Event centrality in social anxiety disorder and major depressive disorder.

Event centrality is defined by the extent to which a memory of an event has become central to an individual's identity and life story. Previous research predominantly focused on the link between event centrality and trauma-related symptomatology. Nevertheless, it can be argued that the perception of (adverse) events as central to one's self is not exclusive to Posttraumatic Stress Disorder (PTSD). Other disorders where adverse events are linked to the onset of symptoms might also be related to event centrality. This study examined the relevance of event centrality for Social Anxiety Disorder (SAD) and for Major Depressive Disorder (MDD) separately. Moreover, we examined which cognitive and emotion regulation variables (i.e., trait anxiety, rumination, worry, intrusions and avoidance, and posttraumatic cognitions) mediated these relationships. No significant correlation was found between event centrality and social anxiety. However, a significant positive correlation was found between event centrality and depression. In a combined group, this relation was mediated by all cognitive and emotion regulation variables except for worry.

The effect of imagery rescripting on core beliefs and eating disorder symptoms in a subclinical population.

BACKGROUND AND OBJECTIVES: This study compared the effect of imagery rescripting focusing on self-compassion, imagery rescripting focusing on mastery, and a positive memory control condition on (1) emotional responses towards the memory (one day after), (2) changes in the believability of negative core beliefs, and dysfunctional eating behaviors (one week after) in individual at risk for developing an eating disorder. METHODS: Female participants (N = 69) were allocated to one of three conditions: ImRs focusing on self-compassion (N = 24), ImRs focusing on self-mastery (N = 23), and positive memory control condition (N = 22). Participants in the ImRs conditions received a 20-min self-guided ImRs intervention, whereas participants in the control condition received a 20-min self-guided task focusing on an unrelated positive memory. RESULTS: The experimental manipulation successfully induced the use of self-compassion and mastery strategies in the respective imagery rescripting condition. However, our data show that a single 20-min session of self-guided imagery rescripting focusing on compassion and/or mastery has no effect on the emotional response towards the aversive memory or in the change of core beliefs and eating behaviors at follow up. LIMITATIONS: We discuss potential reasons for the null findings, including the use of a single imagery rescripting session, the sample size and the measurement of manipulation checks. CONCLUSION: Future studies are needed to rule out methodological explanations for the null results. These findings may be of value for the development of future experimental lab paradigms which aim to evaluate the causal effects and working mechanisms of imagery rescripting.

The effectiveness of schema therapy for patients with anxiety disorders, OCD, or PTSD: A systematic review and research agenda.

OBJECTIVES: We reviewed the evidence regarding the effectiveness of schema therapy for anxiety disorders, obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD). METHODS: This systematic review followed the recommendation of the PRISMA guidelines. A database search (PsycINFO, MEDLINE, EMBASE, WEB OF SCIENCE, and Academic Search Ultimate) was conducted to identify eligible studies up until 2 April 2021. The search included the keywords ('schema therap*' or 'schema group therap*' or 'schema mode therap*' or 'schema focused' or 'young's model') and ('anxiety disorder*' or 'anxiety-related disorder*' or 'agoraphobia' or 'health anxiety' or 'phobi*' or 'panic disorder' or 'obsessive compulsive disorder' or 'OCD' or 'posttraumatic stress' or 'post traumatic stress' or 'PTSD' or 'hypochondria' or 'axis 1'). Included studies were appraised on methodological quality according to the Psychotherapy Outcome study Methodology Rating Form. RESULTS: We identified 41 studies that were eligible based on the topic. However, only six (comprising 316 anxiety, OCD, and PTSD patients) could be included despite lenient methodological inclusion/exclusion criteria. Results showed that schema therapy can lead to beneficial effects in disorder-specific symptoms and early maladaptive schemas. Yet, we also uncovered substantial methodological limitations in most studies. CONCLUSIONS: Schema therapy is a promising treatment for anxiety, OCD, and PTSD. Yet, there is a systematic problem in the quality of research despite growing clinical interest and application. We therefore concluded with a research agenda presenting recommendations for future research that will be crucial for building a solid evidence-base for schema therapy in chronic anxiety, OCD, and PTSD. PRACTITIONER POINTS: A systematic review on the effectiveness of schema therapy for anxiety disorders, OCD, and PTSD. Preliminary but limited evidence that schema therapy leads to beneficial effects in disorder-specific symptoms. Preliminary but limited evidence that schema therapy leads to beneficial effects in early maladaptive schemas in anxiety, OCD, and PTSD. More research of higher methodological quality is needed to provide more conclusive empirical support for the use of schema therapy for anxiety, OCD, and PTSD.

