Background: Peritraumatic dissociation is thought to contribute to posttraumatic symptoms like intrusions and memory disturbances. However, trauma-analogue studies that examined effects of experimental dissociation-induction on intrusions and memory were inconclusive. To better understand this, a necessary first step is to more systematically compare various induction methods.Objective: We evaluate different dissociation-induction-methods regarding their effectiveness, the intensity and quality of induced dissociation, and their effects on intrusions and memory in a pre-registered randomised-controlled online experiment.Method: Healthy participants (N = 213) were randomised to one of six dissociation-induction-methods: audio-photic stimulation, hypnotic-suggestion, or spiral-staring, each for one-minute or three-minute duration. Participants also completed two further conditions: a non-dissociation-inducing picture task (control condition) and the comparison dissociation-induction-method dot-staring (benchmark condition). Each condition was followed by an aversive ('trauma') film. Peri-film dissociation intensity (measured using an adapted version of the Peritraumatic Dissociative Experiences Questionnaire) and quality, as well as film-specific intrusion-load and memory performance, were assessed. Dissociation-induction-methods were deemed successful if they elicited dissociation levels higher than the control condition and at least as high as the benchmark condition. Only successful dissociation-induction-methods were examined further.Results: Three minutes of hypnotic-suggestion and one minute of spiral-staring successfully induced dissociation during the film, while other methods did not meet the effectiveness threshold. Hypnotic-suggestion led to a greater increase in dissociation intensity than spiral-staring, dissociation induced by spiral-staring was perceived as more uncontrollable and unpleasant. Results did not support an adverse effect of dissociation-induction or dissociation intensity on intrusion-load, but they did support an adverse effect on self-reported and objectively assessed memory performance.Conclusions: Results indicate that hypnotic-suggestion and spiral-staring constitute effective, easy-to-implement, and in principle, neuroimaging-compatible dissociation-induction-methods that allow studying dissociation in the laboratory. The present data did not support the notion that dissociation fosters intrusion formation but provides causal support for effects of dissociation on trauma memory.

Abstract This preregistered ex vivo investigation examined the dentinal hybrid layer formation of a resinous infiltrant (Icon), with reference to both thickness (HLT) and homogeneity when combined with modified tunnel preparation (occlusal cavity only) and internal/external caries infiltration. The adhesives Syntac and Scotchbond MP were used as controls (Groups 1 and 3) or in combination with Icon (Groups 2 and 4). A split-tooth design using healthy third molars from 20 donors resulted in 20 prepared dentine cavities per experimental group. The cavity surfaces (n = 80) were etched (37% H3PO4), rinsed, and air-dried. Rewetting with ethanol was followed by application of the respective primers. After labeling with fluorescent dyes, either Syntac Adhesive/Heliobond or Scotchbond MP Adhesive was used alone or supplemented with Icon. HLT, as evaluated by scanning electron microscopy, did not significantly differ (P > 0.05), and confocal laser scanning microscopy revealed homogeneously mixed/polymerized resin-dentine interdiffusion zones in all groups. Icon can be successfully integrated into an ethanol-wet dentine bonding strategy, and will result in compact and homogeneous hybrid layers of comparable thickness considered equivalent to the non-Icon controls, thus allowing for preservation of the tooth’s marginal ridge and interdental space in the case of internal/external infiltration of proximal caries.

