Lifetime adversity interacts with peritraumatic data-driven processing to predict intrusive memories.

BACKGROUND AND OBJECTIVES: Although most trauma survivors experience some intrusive recollections of the traumatic event, only few subsequently develop posttraumatic stress disorder (PTSD). A well-established proximal risk-factor predictive of post-trauma psychopathology is peritraumatic cognitive processing. Another, more distal risk-factor is pre-trauma lifetime adversity. The present experimental analogue study tested the hypothesis that pre-trauma lifetime adversity interacts with peritraumatic perceptual (i.e., data-driven) processing to predict intrusive memory development. METHODS: Fifty-three young adult women (non-clinical sample) indicated how much data-driven and conceptual processing they had engaged in while watching aversive film-clips (i.e., analogue trauma). On the subsequent three days, they reported intrusions of those clips. Moderation analyses tested for an interaction effect between lifetime adversity and data-driven processing in predicting intrusion load (number of intrusions weighted for their overall distress). RESULTS: Increased data-driven processing predicted intrusion load primarily in individuals reporting more than three lifetime adversities, explaining 55% of variance. No such relationship was found for conceptual processing. LIMITATIONS: Present analogue findings have yet to be replicated in a clinical population. Moreover, the conceptual processing scale was restricted by low internal consistency. CONCLUSION: Present findings support the idea that intrusions are the result of poorly elaborated and primarily perceptually-formed memory traces; however, this was primarily the case in vulnerable individuals reporting several lifetime adversities. Results replicate the importance of peritraumatic processing in intrusion development but additionally point to a moderating effect of lifetime adversity.

Peritraumatic dissociation revisited: associations with autonomic activation, facial movements, staring, and intrusion formation.

Background: Peritraumatic dissociation is purported to emerge together with attenuated autonomic arousal, immobility, and staring. However, empirical evidence is scarce and heterogeneous. Moreover, it is still a matter of debate whether these responses predict intrusion formation. Objective: The present trauma-analogue study examined associations between peritraumatic dissociation, autonomic activation, facial movements, staring, and intrusion formation. Method: Seventy-one healthy women watched a highly aversive film, while autonomic activation (heart rate, respiratory sinus arrhythmia, skin conductance level), facial movements (temporal variations in corrugator electromyography), and staring (fixation duration, tracklength) were assessed. Afterwards, participants rated the intensity of dissociation during film viewing and reported intrusions and associated distress in a smartphone application for 24 hours. Results: Peritraumatic dissociation was linked to higher autonomic arousal (higher heart rate and, on a trend-level, lower respiratory sinus arrhythmia), increased facial movements, and staring (lower tracklength). Peritraumatic dissociation, higher autonomic arousal (higher heart rate and lower respiratory sinus arrhythmia), staring (higher fixation duration), and, on a trend-level, more facial movements were linked to higher intrusion load (number x distress of intrusions) and together explained 59% of variance. Skin conductance level was neither linked to peritraumatic dissociation nor intrusion load. Conclusions: Our results suggest that, at low-dissociation-levels observed in trauma-analogue studies, peritraumatic dissociation may occur together with heightened autonomic arousal and facial movements, indexing increased negative affect. Staring might, irrespectively of dissociation-levels, serve as objective marker for dissociation. Together, peritraumatic dissociation and its psychophysiological correlates might set the stage for later intrusion formation.

Antecedentes: Se supone que la disociación peritraumática surge junto con la activación autonómica atenuada, la inmovilidad y la mirada fija. Sin embargo, la evidencia empírica es escasa y heterogénea. Además, sigue siendo objeto de debate si estas respuestas predicen la formación de intrusiones.Objetivo: El presente estudio análogo al trauma examinó las asociaciones entre la disociación peritraumática, la activación autonómica, los movimientos faciales, la mirada fija y la formación de intrusiones.Método: Setenta y una mujeres sanas vieron una película altamente aversiva mientras se evaluaba la activación autonómica (frecuencia cardíaca, arritmia sinusal respiratoria, nivel de conductancia de la piel), los movimientos faciales (variaciones temporales en la electromiografía del corrugador) y la mirada fija (duración de la fijación, longitud del seguimiento). Posteriormente, las participantes calificaron la intensidad de la disociación durante la visualización de la película e informaron sobre las intrusiones y la angustia asociada en una aplicación para teléfonos inteligentes durante 24 horas.Resultados: La disociación peritraumática se relacionó con una mayor activación autonómica (mayor frecuencia cardíaca y, a nivel de tendencia, menor arritmia sinusal respiratoria), mayores movimientos faciales y mirada fija (menor duración del seguimiento). La disociación peritraumática, la mayor activación autonómica (mayor frecuencia cardíaca y menor arritmia sinusal respiratoria), la mirada fija (mayor duración de la fijación) y, en un nivel de tendencia, más movimientos faciales estaban vinculados a una mayor carga de intrusiones (número x angustia de intrusiones) y juntos explicaban el 59% de la varianza. El nivel de conductancia de la piel no se relacionó con la disociación peritraumática ni con la carga de intrusión.Conclusiones: Nuestros resultados sugieren que, a niveles bajos de disociación observados en estudios de trauma análogos, la disociación peritraumática puede ocurrir junto con una mayor activación autonómica y movimientos faciales, lo que indica un aumento del afecto negativo. La mirada fija, independientemente de los niveles de disociación, podría servir como marcador objetivo de disociación. En conjunto, la disociación peritraumática y sus correlatos psicofisiológicos podrían sentar las bases para la formación posterior de intrusiones.