Schema therapy with exposure and response prevention for the treatment of chronic anxiety with comorbid personality disorder.

BACKGROUND AND OBJECTIVES: A considerable group of patients with anxiety disorders do not respond to guideline CBT treatment, possibly due to comorbid personality disorder (PD) traits. Schema therapy (ST) is an integrative treatment for personality disorders, and preliminary evidence suggests that it also affects anxiety. The present study examined the effects of a combination treatment ('SCHerp': ST + exposure and response prevention) in a non-responsive outpatient group suffering from chronic anxiety and comorbid cluster C personality disorder. METHODS: Psychological malfunction (n = 42), and adaptive and maladaptive schema modes (n = 49) were assessed pre- and post-treatment. RESULTS: Patients showed statistically significant decreases in psychological malfunction and maladaptive modes, and significant increases in adaptive modes from pre- to post-treatment. Changes in modes were correlated with changes in psychological malfunction. LIMITATIONS: No control group or follow-up measurements were included. CONCLUSIONS: The combination of ST and exposure with response prevention may be a viable avenue for research and treatment for this subpopulation. However, further research is needed to confirm and enhance effectiveness and identify working mechanisms of SCHerp. PRACTITIONER POINTS: The SCHerp programme combines schema therapy with exposure and response prevention to tackle chronic anxiety in patients with comorbid personality disorder SCHerp significantly reduced psychological malfunction and maladaptive modes, and increased adaptive modes Changes in schema modes correlated with changes in psychological malfunction, suggesting that schema modes are an appropriate treatment target in this population No active control group was included so no therapy-specific factors can be determined at this stage.

Characteristics and content of intrusive images in patients with eating disorders.

The aim of this study was to examine the characteristics and content of intrusive images in patients with different subtypes of eating disorders (EDs). Data were collected from 74 ED patients, 22 dieting, and 29 nondieting controls. Participants completed a set of self-report questionnaires. Intrusive images of ED patients were significantly more repetitive, detailed, vivid, and distressing than intrusive images of dieting and/or nondieting controls. Most of the intrusive images were the same for the ED subtypes; however, patients with anorexia nervosa were more likely to report an observer vantage perspective than patients with bulimia nervosa, who were more likely to report a field vantage perspective. As expected, intrusive images' content was related to body checking (weight and shape) or negative self (evaluated by themselves or others). Finally, there were significant associations between intrusive images' vividness and weight and shape concerns. These findings indicate that intrusive images may be a core element of EDs and targeting intrusive images in therapy may be helpful.

Vantage perspective in analogue trauma memories: an experimental study.

Vantage perspective during recall is thought to affect the emotionality and accessibility of distressing memories. This study aimed to test the effects of vantage perspective during recall on memory associated distress and intrusion development. An adapted version of the trauma film paradigm was used in an experimental design with three conditions. Participants were asked to listen to eyewitness reports of car accidents (e.g. Trauma Analogue Induction) and imagine the scenes vividly using mental imagery. Afterwards, they were asked to recall the most distressing scene from field perspective, observer perspective, or to recall a neutral image from observer perspective (control condition) (e.g. Trauma Analogue Recall). Recall from field perspective resulted in higher negative mood, state-anxiety, and a higher number of short-term intrusions compared to the observer perspective condition and control condition. Negative mood and state-anxiety were mediators in the relationship between vantage perspective and intrusions. In comparison to observer perspective, field perspective increased the amount of short-term intrusions as a result of higher levels of negative mood and state-anxiety after memory retrieval. Future research on the interaction between vantage perspective at recall and negative mood and anxiety effects is warranted.

Can an experimental self-efficacy induction through autobiographical recall modulate analogue posttraumatic intrusions?

