSD. Multilevel regression modelling was used to compare symptom scores between the groups. RESULTS: Homicidally bereaved individuals reported significantly higher levels of PGD (d=0.86) and PTSD (d=0.28) than relatives of missing persons, when taking relevant covariates (i.e., gender, time since loss, and kinship to the disappeared/deceased person) into account. LIMITATIONS: A limitation of this study is the use of self-report measures instead of clinical interviews. CONCLUSION: Prior studies among relatives of missing persons and homicidally bereaved individuals in the context of armed conflict may not be generalizable to similar samples outside these contexts. Future research is needed to further explore differences in bereavement-related psychopathology between different groups and correlates and treatment of this psychopathology.

Cognitive behavioural therapy for psychopathology in relatives of missing persons: study protocol for a pilot randomised controlled trial.

BACKGROUND: It is hypothesized that the grieving process of relatives of missing persons is complicated by having to deal with uncertainty about the fate of their loved one. We developed a cognitive behavioural therapy (CBT) with mindfulness that focuses on dealing with this uncertainty. In this article, we elucidate the rationale of a pilot randomised controlled trial (RCT) for testing the feasibility and potential effectiveness of this CBT for reducing symptoms of psychopathology in relatives of missing persons. METHODS: A pilot RCT comparing participants of the CBT condition (n = 15) with waiting list controls (n = 15) will be executed. Individuals suffering from psychopathology related to the long-term disappearance of a loved one are eligible to participate. The treatment consists of eight individual sessions. Questionnaires tapping psychological constructs will be administered before, during, and after the treatment. The feasibility of the treatment will be evaluated using descriptive statistics (e.g., attrition rate). The primary analysis consists of a within-group analysis of changes in mean scores of persistent complex bereavement disorder from baseline to immediately post-treatment and follow-up (12 and 24 weeks post-treatment). DISCUSSION: A significant number of people experience the disappearance of a loved one. Surprisingly, an RCT to evaluate a treatment for psychopathology among relatives of missing persons has never been conducted. Knowledge about treatment effects is needed to improve treatment options for those in need of help. The strengths of this study are the development of a tailored treatment for relatives of missing persons and the use of a pilot design before exposing a large sample to a treatment that has yet to be evaluated. Future research could benefit from the results of this study. TRIAL REGISTRATION: NTR4732 (The Netherlands National Trial Register (NTR)).