Intrusive memories as conditioned responses to trauma cues: An empirically supported concept?

Intrusions in posttraumatic stress disorder (PTSD) are clinically understood as conditioned responses (CRs) to trauma-cues; however, experimental evidence for this is limited. We subjected 84 healthy participants to a differential conditioned-intrusion paradigm, where neutral faces served as conditioned stimuli (CSs) and aversive film clips as unconditioned stimuli (USs). While one group only completed acquisition, another group additionally received extinction. Subsequently, participants provided detailed e-diary intrusion reports. Several key findings emerged: First, participants in both groups re-experienced not only USs but also CSs as content of their intrusions. Second, intrusions were elicited by cues resembling CSs, USs, and experimental context. Third, extinction reduced probability and severity of US intrusions, and accelerated their decay, and this was particularly the case in participants showing greater cognitive (US-expectancy) and physiological (SCR) differential responding to CS+ vs. CS- at end of acquisition (i.e., conditionability). Similarly, extinction reduced CS-intrusion probability and severity, but only in participants with greater cognitive conditionability. These results support conditioning's role in re-experiencing in two critical ways: (1) Conditioning during trauma provides cues that not only function as reminder cues, but also as content of intrusions; (2) After strong conditioning, weakening the original CS-US relationship via extinction reduces intrusion formation after analogue-trauma.

Sensation seeking and neuroticism in fear conditioning and extinction: The role of avoidance behaviour.

Maladaptive avoidance behaviour, a key symptom of anxiety-related disorders, prevents extinction learning and maintains anxiety. Individual personality traits likely influence avoidance propensity: high sensation-seeking may decrease avoidance, thereby increasing extinction, and neuroticism may have the reverse effect. However, research on this is scarce. Using a naturalistic conditioned avoidance paradigm, 163 women underwent differential fear acquisition to a conditioned stimulus (CSplus). Next, during extinction, participants could either choose a risky shortcut, anticipating shock signalled by CSplus, or a time-consuming avoidance option (lengthy detour). Across participants, increased skin conductance (SCR) acquisition learning predicted subsequent instrumental avoidance. Avoidance, in turn, predicted elevated post-extinction SCR and shock-expectancy, i.e., 'protection-from-extinction'. Mediation analyses revealed that sensation seeking decreased protection-from-extinction-both for shock-expectancy and SCR-via attenuating avoidance. Neither sensation seeking nor neuroticism were related to acquisition learning and neuroticism was neither related to avoidance nor extinction. Transcranial direct currentstimulation administered before extinction did not influence present results. Results highlight the important role of elevated avoidance propensity in fear maintenance. Results moreover provide evidence for reduced sensation-seeking and increased acquisition learning to be avoidance-driving mechanisms. Since approach-avoidance conflicts are faced by anxiety patients on a daily basis, strengthening sensation-seeking-congruent attitudes and approach behaviours may optimize individualized treatment.

Neural Processing During Fear Extinction Predicts Intrusive Memories.

BACKGROUND: Deficient extinction learning has been suggested as an important mechanism involved in the etiology of posttraumatic stress disorder. A key feature of posttraumatic stress disorder, reexperiencing the trauma in form of intrusions, may be linked to deficient extinction learning. This link is investigated in a novel, functional magnetic resonance imaging-compatible fear conditioning procedure that uses trauma films. Based on previous results, we expected deficient fear extinction indexed by exaggerated responding in the anterior insula and dorsal anterior cingulate cortex to predict subsequent intrusions. METHODS: A total of 58 healthy participants underwent acquisition and extinction learning with faces as conditioned stimuli (CS) and highly aversive 16-second films depicting interpersonal violence as unconditioned stimuli. During the subsequent 3 days, participants reported intrusive memories on their smartphone. RESULTS: Successful fear acquisition was evidenced by differential (CS+ > CS-) activity (threat cues associated with trauma films > cues paired only with neutral films) of a widespread network, including the anterior insula and dorsal anterior cingulate cortex, whereas extinction was characterized exclusively by differential anterior insula activity. Differential conditioned responding during late extinction in the anterior insula and dorsal anterior cingulate cortex was positively related to intrusive memory frequency independent of unconditioned stimuli responding. Exploratory analysis also revealed intrusion sensitivity of the hippocampus, rostral anterior cingulate cortex, and ventromedial prefrontal cortex, among others. CONCLUSIONS: Results support the role of extinction learning in intrusive memory formation; a failure to uncouple conditioned emotional responding from external threat cues was associated with subsequent intrusive memories, representing a potential risk marker for developing posttraumatic stress disorder symptomatology after trauma.

