Dorthe Berntsen

A memory-based model of posttraumatic stress disorder: evaluating basic assumptions underlying the PTSD diagnosis.

In the mnemonic model of posttraumatic stress disorder (PTSD), the current memory of a negative event, not the event itself, determines symptoms. The model is an alternative to the current event-based etiology of PTSD represented in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000). The model accounts for important and reliable findings that are often inconsistent with the current diagnostic view and that have been neglected by theoretical accounts of the disorder, including the following observations. The diagnosis needs objective information about the trauma and peritraumatic emotions but uses retrospective memory reports that can have substantial biases. Negative events and emotions that do not satisfy the current diagnostic criteria for a trauma can be followed by symptoms that would otherwise qualify for PTSD. Predisposing factors that affect the current memory have large effects on symptoms. The inability-to-recall-an-important-aspect-of-the-trauma symptom does not correlate with other symptoms. Loss or enhancement of the trauma memory affects PTSD symptoms in predictable ways. Special mechanisms that apply only to traumatic memories are not needed, increasing parsimony and the knowledge that can be applied to understanding PTSD.

Cultural life scripts structure recall from autobiographical memory

Three classes of evidence demonstrate the existence oflife scripts, or culturally shared representations of the timing of major transitional life events. First, a reanalysis of earlier studies on age norms shows an increase in the number of transitional events between the ages of 15 and 30 years, and these events are associated with narrower age ranges and more positive emotion than events outside this period. Second, 1,485 Danes estimated how old hypothetical centenarians were when they had been happiest, saddest, most afraid, most in love, and had their most important and most traumatic experiences. Only the number of positive events showed an increase between the ages of 15 and 30 years. Third, undergraduates generated seven important events that were likely to occur in the life of a newborn. Pleasantness and whether events were expected to occur between the ages of 15 and 30 years predicted how frequently events were recorded. Life scripts provide an alternative explanation of the reminiscence bump. Emphasis is on culture, not individuals.

Emotionally Charged Autobiographical Memories Across the Life Span: The Recall of Happy, Sad, Traumatic, and Involuntary Memories

A sample of 1,241 respondents between 20 and 93 years old were asked their age in their happiest, saddest, most traumatic, most important memory, and most recent involuntary memory. For older respondents, there was a clear bump in the 20s for the most important and happiest memories. In contrast, saddest and most traumatic memories showed a monotonically decreasing retention function. Happy involuntary memories were over twice as common as unhappy ones, and only happy involuntary memories showed a bump in the 20s. Life scripts favoring positive events in young adulthood can account for the findings. Standard accounts of the bump need to be modified, for example, by repression or reduced rehearsal of negative events due to life change or social censure.

Involuntary autobiographical memories

Results from a diary study of involuntary memories are presented (14 subjects; 7 males, 7 females, average age 23 years). Virtually all of the recorded memories had identifiable cues. Memory access was biased towards (a) mood-congruent (b) recent and (c) distinctive (unusual) events. The memories were most frequently rated as emotionally positive and prior rehearsal was rated low. Also, the memories were found to influence current mood consonant with the emotional valence of the memories. Stressful and repetitive involuntary recollections—as they are observed in clinical settings subsequent to traumatic events—may be viewed as a malignant effect of normal mechanisms of involuntary memories.

Life scripts help to maintain autobiographical memories of highly positive, but not highly negative, events

A representative sample of 1,307 respondents between the ages of 20 and 94 was asked how old they were when they felt most afraid, most proud, most jealous, most in love, and most angry. They were also asked when they had experienced their most important event and whether this event was positive or negative. In general, there was a reminiscence “bump” for positive but not negative events. To provide data on life scripts, 87 psychology students answered the same questions for a hypothetical 70-yearold. The undergraduates were more confident in dating positive than in dating negative events, and when they were confident, the distribution of responses predicted the survey data. The results support the idea of culturally shared life scripts for positive but not negative events, which structure retrieval processes and spaced practice.

Memory in posttraumatic stress disorder: properties of voluntary and involuntary, traumatic and nontraumatic autobiographical memories in people with and without posttraumatic stress disorder symptoms.

