Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-24T02:22:09.642Z Has data issue: false hasContentIssue false

Cognitive distortions in an acutely traumatized sample: an investigation of predictive power and neural correlates

Published online by Cambridge University Press:  04 March 2011

J. K. Daniels
Affiliation:
Department of Psychiatry, The University of Western Ontario, London, Ontario, Canada Department of Psychiatry, Division of Mind and Brain Research, Universitaetsklinik Charité, Berlin, Germany
K. Hegadoren
Affiliation:
Faculty of Nursing, The University of Alberta, Edmonton, Alberta, Canada
N. J. Coupland
Affiliation:
Department of Psychiatry, The University of Alberta, Edmonton, Alberta, Canada
B. H. Rowe
Affiliation:
Department of Emergency Medicine and School of Public Health, The University of Alberta, Edmonton, Alberta, Canada
R. W. J. Neufeld
Affiliation:
Department of Psychology, The University of Western Ontario, London, Ontario, Canada
R. A. Lanius*
Affiliation:
Department of Psychiatry, The University of Western Ontario, London, Ontario, Canada
*
*Address for correspondence: R. A. Lanius, M.D., Ph.D., Department of Psychiatry, The University of Western Ontario, 339 Windermere Road, University Hospital, London, Ontario N6A 2A2, Canada. (Email: [email protected])

Abstract

Background

Current theories of post-traumatic stress disorder (PTSD) place considerable emphasis on the role cognitive distortions such as self-blame, hopelessness or preoccupation with danger play in the etiology and maintenance of the disorder. Previous studies have shown that cognitive distortions in the early aftermath of traumatic events can predict future PTSD severity but, to date, no studies have investigated the neural correlates of this association.

Method

We conducted a prospective study with 106 acutely traumatized subjects, assessing symptom severity at three time points within the first 3 months post-trauma. A subsample of 20 subjects additionally underwent a functional 4-T magnetic resonance imaging (MRI) scan at 2 to 4 months post-trauma.

Results

Cognitive distortions proved to be a significant predictor of concurrent symptom severity in addition to diagnostic status, but did not predict future symptom severity or diagnostic status over and above the initial symptom severity. Cognitive distortions were correlated with blood oxygen level-dependent (BOLD) signal strength in brain regions previously implicated in visual processing, imagery and autobiographic memory recall. Intrusion characteristics accounted for most of these correlations.

