Lecture 9: Intrusive thinking Flashcards
“the most common mode for recollecting past events in everyday life” =
involuntary memories
Proust’s madeleine=
transports him back to his childhood: a trivial cue induces strong emotional experiences
…% of new parents have intrusive thoughts about their kids: the baby suffocating, having an accident, being harmed.
90%
intrusive thought definitie
any distinct, identifiable cognitive event that is unwanted, unintended and recurrent. It interrupts the flow of thought, interferes in task performance, is associated with negative affect, and is difficult to control.
deze definitie zegt: “conscious, involuntary and unwanted thought”
maar dit is een betere definitie: “interruptive, salient, experienced mental events”
typical content of intrusive thoughts
- past and future emotional events
- unsolved problems/tasks
- uncertain events
- frequent stimuli (songs etc)
images=
Representations and the accompanying experience of sensory information without a direct external stimulus
- Seeing in the mind’s eye, hearing with our mind’s ear
- “here and now” quality
- strong link to emotions
everyday intrusive thinking - triggers
Seem to come out of nowhere, but usually
triggered by associated cues:
- External cues: sight, sounds, smells
- Internal cues: mood/ physiology
Probability increases with diminished cognitive control (e.g., sleep loss)
everyday intrusive thinking - need to control
- A spontaneous thought/ memory that causes a lot of distress is usually intrusive.
- However, often it’s not so much the content (which can also be neutral or pleasant) but the moment at which the thought comes to mind that makes it intrusive.
- Many situations require you to control your thoughts
wat is kenmerkend voor PTSD en wat voor OCD?
ptsd = memories
ocd = thoughts
hoe is het schema van PTSD en OCD (soort venndiagram)
links:
- involuntary (spontaneous)
- intrusive memory (interruptive & salient and/or distressing)
- clinical: PTSD (impairing)
rechts:
- involuntary thought (spontaneous)
- intrusive thought (interruptive & salient and/or distressing)
- clinical: OCD (impairing)
most prototypical forms of intrusions
- Posttraumatic stress disorder (Intrusive memories, flashbacks)
- Obsessive compulsive disorder (obsessions, compulsions)
ptsd DSM5
- Intrusion symptoms (one or more):
- Recurrent, involuntary, and intrusive distressing memories of the trauma
- Recurrent, distressing dreams related to the event(s)
- Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the trauma(s) were recurring
- Intense or prolonged distress or physiological reactivity in response to reminders of the trauma(s)
- Avoidance, negative alterations in mood and cognition, arousal and reactivity
- Symptoms start or worsened after trauma, present >1 month
wat is een key woord in ptsd
re-experiencing
wat liet de Pécrot train crash zien
dat 86% van de witnesses intrusive memories meemaakten na 3 weken
In a study of motor vehicle accident patients, 76% had intrusive memories in the first few weeks, 25% at 3 months, and 24% at 1 year.
Does initial presence/ frequency predict later PTSD?
no, the initial presence does not fully predict the development of ptsd. it is a sensitive marker, but not specific
wanneer is iets intrusive
als je echt actief probeert om ergens anders over na denken
hoe gaat de controle van intrusive thoughts in healthy individuals
In healthy individuals, when intrusive thoughts occur, they are usually perceived as unwanted, at least at that moment. As a result, people often try to exclude them from awareness in an effort to regain control over thoughts and emotions. When successful, such efforts enable a person to put unwelcome thoughts out of mind, thus diminishing their accessibility in memory and reducing their tendency to return.
several contexts in everyday life in which people are motivated to forget thoughts for a functional reason:
- concentration during tasks
- executing high-performance cognitive and motor skills
- regulating pain
- regulating affect
- persisting in the face of failure
- protecting self-image
- justifying inappropriate behaviour
- maintaining attitudes and beliefs
- forgiving others and maintaining attachment
suddenly realizing that while our
eyes have been moving across the page, our minds have been temporarily
sidetracked by thoughts unrelated to the text=
mind wandering
sensitivity vs specificity
Sensitivity refers to a test’s ability to designate an individual with disease as positive. A highly sensitive test means that there are few false negative results, and thus fewer cases of disease are missed. The specificity of a test is its ability to designate an individual who does not have a disease as negative.