RATIONALE:A subanesthetic dose of ketamine, a non-competitive N-methyl-D-aspartate glutamate receptor (NMDAR) antagonist, elicits dissociation in individuals with posttraumatic stress disorder (PTSD), who also often suffer from chronic dissociative symptoms in daily life. These debilitating symptoms have not only been linked to worse PTSD trajectories, but also to increased resting-state functional connectivity (RSFC) between medial prefrontal cortex (mPFC) and amygdala, supporting the conceptualization of dissociation as emotion overmodulation. Yet, as studies were observational, causal evidence is lacking. OBJECTIVES:The present randomized controlled pilot study examines the effect of ketamine, a dissociative drug, on RSFC between mPFC subregions and amygdala in individuals with PTSD. METHODS:Twenty-six individuals with PTSD received either ketamine (0.5mg/kg; n = 12) or the control drug midazolam (0.045mg/kg; n = 14) during functional magnetic resonance imaging (fMRI). RSFC between amygdala and mPFC subregions, i.e., ventromedial PFC (vmPFC), dorsomedial PFC (dmPFC) and anterior-medial PFC (amPFC), was assessed at baseline and during intravenous drug infusion. RESULTS:Contrary to pre-registered predictions, ketamine did not promote a greater increase in RSFC between amygdala and mPFC subregions from baseline to infusion compared to midazolam. Instead, ketamine elicited a stronger transient decrease in vmPFC-amygdala RSFC compared to midazolam. CONCLUSIONS:A dissociative drug did not increase fronto-limbic RSFC in individuals with PTSD. These preliminary experimental findings contrast with prior correlative findings and call for further exploration and, potentially, a more differentiated view on the neurobiological underpinning of dissociative phenomena in PTSD.

Background: Posttraumatic stress disorder and medically unexplained pain frequently co-occur. While pain is common during traumatic events, the processing of pain during trauma and its relation to audiovisual and pain intrusions is poorly understood.Objective: Here we investigate neural activations during painful analogue trauma, focusing on areas that have been related to threat and pain processing, and how they predict intrusion formation. We also examine the moderating role of cumulative lifetime adversity.Methods: Sixty-five healthy women were assessed using functional magnetic resonance imaging. An analogue trauma was induced by an adaptation of the trauma-film paradigm extended by painful electrical stimulation in a 2 (film: aversive, neutral) x 2 (pain: pain, no-pain) design, followed by 7-day audiovisual and pain intrusion assessment using event-based ecological momentary assessment. Intrusions were fitted with Bayesian multilevel regression and a hurdle lognormal distribution.Results: Conjunction analysis confirmed a wide network including anterior insula (AI) and dorsal anterior cingulate cortex (dACC) being active both, during aversive films and pain. Pain resulted in activation in areas amongst posterior insula and deactivation in a network around ventromedial prefrontal cortex (VMPFC). Higher AI and dACC activity during aversive>neutral film predicted greater audiovisual intrusion probability over time and predicted greater audiovisual intrusion frequency particularly for participants with high lifetime adversity. Lower AI, dACC, hippocampus, and VMPFC activity during pain>no-pain predicted greater pain intrusion probability particularly for participants with high lifetime adversity. Weak regulatory VMPFC activation was associated with both increased audiovisual and pain intrusion frequency.Conclusions: Enhanced AI and dACC processing during aversive films, poor pain vs. no-pain discrimination in AI and dACC, as well as weak regulatory VMPFC processing may be driving factors for intrusion formation, particularly in combination with high lifetime adversity. Results shed light on a potential path for the etiology of PTSD and medically unexplained pain.

Sensory over-responsivity (SOR) is a prevalent cross-diagnostic condition that is often associated with anxiety. The biological mechanisms underlying the co-occurrence of SOR and anxiety symptoms are not well understood, despite having important implications for targeted intervention. We therefore investigated the unique associations of SOR and anxiety symptoms with physiological and neural responses to sensory stimulation for youth with anxiety disorders (ANX), autism spectrum disorder (ASD), or typical development (TD). Age/IQ-matched youth aged 8-18 years (22 ANX; 30 ASD; 22 TD) experienced mildly aversive tactile and auditory stimuli during functional magnetic resonance imaging and then during skin conductance response (SCR) and heart rate (HR) measurements. Caregivers reported on participants' SOR and anxiety symptoms. ASD/ANX youth had elevated SOR and anxiety symptoms compared to TD. ASD/ANX youth showed similar, heightened brain responses to sensory stimulation compared to TD youth, but brain responses were more highly related to SOR symptoms in ASD youth and to anxiety symptoms in ANX youth. Across ASD/ANX youth, anxiety symptoms uniquely related to greater SCR whereas SOR uniquely related to greater HR responses to sensory stimulation. Behavioral and neurobiological over-responsivity to sensory stimulation was shared across diagnostic groups. However, findings support SOR and anxiety as distinct symptoms with unique biological mechanisms, and with different relationships to neural over-reactivity dependent on diagnostic group. Results indicate a need for targeted treatment approaches.