BACKGROUND AND OBJECTIVES: Research has shown a link between self-efficacy appraisals and PTSD symptoms. Less is known about the relation between perceived self-efficacy and specific PTSD symptoms such as intrusions. These two experiments tested the causal relationship between perceived self-efficacy and intrusions from a trauma film. METHODS: In Experiment I, healthy student participants received a self-efficacy manipulation consisting of the recall of autobiographical memories of success (high self-efficacy condition), failure (low self-efficacy condition) or 'important' memories (control condition). Afterwards, they viewed a trauma film and recorded their intrusions of the film in the following week. In Experiment II the self-efficacy manipulation was given after the film. RESULTS: In contrast to expectations, the high self-efficacy condition reported a higher number of intrusions relative to the low self-efficacy condition in both experiments. LIMITATIONS: The trauma film provides experimental control but precludes generalization to real-life trauma. The effect of the experimental manipulation was small. The control condition also affected mood and confidence. CONCLUSIONS: The results suggest that the relation between self-efficacy and intrusions development is causal, but not straightforward. Recalling personal memories of success before or after a traumatic event may increase the risk of developing intrusions, at least under some circumstances. Conversely, recalling past failure experiences may be protective, perhaps by preparing the individual for adversity, or prompting them to search for coping strategies that have been successful in the past. Overall, autobiographical recall involves complex processes related to the self that could be useful but need to be more fully understood.

Examining temporal alterations in Social Anxiety Disorder and Posttraumatic Stress Disorder: The relation between autobiographical memory, future goals, and current self-views.

The self is a multi-faceted and temporally dynamic construct reflecting representations and beliefs about identity in the past, present, and future. Clinical studies have shown that individuals with Posttraumatic Stress Disorder (PTSD) and Social Anxiety Disorder (SAD) exhibit alterations in self-related processing but these studies have focused primarily on memory. Few studies in PTSD and SAD have examined self-related processing for the present and future, and no studies have directly compared these processes across these two disorders. Individuals diagnosed with PTSD (n=21), SAD (n=21), and healthy controls (n=21) completed cognitive tasks related to the past, present, and future. Disorder congruent temporal alterations were found across both disorders. Further, regression analyses revealed that trauma-related memories were significantly predicted by future goals related to the trauma, whereas social anxiety-related recall was predicted by current socially anxious self-views. Thus, although self-related processing may be common in PTSD and SAD, those aspects of the self most strongly associated with disorder-congruent recall differ by disorder. Self-alterations may be modifiable and developing a better understanding of past, present, and future self-processing might aid in the development of interventions that target these process.

Modification of cognitive biases related to posttraumatic stress: A systematic review and research agenda.

Cognitive models of Posttraumatic Stress Disorder (PTSD) postulate that cognitive biases in attention, interpretation, and memory represent key factors involved in the onset and maintenance of PTSD. Developments in experimental research demonstrate that it may be possible to manipulate such biases by means of Cognitive Bias Modification (CBM). In the present paper, we summarize studies assessing cognitive biases in posttraumatic stress to serve as a theoretical and methodological background. However, our main aim was to provide an overview of the scientific literature on CBM in (analogue) posttraumatic stress. Results of our systematic literature review showed that most CBM studies targeted attentional and interpretation biases (attention: five studies; interpretation: three studies), and one study modified memory biases. Overall, results showed that CBM can indeed modify cognitive biases and affect (analog) trauma symptoms in a training congruent manner. Interpretation bias procedures seemed effective in analog samples, and memory bias training proved preliminary success in a clinical PTSD sample. Studies of attention bias modification provided more mixed results. This heterogeneous picture may be explained by differences in the type of population or variations in the CBM procedure. Therefore, we sketched a detailed research agenda targeting the challenges for CBM in posttraumatic stress.

Visuospatial context learning and configuration learning is associated with analogue traumatic intrusions.

BACKGROUND AND OBJECTIVES: Cognitive and information processing theories of Post-Traumatic Stress Disorder (PTSD) assert that trauma intrusions are characterized by poor contextual embedding of visuospatial memories. Therefore, efficient encoding of visuospatial contextual information might protect against intrusions. We tested this idea using indices of visuospatial memory embedding along with the trauma film paradigm. METHODS: Individual differences in spatial configuration learning, as well as the degree to which visual recognition memory depends on its visual encoding context (i.e., memory contextualization), were assessed in 81 healthy participants. Next, participants viewed a distressing film. Intrusions and other PTSD analogue symptoms were assessed subsequently. RESULTS: Participants displaying stronger memory contextualization developed fewer intrusions and PTSD analogue symptoms. Spatial configuration learning was unrelated to memory contextualization and, contrary to prior findings, predicted higher levels of intrusions. LIMITATIONS: Due to the analogue design, our findings may not translate directly to clinical populations. Furthermore, due to the correlational design of the study, causal relations remain to be tested. CONCLUSIONS: Our results suggest a protective role for the ability to integrate memories in their original visual learning context against the development of PTSD symptoms.

