The COVID-19 pandemic does not fit into prevailing Post-traumatic Stress Disorder (PTSD) models, or diagnostic criteria, yet emerging research shows traumatic stress symptoms as a result of this ...ongoing global stressor. Current pathogenic event models focus on past, and largely direct, trauma exposure to certain kinds of life-threatening events. Yet, traumatic stress reactions to future, indirect trauma exposure, and non-Criterion A events exist, suggesting COVID-19 is also a traumatic stressor which could lead to PTSD symptomology. To examine this idea, we asked a sample of online participants (N = 1,040), in five western countries, to indicate the COVID-19 events they had been directly exposed to, events they anticipated would happen in the future, and other forms of indirect exposure such as through media coverage. We then asked participants to complete the Posttraumatic Stress Disorder Checklist-5, adapted to measure pre/peri/post-traumatic reactions in relation to COVID-19. We also measured general emotional reactions (e.g., angry, anxious, helpless), well-being, psychosocial functioning, and depression, anxiety, and stress symptoms. We found participants had PTSD-like symptoms for events that had not happened and when participants had been directly (e.g., contact with virus) or indirectly exposed to COVID-19 (e.g., via media). Moreover, 13.2% of our sample were likely PTSD-positive, despite types of COVID-19 "exposure" (e.g., lockdown) not fitting DSM-5 criteria. The emotional impact of "worst" experienced/anticipated events best predicted PTSD-like symptoms. Taken together, our findings support emerging research that COVID-19 can be understood as a traumatic stressor event capable of eliciting PTSD-like responses and exacerbating other related mental health problems (e.g., anxiety, depression, psychosocial functioning, etc.). Our findings add to existing literature supporting a pathogenic event memory model of traumatic stress.
Maladaptive metacognitive beliefs are associated with the development of post-traumatic stress disorder (PTSD) symptoms following trauma, however it remains unclear whether training people to adopt ...healthy metacognitive beliefs helps to protect against the development of PTSD symptoms. We developed and tested a new cognitive bias modification training protocol (CBMMetacog) that aimed to prevent analogue PTSD by training people to adopt healthy metacognitive beliefs prior to watching a distressing film.
Participants (N = 135) received CBMMetacog or a control CBM training and then watched a trauma film. We assessed participants’ metacognitive appraisal style/beliefs, analogue PTSD symptoms, including intrusions and meta-awareness of their intrusions.
CBMMetacog led participants to adopt healthier metacognitive beliefs relative to the control training. Importantly, CBMMetacog participants reported fewer film intrusions over a 7-day period compared to the control group. CBMMetacog did not increase participants’ meta-awareness of their intrusions.
As this was the first study to manipulate metacognitive beliefs related to an analogue trauma via CBM, we chose to use a healthy participant sample. Therefore, further research is needed before these results can be generalised to clinical samples.
Overall, these results suggest that training people to adopt healthy metacognitive beliefs, prior to trauma exposure, may help reduce vulnerability to PTSD.
•Metacognitive beliefs can be manipulated via CBM training.•Healthy metacognitive beliefs associated with fewer reported intrusions.•Following replication, results may have implications for the prevention of PTSD.
•Current practice for measuring intrusions relies on spontaneous self-report.•We used both self-caught and probe-caught (experience sampling) methods.•Participants were often caught engaging in ...unreported trauma-oriented thoughts.•People may lack meta-awareness of some trauma-related cognition.
Research examining maladaptive responses to trauma routinely relies on spontaneous self-report to index intrusive thoughts, which assumes people accurately recognize and report their intrusive thoughts. However, “mind-wandering” research reveals people are not always meta-aware of their thought content: they often fail to notice shifts in their attention. In two experiments, we exposed subjects to trauma films, then instructed them to report intrusive thoughts during an unrelated reading task. Intermittently, we asked whether they were thinking about the trauma. As expected, subjects often spontaneously reported intrusive thoughts. However, they were also “caught” engaging in unreported trauma-oriented thoughts. The presence and frequency of intermittent probes did not influence self-caught intrusions. Both self-caught and probe-caught intrusions were related to an existing tendency toward intrusive cognition, film-related distress, and thought suppression attempts. Our data suggest people may lack meta-awareness of trauma-related thoughts, which has implications for theory, research and treatment relating to trauma-related psychopathology.
Deng, Li and Tang (2014) reported that depression symptom severity is negatively associated with dispositional mindfulness and importantly, positively associated with zone-outs (mind-wandering ...without meta-awareness). We replicated and extended their study by exploring possible explanations for these relationships, and by also investigating whether mind-wandering is related to (1) trait rumination subtype—brooding, depressive or reflective, and (2) trauma intrusions—a hallmark PTSD symptom, since both rumination and trauma intrusions strongly correlate with depression. We also explored if dispositional mindfulness—the opposing construct of mind-wandering—mediated these relationships.