Sex differences in emotional concordance.

Emotions involve response synchronization across experiential, physiological, and behavioral systems, referred to as concordance or coherence. Women are thought to be more emotionally aware and expressive than men and may therefore display stronger response concordance; however, research on this topic is scant. Using a random-order film-average design, we assessed concordance among experiential (arousal, valence), autonomic (electrodermal activity, heart rate, preejection period, respiratory sinus arrhythmia), respiratory (respiratory rate), and behavioral (corrugator and zygomatic electromyography) responses to 15 two-minute films varying in valence and arousal. We then calculated for each participant and pair of measures a within-subject correlation index using averages from the 15 films. Pronounced individual concordance of up to 0.9 was observed. Arousal-physiology and valence-behavior concordances were particularly pronounced. Women displayed higher concordance than men for almost all pairs of measures. Findings indicate stronger psychophysiological response coupling in women than men and provide novel insights into affective differences between the sexes.

Fear acquisition and extinction deficits in amnestic mild cognitive impairment and early Alzheimer's disease.

Impaired learning and memory functioning are prime markers for Alzheimer's disease (AD). Although initial evidence points to impaired fear acquisition in later AD, no study has investigated fear conditioning in early stages and amnestic mild cognitive impairment (aMCI), a condition often preceding AD. The present study examined if fear conditioning gradually decays from healthy elderly to patients with aMCI, to patients with AD. Patients with AD (n = 43), patients with aMCI (n = 43), and matched healthy controls (n = 40) underwent a classical fear conditioning paradigm. During acquisition, a neutral face (conditioned stimulus, CS+) was paired with an electrical stimulus, whereas another face (unconditioned stimulus, CS-) was unpaired. Conditioned responses were measured by unconditioned stimulus expectancy, valence, and skin conductance. Compared to healthy controls, both patient groups showed less differential (CS+ vs. CS-) fear acquisition across all measures. Patients further displayed slowed extinction indexed by higher unconditioned stimulus expectancy and reduced positive valence for CS+, declining from aMCI to AD. Groups did not differ in responses during a preconditioning habituation phase and in unconditioned responding. Diminished differential fear acquisition and slowed extinction could represent prognostic markers for AD onset.

Frequency of Intrusions and Appraisal of Related Distress After Analogue Trauma: A Comparative Ecological Momentary Assessment Methods Study.

Intrusive thoughts, images, and their appraisal remain difficult to study despite their clinical relevance. Clinical studies typically used time-based (frequency and distress per observation period), while analogue studies mainly used event-based (report upon occurrence) assessment. A comparison of intrusion frequency, distress appraisal, compliance, and reactivity across different assessments is mostly lacking, particularly with regard to analogue research. Here, intrusions were induced via aversive films and assessed by a smart phone application for 4 days. Three sampling modes were compared by randomizing participants to one of three conditions: either one, or five time-based daily prompts, or event-based assessment. At the end of the study, all participants reported intrusions once again in a retrospective summary assessment. Results indicate that intrusions and their distress decayed over a few days. The three assessments did not differ in intrusion frequency, distress appraisal, compliance (generally high), reactivity (generally low), or retrospective summary assessment. Across groups, the more aversive and arousing participants rated the film clips and the more reactivity to the electronic-diary assessment they reported, the more intrusive memories they had; assessment modes did not differ on this. Thus, no general differences were found between electronic-diary assessment modes for analogue intrusions, giving researchers flexibility for tailoring ecological momentary assessment to specific study aims.

Peritraumatic Neural Processing and Intrusive Memories: The Role of Lifetime Adversity.