Vantage perspective during encoding: The effects on phenomenological memory characteristics.

The vantage perspective from which a memory is retrieved influences the memory's emotional impact, intrusiveness, and phenomenological characteristics. This study tested whether similar effects are observed when participants were instructed to imagine the events from a specific perspective. Fifty student participants listened to a verbal report of car-accidents and visualized the scenery from either a field or observer perspective. There were no between-condition differences in emotionality of memories and the number of intrusions, but imagery experienced from a relative observer perspective was rated as less self-relevant. In contrast to earlier studies on memory retrieval, vantage perspective influenced phenomenological memory characteristics of the memory representation such as sensory details, and ratings of vividness and distancing of the memory. However, vantage perspective is most likely not a stable phenomenological characteristic itself. Implications and suggestions for future research are discussed.

Involuntary cognitions in everyday life: exploration of type, quality, content, and function.

Psychological research into spontaneous or intrusive cognitions has typically focused on cognitions in one predefined domain, such as obsessional thoughts in OCD, intrusive memories in posttraumatic stress disorder and depression, or involuntary autobiographical memories and daydreaming in everyday life. Such studies have resulted in a wealth of knowledge about these specific cognitions. However, by focusing on a predefined type of cognition, other subtypes of cognition that may co-occur can be missed. In this exploratory study, we aimed to assess involuntary cognitions in everyday life without a pre-determined focus on any specific subtype of cognition. Seventy unselected undergraduate student participants were administered a questionnaire that assessed the presence of any involuntary cognitions in the past month, their quality, type, content, and potential function. In addition, participants provided self-descriptions and completed measures of psychopathology. Content analyses showed that involuntary cognitions were common, predominantly visual in nature, emotional, often about social relationships, and often related to a hypothetical function of emotional processing. About two-thirds of the cognitions that participants reported were memories. Non-memories included daydreams, imaginary worst case scenarios, imaginary future events, hypothetical reconstructions, and ruminations. Memories and non-memories were strikingly similar in their subjective experience of content and emotionality. Negative (but not positive) self-descriptions were associated with negative involuntary cognitions and psychopathology, suggesting a link between involuntary cognitions and the self. Overall, the findings suggest that people experience a wide variety of subtypes of involuntary cognitions in everyday life. Moreover, the specific subtype of involuntary cognition appears to be less important than its valence or content, at least to the subjective experience of the individual.

Autobiographical memory bias in social anxiety.

In social anxiety the psychological self is closely related to the feared stimulus. Socially anxious individuals are, by definition, concerned about how the self is perceived and evaluated by others. As autobiographical memory is strongly related to views of the self it follows that biases in autobiographical memory play an important role in social anxiety. In the present study high (n = 19) and low (n = 29) socially anxious individuals were compared on autobiographical memory bias, current goals, and self-discrepancy. Individuals high in social anxiety showed a bias towards recalling more negative and more social anxiety-related autobiographical memories, reported more current goals related to overcoming social anxiety, and showed larger self-discrepancies. The pattern of results is largely in line with earlier research in individuals with PTSD and complicated grief. This suggests that the relation between autobiographical memory bias and the self is a potentially valuable trans-diagnostic factor.

The self and involuntary memory: identifying with the victim increases memory accessibility for stressful events.

Autobiographical memory is intimately linked to the self. However, the relation between the self and involuntary recall has been understudied. Theoretically, the more relevant an event is to the self the more accessible the memory should be. In line with this prediction, the present study tested the hypothesis that self-relevance of a stressor modulates involuntary recall. Healthy student participants viewed distressing film clips and were presented with information that defined the main characters as more or less similar to them, or without any information about the characters. In line with predictions, participants in the high self-relevance condition reported more involuntary memories of the film clips after one week compared to participants in the low self-relevance and control conditions. The findings support the theoretical relation between the self and memory accessibility and extend findings from previous research to the domain of involuntary recall.

Intrusive images and voluntary memory for affective pictures: contextualization and dual-task interference.

