Feasibility of an adjunctive cognitive task in the treatment of posttraumatic stress disorder

Visuospatial cognitive tasks that influence memory reconsolidation may be of benefit in reducing intrusive memories for traumatic events when used as an adjunct to trauma-focused psychotherapy. We conducted a feasibility assessment of a protocol that involved the use of a visuospatial cognitive task, the Tetris intervention, alongside routine exposure-based treatment for posttraumatic stress disorder (PTSD). Participants were inpatients attending for PTSD treatment at a psychiatric hospital. The Tetris intervention was administered on three occasions when imaginal exposure had formed part of the treatment session. Using a phone app, participants also monitored intrusive memories over a 3-week period. Feasibility outcomes were fully met for the demand, implementation, practicality and adaptability criteria. Only a single criterion was not met for each of the acceptability and implementation criteria. Limited-efficacy testing outcomes are also discussed. Overall, the findings from our feasibility study indicated viability of the protocol, which involved implementation of the Tetris intervention alongside routine exposure-based treatment for PTSD, in a clinical inpatient setting.

Alptraumstörungen: Hilfe durch Imagery Rescripting und Imaginal Exposure

Alpträume können als Symptom einer posttraumatischen Belastungsstörung (PTBS), aber auch idiopathisch ohne traumatische Auslöser auftreten. Derzeit gibt es unterschiedliche Ansätze, um chronische Alptraumstörungen zu behandeln – in der Vergangenheit erwiesen sich sowohl das Imagery Rescritping (IR) als auch das Imaginal Exposure (IE) als wirksam. Bislang gibt es jedoch keine Studie, die beide Ansätze bezüglich ihrer Wirksamkeit vergleicht.

Modulation of Trust in Borderline Personality Disorder by Script-Based Imaginal Exposure to Betrayal

Interpersonal and trust-related difficulties are central features of Borderline Personality Disorder (BPD). In this study, we applied script-driven betrayal imagery to evoke mistrustful behavior in a social reinforcement learning task. We compared this approach to the standard confederate paradigm in twenty-one BPD and twenty healthy control (HC) participants. The script-driven imagery evoked transient negative affect and decreased trusting behavior in both groups. Across conditions, we also replicated previously reported between-group differences in affect and task behavior, results that support the validity of script-driven imagery as an alternative social task stimulus. This approach is appealing for eliminating deception, scaling easily, and evoking disorder-specific states of social difficulty.

Case Example 3

Exposure therapy is one of the treatment strategies identified as being effective in treating posttraumatic stress disorder. However, conducting exposure therapy with a survivor of sexual assault requires clinicians to be skilled in how to conduct imaginal exposure to ensure that the survivor includes sufficient detail for the exposure to be effective. This chapter contains a case example in which a clinician works with a client to begin imaginal exposure therapy for posttraumatic stress disorder secondary to a sexual assault. This chapter provides recommendations to help clinicians elicit more details about the sexual assault and encourage the client to use sexual terminology while recounting their memory of the traumatic event.

Imaginal exposure for chronic worry : the role of anxious arousal and imaginal sensory information

This study examined the effect of exposure script references to anxious physiological sensations and the five senses upon anxious arousal during a single 30-minute imaginal exposure. Forty-five high worriers were randomized to two conditions: Comprehensive (all reference types included) or Limited (only visual and auditory references included). Anxious arousal was measured via heart rate (HR), skin conductance level (SCL) and self-report. Both conditions exhibited increased arousal patterns from baseline. SCL did not significantly decrease in either condition during exposure. For self-reported anxiety, Comprehensive participants exhibited significant decreases throughout exposure; but Limited participants demonstrated significant increases. Comprehensive participants reported significantly greater anticipated ability to cope after exposure. Results are discussed in the context of emotional processing theory.

Imaginal exposure for chronic worry : the role of anxious arousal and imaginal sensory information

This study examined the effect of exposure script references to anxious physiological sensations and the five senses upon anxious arousal during a single 30-minute imaginal exposure. Forty-five high worriers were randomized to two conditions: Comprehensive (all reference types included) or Limited (only visual and auditory references included). Anxious arousal was measured via heart rate (HR), skin conductance level (SCL) and self-report. Both conditions exhibited increased arousal patterns from baseline. SCL did not significantly decrease in either condition during exposure. For self-reported anxiety, Comprehensive participants exhibited significant decreases throughout exposure; but Limited participants demonstrated significant increases. Comprehensive participants reported significantly greater anticipated ability to cope after exposure. Results are discussed in the context of emotional processing theory.