L9 Intrusive Thinking Flashcards

Question

Pécrot study - overview of important findings

Answer 1

Is there a significant difference in the following between clinical and non-clinical PTSD patients? - presence of initial intrusion (no) - content of intrusions (no) - presence of other symptoms

Answer 2

(see graph) - on graph you can see % of intrusions in PTSD patients and non-PTSD patients - there is significant difference at the start as well, but it is not significant enough to predict later PTSD onset at individual level → so answer is yes and no

Answer 3

- involve sensory experiences > sounds (crash, victims) > visual images (visual remains, victims) > thoughts (victims, relatives)

Answer 4

(see graph) - 50% of participants presented sensory experiences only, both in PTSD and no PTSD patients → this shows that content of intrusions does not distinguish between clinical and non-clinical intrusions

Answer 5

- distress (66%) - cognitive avoidance (66%) - hypervigilance (62%) → intrusions usually lead to other symptoms as well Avoidance (see graph) - at 1 week→ no one was avoiding memories of trauma (yet) - at 6 months→ big avoidance in PTSD people, but just little avoidance in no-PTSD people

Answer 6

- intrusive memories of trauma are at the core of all symptoms - they are the driver of the three other symptoms clusters: avoidance, negative alterations in cognition and mood, hyperarousal - in turn, avoidance maintains symptoms > e.g. if no exposure→ no new neutral associations

Answer 7

We talked about the most common types (PTSD and OCD) already, but there are intrusions in other disorders as well: - **Substance use disorder** (craving) > can happen at different stages of the addition, and it can come from internal and external cues. It's the first cause leading to drug taking and relapse. Becomes more of an intrusion in later stages. - **Mood disorders** (rumination, flash forward) > rumination, sucidal thoughts, negative automatic thoughts (on negative schemata) and flight of ideas (mania). Rumination usually on the cause of distress, shortcomings, failures and mistakes. - **Anxiety** (worry, future) > for anxious arousal, the intrusive thoughts concern e.g. panic attacks, phobic object, ... > for anxious apprehension, intrusive thoughts are related to future events (intolerance of uncertainty) - **Bipolar disorder** (flash forward) - **Psychosis** (hallucinations, thought insertions) > thought insertion (e.g.) are salient, interruptive and unwanted, but attributed to outside agent, and delusional people do not perceive them as interruptive - **ADHD** (impulsive action, inattention, mind wandering) > are distracting internal thoughts intrusions? (disruptive and maladaptive, but not unwanted and default) (for Psychosis and Attention deficit disorder, the rules on whether the above are considered clinical are less clear)

Answer 8

- looking at physiological response → what is the causal direction? - how do we invoke spontaneous thoughts? > most times, we don't know the triggers - self report → people don't remember their own intrusions → people would need to know exact definition of intrusion → people migh lie because of shame (e.g. of content), or distress (traumatic content) = hard to study the timing of the intrusions

Answer 9

- Experience sampling - Trauma Film Paradigm → single vs dual trace - Think/ No think paradigm → (deficit in) cognitive control - Memory processing - Pavlovian conditioning → e.g. Contemporary Learning Theory

Answer 10

(see picture) - invoking intrusions in lab by letting participants do very poor tasks > e.g. having to press button when seeing number 3, for 20 min - this is a very boring task, and participants get distracted - people asked to report distractions and intrusions > either they stop the task every time they have an intrusion and write it down > or researchers stop task every few minutes and ask participants what they are thinking about = shows that having an experience and knowing that you're having an experience are different things

Answer 11

Pros: - both naturally occurring intrusions and intrusions cued by peculiar prompts - translation from lab to real-life Cons: - Requires meta-awareness (the participants need to be aware of when they are having an intrusion) > hard to realize, if doing a boring task (awareness usually after 30s) > can be compromised in clinical populations - non clinical participants don't really know what an intrusion is > i.e. without a clear event or cue to induce intrusions - No control over event, peri-event factors (for intrusions relating to past events) > e.g. for something happened in the past, we can only rely on participant's memory and report - No control over timing of intrusion > no precise report of timing of intrusion - Involuntariness difficult to verify > e.g. to some degree, worry is voluntary

Answer 12

- intrusions are often images of the worst moment of the trauma - knowing how they arise and persist may point at targets for treatment → to study this, we want to manipulate event itself (memory research)

Answer 13

(see graph) - Atkinson & Shiffrin - sensory input→ sensory memory→ attention→ short-term memory (+ maintenance reharsal)→ encoding→ long-term memory (+retrieval→ short-term m.) Research questions - what is it about stimulus that makes something intrusive? - does it have to be long, hard, unexpected, physically endangering, ... ? - how does attention change when consuming lots of alcohol? - what happens during and shortly after event that makes certain memories engrained in brain? > Single and Dual Trace theory