Conclusions

This investigation revealed significant predictive value of cognitive distortions concerning concurrent PTSD severity and also established a significant relationship between cognitive distortions and neural activations during trauma recall in an acutely traumatized sample. These data indicate a direct link between the extent of cognitive distortions and the intrusive nature of trauma memories.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Addis, DR, Wong, AT, Schacter, DL (2007). Remembering the past and imagining the future: common and distinct neural substrates during event construction and elaboration. Neuropsychologia 45, 13631377.CrossRefGoogle ScholarPubMed
Beck, JG, Coffey, SF, Palyo, SA, Gudmundsdottir, B, Miller, LM, Colder, CR (2004). Psychometric properties of the Posttraumatic Cognitions Inventory (PTCI): a replication with motor vehicle accident survivors. Psychological Assessment 16, 289298.CrossRefGoogle ScholarPubMed
Blake, DD, Weathers, FW, Nagy, LM, Kaloupek, DG, Gusman, FD, Charney, DS, Keane, TM (1995). The development of a Clinician-Administered PTSD Scale. Journal of Traumatic Stress 8, 7590.Google ScholarPubMed
Brewin, CR, Gregory, JD, Lipton, M, Burgess, N (2010). Intrusive images in psychological disorders: characteristics, neural mechanisms, and treatment implications. Psychology Review 117, 210232.CrossRefGoogle ScholarPubMed
Briere, J (2000). Cognitive Distortions Scales – Professional Manual. Psychological Assessment Resources: Lutz.Google Scholar
Bryant, RA, Moulds, ML, Guthrie, RM (2000). Acute Stress Disorder Scale: a self-report measure of acute stress disorder. Psychological Assessment 12, 6168.CrossRefGoogle Scholar
Butler, T, Pan, H, Tuescher, O, Engelien, A, Goldstein, M, Epstein, J, Weisholtz, D, Root, JC, Protopopescu, X, Cunningham-Bussel, AC, Chang, L, Xie, XH, Chen, Q, Phelps, EA, Ledoux, JE, Stern, E, Silbersweig, DA (2007). Human fear-related motor neurocircuitry. Neuroscience 150, 17.CrossRefGoogle ScholarPubMed
Dunmore, E, Clark, DM, Ehlers, A (2001). A prospective investigation of the role of cognitive factors in persistent posttraumatic stress disorder (PTSD) after physical or sexual assault. Behaviour Research and Therapy 39, 10631084.CrossRefGoogle ScholarPubMed
Ehlers, A, Clark, DM (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy 38, 319345.CrossRefGoogle ScholarPubMed
Ehlers, A, Clark, DM, Hackmann, A, McManus, F, Fennell, M (2005). Cognitive therapy for post-traumatic stress disorder: development and evaluation. Behaviour Research and Therapy 43, 413431.CrossRefGoogle ScholarPubMed
Ehlers, A, Mayou, RA, Bryant, B (1998). Psychological predictors of chronic posttraumatic stress disorder after motor vehicle accidents. Journal of Abnormal Psychology 107, 508519.CrossRefGoogle ScholarPubMed
Ehlers, A, Suendermann, O, Boellinghaus, I, Vossbeck-Elsebusch, A, Gamer, M, Briddon, E, Martin, M, Glucksman, E (2010). Heart rate responses to standardized trauma-related pictures in acute posttraumatic stress disorder. International Journal of Psychophysiology 78, 2734.CrossRefGoogle ScholarPubMed
Ehring, T, Ehlers, A, Glucksman, E (2008). Do cognitive models help in predicting the severity of posttraumatic stress disorder, phobia, and depression after motor vehicle accidents? A prospective longitudinal study. Journal of Consulting and Clinical Psychology 76, 219230.CrossRefGoogle ScholarPubMed
Elsesser, K, Freyth, C, Lohrmann, T, Sartory, G (2009). Dysfunctional cognitive appraisal and psychophysiological reactivity in acute stress disorder. Journal of Anxiety Disorders 23, 979985.CrossRefGoogle ScholarPubMed
Foa, EB, Ehlers, A, Clark, DM, Tolin, DF, Orsillo, SM (1999). The posttraumatic cognitions inventory (PTCI): development and validation. Psychological Assessment 11, 303314.CrossRefGoogle Scholar
Foa, EB, Rauch, SA (2004). Cognitive changes during prolonged exposure versus prolonged exposure plus cognitive restructuring in female assault survivors with posttraumatic stress disorder. Journal of Consulting and Clinical Psychology 72, 879884.CrossRefGoogle ScholarPubMed
Foa, EB, Rothbaum, BO (1998). Treating the Trauma of Rape: Cognitive-Behavioral Therapy for PTSD. Guilford Press: New York.Google Scholar
Gerardin, E, Sirigu, A, Lehericy, S, Poline, JB, Gaymard, B, Marsault, C, Agid, Y, Le Bihan, D (2000). Partially overlapping neural networks for real and imagined hand movements. Cerebral Cortex 10, 10931104.CrossRefGoogle ScholarPubMed
Gilboa, A, Winocur, G, Grady, CL, Hevenor, SJ, Moscovitch, M (2004). Remembering our past: functional neuroanatomy of recollection of recent and very remote personal events. Cerebral Cortex 14, 12141225.CrossRefGoogle ScholarPubMed
Guillot, A, Collet, C, Nguyen, VA, Malouin, F, Richards, C, Doyon, J (2009). Brain activity during visual versus kinesthetic imagery: an fMRI study. Human Brain Mapping 30, 21572172.CrossRefGoogle ScholarPubMed
Hasnain, MK, Fox, PT, Woldorff, MG (1998). Intersubject variability of functional areas in the human visual cortex. Human Brain Mapping 6, 301315.3.0.CO;2-7>CrossRefGoogle ScholarPubMed
Hopper, JW, Frewen, PA, Sack, M, Lanius, RA, van der Kolk, BA (2007). The Responses to Script-Driven Imagery Scale (RSDI): assessment of state posttraumatic symptoms for psychobiological and treatment research. Journal of Psychopathology and Behavioral Assessment 29, 249268.CrossRefGoogle Scholar
Karl, A, Rabe, S, Zollner, T, Maercker, A, Stopa, L (2009). Negative self-appraisals in treatment-seeking survivors of motor vehicle accidents. Journal of Anxiety Disorders 23, 775781.CrossRefGoogle ScholarPubMed
