Remembering and Responding to Distressing Autobiographical Memories: Exploring Risk and Intervention Targets for Posttraumatic Stress in Traumatized Refugees
Restricted accessResearch articleFirst published online September, 2017
Remembering and Responding to Distressing Autobiographical Memories: Exploring Risk and Intervention Targets for Posttraumatic Stress in Traumatized Refugees
It is tragic that more than 65 million people are currently forcibly displaced due to civil war, ethnic cleansing, and related atrocities. They suffer at high rates from trauma- and stress-related mental health problems. To advance development of effective mental health interventions tailored to refugees and asylum seekers, we need to significantly increase knowledge of risk processes and intervention targets. Accordingly, in an experimental laboratory study, we examined the nature and function(s) of remembering and responding to a distressing autobiographical memory among 110 severely traumatized Sudanese refugees. We found that (a) posttraumatic stress symptom severity predicted emotional reactivity, but not avoidance, in response to remembering a distressing memory and that (b) relative to a self-distanced perspective, a self-immersed perspective during memory recall led to lower levels of avoidance, but not emotional reactivity. Findings are discussed with respect to extant theory, intervention development, and implementation for traumatized refugee populations.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
2.
AydukO.KrossE. (2008). Enhancing the pace of recovery: Differential effects of analyzing negative experiences from a self-distanced vs. self-immersed perspective on blood pressure reactivity. Psychological Science, 19, 229–231.
3.
BadriA.CrutzenR.Van den BorneH. W. (2012). Exposures to war-related traumatic events and post-traumatic stress disorder symptoms among displaced Darfuri female university students: An exploratory study. BMC Public Health, 12(1), 603. doi:10.1186/1471-2458-12-603
4.
BasogluM. (2006). Rehabilitation of traumatised refugees and survivors of torture. BMJ, 333, 1230–1231.
5.
BattenS. V.OrsilloS. M.WalserR. D. (2005). Acceptance and mindfulness-based approaches to the treatment of posttraumatic stress disorder. In OrsilloS. M.RoemerL. (Eds.), Acceptance and mindfulness-based approaches to anxiety (pp. 241–269). Amsterdam, Netherlands: Springer.
6.
BeckA. T. (1970). Cognitive therapy: Nature and relation to behavior therapy. Behavior Therapy, 1, 184–200.
7.
BenightC. C.BanduraA. (2004). Social cognitive theory of posttraumatic recovery: The role of perceived self-efficacy. Behaviour Research and Therapy, 42, 1129–1148.
8.
BernsteinA.HadashY.LichtashY.TanayG.ShepherdK.FrescoD. M. (2015). Decentering and related constructs: A critical review and metacognitive processes model. Perspectives on Psychological Science, 10, 599–617.
9.
BoeschenL. E.KossM. P.FigueredoA. J.CoanJ. A. (2001). Experiential avoidance and post-traumatic stress disorder: A cognitive mediational model of rape recovery. Journal of Aggression, Maltreatment & Trauma, 4, 211–245.
10.
BreslauN.DavisG. C.AndreskiP.PetersonE. L.SchultzL. R. (1997). Sex differences in posttraumatic stress disorder. Archives of General Psychiatry, 54, 1044–1048.
11.
BrewinC. R.HolmesE. A. (2003). Psychological theories of posttraumatic stress disorder. Clinical Psychology Review, 23, 339–376.
12.
BryantR. A. (2007). Does dissociation further our understanding of PTSD?Journal of Anxiety Disorders, 21, 183–191.
13.
CarlssonJ.SonneC.SiloveD. (2014). From pioneers to scientists: Challenges in establishing evidence-gathering models in torture and trauma mental health services for refugees. Journal of Nervous and Mental Disease, 202, 630–637.
14.
CieslakR.BenightC. C.RogalaA.SmoktunowiczE.KowalskaM.ZukowskaK.. . . LuszczynskaA. (2016). Effects of Internet-based self-efficacy intervention on secondary traumatic stress and secondary posttraumatic growth among health and human services professionals exposed to indirect trauma. Frontiers in Psychology, 7, 1009.
15.
CollinsP. Y.PatelV.JoestlS. S.MarchD.InselT. R.DaarA. S.. . . FairburnC. (2011). Grand challenges in global mental health. Nature, 475, 27–30.
16.
