[Effectiveness of psychotherapy on dissociative symptoms in adult populations: A PRISMA systematic review]. / Efficacité des psychothérapies sur les symptômes dissociatifs en population adulte : une revue de la littérature PRISMA.

INTRODUCTION: Dissociation is a psychological process in reaction to threat which can be found in many psychiatric conditions. Dissociative symptoms can become very disabling, whether in daily life or in care. Nevertheless, few studies seem to have examined the efficacy of psychotherapy on the latter and its relevance as a therapeutic target. METHOD: A systematic review of the literature (PRISMA) on the efficacy of psychotherapy on dissociative symptoms in adults with mental disorders was conducted. Effectiveness was considered in terms of reduction in dissociative symptomatology. The search was conducted on Scopus, PubMed and PsycInfo. Overall, 50 full-text articles were evaluated. RESULTS: Fourteen studies were included in the review. In all, 711 adult subjects with post-traumatic stress disorder, borderline personality disorder or dissociative disorder were included. Overall, this systematic review reports a reduction in dissociative symptoms associated with a variety of psychotherapeutic interventions, without allowing any conclusions to be drawn on the superiority of one psychotherapy over another. DISCUSSION: The conclusions of this work highlight three possible therapeutic orientations for reducing dissociative symptoms: (i) by reintegrating the dynamic subsystems, (ii) by treating the cognitive processes underlying dissociation, and (iii) by acting on the processes identified as common to the effectiveness of psychotherapy.

Inhibitory control of threat remembering in PTSD.

Intrusive traumatic recollections suggest an inability in Posttraumatic Stress Disorder (PTSD) to control and notably to inhibit memories for trauma-related information. Supported by inhibitory deficits found on experimental settings in PTSD, memory functioning and memory biases in the disorder were usually explained through inhibitory and control deficits in the processing of trauma-related information. The present study aimed to directly assess this hypothesis by investigating memory control abilities for emotional information in PTSD. For this purpose, 34 patients diagnosed with PTSD were compared to 37 non-PTSD controls on an item-cued directed forgetting paradigm for emotional words combined with a Remember/Know recognition procedure. Results revealed enhanced amounts of Remember recognitions for trauma-related words in PTSD. Moreover, we replicated findings of memory control impairments in the disorder. However, such impairments only occurred for non-trauma-related words. Accordingly, it appeared that PTSD patients presented preserved memory control abilities for trauma-related words, at the expenses of other emotional valences. Surprisingly, PTSD patients presented a preserved ability to control and notably to inhibit their memory functioning for trauma-related material. In addition to potential theoretical and clinical relevance, these results are discussed in the light of resource reallocation hypotheses and vigilant-avoidant theories of information processing in PTSD.

Treating Trauma in Addiction with EMDR: A Pilot Study.

UNLABELLED: Abstract Objective: This study investigated the effects of standard eye movement desensitization and reprocessing (EMDR) protocol in chronically dependent patients. We propose that reprocessing traumatic memories with EMDR would lead to measurable changes of addiction symptoms. METHOD: Twelve patients with alcohol and/or drug dependency were randomly assigned to one of two treatment conditions: treatment as usual (TAU) or TAU plus eight sessions of EMDR (TAU+EMDR). Measures of PTSD symptoms, addiction symptoms, depression, anxiety, self-esteem, and alexithymia were included in this study. RESULTS: The TAU+EMDR group showed a significant reduction in PTSD symptoms but not in addiction symptoms. EMDR treatment was also associated with a significant decrease in depressive symptoms, while patients receiving TAU showed no improvement in this area. The TAU+EMDR group also showed significant changes in self-esteem and alexithymia post-treatment. CONCLUSIONS: This study suggests that PTSD symptoms can be successfully treated with standard EMDR protocol in substance abuse patients.

Childhood trauma and alcohol misuse in college students: The moderating role of minimization.

BACKGROUND: History of childhood trauma as a risk factor for alcohol misuse in early adulthood is very well documented. Given the associations between childhood trauma and alcohol misuse, more work is needed to understand the factors that influence this relationship. OBJECTIVE: The purpose of this study was to examine the relationship between childhood trauma, minimization of such events and alcohol misuse in a French college student sample. PARTICIPANTS AND SETTING: A convenience sampling method was used to recruit students from several colleges located in Western France. The data set included 1180 records with complete responses. METHODS: This study employed a cross-sectional online survey. Data collection instruments included the Childhood Trauma Questionnaire Short-Form (CTQ-SF) and the Alcohol Use Disorders Identification Test (AUDIT). RESULTS: The strength of the association between CTQ score and AUDIT total score was increased by minimization score (ß = 0.122, p = .07). This result suggests that under-reporting childhood trauma experiences tends to increase the impact of such events on alcohol misuse. CONCLUSION: These findings suggest that a tendency to minimize threatening childhood events may specifically be related to increased risk of greater alcohol misuse among college students. Therefore, it may be important for clinician to assess minimization of early events in students with a history of childhood trauma.

Working memory processing of traumatic material in women with posttraumatic stress disorder.