Kessler, RC, Sonnega, A, Bromet, E, Hughes, M, Nelson, CB (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry 52, 10481060.CrossRefGoogle ScholarPubMed
Kleim, B, Ehlers, A, Glucksman, E (2007). Early predictors of chronic post-traumatic stress disorder in assault survivors. Psychological Medicine 37, 14571467.CrossRefGoogle ScholarPubMed
Lane, RD, Reiman, EM, Bradley, MM, Lang, PJ, Ahern, GL, Davidson, RJ, Schwartz, GE (1997). Neuroanatomical correlates of pleasant and unpleasant emotion. Neuropsychologia 35, 14371444.CrossRefGoogle ScholarPubMed
Lanius, RA, Hopper, JW, Menon, RS (2003). Individual differences in a husband and wife who developed PTSD after a motor vehicle accident: a functional MRI case study. American Journal of Psychiatry 160, 667669.CrossRefGoogle Scholar
Lanius, RA, Williamson, PC, Boksman, K, Densmore, M, Gupta, M, Neufeld, RW, Gati, JS, Menon, RS (2002). Brain activation during script-driven imagery induced dissociative responses in PTSD: a functional magnetic resonance imaging investigation. Biological Psychiatry 52, 305311.CrossRefGoogle ScholarPubMed
Lanius, RA, Williamson, PC, Densmore, M, Boksman, K, Gupta, MA, Neufeld, RW, Gati, JS, Menon, RS (2001). Neural correlates of traumatic memories in posttraumatic stress disorder: a functional MRI investigation. American Journal of Psychiatry 158, 19201922.CrossRefGoogle ScholarPubMed
Lanius, RA, Williamson, PC, Densmore, M, Boksman, K, Neufeld, RW, Gati, JS, Menon, RS (2004). The nature of traumatic memories: a 4-T fMRI functional connectivity analysis. American Journal of Psychiatry 161, 3644.CrossRefGoogle ScholarPubMed
McCann, IL, Pearlman, LA (1990). Psychological Trauma and the Adult Survivor: Theory, Therapy, and Transformation. Brunner/Mazel: New York.Google Scholar
Michael, T, Ehlers, A, Halligan, SL, Clark, DM (2005). Unwanted memories of assault: what intrusion characteristics are associated with PTSD? Behaviour Research and Therapy 43, 613628.CrossRefGoogle ScholarPubMed
Moser, JS, Hajcak, G, Simons, RF, Foa, EB (2007). Posttraumatic stress disorder symptoms in trauma-exposed college students: the role of trauma-related cognitions, gender, and negative affect. Journal of Anxiety Disorders 21, 10391049.CrossRefGoogle ScholarPubMed
Munzert, J, Zentgraf, K, Stark, R, Vaitl, D (2008). Neural activation in cognitive motor processes: comparing motor imagery and observation of gymnastic movements. Experimental Brain Research 188, 437444.CrossRefGoogle ScholarPubMed
O'Donnell, ML, Elliott, P, Wolfgang, BJ, Creamer, M (2007). Posttraumatic appraisals in the development and persistence of posttraumatic stress symptoms. Journal of Traumatic Stress 20, 173182.CrossRefGoogle ScholarPubMed
Perkonigg, A, Kessler, RC, Storz, S, Wittchen, H-U (2000). Traumatic events and post-traumatic stress disorder in the community: prevalence, risk factors and comorbidity. Acta Psychiatrica Scandinavica 101, 4659.CrossRefGoogle ScholarPubMed
Phillips, ML, Young, AW, Scott, SK, Calder, AJ, Andrew, C, Giampietro, V, Williams, SC, Bullmore, ET, Brammer, M, Gray, JA (1998). Neural responses to facial and vocal expressions of fear and disgust. Proceedings of the Royal Society B: Biological Sciences 265, 18091817.CrossRefGoogle ScholarPubMed
Piefke, M, Weiss, PH, Markowitsch, HJ, Fink, GR (2005). Gender differences in the functional neuroanatomy of emotional episodic autobiographical memory. Human Brain Mapping 24, 313324.CrossRefGoogle ScholarPubMed
Piefke, M, Weiss, PH, Zilles, K, Markowitsch, HJ, Fink, GR (2003). Differential remoteness and emotional tone modulate the neural correlates of autobiographical memory. Brain 126, 650668.CrossRefGoogle ScholarPubMed
Resick, PA, Schnicke, MK (1992). Cognitive processing therapy for sexual assault victims. Journal of Consulting and Clinical Psychology 60, 748756.CrossRefGoogle ScholarPubMed
Schnell, K, Herpertz, SC (2007). Effects of dialectic-behavioral-therapy on the neural correlates of affective hyperarousal in borderline personality disorder. Journal of Psychiatric Research 41, 837847.CrossRefGoogle ScholarPubMed
Shin, LM, McNally, RJ, Kosslyn, SM, Thompson, WL, Rauch, SL, Alpert, NM, Metzger, LJ, Lasko, NB, Orr, SP, Pitman, RK (1999). Regional cerebral blood flow during script-driven imagery in childhood sexual abuse-related PTSD: a PET investigation. American Journal of Psychiatry 156, 575584.CrossRefGoogle ScholarPubMed
Szameitat, AJ, Shen, S, Sterr, A (2007). Effector-dependent activity in the left dorsal premotor cortex in motor imagery. European Journal of Neuroscience 26, 33033308.CrossRefGoogle ScholarPubMed
van der Kolk, B, Fisler, R (1995). Dissociation and the fragmentary nature of traumatic memories: overview and exploratory study. Journal of Traumatic Stress 8, 505525.CrossRefGoogle ScholarPubMed
Watson, D, Clark, LA (1991). The Mood and Anxiety Symptom Questionnaire. University of Iowa: Iowa City.Google Scholar
Williams, LM, Phillips, ML, Brammer, MJ, Skerrett, D, Lagopoulos, J, Rennie, C, Bahramali, H, Olivieri, G, David, AS, Peduto, A, Gordon, E (2001). Arousal dissociates amygdala and hippocampal fear responses: evidence from simultaneous fMRI and skin conductance recording. NeuroImage 14, 10701079.CrossRefGoogle ScholarPubMed
Yoo, SS, Freeman, DK, McCarthy, JJ 3rd, Jolesz, FA (2003). Neural substrates of tactile imagery: a functional MRI study. Neuroreport 14, 581585.CrossRefGoogle ScholarPubMed