Answer 14

- (memory is stronger) - enhanced memory activation → this creates noradrenaline → this consolidates memory better in long-term memory → better memory is more accessible → more intrusive and distressing recollections = emotional intensity strengthens memory consolidation making memory much more accessible = emotional memories are simply stronger memories, making them more accessible and easily triggered

Answer 15

Emotional memories are... - typically vivid - often particularly resistant to the passive processes that usually lead memories to be forgotten over time

Answer 16

- memory is not stronger, but less contextualized and more fragmented (more selective) - overwhelming stress → over-consolidation of perceptual elements → this impairs integration with contextual fears in autiobiographical memories > (not integrated in whole story line, context is not consolidated) > we can't recall where, when, how it happened → more fragmented memory → traumatic recollections feel as if they were happening in the present (e.g. PTSD) = stress disrupts proper memory integration, making the trauma feel ever-present

Answer 17

- the intrusiveness of a memory can be selectively reduced while leaving the voluntary recall of a memory intact (and vice versa) - these types of memories might rely on distinct systems or at least distinct representations

Answer 18

- method used in research to study how people repond to traumatic experiences (memories and intrusions) - participants shown distressing film clips - in the following week, participants keep a diary of any intrusive memories regarding film clips - after 1 week, participants took a test of vulontary memory → helps us test voluntary and involuntary memory

Answer 19

- engaging in a competing visuospatial task, during or shortly after experiencing an event, can reduce the frequency of intrusions of that event over the subsequent week - when people are instructed to forget the immediately preceding memory item in a list, the instruction has a large impact on later retention of the memory, rendering to-be-forgotten items signifi cantly less accessible, even for emotionally unpleasant scenes = participants can successfully block the encoding of recent events into long-term memory when motivated to do so

Answer 20

Pros 1- Controlled environment > researchers can control the type of trauma shown and factors around it 2- Reliable memory testing > "golden standard" for accuracy of memory > allows comparison to measures of voluntary recall > since everyone sees the same film, researchers can accurately measure how well memories are formed and recalled 3- Relatively high ecological validity > compared to pictures, conditioning, ... > watching a film is more like real-life experiences

Answer 21

1- Requires meta-awareness 2- Film only a proxy for trauma, not autiobiographical > it's not a real trauma and you are only a witness > much more effective if you are actor in situation 3- No control over timing of intrusions > form of real-life experience sampling 4- Involuntariness difficult to verify 5- Ethical? Informed consent, proper screening, and if necessary, after care!

Answer 22

- wear a seat belt - the "hotspot" can be anything, from the glass shattering, any sentence said before the crush, the blood, the screams, seeing someone being couply in cars, the honking, ... - when asking people that experienced a traumatic event, often they are not able to report events cronologically > as the perceptual memories are very strong but not integrated with the context of the trauma (she didn't say that one model is better than the other, she just connected the fragments one to this clip)

Answer 23

(this is the cognitive take on how traumatic memories are encoded and consolidated) - Poorly processed trauma memory > fragmented and disorganized - Strong perceptual priming > sensory based fragments (unconstrained by context) are activated by stimuli that resemble elements of the hotspot, or that were persent around the time of the hotspot > the context helps us place the memory in the past, but if it's not complete, then the memory might come back as present

Answer 24

- if Film Paradigm focuses on the encoding, the Think/no think Paradigm focuses on the retrieval processes - "how well are you able to suppress thoughts at a later time point?"

Answer 25

(see picture) - all participants study associations between words and images - in second phase, the words would come back either in red or green, without the image > if word in green→ participants had to recall image > if word in red→ participants had to inhibit image

Answer 26

- if actively suppressed memory, there is worse recall afterwards, even when asked to try to remember image - active suppression has lasting effect - "amnesic shadow" surrounds images that were once actively suppressed - suppression-induced forgetting → increases with the number of times that people suppress the unwanted content > if try to recall image in another context to the one of experiment, memory might be a bit more easily recalled

Answer 27

- not only for simple pairs, but also for objects or complex scenes - irrespective of whether neutral or negatively valenced - influences both explicit and implicit memories - reduction in affective responses to the suppressed content when participants see it later = retrieval suppression (healthy p.) regulates the negative affect associated with intrusive memories - linked to lower rumination, greater thought control, fewer intrusive memories > psychiatric populations struggle with cognitive control (→ difficulty in suppressing)

Answer 28

1- Environment control > control over event and ‘peri-trauma’ factors 2- Accurate memory testing > ’golden standard’ for accuracy of memory, which allows comparison to measures of voluntary recall 3- Control over timing of intrusion (ideal for concurrent neural/ physiological assessments) 4- Clear inference of involuntariness > since participants were asked not to think about it, any intrusion is clear evidence of involuntary thought > intrusions occur about 30% of no-think trials, providing a clear, measurable way to assess how vulnerable someone is to unwanted thoughts

Answer 29

1- Requires meta-awareness 2- Demand bias? (participants are instructed to suppress) 3- Low ecological validity

Answer 30

(this is the cognitive take on how traumatic memories are recalled) - poor cognitive control leads to involuntary retrievals of past and imagined events - insufficient inhibition of hippocampus and amygdala - lack of sleep and pre-existing conditions can worsen this, creating a vicious cycle (see pictures) trauma→ no cognitive control→ daily problems→ no cognitive control→ ...