Objective: This study investigated the impact of war exposure on post-traumatic stress symptoms (PTSS) and sleep disturbance across Ukraine. Subjective and objective indicators of war exposure were modelled as predictors of these symptoms.Methods: We created two predictors: first, we used governmental and crowd-sourced data to create an objective war exposure index for each of the 21 non-occupied regions of Ukraine, based on the number of air raid alarms, explosions, and proximity to frontline; and second, we obtained self-report cross-sectional data, using convenience sampling, from a nation-wide survey (N = 991) on subjective experience of threat triggered by the war. The survey also measured the outcome variables of PTSS and sleep disturbance. Hierarchical multilevel regressions modelled the relationship of this objective war exposure index with the two outcome variables, after accounting for demographics. A final regression step modelled subjective threat as predictor of these symptoms.Results: We observed strongly elevated levels of PTSS and sleep disturbance and strong regional differences in objective and subjective war indicators. Objective war exposure predicted PTSS but not sleep disturbance, whereas subjective threat predicted both symptom domains.Conclusion: The study demonstrates the utility of objective war exposure data for predicting the prevalence of PTSS in the different regions. The results further underscore the prominent role of subjective appraisal processes in the symptomatology of PTSS and sleep disturbance, thus informing theories on trauma-related disorders. Our results can guide the allocation of mental health services by identifying highly affected regions. Objective data on air raid alarms and explosions have been prospectively collected in Ukraine.We related those objective data to symptom reports of 991 responders in most Ukraine regions.Objective data explained symptoms of post-traumatic stress but not sleep disturbance. Objetivo: Este estudio investig & oacute; el impacto de la exposici & oacute;n a la guerra en los s & iacute;ntomas de estr & eacute;s postraum & aacute;tico (SEPT) y los trastornos del sue & ntilde;o en Ucrania. Se modelaron indicadores subjetivos y objetivos de exposici & oacute;n a la guerra como predictores de estos s & iacute;ntomas.M & eacute;todos: Creamos dos predictores: primero, utilizamos datos gubernamentales y de datos de colaboraci & oacute;n colectiva para crear un & iacute;ndice objetivo de la exposici & oacute;n a la guerra para cada una de las 21 regiones no ocupadas de Ucrania, en funci & oacute;n del n & uacute;mero de alarmas de ataques a & eacute;reos, explosiones, y proximidad a la primera l & iacute;nea; y segundo, obtuvimos datos transversales de autoinforme, utilizando un muestreo de conveniencia, de una encuesta nacional (N = 991) sobre la experiencia subjetiva de la amenaza desencadenada por la guerra. La encuesta tambi & eacute;n midi & oacute; las variables de resultado de los SEPT y los trastornos del sue & ntilde;o. Las regresiones jer & aacute;rquicas multinivel modelaron la relaci & oacute;n de este & iacute;ndice objetivo de exposici & oacute;n a la guerra con las dos variables de resultado, despu & eacute;s de tener en cuenta la demograf & iacute;a. El paso final de regresi & oacute;n model & oacute; la amenaza subjetiva como predictor de estos s & iacute;ntomas.Resultados: Observamos niveles fuertemente elevados de los SEPT y los trastornos del sue & ntilde;o y fuertes diferencias regionales en los indicadores objetivos y subjetivos de la guerra. La exposici & oacute;n objetiva a la guerra predijo los SEPT, pero no los trastornos del sue & ntilde;o, mientras que la amenaza subjetiva predijo ambos dominios de s & iacute;ntomas.Conclusi & oacute;n: El estudio demuestra la utilidad de los datos objetivos de exposici & oacute;n a la guerra para predecir la prevalencia de los SEPT en las diferentes regiones. Los resultados subrayan a & uacute;n m & aacute;s el papel destacado de los procesos de evaluaci & oacute;n subjetiva en la sintomatolog & iacute;a de los SEPT y los trastornos del sue & ntilde;o, informando as & iacute; las teor & iacute;as sobre los trastornos relacionados con el trauma. Nuestros resultados pueden orientar la asignaci & oacute;n de servicios de salud mental mediante la identificaci & oacute;n de regiones altamente afectadas.

