Spring Conference and Workshops - Trauma across the Lifespan

Abstracts

Keynote Address
 

CBT for PTSD: Where to from here?
Reg Nixon, School of Psychology, Flinders University, Australia
  Trauma-focused CBT currently has the strongest evidence-base for the treatment of PTSD. A consistent body of research shows CBT is efficacious for a variety of trauma types, resulting in significant reductions of PTSD and associated psychopathology. It is also clear that the traumatic stress field faces a number of challenges. Not all PTSD sufferers reach what we would consider an optimal outcome following therapy; many show only modest response to treatment and a number drop-out. Trauma-focused CBT is not offered as widely as it could be in community mental health settings.
Dissemination trials of PTSD therapy are few and far between and our evaluation of these dissemination efforts are in their infancy. I will discuss these issues and outline (some) of the paths we might follow to ensure that the significant contribution CBT has made to the traumatic stress field to date is continued in the years ahead.
Keynote Address
  Recent Insights into the Nature of Memory Dysfunction in Posttraumatic Stress Disorder
Chris Brewin, University College London
 

I will review a number of recent studies that are relevant to the dual representation theory of PTSD and the distinction between verbally accessible and image-based memory (VAM and SAM). Studies with healthy participants exposed to a trauma film have yielded valuable insights into the origin of intrusive images by manipulating the conditions under which films are viewed, for example by examining the effects of different doses of alcohol. Research in cognitive neuroscience provides strong support for the parallel neural processing of information about objects and scenes in ventral and dorsal visual streams, and the characteristics of these pathways provide a compelling neural basis for VAM and SAM. An updated dual representation model will be illustrated with structural and functional MRI data, and the implications for treatment discussed.
Keynote Address

Shame, Trauma and Disorder
Bernice Andrews, Royal Holloway, University of London
  Shame is an intense and often incapacitating emotion involving feelings of inferiority, powerlessness and self-consciousness, along with the desire to hide and conceal deficiencies. People can feel ashamed about who they are, how they look, what they do, and how they are treated by others. In its dysfunctional form it is recognised as one of the most toxic human emotions. This lecture discusses shame and its specific relation to trauma from developmental, biosocial and clinical perspectives.  It covers the evolutionary and social functions of shame, its association with coercion and stigma, and its role in the causation and consequences of common emotional disorders including depression and posttraumatic stress disorder.
Keynote Address

 

 Flashbacks: From an Experimental Psychopathology Perspective
Emily A Holmes, University of Oxford
 

Flashbacks take the forms of emotional mental images. Can we reduce flashbacks by playing Tetris in the immediate aftermath of trauma? This may sound like a rather strange suggestion. It certainly does not sound like the current therapies we have for early interventions after trauma. In my talk I will discuss experimental psychopathology research for future therapy innovation. A key research interest is emotional mental imagery. Intrusive image-based memories (flashbacks) occur in Post traumatic Stress Disorder (PTSD) and across psychological disorders. We know little about involuntary memory or its modulation.  Recent Cognitive Behaviour Therapy models of PTSD are summarised, providing foundations for experimental predictions (Holmes & Bourne, 2008).  In the laboratory, films with traumatic content are used as analogues for real trauma.  Previous work examined peri-traumatic processing – i.e. during trauma encoding (Holmes, Brewin & Hennessy, 2004). We have recently focussed on “post-traumatic” processing, that is, manipulating cognitive processing in the aftermath of trauma. It appears that visuospatial tasks post-trauma, including a computer game - Tetris - may protect against later intrusions (flashbacks) (Holmes, James , Coode-Bate, & Deeprose, 2009). However, some tasks post-trauma (e.g. a verbal Pub Quiz) may even increase later flashbacks to a stressful film (Holmes, James, Kilford & Deeprose, 2010). This experimental work will be presented. We speculate on memory consolidation post-trauma.   I propose a continued interweave between the laboratory and the clinic to develop much-needed therapies for the future.

Holmes EA, James EL, Coode-Bate T, Deeprose C. Can Playing the Computer Game 'Tetris' Reduce the Build-up of Flashbacks for Trauma?' A Proposal from Cognitive Science. PLoS ONE. 2009;4(1):e4153 doi:10.1371/journal.pone.0004153

Holmes EA, James EL, Kilford EJ, Deeprose C (2010) Key Steps in Developing a Cognitive Vaccine against Traumatic Flashbacks: Visuospatial Tetris versus Verbal Pub Quiz. PLoS ONE 5(11): e13706. doi:10.1371/journal.pone.0013706
Symposium: New Advances in Treating PTSD
  Preventative treatment interventions for intrusive trauma memories: From memory consolidation to reconsolidation.
Ella L. James, John R. Geddes, Catherine Deeprose, Thomas Coode-Bate, Emma J. Kilford & Emily A. Holmes, University of Oxford, United Kingdom.
 