BACKGROUND AND OBJECTIVES: The present study addressed the role of context information and dual-task interference during the encoding of negative pictures on intrusion development and voluntary recall. METHODS: Healthy participants were shown negative pictures with or without context information. Pictures were either viewed alone or concurrently with a visuospatial or verbal task. Participants reported their intrusive images of the pictures in a diary. At follow-up, perceptual and contextual memory was tested. RESULTS: Participants in the context group reported more intrusive images and perceptual voluntary memory than participants in the no context group. No effects of the concurrent tasks were found on intrusive image frequency, but perceptual and contextual memory was affected according to the cognitive load of the task. LIMITATIONS: The analogue method cannot be generalized to real-life trauma and the secondary tasks may differ in cognitive load. CONCLUSIONS: The findings challenge a dual memory model of PTSD but support an account in which retrieval strategy, rather than encoding processes, accounts for the experience of involuntary versus voluntary recall.

Unconscious thought reduces intrusion development: a replication and extension.

BACKGROUND AND OBJECTIVES: Intrusive images after a traumatic event, a hallmark feature of post-traumatic stress disorder, are suggested to develop because the trauma memory is disorganized and not integrated into autobiographical memory. Unconscious Thought Theory predicts that information can be conceptually organized after a period of unconscious thought (UT), more so than after conscious thought (CT). We aimed to test the hypothesis that UT decreases intrusions and increases conceptual organization in memory. METHODS: Participants were shown a stressful film and were required to perform an UT task, a CT task, or a distraction task. Intrusions of the film, intrusion qualities, and sequence memory were measured afterwards. RESULTS: We confirmed our hypothesis that UT (versus CT or mere distraction) leads to fewer intrusions, thereby replicating earlier research. Contrary to prediction, we found no difference between the conditions on sequence memory. In addition, conscious thought appeared to increase intrusion nowness and arousal. LIMITATIONS: The analogue design and healthy participant sample prevent from generalizing results to other populations. Intrusion frequency and qualities were assessed immediately after the film thereby prohibiting us from drawing conclusions about any long-term effects. CONCLUSIONS: Engaging in unconscious thought after a stressful film can reduce intrusion frequency. This has potential implications for clinical interventions to prevent initial stress symptoms. The underlying mechanism remains unclear for now and provides an avenue for future research.

Analogue trauma results in enhanced encoding of threat information at the expense of neutral information.

This study investigated whether trauma-related stimuli are preferentially processed at the expense of ongoing processing of neutral stimuli. Participants in the experimental group viewed negative pictures (Trauma) as an analogue trauma induction. Participants in the control group viewed visually similar neutral pictures (Neutral Match). In a Rapid Serial Visual Presentation (RSVP) task participants identified two target pictures. The first target (T1) was a neutral picture, whereas the second target (T2) was a familiar negative or neutral picture or a new neutral or negative picture. In line with hypotheses, only participants in the experimental group showed preferential processing of Trauma pictures. In the experimental group, negative T2 impaired the identification of (neutral) T1 if the T2 immediately followed the T1 in the RSVP stream. The results are consistent with a processing priority of trauma-related information, apparently at the expense of the ongoing processing of neutral information.

Motion effects on intrusion development.

Analogue studies on intrusion development have found that visuospatial tasks performed during the encoding of aversive information reduce subsequent intrusion development. However, these studies cannot rule out a physical explanation in terms of simple movement. In the current study we addressed this issue. Healthy participants viewed an aversive film while performing a visuospatial movement task, a configurational movement task, or no task. Intrusive images from the film were reported in a diary during the week following film viewing. In line with an information-processing account of posttraumatic stress disorder, intrusion frequency was significantly reduced by the visuospatial movement task but not the configurational movement task compared to no task. This finding supports the role of visuospatial processing specifically in intrusion development.

"I see what you're saying": intrusive images from listening to a traumatic verbal report.

We tested the hypothesis that intrusive visual images could develop from listening to a traumatic verbal report. Eighty-six participants listened to a traumatic verbal report under one of three conditions: while shaping plasticine (visuospatial condition), while performing articulatory suppression (verbal condition), or with no extra task (control condition). Results showed that intrusive visual images developed from listening to the traumatic report. In line with the idea that central executive processes guide encoding of information, intrusion frequency was reduced in both the visuospatial and the verbal condition compared to the no task control condition. Overall, this pattern is similar to intrusive images from a traumatic film as found in earlier studies. This study provides a valuable addition to models of posttraumatic stress disorder and autobiographical memory. Additionally, the results have potential implications for therapists working with traumatized individuals.