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      Re-experiencing traumatic events in PTSD: new avenues in research on intrusive memories and flashbacks

      research-article
      *
      European Journal of Psychotraumatology
      Co-Action Publishing
      Posttraumatic stress disorder, memory, flashbacks

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          Abstract

          Posttraumatic flashbacks, consisting of the intrusive re-experiencing of traumatic experiences in the present, have been more clearly defined for the first time in DSM-5 and have been identified as a unique symptom of posttraumatic stress disorder in the proposed ICD-11 diagnostic criteria. Relatively little research into flashbacks has been conducted, however, and new research efforts are required to understand the cognitive and biological basis of this important symptom. In addition, there is considerable scope for research into how flashbacks should be assessed and into flashbacks occurring in different contexts, such as psychosis or intensive care.

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          Most cited references34

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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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            Intrusive re-experiencing in post-traumatic stress disorder: phenomenology, theory, and therapy.

            The article describes features of trauma memories in post-traumatic stress disorder (PTSD), including characteristics of unintentional re-experiencing symptoms and intentional recall of trauma narratives. Reexperiencing symptoms are usually sensory impressions and emotional responses from the trauma that appear to lack a time perspective and a context. The vast majority of intrusive memories can be interpreted as re-experiencing of warning signals, i.e., stimuli that signalled the onset of the trauma or of moments when the meaning of the event changed for the worse. Triggers of re-experiencing symptoms include stimuli that have perceptual similarity to cues accompanying the traumatic event. Intentional recall of the trauma in PTSD may be characterised by confusion about temporal order, and difficulty in accessing important details, both of which contribute to problematic appraisals. Recall tends to be disjointed. When patients with PTSD deliberately recall the worst moments of the trauma, they often do not access other relevant (usually subsequent) information that would correct impressions/predictions made at the time. A theoretical analysis of re-experiencing symptoms and their triggers is offered, and implications for treatment are discussed. These include the need to actively incorporate updating information ("I know now ...") into the worst moments of the trauma memory, and to train patients to discriminate between the stimuli that were present during the trauma ("then") and the innocuous triggers of re-experiencing symptoms ("now").
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              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.
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                Author and article information

                Journal
                Eur J Psychotraumatol
                Eur J Psychotraumatol
                EJPT
                European Journal of Psychotraumatology
                Co-Action Publishing
                2000-8198
                2000-8066
                19 May 2015
                2015
                : 6
                : 10.3402/ejpt.v6.27180
                Affiliations
                Clinical Educational & Health Psychology, University College London, London, United Kingdom
                Author notes
                [* ]Correspondence to: Chris R. Brewin, University College London, London, United Kingdom, Email: c.brewin@ 123456ucl.ac.uk
                Article
                27180
                10.3402/ejpt.v6.27180
                4439411
                25994019
                a77bd5d3-84ae-40f2-b57c-5e59449ecefc
                © 2015 Chris R. Brewin

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License, allowing third parties to copy and redistribute the material in any medium or format, and to remix, transform, and build upon the material, for any purpose, even commercially, under the condition that appropriate credit is given, that a link to the license is provided, and that you indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.

                History
                : 06 January 2015
                : 22 February 2015
                : 26 February 2015
                Categories
                Trauma and PTSD: Setting the Research Agenda

                Clinical Psychology & Psychiatry
                posttraumatic stress disorder,memory,flashbacks
                Clinical Psychology & Psychiatry
                posttraumatic stress disorder, memory, flashbacks

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