Background Intrusive re-experiencing of trauma is a core symptom of posttraumatic stress disorder. Intrusive re-experiencing could potentially be reduced by 'rewinding', a new treatment approach assumed to take advantage of reconsolidation-updating by mentally replaying trauma fast-backward.Methods The present analogue study was the first to investigate 'rewinding' in a controlled laboratory setting. First, 115 healthy women watched a highly aversive film and were instructed to report film-related intrusions during the following week. Twenty-four hours after film-viewing, participants reporting at least one intrusion (N = 81) were randomly allocated to an intervention (fast-backward, or fast-forward as active control condition) or a passive control condition. Intervention groups reactivated their trauma memory, followed by mentally replaying the aversive film either fast-backward or fast-forward repeatedly.Results Results indicate that replaying trauma fast-backward reduced intrusion load (intrusion frequency weighted for intrusion distress) compared to the passive group, whereas replaying fast-forward did not. No above-threshold differences between fast-backward and fast-forward emerged.Conclusion Present findings strengthen the view that 'rewinding' could be a promising intervention to reduce intrusions.

Aim: The purpose of the present investigation was to evaluate the accuracy of root canal length (RCL) determination according to CBCT acquisition protocol and evaluate the influence of additional superimposed computerized optical impressions.Materials and methods: CBCT scans with low-dose (LD) and high-definition (HD) protocols as well as computerized optical impressions of 30 extracted human molars were acquired. Sicat Endo software (Sicat) was used for CBCT RCL measurements with (LD+, HD+) and without (LD-, HD-) a superimposed optical impression. To evaluate the accuracy, absolute differences between test groups and the actual root canal length (ARCL) were calculated and statistically analyzed using the Wilcoxon rank sum test.Results: Absolute differences between the ARCL and the tested measurement methods varied significantly (P <0.05). Both higher resolution and additionally superimposed computerized optical impression improved measurement accuracy. Mean differences compared with the ARCL were 0.26 mm (HD+), 0.34 mm (HD-), 0.43 mm (LD+), and 0.66 mm (LD-). 93.4% of all measurements in the HD+ group were within the limits of +/- 0.5 mm. Conclusion: Both resolution and superimposition of additional computerized optical impressions have a significant influence on RCL measurements using CBCT.

Background: The fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduced the dissociative subtype of posttraumatic stress disorder (D-PTSD). To assess this subtype, the Dissociative Subtype of PTSD Scale (DSPS), a 15-item self-report measure to identify lifetime and current dissociative symptoms of D-PTSD, was developed. However, so far, the scale has only been validated in war veterans. Moreover, criterion validity and diagnostic utility have not been examined yet.Objective: We aimed to validate the DSPS in two samples of civilian trauma-exposed German-speaking participants.Methods: In Study 1, a pre-registered online study, participants with and without PTSD symptoms (N = 558) answered questionnaires about traumatic experiences, dissociation, PTSD, depression, generalized anxiety disorder, somatic symptom disorder, alcohol use disorder, absorption, and dissociative responding to trauma-related questionnaires. In Study 2, which used secondary data of a pre-registered clinical study, participants with a PTSD diagnosis (N = 71) answered questionnaires about traumatic experiences, dissociation, PTSD, depression, generalized anxiety disorder, somatic symptom disorder, and dissociative responding to standardized trauma exposure. Moreover, PTSD, D-PTSD, and other diagnoses were assessed with structured clinical interviews.Results: Analyses confirmed a three-factor structure as well as high internal consistency, and high convergent, discriminant, and criterion validity of the DSPS. Moreover, the scale was able to identify a latent D-PTSD group and individuals with D-PTSD diagnosis.Conclusions: The DSPS constitutes a reliable and valid tool to assess D-PTSD symptoms in clinical practice and research and thereby may contribute to a better understanding of these debilitating symptoms.