Drožd–ekB.WilsonJ. P.TurkovicS. (2013). Posttraumatic stress disorder (PTSD) and psychopathology in refugees: A reflective cross-cultural contextual view of mental health interventions. In Drožd–ekB. (Ed.), If you want to go fast go alone, if you want to go far go together. On context-sensitive group treatment of asylum seekers and refugees traumatized by war and terror (pp. 31–49). Enschede, The Netherlands: Ipskamp Drukkers.
17.
EhlersA.ClarkD. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319–345.
18.
FoaE. B.KozakM. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20–35.
19.
FoaE. B.RiggsD. S.MassieE. D.YarczowerM. (1995). The impact of fear activation and anger on the efficacy of exposure treatment for posttraumatic stress disorder. Behavior Therapy, 26, 487–499.
20.
FujitaK.TropeY.LibermanN.Levin-SagiM. (2006). Construal levels and self-control. Journal of Personality and Social Psychology, 90, 351–367.
21.
GeisingerK. F. (1994). Cross-cultural normative assessment: Translation and adaptation issues influencing the normative interpretation of assessment instruments. Psychological Assessment, 6, 304–312.
22.
GruberJ.HarveyA. G.JohnsonS. L. (2009). Reflective and ruminative processing of positive emotional memories in bipolar disorder and healthy controls. Behaviour Research and Therapy, 47, 697–704.
23.
HenrichJ.HeineS. J.NorenzayanA. (2010a). Most people are not WEIRD. Nature, 466, 29–29.
24.
HenrichJ.HeineS. J.NorenzayanA. (2010b). The weirdest people in the world?Behavioral and Brain Sciences, 33, 61–83.
25.
HintonD. E.Lewis-FernándezR. (2011). The cross-cultural validity of posttraumatic stress disorder: Implications for DSM-5. Depression & Anxiety, 28, 783–801. doi:10.1002/da.20753
26.
HintonD. E.NickersonA.BryantR. A. (2013). Prolonged grief in Cambodian refugees following genocide: Rebirth concerns and avoidance of reminders. Journal of Loss and Trauma, 18, 444–460.
27.
HollifieldM.WarnerT. D.LianN.KrakowB.JenkinsJ. H.KeslerJ.. . . WestermeyerJ. (2002). Measuring trauma and health status in refugees: A critical review. JAMA, 288, 611–621.
28.
HoobermanJ.RosenfeldB.RasmussenA.KellerA. (2010). Resilience in trauma-exposed refugees: The moderating effect of coping style on resilience variables. American Journal of Orthopsychiatry, 80, 557–563. doi:10.1111/j.1939-0025.2010.01060.x
29.
JobsonL.O’KearneyR. (2006). Cultural differences in autobiographical memory of trauma. Clinical Psychologist, 10, 89–98.
30.
KennyL. M.BryantR. A. (2007). Keeping memories at an arm’s length: Vantage point of trauma memories. Behaviour Research and Therapy, 45, 1915–1920.
31.
KrossE.AydukO. (2008). Facilitating adaptive emotional analysis: Distinguishing distanced-analysis of depressive experiences from immersed-analysis and distraction. Personality and Social Psychology Bulletin, 34, 924–938.
32.
KrossE.AydukO. (2009). Boundary conditions and buffering effects: Does depressive symptomology moderate the effectiveness of self-distancing for facilitating adaptive emotional analysis?Journal of Research in Personality, 43, 923–927.
33.
KrossE.AydukO.MischelW. (2005). When asking “why” does not hurt distinguishing rumination from reflective processing of negative emotions. Psychological Science, 16, 709–715.
34.
KrossE.GardD.DeldinP.CliftonJ.AydukO. (2012). “Asking why” from a distance: Its cognitive and emotional consequences for people with major depressive disorder. Journal of Abnormal Psychology, 121, 559–569.
35.
LilienfeldS. O. (2007). Psychological treatments that cause harm. Perspectives on Psychological Science, 2, 53–70.
36.
MarsellaA. J.FriedmanM. J.GerrityE. T.ScurfieldR. M. (1996). Ethnocultural aspects of PTSD: Some closing thoughts. In MarsellaA. J.FriedmanM. J.GerrityE. T.ScurfieldR. M. (Eds.), Ethnocultural aspects of posttraumatic stress disorder: Issues, research, and clinical applications (pp. 529–538). Washington, DC: American Psychological Association.
37.