intrusive memories bestaan uit…
- sounds
- visual images
- thoughts
waar zorgen intrusive memories of trauma voor
- involve sensory experiences, ook in non-PTSD mensen -> dit is heel normaal (daarom ook kritiek op acute stress disorder)
- evoke distress when avoided
- lead to avoidance
- negative alterations in cognition and mood
- hyperarousal
Cognitive models of PTSD place […] at the hub of symptomatology, potentially […]
intrusive memories of trauma
acting as a driver of the other three symptom clusters (avoidance, negative alterations in cognitions and mood, and hyperarousal)
obsessions =
- Recurrent, intrusive, persistent, unwanted thoughts, urges, or images.
- The attempt to ignore, suppress, or neutralize such thoughts, urges, or images
compulsions=
- Repetitive behaviors or mental actions that a person feels compelled to perform -in response to obsessions or according to rigid rules -to prevent distress or a dreaded event
- Acts that are excessive or unlikely to prevent the dreaded situation
hoe komt intrusive thinking ook nog voor (maar less prototypical)
- Substance use disorder (craving)
- Mood disorders (rumination, flash forward)
- Anxiety (worry)
- Bipolar disorder (flash forward)
- Psychosis? (hallucinations, thought insertions)
- Attention deficit disorder? (impulsive action, inattention, mind wandering)
hoe kan je differentieren tussen clinical and non-clinical manifestations of intrusions
(want intrusions per definition interfere with task at hand/ongoing thought process)
- frequency
- negative appraisal of the intrusions
- vividness/distress
- avoidance (including dissociation)
wat is anders aan OCD vergeleken met PTSD
- intrusive thoughts in OCD are not re-experiences of trauma
- and usually people have compulsions to relieve stress
- intrusions are ego-dystonic (komen niet overeen met hoe zij zichzelf zien). they do not want to do these things, but they fear they might secretly want them. but the fact that they have these thoughts, can be extremely scary.
wat is een predictive factor van OCD
a lot of people have intrusive thoughts: only those who believe that having such thoughts makes those events more likely to occur show higher probability of OCD
-> thought-action fusion
wat is predictive voor ptsd
negative appraisal of intrusions (both pre- and post-trauma)
research paradigms & putative mechanisms
- Experience sampling
- Trauma Film Paradigm
- Think/ No think paradigm -> (Deficit in) cognitive control
- Memory processing
- Pavlovian conditioning (e.g., Contemporary Learning Theory)
intrusions are per definition intrusive: when are they then problematic?
- when people try to avoid them
- negative appraisal (when they interpret them in a negative way)
in clinical cases, intrusions are usually concurrent (terugkomend), maar in everyday life kan eentje ook al intrusive zijn
oke
experience/thought sampling=
research paradigm waarbij bv een boring lab task wordt uitgevoerd. hierna worden de experiences/thoughts van de participanten verzameld.
soorten:
related to the task/unrelated to the task
self-generated/perceptually guided
soorten experiences bij de experience/thought sampling task
task focus = perceptually guided & task related (gewoon de task uitvoeren)
distracted = perceptually guided & unrelated to task (geluidje horen van telefoon, of naar buiten kijken)
self-generated + task related (GRRR wtf is het nut van deze oefening)
self-generated + task unrelated (vakantie!! was doen!!)
intrusive thoughts = self-generated (en dan beiden related to the task en unrelated to the task)
zie schrift
pro’s van experience/thought sampling=
- naturally occuring intrusions
- translation from lab to real life
cons van experience/thought sampling
- requires meta-awareness (je moet echt weten wat er was gebeurd, self-caught more than probed report), which can be compromised in clinical populations
- in healthy populations: concept of intrusions is quite abstract
- no control over event, peri-event factors (for intrusions relating to past events)
- no control over the timing of intrusions
- involuntariness is difficult to verify (wilden ze echt niet over die vakantie nadenken?)
