trauma memories

1
trauma memories social anxiety

• intrusive images are very commonly associated
  with anxiety provoking situations for people with
  social anxiety disorder.
• these images are often visual but may also occur
  as an internal felt-sense or via other (often
  multiple) sensory channels.
• intrusive visual images of social situations are
  typically from an observer rather than from a
  first person perspective.
• the majority of subjects can link intrusive
  images to early memories when typically the
  social anxiety disorder first became particularly
  troublesome.
• holding the intrusive negative image (instead of
  a neutral or positive image) aggravates symptoms
  (feelings, attentional biases mis-estimations)
  and performance as judged by the subject,
  others involved socially, by external observers
  
• non socially anxious subjects also have their
  performance disrupted if trained to hold negative
  rather than neutral images of their performance

2
clinical implications 2

• educate socially anxious subjects about the
  frequency, type, importance, origins, effects,
  and management of images.
• emotional processing of associated early memories
  is likely to be helpful in its own right and
  may guide the nature of subsequent coping image
  work.
• consider training social anxiety sufferers to
  hold coping rather than negative
  images before and during social
  challenges.
• it is reasonable to encourage these coping
  images to involve a variety of
  sensory channels for example
  visual, felt-sense auditory.
• coping visual images should be from a first
  person rather than an observer
  perspective.
• try training preparatory coping images (guided or
  self-directed) as a sequence involving
  experiencing initial difficulties, but
  progressively mastering the social interaction
  with eventual successful outcome.

3
trauma memories agoraphobia

• when questioned, all of a group of 20
  agoraphobics but none of a group of 20 matched
  controls reported having distinct recurrent
  intrusive images in agoraphobic situations.
• most intrusive images involved several sensory
  modalities such as vision, internal felt-sense,
  sound, touch, smell taste (note vision wasnt
  always present as a component).
• on discussion, all subjects linked an aversive
  memory to the intrusive image, but only 15
  (3/20) reported having thought about the content
  of the memory prior to the interview.
• the mean age at the time of the memory was 14.3
  years.
• 75 (15/20) of the subjects believed the memory
  affected their anxiety in agoraphobic situations.
• common themes with both intrusive images and
  associated memories were of catastrophic danger
  and of a negative view of self (such as the self
  intimidated, humiliated and misunderstood).

Day SJ, Holmes EA Hackmann, A. Occurrence of
imagery and its link with early memories in
agoraphobia. Memory 2004 12(4) 416-27
4
clinical implications 3

• when asking about intrusive images in
  agoraphobia (or other psychological disorders) it
  may be worth getting the sufferer to imagine (or
  actually revisit) an upsetting episode
• note that recurrent intrusive images can come
  visually or as a internal felt-sense or
  via other (often multiple)
  sensory channels
• although on questioning the majority of subjects
  can link this intrusive image to
  an early memory, they may well not
  have made this link before
• subjects often recognize quite readily that the
  image tends to aggravate their
  symptoms
• exploring the meaning and beliefs around the
  image and memory may well make good sense

5
trauma memories OCD

• of 34 inpatients with OCD, 71 (24/34) reported
  that they had intrusive visual images when
  their OCD was really bad.
• for patients with visual images, 33 (8/24)
  recognized their images as memories of actual
  aspects of earlier traumas.
• when the remaining 16 patients with visual images
  were asked about their earliest
  recollection of having had similar
  sensations and feelings, 94 (15/16)
  could identify a particular traumatic
  experience that was linked to the
  visual image.
• the perceived similarity between the visual image
  the memory of the traumatic experience was
  very high, both in terms of sensory
  characteristics and in terms of interpersonal
  meanings.
• it seems likely that many of the 29 (10/34), who
  did not report intrusive visual images, might
  have reported images if questioned about
  felt-sense and other sensory channels.

Speckens A, Ehlers A, et al Imagery and early
traumatic memories in obsessive compulsive
disorder. BABCP Annual Conference Abstracts
p.44. York, 2003
6
trauma memories other disorders

• Hinrichson H, Morrison T, et al. Triggers of
  vomiting in bulimic disorders the roles of core
  beliefs and imagery. BABCP Annual Conference
  Abstracts page 8. York, 2003.
• Cooper M, and Turner H. The effect of using
  imagery to modify core beliefs in bulimia
  nervosa an experimental pilot study. BABCP
  Annual Conference Abstracts pp 8-9. York, 2003.
• Osman S, Cooper M, et al. Spontaneously
  occurring images and early memories in people
  with body dysmorphic disorder. Memory 2004
  12(4) 428-36
• Brewin CR, Watson M, et al. Memory processes
  course of anxiety and depression in cancer
  patients. Psychol Med 1998 28 219-24.
• Finkenauer C, and Rimé B. Keeping emotional
  memories secret health and subjective well-being
  when emotions are not shared. Journal of Health
  Psychology 1998 3(1) 47-58.
• Morrison A. Trauma and psychosis cause,
  consequence, common processes and clinical
  implications. BABCP Annual Conference Abstracts
  p 21. York, 2003.