Two hundred participants completed mindfulness tendency and depression severity measures, counterbalanced with the Sustained Attention to Response Task (SART)—including thought probes to index behavioral mind-wandering (target-error frequency), subjective mind-wandering and meta-awareness—then the rumination style and trauma intrusion frequency measures.
Depression scores positively correlated with mind-wandering with and without meta-awareness and with SART target-error rates, and negatively correlated with dispositional mindfulness. Further, trait brooding positively correlated with mind-wandering without meta-awareness. Dispositional mindfulness mediated the relationships between brooding and depression, and depression and mind-wandering, and also negatively correlated with trauma intrusion frequency.
Limitations include measurement and mind-wandering definitions, and an inability to make causal claims.
People experiencing greater depression symptomology, and/or who have a greater tendency to brood, mind-wandered more often. Further, people who experience more trauma intrusions tend to be less mindful. These results point to potential harmful effects of mind-wandering through people's reduced propensity to be mindful, facilitating a negative self-referenced cognitive loop that may maintain or increase depression.
•Depression symptom severity increases as mind-wandering increases.•Mind-wandering without meta-awareness positively correlates with trait brooding.•Trauma intrusions negatively correlate with dispositional mindfulness.•Findings indicate a potential harmful effect of mind-wandering.
In general, memory of highly negative and even traumatic events can distort. However, the effect of misinformation exposure on such memories requires further investigation given the inconsistent past ...findings. With two experiments, we investigated: (1) whether misinformation distorts memory for highly negative analogue events, (2) whether memory distortion is increased for more emotional and potentially traumatic details compared to unemotional details, and (3) whether repeated misinformation exposure further increases memory distortion for highly negative events compared to single exposure, a possibility that has not been investigated to our knowledge. In both experiments, participants viewed a trauma analogue film with some scenes removed. Twenty-four hours later, they were given three “eyewitness” reports describing the film’s events. To manipulate misinformation repetition, either zero, one, or all three of the reports described removed scenes. To determine whether memory distortion is increased for emotional details, half of the removed scenes were more traumatic than the other half. Participants exposed to misinformation falsely remembered more removed scenes compared to participants who were not exposed to misinformation. Further, memory distortion was increased for emotional (vs. unemotional) aspects of the film. Repeated misinformation exposure, however, did
not
lead to significantly higher error rates compared to single exposure. The lack of perceptual overlap between our written misinformation and film test items may have limited false memories even with repeated misinformation. Alternatively, the repeated vs. single misinformation effect may exist but be very small, as suggested by our raw means and effect sizes.
Trigger warnings have been described as helpful—enabling people to “emotionally prepare” for upcoming trauma-related material via “coping strategies.” However, no research has asked people what they ...think they would do when they come across a warning—an essential first step in providing evidence that trigger warnings are helpful.
Here, participants from Amazon's Mechanical Turk (n = 260) completed one of two future thinking scenarios; we asked half to think about coming across a warning related to their most stressful/traumatic experience; the others thought about actual content (but no warning) related to their most stressful/traumatic experience.
The warning condition did not produce differences in coping strategies, state anxiety, or phenomenology (e.g., vividness, valence) relative to the content condition. Only one key difference emerged: participants who imagined encountering a warning used fewer positive words, when describing how they would react.
Although measuring actual behavior was not our aim, hypothetically simulating the future may not capture what actual future behavior would look like (i.e., an intention-behaviour gap).
One potential explanation for the consistent finding in the literature that trigger warnings fail to ameliorate negative emotional reactions is that these warnings may not help people bring coping strategies to mind. Although, further empirical work is necessary to fully substantiate this potential interpretation.
•Participants recalled their most stressful/traumatic experience.•Participants imagined a trigger warning or content related to this experience.•Similar levels/types of coping strategies were reported in both conditions.•Participants in the warning condition used fewer positive emotion words.
The right hemisphere plays a critical role in visuospatial attention and emotional perception, particularly for negative emotions. Therefore, preferential processing of emotional stimuli by the ...right, compared to the left, hemisphere could enhance our memory for emotional stimuli. We examined whether recognition memory for negative versus neutral IAPS images (Experiment 1) and negative versus positive IAPS and NAPS images (Experiment 2) differed depending on initial right or left hemisphere processing-manipulated by presenting images in the left (i.e., right hemisphere) or the right (i.e., left hemisphere) visual field. We tested recognition memory for valence-matched image pairs encoded for 500 ms. We manipulated image valence and visual field of presentation within-participants. In Experiment 1, valence and visual field interacted to influence recognition memory: people recognized negative images encoded from the left visual field (right hemisphere) more accurately than negative images encoded from the right visual field (left hemisphere). There were no visual field differences for neutral images. In Experiment 2, recognition memory for positive and negative images was equally enhanced when these images appeared in the left compared to the right visual field. Our findings suggest preferential right hemisphere processing of visuospatial and emotional information enhances recognition memory for emotional images. We interpret these findings as a left hemisphere memory deficit for emotional images, because right hemisphere processing led to similar recognition memory of emotional as neutral images, whereas left hemisphere processing led to worse recognition memory of emotional than neutral images. These findings aid our understanding of how lateralized functions contribute to emotional processing.
