Exploring intrusions without awareness: A preliminary study of the characteristics and influences of meta-awareness failures.

BACKGROUND AND OBJECTIVES: Research shows that people can lack meta-awareness (i.e., being explicitly aware) of their trauma-related thoughts, which impacts our understanding of re-experiencing symptoms, a key symptom type in posttraumatic stress disorder (PTSD), assessed through self-report. This preliminarily study explored differences between (meta-)aware and unaware intrusion characteristics to understand why some intrusions are not immediately apparent to individuals. METHODS: Trauma-exposed participants (N = 78) were recruited from online crowd-sourcing platforms to complete an online meta-awareness task. During a reading task, participants were intermittently probed to index the occurrence of unreported (i.e., unaware) trauma-related intrusions. Once participants indicated trauma-related intrusions were present, they then completed a questionnaire that indexed intrusion characteristics. RESULTS: Although unaware intrusions did occur in a subset of the sample, there were no fundamental differences between aware and unaware intrusions in terms of modality of experience (imagery vs. non-imagery), meaningfulness, accessibility, or other characteristics (e.g., vividness). LIMITATIONS: There was potential for lower participant engagement and attention due to the online delivery of the meta-awareness task, which may have minimized meta-awareness failure. Future research could consider using a continuous measure to index levels of meta-awareness. In addition, recruiting clinical samples (e.g., individuals with PTSD) who typically experience multiple daily intrusions would allow generalizability of the current findings to be tested. CONCLUSIONS: Our findings from this preliminary study suggest that unaware and aware intrusions show more commonality than not in their characteristics, with further research required to improve our understanding of the mechanisms leading to meta-awareness or lack of in PTSD.

Are Individuals Always Aware of Their Trauma-Related Intrusive Thoughts? A Study of Meta-Awareness.

Individuals are not always aware of their mental content. We tested whether lack of awareness occurs in those who have experienced trauma, with and without posttraumatic stress disorder (PTSD). We also examined the role of proposed cognitive mechanisms (working memory and inhibition) in explaining unnoticed intrusions. Individuals with PTSD (n = 44), and varying levels of symptoms (high posttraumatic stress [PTS]: n = 24; low PTS: n = 37) reported on intrusive thoughts throughout a reading task. Intermittently, participants responded to probes about whether their thoughts were trauma related. Participants were "caught" engaging in unreported trauma-related thoughts (unnoticed intrusions) for between 24 and 27% of the probes in the PTSD and high PTS groups, compared with 15% of occasions in the low PTS group. For trauma-related intrusions only, participants lacked meta-awareness for almost 40% of probes in the PTSD group, which was significantly less than that observed in the other groups (∼60%). Contrary to predictions, working memory and response inhibition did not predict unnoticed intrusions. The results suggest that individuals who have experienced significant trauma can lack awareness about the frequency of their trauma-related thoughts. Further research is warranted to identify the mechanisms underpinning the occurrence of unnoticed intrusions.