MarshallR. D.TurnerJ. B.Lewis-FernandezR.KoenanK.NeriaY.DohrenwendB. P. (2006). Symptom patterns associated with chronic PTSD in male veterans: New findings from the National Vietnam Veterans Readjustment Study. Journal of Nervous and Mental Disease, 194, 275–278.
38.
MarxB. P.SloanD. M. (2002). The role of emotion in the psychological functioning of adult survivors of childhood sexual abuse. Behavior Therapy, 33, 563–577.
39.
MarxB. P.SloanD. M. (2005). Peritraumatic dissociation and experiential avoidance as predictors of posttraumatic stress symptomatology. Behaviour Research and Therapy, 43, 569–583.
40.
McCallG. J.ResickP. A. (2003). A pilot study of PTSD symptoms among Kalahari bushmen. Journal of Traumatic Stress, 16, 445–450.
41.
McIsaacH. K.EichE. (2004). Vantage point in traumatic memory. Psychological Science, 15, 248–253.
42.
McNallyR. J.BryantR. A.EhlersA. (2003). Does early psychological intervention promote recovery from posttraumatic stress?Psychological Science in the Public Interest, 4, 45–79.
43.
MichaelT.HalliganS. L.ClarkD. M.EhlersA. (2007). Rumination in posttraumatic stress disorder. Depression and Anxiety, 24, 307–317.
44.
MichalopoulosL. M.UnickG. J.HarozE. E.BassJ.MurrayL. K.BoltonP. A. (2015). Exploring the fit of Western PTSD models across three non-Western low- and middle-income countries. Traumatology, 21, 55–63.
45.
MollicaR. F.Caspi-YavinY.BolliniP.TruongT.TorS.LavelleJ. (1992). The Harvard Trauma Questionnaire: Validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. The Journal of Nervous and Mental Disease, 180, 111–116.
46.
MollicaR. F.Caspi-YavinY.LavelleJ.TorS.YangT.ChanS.. . .De MarneffeD. (1996). The Harvard Trauma Questionnaire (HTQ) Manual: Cambodian, Laotian, and Vietnamese versions. Torture Quarterly Journal on Rehabilitation of Torture Victims and Prevention of Torture, 6, 19–42.
47.
MurrayK. E.DavidsonG. R.SchweitzerR. D. (2010). Review of refugee mental health interventions following resettlement: Best practices and recommendations. American Journal of Orthopsychiatry, 80, 576–585.
48.
National Institute for Health and Clinical Excellence. (2005). Posttraumatic stress disorder: The management of PTSD in adults and children in primary and secondary care (National Clinical Practice Guideline 26). Leicester, England: Gaskell and the British Psychological Society.
49.
NickersonA.BryantR. A.SiloveD.SteelZ. (2011). A critical review of psychological treatments of posttraumatic stress disorder in refugees. Clinical Psychology Review, 31, 399–417.
50.
NickersonA.PriebeS.BryantR. A.MorinaN. (2014). Mechanisms of psychological distress following war in the former Yugoslavia: The role of interpersonal sensitivity. PLoS ONE, 9, e90503.
51.
NigroG.NeisserU. (1983). Point of view in personal memories. Cognitive Psychology, 15, 467–482.
52.
OgleC. M.SieglerI. C.BeckhamJ. C.RubinD. C. (2016). Neuroticism increases PTSD symptom severity by amplifying the emotionality, rehearsal, and centrality of trauma memories. Journal of Personality. Advance online publication. doi:10.1111/jopy.12278
53.
OlffM.LangelandW.DraijerN.GersonsB. P. (2007). Gender differences in posttraumatic stress disorder. Psychological Bulletin, 133, 183–204.
54.
PlumbJ. C.OrsilloS. M.LuterekJ. A. (2004). A preliminary test of the role of experiential avoidance in post-event functioning. Journal of Behavior Therapy and Experimental Psychiatry, 35, 245–257.
55.
PorterM.HaslamN. (2005). Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: A meta-analysis. JAMA, 294, 602–612.
56.
RasmussenA.KatoniB.KellerA. S.WilkinsonJ. (2011). Posttraumatic idioms of distress among Darfur refugees: Hozun and Majnun. Transcultural Psychiatry, 48, 392–415.
57.
RasmussenA.SmithH.KellerA. S. (2007). Factor structure of PTSD symptoms among west and central African refugees. Journal of Traumatic Stress, 20, 271–280.
58.
RayR. D.WilhelmF. H.GrossJ. J. (2008). All in the mind’s eye? Anger rumination and reappraisal. Journal of Personality and Social Psychology, 94, 133–145.