Extant research suggests a complex relationship between prospective memory (PM) and post-traumatic stress disorder (PTSD) symptom severity. In a general population, this relationship exists for ...self-report assessment but not objective, in-lab PM performance (e.g., pressing a certain key at a particular time, or when particular words appear). However, both these measurement methods have limitations. Objective, in-lab PM tasks might not represent typical everyday performance, while self-report measurement might be biased by metacognitive beliefs. Thus, we used a naturalistic diary paradigm to answer the overarching question: are PTSD symptoms associated with PM failures in everyday life? We found a small positive correlation between diary-recorded PM errors and PTSD symptom severity (
r
= .21). Time-based tasks (i.e., intentions completed at a particular time, or after a specified time has elapsed;
r
= .29), but not event-based tasks (i.e., intentions completed in response to an environmental cue;
r
= .08), correlated with PTSD symptoms. Moreover, although diary-recorded and self-report PM correlated, we did not replicate the finding that metacognitive beliefs underpin the PM-PTSD relationship. These results suggest that metacognitive beliefs might be particularly important for self-report PM only.
Disgust reactions commonly occur during/following trauma and predict posttraumatic stress (PTS) symptoms. Yet, disgust is not mentioned in DSM-5 PTSD criteria. To investigate disgust’s clinical ...significance in PTSD, we measured the relationship between disgust (and fear) reactions to a personal trauma, and problematic intrusion characteristics (e.g., distress) and intrusion symptom severity. We focused on intrusions because they are a transdiagnostic PTSD symptom, though we also measured overall PTS symptoms to replicate prior work. Participants (N = 471) recalled their most traumatic/stressful event from the past six months. They then rated disgust and fear reactions to this event and completed the Posttraumatic Stress Disorder Checklist-5. Participants who had experienced intrusions about their event in the past month (n = 261) rated these intrusions on several characteristics (e.g., distress, vividness). We found stronger traumatic event-related disgust reactions were associated with more problematic intrusion characteristics, higher intrusion symptom severity, and higher overall PTS symptom severity. Notably, disgust reactions uniquely predicted these variables after statistically controlling for fear reactions. We conclude disgust reactions to trauma may be similarly pathological to fear reactions for intrusion and broader PTS symptoms. Therefore, PTSD diagnostic manuals and treatments should recognize disgust as a trauma-relevant emotion.
•Disgust uniquely predicts problematic intrusion characteristics over and above fear.•Disgust uniquely predicts intrusion symptom severity over and above fear.•Disgust uniquely predicts posttraumatic stress symptom severity over and above fear.•Disgust propensity predicts stronger traumatic event- and intrusion-related disgust.
•Negative valence not sufficient to induce boundary restriction.•Inducing arousal only at encoding, not retrieval, reduces boundary extension.•Heightened arousal, often with a negative stimulus, ...captures attention and restricts memory for image boundaries.•Arousal experienced while viewing images is a key mechanism in the boundary restriction phenomenon.
People’s memory for scenes has consequences, including for eyewitness testimony. Negative scenes may lead to a particular memory error, where narrowed scene boundaries lead people to recall being closer to a scene than they were. But boundary restriction—including attenuation of the opposite phenomenon boundary extension—has been difficult to replicate, perhaps because heightened arousal accompanying negative scenes, rather than negative valence itself, drives the effect. Indeed, in Green et al. (2019) arousal alone, conditioned to a particular neutral image category, increased boundary restriction for images in that category. But systematic differences between image categories may have driven these results, irrespective of arousal. Here, we clarify whether boundary restriction stems from the external arousal stimulus or image category differences. Presenting one image category (everyday-objects), half accompanied by arousal (Experiment 1), and presenting both neutral image categories (everyday-objects, nature), without arousal (Experiment 2), resulted in no difference in boundary judgement errors. These findings suggest that image features—including inherent valence, arousal, and complexity—are not sufficient to induce boundary restriction or reduce boundary extension for neutral images, perhaps explaining why boundary restriction is inconsistently demonstrated in the lab.
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