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      Capturing Intrusive Re-experiencing in Trauma Survivors’ Daily Lives Using Ecological Momentary Assessment

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          Abstract

          Intrusive memories are common following traumatic events and among the hallmark symptoms of posttraumatic stress disorder (PTSD). Most studies assess summarized accounts of intrusions retrospectively. We used an ecological momentary approach and index intrusive memories in trauma survivors with and without PTSD using electronic diaries. Forty-six trauma survivors completed daily diaries for 7 consecutive days recording a total of 294 intrusions. Participants with PTSD experienced only marginally more intrusions than those without PTSD, but experienced them with more “here and now quality,” and responded with more fear, helplessness, anger, and shame than those without PTSD. Most frequent intrusion triggers were stimuli that were perceptually similar to stimuli from the trauma. Individuals with PTSD experienced diary-prompted voluntary trauma memories with the same sense of nowness and vividness as involuntary intrusive trauma memories. The findings contribute to a better understanding of everyday experiences of intrusive reexperiencing in trauma survivors with PTSD and offer clinical treatment implications.

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          Most cited references48

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          The development of a Clinician-Administered PTSD Scale.

          Several interviews are available for assessing PTSD. These interviews vary in merit when compared on stringent psychometric and utility standards. Of all the interviews, the Clinician-Administered PTSD Scale (CAPS-1) appears to satisfy these standards most uniformly. The CAPS-1 is a structured interview for assessing core and associated symptoms of PTSD. It assesses the frequency and intensity of each symptom using standard prompt questions and explicit, behaviorally-anchored rating scales. The CAPS-1 yields both continuous and dichotomous scores for current and lifetime PTSD symptoms. Intended for use by experienced clinicians, it also can be administered by appropriately trained paraprofessionals. Data from a large scale psychometric study of the CAPS-1 have provided impressive evidence of its reliability and validity as a PTSD interview.
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            Multilevel Modeling of Individual and Group Level Mediated Effects.

            This article combines procedures for single-level mediational analysis with multilevel modeling techniques in order to appropriately test mediational effects in clustered data. A simulation study compared the performance of these multilevel mediational models with that of single-level mediational models in clustered data with individual- or group-level initial independent variables, individual- or group-level mediators, and individual level outcomes. The standard errors of mediated effects from the multilevel solution were generally accurate, while those from the single-level procedure were downwardly biased, often by 20% or more. The multilevel advantage was greatest in those situations involving group-level variables, larger group sizes, and higher intraclass correlations in mediator and outcome variables. Multilevel mediational modeling methods were also applied to data from a preventive intervention designed to reduce intentions to use steroids among players on high school football teams. This example illustrates differences between single-level and multilevel mediational modeling in real-world clustered data and shows how the multilevel technique may lead to more accurate results.
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              A dual representation theory of posttraumatic stress disorder.

              A cognitive theory of posttraumatic stress disorder (PTSD) is proposed that assumes traumas experienced after early childhood give rise to 2 sorts of memory, 1 verbally accessible and 1 automatically accessible through appropriate situational cues. These different types of memory are used to explain the complex phenomenology of PTSD, including the experiences of reliving the traumatic event and of emotionally processing the trauma. The theory considers 3 possible outcomes of the emotional processing of trauma, successful completion, chronic processing, and premature inhibition of processing We discuss the implications of the theory for research design, clinical practice, and resolving contradictions in the empirical data.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                J Abnorm Psychol
                J Abnorm Psychol
                Journal of Abnormal Psychology
                American Psychological Association
                0021-843X
                1939-1846
                November 2013
                : 122
                : 4
                : 998-1009
                Affiliations
                [1 ]Institute of Psychiatry, King’s College London, London, United Kingdom, and University of Zurich, Switzerland
                [2 ]Institute of Psychiatry, King’s College London, London, United Kingdom
                [3 ]University of New South Wales, Sydney, Australia
                [4 ]Institute of Psychiatry, King’s College London, London, United Kingdom and University of Oxford, Oxford, United Kingdom
                Author notes
                We would like to thank Laurence Meisch for help with data preparation. The study was funded by the Economic and Social Research Council, ESRC (RES-000-22-2544 awarded to Birgit Kleim and Richard Bryant). Birgit Kleim is funded by the Swiss National Science Foundation (grants PZ00P1_126597, PZ00P1_150812). Anke Ehlers is funded by the Wellcome Trust (grant 069777).
                [*] [* ]Correspondence concerning this article should be addressed to Birgit Kleim, Department of Psychology, University of Zurich, Clinical Psychology and Psychotherapy, Binzmuhlestrasse 14/Box 26, CH-8050 Zurich, Switzerland b.kleim@ 123456psychologie.uzh.ch
                Article
                abn_122_4_998 2013-44247-006
                10.1037/a0034957
                3906879
                24364602
                40b71c58-d7a3-4384-99c0-3c6832ae79fa
                © 2013 The Author(s)

                This article has been published under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Copyright for this article is retained by the author(s). Author(s) grant(s) the American Psychological Association the exclusive right to publish the article and identify itself as the original publisher.

                History
                : 21 February 2013
                : 22 August 2013
                : 26 August 2013
                Categories
                Mood and Anxiety Disorders

                Clinical Psychology & Psychiatry
                ptsd,intrusion,trauma,diary,ecological momentary assessment
                Clinical Psychology & Psychiatry
                ptsd, intrusion, trauma, diary, ecological momentary assessment

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