59.
RobertsonC. L.SavikK.Mathiason-MooreM.MohamedA.HoffmanS. (2016). Modeling psychological functioning in refugees. Journal of the American Psychiatric Nurses Association, 22, 225–232.
60.
RubinD. C.BoalsA.BerntsenD. (2008). Memory in posttraumatic stress disorder: Properties of voluntary and involuntary, traumatic and nontraumatic autobiographical memories in people with and without posttraumatic stress disorder symptoms. Journal of Experimental Psychology: General, 137, 591.
61.
RubinD. C.DennisM. F.BeckhamJ. C. (2011). Autobiographical memory for stressful events: The role of autobiographical memory in posttraumatic stress disorder. Consciousness and Cognition, 20, 840–856.
62.
ShafirR.SchwartzN.BlechertJ.SheppesG. (2015). Emotional intensity influences pre-implementation and implementation of distraction and reappraisal. Social Cognitive and Affective Neuroscience, 10, 1329–1337.
63.
SheppesG.BradyW. J.SamsonA. C. (2014). In (visual) search for a new distraction: The efficiency of a novel attentional deployment versus semantic meaning regulation strategies. Frontiers in Psychology, 5, 346.
64.
SheppesG.CatranE.MeiranN. (2009). Reappraisal (but not distraction) is going to make you sweat: Physiological evidence for self-control effort. International Journal of Psychophysiology, 71, 91–96.
65.
SilversJ. A.WeberJ.WagerT. D.OchsnerK. N. (2015). Bad and worse: Neural systems underlying reappraisal of high and low intensity negative emotions. Social Cognitive and Affective Neuroscience, 10, 172–179.
66.
SlobodinO.de JongJ. T. (2015). Mental health interventions for traumatized asylum seekers and refugees: What do we know about their efficacy?International Journal of Social Psychiatry, 61, 17–26.
67.
SmithR.FeldnerM.BadourC. (2011). Substance use to regulate affective experiences in posttraumatic stress disorder: A review of laboratory-based studies. Journal of Experimental Psychopathology, 2, 3–27.
68.
SteelZ.MomartinS.BatemanC.HafshejaniA.SiloveD. M.EversonN.. . . BlickB. (2004). Psychiatric status of asylum seeker families held for a protracted period in a remote detention centre in Australia. Australian and New Zealand Journal of Public Health, 28, 527–536.
69.
SummerfieldD. (1999). A critique of seven assumptions behind psychological trauma programmes in war-affected areas. Social Science & Medicine, 48, 1449–1462. doi:10.1016/S0277-9536(98)00450-X
70.
ThompsonB.WaltzJ. (2010). Mindfulness and experiential avoidance as predictors of posttraumatic stress disorder avoidance symptom severity. Journal of Anxiety Disorders, 24, 409–415.
71.
TullM. T.GratzK. L.SaltersK.RoemerL. (2004). The role of experiential avoidance in posttraumatic stress symptoms and symptoms of depression, anxiety, and somatization. Journal of Nervous and Mental Disease, 192, 754–761.
72.
United Nations High Commissioner for Refugees. (2016). Global trends: Forced displacement in 2015. Retrieved from http://www.unhcr.org/statistics
73.
WellsR.WellsD.LawsinC. (2015). Understanding psychological responses to trauma among refugees: The importance of measurement validity in cross-cultural settings. Journal and Proceedings of the Royal Society of New South Wales, 148, 60–69.
74.
WilliamsA. D.MouldsM. L. (2007). Cognitive avoidance of intrusive memories: Recall vantage perspective and associations with depression. Behaviour Research and Therapy, 45, 1141–1153.
75.
WiscoB. E.MarxB. P.SloanD. M.GormanK. R.KulishA. L.PinelesS. L. (2015). Self-distancing from trauma memories reduces physiological but not subjective emotional reactivity among veterans with posttraumatic stress disorder. Clinical Psychological Science, 3, 956–963.
76.
YoungP.GordonM. S. (2016). Mental health screening in immigration detention: A fresh look at Australian government data. Australasian Psychiatry, 24, 19–22.
77.
YuvalK.ZvielliA.BernsteinA. (2016). Attentional bias dynamics and posttraumatic stress in survivors of violent conflict and atrocities: New directions in clinical psychological science of refugee mental health. Clinical Psychological Science, 5, 64–73.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