One hundred fifteen undergraduates rated 15 word-cued memories and their 3 most negatively stressful, 3 most positive, and 7 most important events and completed tests of personality and depression. Eighty-nine also recorded involuntary memories online for 1 week. In the first 3-way comparisons needed to test existing theories, comparisons were made of memories of stressful events versus control events and involuntary versus voluntary memories in people high versus low in posttraumatic stress disorder (PTSD) symptom severity. For all participants, stressful memories had more emotional intensity, more frequent voluntary and involuntary retrieval, but not more fragmentation. For all memories, participants with greater PTSD symptom severity showed the same differences. Involuntary memories had more emotional intensity and less centrality to the life story than voluntary memories. Meeting the diagnostic criteria for traumatic events had no effect, but the emotional responses to events did. In 533 undergraduates, correlations among measures were replicated and the Negative Intensity factor of the Affect Intensity Measure correlated with PTSD symptom severity. No special trauma mechanisms were needed to account for the results, which are summarized by the autobiographical memory theory of PTSD.

Involuntary (spontaneous) mental time travel into the past and future.

Mental time travel (MTT) is the ability to mentally project oneself backward in time to relive past experiences and forward in time to pre-live possible future experiences. Previous work has focused on MTT in its voluntary (controlled) form. Here, we introduce the notion of involuntary (spontaneous) MTT. We examined involuntary versus voluntary and past versus future MTT in a diary study. We found that involuntary future event representations-defined as representations of possible personal future events that come to mind with no preceding search attempts-were as common as involuntary autobiographical memories and similar to them regarding cuing and subjective qualities. Future MTT involved more positive and idyllic representations than past MTT. MTT into the distant future/past involved more representations of cultural life script events than MTT into the immediate past/future. The findings are discussed in relation to cultural learning and MTT considered as a higher mental process.

Peace and War Trajectories of Posttraumatic Stress Disorder Symptoms Before, During, and After Military Deployment in Afghanistan

In the study reported here, we examined posttraumatic stress disorder (PTSD) symptoms in 746 Danish soldiers measured on five occasions before, during, and after deployment to Afghanistan. Using latent class growth analysis, we identified six trajectories of change in PTSD symptoms. Two resilient trajectories had low levels across all five times, and a new-onset trajectory started low and showed a marked increase of PTSD symptoms. Three temporary-benefit trajectories, not previously described in the literature, showed decreases in PTSD symptoms during (or immediately after) deployment, followed by increases after return from deployment. Predeployment emotional problems and predeployment traumas, especially childhood adversities, were predictors for inclusion in the nonresilient trajectories, whereas deployment-related stress was not. These findings challenge standard views of PTSD in two ways. First, they show that factors other than immediately preceding stressors are critical for PTSD development, with childhood adversities being central. Second, they demonstrate that the development of PTSD symptoms shows heterogeneity, which indicates the need for multiple measurements to understand PTSD and identify people in need of treatment.

Voluntary and Involuntary Access to Autobiographical Memory

Involuntary autobiographical memories recorded in a diary study are compared to voluntary autobiographical memories retrieved in response to verbal cues in a laboratory. The verbal cues were generated to be comparable to the cues that were found to elicit the involuntary memories. The findings demonstrate that voluntary and involuntary retrieval may access different samples of autobiographical memories. The voluntary memories were (1) less specific, (2) more frequently rehearsed, and (3) less emotionally positive than the involuntary memories. A reanalysis of the diary study examined conditions of involuntary retrieval. The memories occurred most frequently when attention was diffuse. They were typically triggered by environmental cues matching central features of the remembered event. The findings are discussed in relation to current models of autobiographical memory.

The episodic nature of involuntary autobiographical memories

Involuntary autobiographical memories are conscious and unintended recollections of personal experiences. In Study 1, involuntary memories were compared with voluntary word-cued memories, both retrieved in naturalistic settings via a self-paced procedure. The involuntary memories more frequently referred to specific episodes, came with more physical reaction, had more impact on mood, and dealt with more unusual and less positive events. Study 2 demonstrated that these differences were not due to differences between verbal and nonverbal cues, by using Francis Galton’s “memory walk” as a nonverbal method to cue voluntary memories. In both studies, systematic differences were found between specific and nonspecific memories. The findings show that the way autobiographical memories are sampled greatly affects the findings and that involuntary retrieval more often provides access to memories of specific episodes and associated emotional states.