BACKGROUND: Pathological peritraumatic encoding is proposed as a proximal risk factor for the development of posttraumatic stress disorder (PTSD), with trauma-analog studies linking increased neural processing of trauma films to intrusive trauma recollections, a core symptom of PTSD. Cumulative lifetime adversity is proposed as a more distal risk factor, with research indicating a tipping point at about five events with regard to PTSD development following re-exposure to trauma. Thus, within a diathesis × stress framework, increased peritraumatic neural processing may constitute a specific risk factor for PTSD, particularly in individuals with several lifetime adversities. METHODS: Fifty-three healthy women watched highly aversive films depicting severe interpersonal violence versus neutral films during functional magnetic resonance imaging, and they reported involuntary recollections during subsequent days. Moderation analyses tested the interactive relationship between peritraumatic neural processing and lifetime adversity in predicting intrusion load, i.e., the total number of intrusions weighted for their average distress. RESULTS: Increased processing of aversive versus neutral films in the amygdala, anterior insula, dorsal and rostral anterior cingulate cortices, and hippocampus predicted increased intrusion load only in participants reporting above five lifetime adversities; for participants reporting few to none, no such relationship was found. This interactive relationship explained ≤59% of variance. Conditioned stimuli preceding film viewing mirrored this pattern. CONCLUSIONS: Peritraumatic neural processing in multiple salience network regions and cumulative lifetime adversity interactively predicted PTSD-like symptomatology, representing a diathesis × stress framework that might guide identification of at-risk individuals and potential targets for symptom prevention after traumatic incidents.

Peritraumatic unconditioned and conditioned responding explains sex differences in intrusions after analogue trauma.

Higher prevalence of posttraumatic stress disorder (PTSD) in women than men may be explained by sex differences in fear learning processes. Initial evidence points to elevated unconditioned and conditioned fear responding as well as to elevated state anxiety in women as potential peritraumatic mechanisms. Using the "conditioned-intrusion-paradigm", which combines differential fear conditioning with the trauma-film paradigm, neutral sounds were presented as predictors of the occurrence (CS+) or non-occurrence (CS-) of highly aversive films. Intrusions were elicited by these sounds in the laboratory after conditioning and naturalistic intrusions were assessed in daily-life on subsequent days. Compared to men (n = 62), women (n = 60) reported more intrusions and associated distress following analogue trauma. Sex differences in intrusive symptoms were mediated by a) higher unconditioned trauma responding, b) slowed extinction of differential CS valence ratings, and c) elevated state anxiety increase across conditioning in women. Secondary analyses revealed that state anxiety was the strongest mediator, followed by slowed extinction learning. Mediation models were unrelated to sex differences in trait anxiety or depressive symptoms. Thus, associative (extinction learning) and non-associative (state anxiety, trauma responding) mechanisms contribute to sex differences in intrusive symptoms after analogue trauma and might add to the heightened vulnerability to PTSD in women.

Attend or defend? Sex differences in behavioral, autonomic, and respiratory response patterns to emotion-eliciting films.

Sex differences in emotional reactivity have been studied primarily for negative but less so for positive stimuli; likewise, sex differences in the psychophysiological response-patterning during such stimuli are poorly understood. Thus, the present study examined sex differences in response to negative/positive and high/low arousing films (classified as threat-, loss-, achievement-, and recreation-related, vs. neutral films), while measuring 18 muscular, autonomic, and respiratory parameters. Sex differences emerged for all films, but were most prominent for threat-related films: Despite equivalent valence and arousal ratings, women displayed more facial-muscular and respiratory responding than men and pronounced sympathetic activation (preejection period, other cardiovascular and electrodermal measures), while men showed coactivated sympathetic/parasympathetic responding (including increased respiratory sinus arrhythmia). This indicates a prototypical threat-related defense response in women, while men showed a pattern of sustained orienting, which can be understood as a shift toward less threat proximity in the defense cascade model. Clinical implications are discussed within a socio-evolutionary framework.

Higher threat avoidance costs reduce avoidance behaviour which in turn promotes fear extinction in humans.

Theoretical models specifying the underlying mechanisms of the development and maintenance of anxiety and related disorders state that fear responses acquired through classical Pavlovian conditioning are maintained by repeated avoidance behaviour; thus, it is assumed that avoidance prevents fear extinction. The present study investigated behavioural avoidance decisions as a function of avoidance costs in a naturalistic fear conditioning paradigm. Ecologically valid avoidance costs - manipulated between participant groups - were represented via time-delays during a detour in a gamified computer task. After differential acquisitions of shock-expectancy to a predictive conditioned stimulus (CS+), participants underwent extinction where they could either take a risky shortcut, while anticipating shock signaled by the CS+, or choose a costly avoidance option (lengthy detour); thus, they were faced with an approach-avoidance conflict. Groups with higher avoidance costs (longer detours) showed lower proportions of avoiders. Avoiders gave heightened shock-expectancy ratings post-extinction, demonstrating 'protecting from extinction', i.e. failure to extinguish. Moreover, there was an indirect effect of avoidance costs on protection from extinction through avoidance behaviour. No moderating role of trait-anxiety was found. Theoretical implications of avoidance behaviour are discussed, considering the involvement of instrumental learning in the maintenance of fear responses.