Haunting memories of a traumatic event in the form of intrusive mental imagery (e.g. flashbacks) are a hallmark symptom of posttraumatic stress disorder (PTSD).
Newly acquired memories for an event are transiently labile before becoming increasingly resistant to interference over time, a process termed consolidation. During this time period it has been demonstrated that flashback memories can be modified; for example, by completing specific cognitive tasks which compete with the resources necessary for the flashbacks to develop [1, 2]. More recently, studies of human memory have found that the recall of a stabilized, consolidated memory may ‘reactivate’ that specific memory rendering it once again transiently labile and vulnerable to modification. This process, referred to as reconsolidation, may offer a window of opportunity for novel treatment interventions that can be administered following a longer period subsequent to experiencing a traumatic event.

We present a summary of the literature on memory reactivation and subsequent reconsolidation and discuss how this may be able to inform early stage design treatment innovations. We briefly look at the effect of competing tasks on flashback memory development during the memory consolidation phase, i.e. within 6 hours of an analogue traumatic event [1, 2] as well as during the memory reconsolidation phase when memory for an event has stabilized, i.e. at 24 hours following a (analogue) trauma.

Holmes, E. A., James, E. L., Coode-Bate, T., & Deeprose, C. (2009). Can Playing the Computer Game 'Tetris' Reduce the Build-up of Flashbacks for Trauma? A Proposal from Cognitive Science. PLoS ONE, 4(1), e4153 doi:4110.1371/journal.pone.0004153

Holmes, E. A., James, E. L., Kilford, E. J., & Deeprose, C. (2010). Key steps in developing a cognitive vaccine against traumatic flashbacks: visuospatial Tetris versus verbal Pub Quiz. PLoS ONE, 5(11), e13706
 
Why or How?  Preventing the development of intrusions after exposure to trauma
Rachel White, Institute of Psychiatry at King's College London
Jennifer Wild, Experimental Psychology, University of Oxford
 

Research suggests that particular ways of thinking after exposure to trauma are linked to the future development of post-traumatic stress. One such mode of thinking that has been linked to the onset of PTSD is ruminative thinking:  an evaluative thinking style, which focuses on the abstract.  Such thoughts that dominate this thinking style are, for example, ‘why do traumatic events have to happen?’  ‘Why did this event happen to me?’  Some individuals, such as emergency service workers, are regularly exposed to trauma and are at greater risk of developing PTSD compared to the general population.  It is crucial to determine what training may be beneficial to reduce rates of PTSD in these groups.  This study investigated the effect of thinking style (processing mode) after exposure to analogue trauma on the subsequent development of intrusive memories, the hallmark feature of PTSD.  Participants were trained to engage in one of two modes of processing whilst watching traumatic films:  an abstract-evaluative or a concrete mode of processing.  The abstract-evaluative mode of processing focused on why traumatic events happen and on the meaning and implications of these events.  Participants in the concrete-experiential condition were trained to focus on specific details, the sequence of events and steps needed to move the event forward.  Preliminary results showed that participants in the concrete condition developed significantly fewer intrusions in the week following the task than participants in the abstract condition.  They also had significantly lower PTSD symptom scores in the week after the task. This study has implications for the development of evidence-based prevention programmes for groups, such as military and emergency service personnel, at risk of developing intrusive memories and other PTSD symptoms.

 
Prevention begins with assessment:  Self-report vs clinical interview for PTSD in at-risk populations and screen and treat programmes
Jen Wild Jennifer Wild, Experimental Psychology, University of Oxford

Authors: Jennifer Wild, Kirsten Smith, Erin Thompson, Francine Bear, Anke Ehlers, University of Oxford
  Ambulance workers are regularly exposed to trauma and are considered to be a group at risk of developing post-traumatic stress disorder (PTSD). Previous research has reported rates of PTSD based on self-report data to be in the range of 20% in this group (i.e., Sterud et al., 2006).  As part of a large prospective study investigating predictors of PTSD, we assessed N=443 newly recruited ambulance workers with self-report questionnaires and with the Structured Clinical Interview for DSM-IV (SCID; First et al., 1996) during their first week of paramedic training.  Participants completed questionnaires to assess symptoms of PTSD, depression, social phobia, and alcohol use disorders.  They then attended an interview session in which the SCID was administered.  We found significant discrepancies between rates of PTSD, major depression, social phobia and alcohol use disorders when assessed by self-report vs. clinical interview, with self-report over-estimating rates of these disorders.  Efficiency data will be presented focusing on sensitivity and specificity ratings and kappa values. Our results highlight the importance of conducting interview assessments over self-report assessments to gauge rates of clinical disorders in at-risk groups.  The implications of this for screen and treat programmes will be discussed with reference to the successful screen and treat programme implemented for the survivors of the London bombings in 2005.