BackgroundAccording to major cognitive accounts of panic disorder, bodily sensations can lead to automatic activation of an associative fear network, potentially triggering a cascade of cognitive, emotional, and physiological responses culminating in a panic attack. However, the evidence for the automatic associations assumed by these models is mixed. This may reflect the heterogeneous nature of panic disorder, in that the relative importance of different bodily sensations and symptoms varies between individuals. The current study aimed to test this possibility via measuring the associations between three different sets of panic symptoms (cognitive, respiratory, cardiac) and scores on three symptom-specific single target implicit association tests (STIATs).MethodsA total of 226 unselected female participants aged 18-35 completed the STIATs as well as questionnaires assessing panic symptoms and related measures in a web-based study.ResultsOnly limited evidence was found to support the idea of specific associations between STIAT stimuli sets and their related panic symptoms. Exploratory analyses indicated that there were only associations between STIAT scores and panic-relevant questionnaires amongst those participants who had experienced a panic attack in the previous 6 months.ConclusionsThe results have implications for measuring panic-relevant associations and understanding their role in panic disorder.

Interpretation biases (IBs) are central in panic disorder, and there is rich evidence showing that these are correlated with and predictive of panic-relevant symptomatology. However, experimental studies are needed to examine the potential causal effects of IBs, as predicted by cognitive models. Panic-related IBs were manipulated via a sentence-completion Cognitive Bias Modification-Interpretation (CBM-I) training. The sample included N = 112 healthy participants reporting moderate levels of fear of bodily sensations. Participants were randomly allocated to a positive, negative, or control CBM-I condition. To test the trainings’ effect on panic-relevant cognitive processing, IBs were assessed via proximal and distal measures. Symptom provocation tasks were applied to test transfer to panic-relevant symptomatology. Results on the proximal measure showed that positive CBM-I led to more positive IBs compared to negative, and control training. Further, positive CBM-I led to more positive IBs on the distal measure as compared to negative CBM-I. However, there were no differential training effects on panic-related symptomatology triggered via the provocation tasks. The findings indicate a limited generalization of the effects of CBM-I on IBs and panic-related symptoms. Potential means to improve generalization, such as applying more nuanced measures and combining CBM-I with psychoeducation are discussed.

While research has elucidated processes underlying dissociative symptoms in patients with posttraumatic stress disorder, little is known about the circumstances under which trauma-related dissociation initially arises. To experimentally investigate causes and concomitants of peritraumatic dissociation, we subjected sixty-nine healthy women to aversive-audiovisual and painful-electrical stimulation in a 2(aversive/neutral film) x 2(pain/no pain) within-subject design while recording psychophysiological and fMRI-BOLD responses. Afterwards, participants rated negative-affect, pain, and dissociation for each condition. Using Bayesian multilevel regression models, we examined (1) whether aversive-audiovisual and painful-electrical stimulation elicit higher dissociation-levels than control conditions and (2) whether stronger negative-affect and pain responses (operationalized via self-report, psychophysiological, and neural markers) correlate with higher dissociation-levels. Several key findings emerged: Both aversive-audiovisual and painful-electrical stimulation elicited dissociation. Dissociation was linked to higher self-reported negative-affect, but we did not find enough evidence linking it to psychophysiological and neural negative-affect markers. However, dissociation was associated with higher levels of self-reported pain, a skin-conductance-response-based pain marker, and the fMRI-BOLD-based Neurologic-Pain-Signature. Results indicate that both aversive-audiovisual and painful stimuli can independently cause dissociation. Critically, pain responses captured via self-report, psychophysiological, and neural markers were consistently linked to higher dissociation-levels suggesting a specific, evolutionary meaningful, contribution of pain to the rise of dissociation.