trauma film paradigm (+ diary)=
encoding film clips -> na 1 week diary + tests of voluntary memory
dus hiermee heb je verschillende maten, diary laat involuntary zien, en de voluntary memory wordt adhv een test getest. deze twee staan los van elkaar (soms hoe beter de memory van een event, hoe minder intrusions, maar soms ook andersom)
multi-store memory model =
sensory input -> sensory memory -> attention -> short-term memory (maintenance rehearsal erom heen) -> econding -> long term memory (retrieval terug naar short term memory)
zie schrift
theory of planned behaviour
attitude + subjective norm + perceived behavioural control
intention
behaviour
cognitive theories of PTSD:
overwhelming stress -> over-consolidation of perceptual elements -> impairs integration with contextual features in autobiographical memory
intrusive images and ‘hotspots’ of traumatic memories =
loose, sensory fragments, often (but not always!) of the worst moments, that are poorly integrated with other episodic information and just pop up
peri-traumatic =
around the trauma
there is already activity in the brain that can emphasize certain moments during the trauma, which can predict intrusions
oke
trauma film paradigm + diary =
encoding film clips + MRI -> diary after 1 week
trauma film paradigm pro’s
- control over event and ‘peri-trauma’ factors
- ‘golden standard’ for veracity of memory, which allows comparison to measures of voluntary recall
- relatively high ecological validity (compared to eg. picture/conditioning)
trauma film paradigm cons =
- requires meta-analysis
- film only a proxy for trauma
- no control over timing of intrusions
- involuntariness difficult to verify
cognitive theories of intrusive thinking:
poor cognitive control leads to involuntary retrievals of past and imagined events
cognitive control: retrieval suppression
- intrusions are the result of a lapse in cognitive control
- insufficient inhibition of the hippocampus and amygdala
- lack of sleep and pre-existing conditions can worsen this, creasing a vicious cycle
think/no think paradigm
An experimental procedure for studying intentional forgetting of unwanted memories. Subjects are asked to study pairs of semantically unrelated words. They should be able to recall the right word when the left word is presented. An executive control task is then proposed. A cue is presented and subjects must either give the associated response or not think of the response. In the final phase, subjects must recall the response for each pair of words. The results show that memory for words that were given a “no-think” instruction is worse than memory for words that were given a “think” instruction and for words that were given neither a “think” nor a “no-think” instruction.
think/no think paradigm voordelen
- control over events and ‘peri-traumatic’ factors
- ‘golden standard’ for veracity of memory, which allows comparisons to measures of voluntary recall
- control over timing of intrusion (dus je kan tegelijkertijd neurological/physiological assessments doen)
- clear inference of involuntariness (participants are instructed to suppress)
think/no think cons
- requires meta-analysis
- demand bias? (participants are instructed to suppress)
- low ecological validity
retrieval suppression is NOT:
- White bear suppression (checking whether you are not thinking about a specific thought)
- Expressive suppression (mainly motor control, “poker face”)
- (Cognitive) avoidance (of reminders, “not dealing with problem”)
- General distraction (avoiding)
why do we have intrusions?
- epiphenomenon (by-product)?
- to process salient experiences (dus dat intrusions windows of opportunities zijn, voor modificeren van een memory (eg. via processes like reconsolidation))?
- to guide future behaviour (warning signal)
- remember past catastrophes
- simulating future scenarios to assess danger
even kijken naar indirect adaptive functioning grafiek in schrift
oke
intrusive memories of trauma as a conditioned response:
- neural stimulus (CS) triggers intrusions of the aversive outcome (US)
- when intrusions are excessive or fail to extinguish: they are clinical
- Reexperiencing symptoms of PTSD include fear and distress at exposure to reminders of trauma (as well as nightmares and flashbacks), and these emotional reactions can be seen as conditioned emotional responses elicited by reminder cues.
take home messages=
- Intrusive memories and thoughts are common
- May relate to (elaborations on) past, future, or imagined events
- Initial frequency and distress, but most importantly, negative
appraisals, predict later clinical symptoms