BACKGROUND: Posttraumatic stress disorder (PTSD) is associated with medial frontal and amygdala functional alterations during the processing of traumatic material and frontoparietal dysfunctions during working memory tasks. This functional magnetic resonance imaging (fMRI) study investigated the effects of trauma-related words processing on working memory in patients with PTSD. METHODS: We obtained fMRI scans during a 3-back task and an identity task on both neutral and trauma-related words in women with PTSD who had been sexually abused and in healthy, nonexposed pair-matched controls. RESULTS: Seventeen women with PTSD and 17 controls participated in the study. We found no behavioural working memory deficit for the PTSD group. In both tasks, deactivation of posterior parietal midline regions was more pronounced in patients than controls. Additionally, patients with PTSD recruited the left dorsolateral frontal sites to a greater extent during the processing of trauma-related material than neutral material. LIMITATIONS: This study included only women and did not include a trauma-exposed non-PTSD control group; the results may, therefore, have been influenced by sex or by effects specific to trauma exposure. CONCLUSION: Our results broadly confirm frontal and parietal functional variations in women with PTSD and suggest a compensatory nature of these variations with regard to the retreival of traumatic memories and global attentional deficits, respectively, during cognitively challenging tasks.

Recollection of negative information in posttraumatic stress disorder.

The purpose of the present study was to investigate the effects of posttraumatic stress disorder (PTSD) associated with the effects of emotional valence on recall processes in recognition memory. Patients suffering from PTSD (n = 15) were compared with 15 nontraumatized patients with anxious and depressive symptoms and with 15 nontraumatized controls on the remember/know paradigm using negative, positive, and neutral words. The PTSD group remembered more negative words than the nontraumatized controls, F(1, 42) = 7.20, p = .01, but there was no difference between those with PTSD and those with anxiety or depression, F(1, 42) = 2.93, p = .09, or between the latter and controls, F(1, 42) < 1. This study did not allow us to determine whether this recollection bias for negative information was specific to the PTSD status or was triggered by the greater level of anxiety displayed in this group.

Mental disorders and medical conditions associated with causing injury or death: A population-based study.

The aim of the present study is to examine mental disorders and medical conditions associated with causing harm to another person in the general adult population. The sample (n=22,138) was drawn from a cross-sectional survey designed to characterize mental health needs in France. Twelve-month DSM-IV axis I mental disorders and medical conditions, and lifetime occurrence of potentially traumatic events were assessed with the Composite International Diagnostic Interview-SF Overall, 2% (n=430) of the sample reported having injured or killed someone. Causing harm was associated with male gender, lower education level, and being unemployed. The great majority (85%) of those who caused harm had experienced two or more additional potentially traumatic events. When adjusting for gender, employment status, education and number of events experienced, causing harm was associated with certain anxiety disorders, drug dependence and lifetime suicide attempt but not with major depression or post-traumatic stress disorder. Furthermore, causing harm was not associated with medical conditions in multivariate analyses. These results highlight the need for clinicians to be particularly attentive to the psychological burden that may be experienced by those who have harmed or killed someone.

Ageing, remembering, and executive function.

This study was designed to investigate the relationship between executive functions and the age-related decline in episodic memory through the states-of-awareness approach. Following the presentation of a word list, a group of younger adults and a group of older adults undertook a recognition test in which they classified their responses according to the Remember-Know-Guess procedure (Gardiner & Richardson-Klavehn, 2000). In order to operationalise the executive function hypothesis, we investigated three specific executive functions (updating, shifting, and inhibition of a prepotent response) described in Miyake et al.'s (2000) theoretical model, and a complex executive task. The results revealed that fewer "R" responses were made during the recognition test by the older than the younger group, whereas there was no difference between the groups in the number of "K" responses. In addition, correlations indicated that remembering depended on executive function measures, whereas knowing did not. The hierarchical regression analyses showed that controlling for executive function, and particularly for the 2-back test, largely removed the age-related variance in remembering. These findings support the notion that executive dysfunction, and specifically updating decline, plays a central role in age-related memory loss.

The effect of aging in recollective experience: the processing speed and executive functioning hypothesis.

This study was designed to investigate the effects of aging on consciousness in recognition memory, using the Remember/Know/Guess procedure (Gardiner, J. M., & Richarson-Klavehn, A. (2000). Remembering and Knowing. In E. Tulving & F. I. M. Craik (Eds.), The Oxford Handbook of Memory. Oxford University Press.). In recognition memory, older participants report fewer occasions on which recognition is accompanied by recollection of the original encoding context. Two main hypotheses were tested: the speed mediation hypothesis (Salthouse, T. A. (1996). The processing-speed theory of adult age differences in cognition. Psychological Review, 3, 403-428) and the executive-aging hypothesis (West, R. L. (1996). An application of prefrontal cortex function theory to cognitive aging. Psychological Bulletin, 120, 272-292). A group of young and a group of older adults took a recognition test in which they classified their responses according to Gardiner, J. M., & Richarson-Klavehn, A. (2000). Remembering and Knowing. In E. Tulving & F. I. M. Craik (Eds.), The Oxford Handbook of Memory. Oxford University Press. remember-know-guess paradigm. Subsequently, participants completed processing speed and executive function tests. The results showed that among the older participants, R responses decreased, but K responses did not. Moreover, a hierarchical regression analysis supported the view that the effect of age in recollection experience is determined by frontal lobe integrity and not by diminution of processing speed.

PTSD psychiatric patients exhibit a deficit in remembering.

This study investigated the effects of PTSD on levels of awareness in a recognition memory task. A group of PTSD psychiatric patients and a control group without any traumatic experience were compared in remembering (R) versus knowing (K) recognition using non-trauma-related words. Results showed that overall recognition did not differ between the two groups, but in the PTSD group a significantly different pattern of Remember and Know responses was produced, indicating a shift from remembering to knowing. However, this shift from remembering to knowing in individuals with PTSD is associated with modifications in the trait anxiety level. These results are interpreted within theoretical frameworks in which R responses could be associated with distinctiveness (Rajaram, 1996) and conceptual processing (Ehlers & Clark, 2000). These collective findings would suggest the possibility that a poor general ability in the formation of source memory may eventually be a common characteristic across different types of PTSD.