Suppression (i.e., inhibiting one's emotional expression) has typically been associated with social and physio-logical costs. However, recent theorizing calls into question the inevitability of these costs. The present study takes a more nuanced approach and examines the social and physiological correlates of spontaneous (i.e., un-instructed) suppression when considering two potentially critical factors: the valence of the suppressed emotions (i.e., negative vs. positive) and the valence of the emotional context in which emotions are suppressed (i.e., negative conversation vs. positive conversation). Specifically, dating couples (N = 196 couples) completed both a negatively-valenced and a positively-valenced conversation in the laboratory while their autonomic-physiological responses were recorded. After each conversation, participants rated 1) the extent to which they had suppressed their negative and positive emotions, 2) the quality of the conversation, and 3) how connected they felt with their partner. We used Actor-Partner Interdependence Models to estimate actor effects (e.g., as-sociation of one's own suppression and one's own connectedness) and partner effects (e.g., association of one's partner's suppression and one's own connectedness). Suppression was associated with lower conversation quality and connectedness for the actors but largely not for the partners, regardless of the valence of the suppressed emotions and of the context, even when adjusting for felt emotion. Additionally, suppression was consistently not associated with physiological responses of actors or partners. Together, these findings suggest that, during emotional conversations with one's romantic partner, spontaneous (unlike instructed) suppression is associated with social but not physiological costs for the self but not one's partner.

Dissociative symptoms, such as depersonalization and derealization, are experienced by about half of individuals with posttraumatic stress disorder (PTSD). Theoretical models propose that acute dissociation is accompanied by specific behavioral, physiological, and experiential alterations and contributes to unfavorable PTSD symptom course. Yet, empirical evidence is scarce. Here, we explored associations between dissociative and behavioral, physiological, and experiential threat responses as well as effects of dissociative responding on PTSD symptom course. Individuals with PTSD (N = 71) participated in a preregistered script-driven imagery study including exposure to standardized, detail-enriched trauma, and neutral scripts. Stabilometry, eye-tracking, facial electromyography, autonomic psychophysiology, and self-report data were collected. Moreover, PTSD symptoms were assessed before and 3 months after testing. Analyses did not link acute dissociation to bodily and facial immobility or staring in response to trauma scripts. However, dissociation displayed an inverted U-shaped relationship with heart rate and was linked to higher nonspecific skin conductance fluctuation and higher high-frequency heart rate variability in response to trauma scripts. Moreover, acute dissociation was linked to higher self-reported negative affect responses to trauma scripts and displayed a U-shaped relationship with unfavorable PTSD symptom course. While results did not confirm hypothesized behavioral markers of dissociation, they do support defense-cascade model assumptions of an inverted U-shaped relationship between dissociation and psychophysiological arousal resulting from a progression of parasympathetic versus sympathetic dominance with increasing dissociation. On an experiential level, results did not confirm posttraumatic dissociation-induced emotional numbing, questioning theoretical notions. The observed nonlinear associations may help explain the heterogeneity of prior findings and might inform an updated conceptualization of posttraumatic dissociation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The current study investigated heart rate (HR) and heart rate variability (HRV) across day and night in patients with disorders of consciousness (DOC). We recorded 24-h electrocardiography in 26 patients with DOC (i.e., unresponsive wakefulness syndrome (UWS; n = 16) and (exit) minimally conscious state ((E)MCS; n = 10)). To examine diurnal variations, HR and HRV indices in the time, frequency, and entropy domains were computed for periods of clear day- (forenoon: 8 a.m.–2 p.m.; afternoon: 2 p.m.–8 p.m.) and nighttime (11 p.m.–5 a.m.). The results indicate that patients’ interbeat intervals (IBIs) were larger during the night than during the day, indicating HR slowing. The patients in UWS showed larger IBIs compared to the patients in (E)MCS, and the patients with non-traumatic brain injury showed lower HRV entropy than the patients with traumatic brain injury. Additionally, higher HRV entropy was associated with higher EEG entropy during the night. Thus, cardiac activity varies with a diurnal pattern in patients with DOC and can differentiate between patients’ diagnoses and etiologies. Moreover, the interaction of heart and brain appears to follow a diurnal rhythm. Thus, HR and HRV seem to mirror the integrity of brain functioning and, consequently, might serve as supplementary measures for improving the validity of assessments in patients with DOC.

