Frequency of intrusions and flashbacks in patients with posttraumatic stress disorder related to childhood sexual abuse: an electronic diary study.

Intrusions and flashbacks are core features of posttraumatic stress disorder (PTSD). The frequency of these symptoms is usually assessed through retrospective questionnaires, which may be subject to recall bias of unknown magnitude. Electronic diaries that enable real-time assessment have been used to address recall biases in several psychiatric disorders. However, to our knowledge, this is the first study to apply this method to assess intrusions and flashbacks in PTSD related to childhood sexual abuse (CSA). Female patients with PTSD related to CSA (n = 28) were provided with electronic diaries for repeated real-time assessment of intrusions and flashbacks over the period of 1 week. At the end of this period, they were asked to retrospectively report how many such symptoms they recalled having experienced over the past week. The total number of symptoms reported in the electronic diaries (74.5 ± 62.0 intrusions and 24.4 ± 36.0 flashbacks for the week) was substantially higher than those reported in previous studies. Furthermore, electronic diaries revealed the occurrence of about 50% more intrusions and flashbacks than did the retrospective assessment (74.5 vs. 49.5 for intrusions, and 24.4 vs. 13.4 for flashbacks). Such high frequencies are not captured with existing assessment instruments and suggest a possible ceiling effect. Future research needs to clarify whether these high numbers are specific to highly symptomatic PTSD patients or might generalize to other populations of PTSD patients.

Induced ruminative and mindful attention in everyday life: an experimental ambulatory assessment study.

BACKGROUND AND OBJECTIVES: Rumination has been proposed as a risk factor for depression, while mindful attention might be protective. Differential effects of these attention foci have so far only been examined in the laboratory. Therefore, we conducted an experimental ambulatory assessment study using ruminative and mindful attention inductions in everyday life to examine their effects in a natural context. METHODS: Fifty young adults carried palmtops over three weekdays (rumination induction day, mindful attention induction day, noninduction day; randomized cross-over design). Ten times a day, participants rated ruminative self-focus and mood. On the induction days, they were additionally subjected to 3-min inductions of ruminative or mindful attention at each assessment. RESULTS: The two induction modes exhibited differential immediate effects on ruminative self-focus and mood. While induced rumination immediately deteriorated valence and calmness, induced mindful attention specifically enhanced calmness. Depressive symptoms did not moderate these effects. While overall longer term effects of the inductions were missing, the mindful attention day was associated with slightly increasing positive valence over the day. LIMITATIONS: The results need to be replicated in high-risk and patient samples to demonstrate the clinical significance of identified effects. CONCLUSIONS: Results confirm the emotional relevance of rumination and mindful attention in real world settings. Future work may test whether adaptive attention-focusing instructions delivered in daily life can support clinical interventions.