Answer 31

- many clinicians would say that it is (might lead to psychiatric disorders - however, there is evidence that suppresssion is natural and evolutionary: 1. Functional purpose of concentrating on task and suppressing distractions 2. to achieve emotional balance after upsetting event we need to "get over" unwelcome thoughts 3. after trauma, in healthy individuals intrusive memories should diminish over time (natural to reduce them) 4. people that cannot discard anxious thoughts about future events are "less healthy" 5. controlling cognition and behavior is not only desirable but an essential capacity of intelligence

Answer 32

1. The task is self-defeating because it requires one to violate the task’s goals to check whether the goal is being accomplished 2. the White Bear Suppression Inventory measures both thought suppression frequency and experience of intrusiveness (only the latter correlates with clinical symptoms) 3. this task shows non significant differences between control and clinical participants (not valid) 4. patients have difficulties applying inhibitory control (rather than bysuppression being intrinsically maladaptive) = suppression is healthy coping response that, when disordered, poses risk factor in developing intrusive symptoms

Answer 33

Retrieval suppression has been mistakenly equated to: - **White bear suppression** > the task asks to suppress a specific thought, which creates a paradox because we need to remember not to think about the white bear, making us thinking about it → in retrieval suppression, there is no specific content to be inhibited, we just rather have to suppress whatever is associated to the reminder - **Expressive suppression** > inhibit behaviors associated with emotional states (you have retrieved the memory but you try to suppress the expression of the emotion - "poker face") > involves motor control (not control over thoughts or feelings) → in retrieval suppression, we suppress mnemonic processes and content - (cognitive) **Avoidance of reminders** > entirely avoiding reminders that could trigger unwanted thoughts or emotions > not confronting triggers → preserved without alterations (maladaptive process - "not dealing with problems") → in retrieval suppression, you don't avoid reminders, you confront them directly and suppress whatever is associated to them - (General) **Distraction** > removal of attention from emotions/thoughts and refocusing it onto other unrelated stimuli ~ General distraction: attention shifts to stimuli unrelated to the intruding thoughts ~ Specific distraction: interacting with reminders > general distraction functions as avoidance, while specific distraction functions as thought substitution (generating alternative associations in response to reminder) → general distraction ≠ retrieval suppression

Answer 34

- process salient experiences > you are confronted with images until brain deals with them - opportunity to update the memory > e.g. through reconsolidation, integration, extinction, ... - to guide future behaviors (warning signal, survival) > remembering past catastrophes > simulating future scenarios to assess dangers (see graph) (not sure, these are just hypotheses)

Answer 35

- Extinction: repeated presentation of a conditioned stimulus leads to the progressive decrease in behavioral expression of a memory - Reconsolidation: the presentation of an isolated retrieval initiates molecular cascades that can be bidirectionally modulated to either strengthen or weaken memory trace ! intrusive memories might be resistant to modification (we need more research) (here the article re-explained how reconsolidation works)

Answer 36

- Retrieval Competition: stimuli are often associated to multiple different memories, and the brain must choose the correct memory among many competing traces > Retrieval Interference: competition between memories - to successfully retrieve desired memory, the brain must suppress competing memories, but this leads to the suppressed memories being harder to recall later - Retrieval-induced forgetting: the act of remembering something can cause the forgetting of other related memories (that were suppressed during the retrieval)

Answer 37

- might be crucial to reduce the accessibility of negative interpretations and intrusions (via choosing to remember positive events) - Thought Substitution: participants instructed to stop retrieval of unwanted memory by retrieving different content

Answer 38

- participants learn to associate cue with multiple associates > then asked to retrieve subset of the items, but not the rest - focuses on thought substitution, not thought suppression (like think-no think paradigm) ! allows us to understand memory inhibition mechanisms, both at neural level and foundational neurobiological level

Answer 39

- tetris, emdr, ... have been proven successful to update memories, when they are in the active (labile) state - interfering with vividness of image itself (you are not unlearning the memory) (see picture)

Answer 40

- some say that intrusive memories are conditioned response > e.g. intrusions can be other reaction to conditioned stimulus (together with sweating, startle reflex, pupil dialation, ...) Odor-evoked intrusions - unfamiliar odour paired with a specific adverse event (distressing film) triggers memories of that event one week later, but not other events encoded in close temporal proximity → intrusive memories have very clear cues specificity

Answer 41

- Neutral stimulus (CS) triggers intrusions of aversive outcome (US) - when intrusions are excessive or fail to extinguish → clinical - there is some lab evidence → however, difficult to identify what is a CS and what is a US in real-life events