Estradiol during (analogue-) trauma: risk- or protective factor for intrusive re-experiencing?

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.

Virtually renovating the Trauma Film Paradigm: Comparing virtual reality with on-screen presentation of an analogue trauma

Due to the unpredictable nature of traumatic events, prospective research into trauma relies upon laboratory methods utilising distressing film scenes to act as a trauma analogue measuring vulnerability factors and testing interventions applied to posttraumatic stress disorder (PTSD). This is the first study to test whether Virtual Reality (VR) provides a more effective trauma analogue than traditional on-screen presentation by direct comparison of the same real-life trauma film. Participants viewed footage of a staged car accident either presented in VR (N = 31) or on-screen (OS) (N = 30). Both groups recorded sense of presence, pre- and post-film mood and state anxiety. After the film, some participants (VR: n = 18; OS: n = 12) reported involuntary intrusions of the film and recorded the emotionality of these. VR presentation evoked a greater sense of presence, yet both VR and OS presentation elicited negative mood and involuntary intrusions. Although intrusions were more vivid in the VR condition, there were no significant differences in frequency or distress. However, a greater sense of presence, regardless of medium, was predictive of increased emotional reaction to the film and greater intrusion frequency and distress. Therefore, implementing a VR paradigm could be directly beneficial for TFP research concerning sense of presence or vividness of intrusions. The association between enhanced sense of presence and stress response suggests that an effective trauma analogue should be immersive, and VR presentation is a useful medium to elicit a greater sense of immersion.

Intrusive memories as conditioned responses to trauma cues: an empirically supported concept?

Intrusions in posttraumatic stress disorder (PTSD) are clinically understood as conditioned responses (CRs) to trauma-cues; however, experimental evidence for this is limited. We subjected 84 healthy participants to a differential conditioned-intrusion paradigm, where neutral faces served as conditioned stimuli (CS) and aversive film clips as unconditioned stimuli (US). While one group only completed acquisition, another group additionally received extinction. Subsequently, participants provided detailed e-diary intrusion reports. Several key findings emerged: First, participants in both groups re-experienced not only US but also CS as content of their intrusions. Second, intrusions were triggered by stimuli resembling CS, US, and experimental context. Third, extinction reduced probability and severity of US intrusions, and accelerated their decay, and this was particularly the case in participants showing greater cognitive (US-expectancy) and physiological (SCR) differential responding to CS+ vs. CS- at end of acquisition (i.e., conditionability). Similarly, CS-intrusion probability and severity was reduced by extinction in participants with greater cognitive conditionability. These results support conditioning’s role in re-experiencing in two critical ways: (1) Conditioning during trauma provides cues that not only function as triggers, but also as content of intrusions; (2) After strong conditioning, weakening the original CS-US relationship via extinction prevents intrusion formation after analogue-trauma.

Investigating predictors of trauma induced data-driven processing and its impact on attention bias and free recall

Background:Whilst data-driven processing (DDP) during trauma has been shown to play a role in poor memory integration and is associated with post-traumatic stress disorder (PTSD) re-experiencing symptoms, the pre-trauma risk factors and related cognitive mechanisms are uncertain.Aims:This experimental study aimed to investigate predictors of peri-traumatic DDP, as well as its role in attention bias to threat and free recall.Method:A virtual reality video was used to simulate an analogue trauma. Questionnaires, a free recall task, and an eye-tracking measure assessed cognitive changes after exposure.Results:Regression analysis demonstrated that trait dissociation at pre-exposure to trauma significantly predicted DDP. Attention bias towards threat-related images was found. Results showed that DDP and poorer free recall predicted attention bias to threat images and higher levels of DDP actually predicted higher overall scores in the free recall task.Conclusions:This study showed that DDP is strongly linked to dissociative traits, and along with memory disintegration it may predict attention changes after exposure to a trauma.

Do Cognitive Tasks Reduce Intrusive-Memory Frequency After Exposure to Analogue Trauma? An Experimental Replication

Cognitive task interventions that interfere with visuospatial working memory during the memory consolidation window hold promise for reducing intrusive memories in trauma-exposed people. Our study provides an independent replication study to test and verify findings that have primarily originated from a single research group. We hypothesized that participants engaging in a visuospatial task (cognitive task intervention including Tetris or D-Corsi) following a trauma-film paradigm (TFP) would report fewer intrusive memories over the course of a week compared with control participants. Participants ( N = 110) were randomly assigned to an experimental condition after viewing the TFP. Generalized linear mixed models indicated that the cognitive task including Tetris was associated with fewer intrusions for the TFP compared with both the D-Corsi-intervention and control conditions. Our findings are congruent with existing literature indicating that cognitive tasks, such as an intervention including Tetris, may promote effective memory consolidation after exposure to a potentially traumatic event.