Intrusions, a key symptom of posttraumatic stress disorder (PTSD), can occur as classically conditioned responses to trauma-related cues, both in the form of images and pain sensations. Women are more vulnerable to experiencing intrusions, and gonadal hormones may underlie this sex difference. Yet so far, particularly estradiol’s influence on intrusions is unclear, as PTSD-symptom studies suggesting a vulnerable window for intrusions during the high estradiol-progesterone phase diverge from fear-conditioning studies suggesting a protective role of estradiol. Here, we aim to address this discrepancy and examine the effects of estradiol on intrusions while also considering stress as potential moderator.Forty free-cycling women participated in an ecologically informed trauma-pain-conditioning (TPC) paradigm, using trauma-films and pain as unconditioned stimuli. Predictors were salivary estradiol and stress indexed by salivary cortisol and self-reported state-anxiety during TPC. Outcomes were film- and pain-intrusions occurring during daily-life in the week following TPC and a memory-triggering-task in response to conditioned stimuli 24h after TPC.Estradiol yielded time- and stress-dependent effects on film-intrusions during daily-life: women with higher estradiol showed initially greater probability of experiencing film-intrusions, switching to lower probability toward the end of the week. This late protective effect of estradiol on film-intrusions only held for higher state-anxious women. In contrast, estradiol showed consistent protective effects on pain-intrusions during daily-life and memory-triggering-task. Together, these data suggest that high estradiol during trauma may shield women from long-term audiovisual trauma intrusions, as well as from pain-intrusions, and thereby possibly constitute a protective factor for PTSD and potentially also for chronic pain.

While research has started to elucidate the processes underlying chronic dissociative symptoms in patients with posttraumatic stress disorder, little is known about the circumstances under which trauma-related dissociation initially arises, i.e., the triggers of and mechanisms behind peritraumatic dissociation. Here, we expanded the analogue trauma-film approach by pain stimulation to increase ecological validity and examined effects on dissociation.

Franke, Laila K.a,*; Miedl, Stephan F.a; Danböck, Sarah K.a; Liedlgruber, Michaela; Grill, Markusa; Kronbichler, Martinb,c; Flor, Hertad,e; Wilhelm, Frank H.a Author Information

BACKGROUND AND OBJECTIVES:Although most trauma survivors experience some intrusive recollections of the traumatic event, only few subsequently develop posttraumatic stress disorder (PTSD). A well-established proximal risk-factor predictive of post-trauma psychopathology is peritraumatic cognitive processing. Another, more distal risk-factor is pre-trauma lifetime adversity. The present experimental analogue study tested the hypothesis that pre-trauma lifetime adversity interacts with peritraumatic perceptual (i.e., data-driven) processing to predict intrusive memory development. METHODS:Fifty-three young adult women (non-clinical sample) indicated how much data-driven and conceptual processing they had engaged in while watching aversive film-clips (i.e., analogue trauma). On the subsequent three days, they reported intrusions of those clips. Moderation analyses tested for an interaction effect between lifetime adversity and data-driven processing in predicting intrusion load (number of intrusions weighted for their overall distress). RESULTS:Increased data-driven processing predicted intrusion load primarily in individuals reporting more than three lifetime adversities, explaining 55% of variance. No such relationship was found for conceptual processing. LIMITATIONS:Present analogue findings have yet to be replicated in a clinical population. Moreover, the conceptual processing scale was restricted by low internal consistency. CONCLUSION:Present findings support the idea that intrusions are the result of poorly elaborated and primarily perceptually-formed memory traces; however, this was primarily the case in vulnerable individuals reporting several lifetime adversities. Results replicate the importance of peritraumatic processing in intrusion development but additionally point to a moderating effect of lifetime adversity.