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Biomedical subjects

C R Brewin

Publications and source records attributed to C R Brewin.

At least 19 recordsLinked to original sources
PubMed2002

A comparison of flashbacks and ordinary autobiographical memories of trauma: cognitive resources and behavioural observations.

We investigated predictions derived from the dual representation theory of posttraumatic stress disorder, which proposes that flashbacks and ordinary memories of traumas are supported by different types of representation. Sixty-two participants, meeting DSM-IV diagnostic criteria for posttraumatic stress disorder, completed a detailed written trauma narrative, and afterwards identified those sections in the narrative that had been written in flashback and ordinary memory periods. Performance on cognitive tasks confirmed predictions that flashback periods would be associated with a specific decrement in visuospatial processing. Contrary to prediction, periods of both flashback and ordinary memory were associated with decrements on a verbal processing task. Independent observer ratings also confirmed that flashback periods were associated with increases in a wide range of autonomic and motor behaviours.

Adult↗
PubMed2002

Thought suppression, intelligence, and working memory capacity.

The importance of individual differences in intelligence and working memory capacity in predicting the ability to intentionally suppress thoughts was investigated. Sixty participants completed a thought suppression task, and measures of working memory capacity (OSPAN), fluid intelligence (Raven's Matrices), and crystallised intelligence (the National Adult Reading Test). As predicted, the results indicated that more effective thought suppression was independently related to higher working memory capacity and greater fluid intelligence, but was unrelated to crystallised intelligence. The findings have theoretical implications for understanding the mechanisms underlying a failure to inhibit unwanted intrusions and clinical implications for disorders involving high levels of intrusive thoughts and memories.

Adolescent↗
PubMed2001

A cognitive neuroscience account of posttraumatic stress disorder and its treatment.

Recent research in the areas of animal conditioning, the neural systems underlying emotion and memory, and the effect of fear on these systems is reviewed. This evidence points to an important distinction between hippocampally-dependent and non-hippocampally-dependent forms of memory that are differentially affected by extreme stress. The cognitive science perspective is related to a recent model of posttraumatic stress disorder, dual representation theory, that also posits separate memory systems underlying vivid reexperiencing versus ordinary autobiographical memories of trauma. This view is compared with other accounts in the literature of traumatic memory processes in PTSD, and the contrasting implications for therapy are discussed.

Animals↗
PubMed2001

A blind, randomized, controlled trial of cognitive-behavioural intervention for patients with recent onset rheumatoid arthritis: preventing psychological and physical morbidity.

This study examined the efficacy of a cognitive and behavioural intervention (CBT) for patients with recent onset, seropositive rheumatoid arthritis. Fifty-three participants with a diagnosis of classical or definite rheumatoid arthritis, who were seropositive and had less than 2 years of disease history were recruited into the trial. All participants received routine medical management during the study, although half were randomly allocated to receive an adjunctive psychological intervention. All pre- and post-treatment assessments were conducted blind to the allocation. Analyses were conducted of treatment completers and also by intention-to-treat. Significant differences were found between the groups at both post-treatment and 6-month follow-up in depressive symptoms. While the CBT group showed a reduction in depressive symptoms, the same symptoms increased in the Standard group. At outcome but not follow-up, the CBT group also showed reduction in C-reactive protein levels. However, the CBT group did show significant improvement in joint involvement at 6-month follow-up compared with the Standard group, indicating physical improvements above those achieved with standard care. These results indicate that cognitive-behavioural intervention offered as an adjunct to standard clinical management early in the course of RA is efficacious in producing reductions in both psychological and physical morbidity

Adaptation, Psychological↗
PubMed2001

Characteristics of handicap for patients with recent onset rheumatoid arthritis: the validity of the Disease Repercussion Profile.

OBJECTIVES: To investigate the applicability of the Disease Repercussion Profile (DRP) in the assessment of people with recently diagnosed rheumatoid arthritis. Previous research using this instrument has been confined to chronic samples. METHODS: Fifty-three patients with recent onset rheumatoid arthritis completed the DRP and other commonly used clinical outcome measures. RESULTS: The life areas of the DRP were highly interrelated, with the exception of finance. The total DRP score was associated with joint function, disability, subjective pain and coping, but was most highly associated with emotional disturbance, particularly depressive symptoms. No associations were found between measures of disease or demographic variables and DRP subscales. Activity was the area most often affected, with social life, emotions and appearance all more strongly endorsed than finances and relationships. However, whenever any of the areas was endorsed as affected, its impact was inevitably rated as very important. The pattern of self-perceived handicap was different from that reported in people with chronic arthritis. CONCLUSIONS: These results offer evidence that the DRP provides a valid measure of handicap for patients with early illness even with relatively low levels of disability. However, handicap in early rheumatoid arthritis may be more highly associated with psychological distress than in later stages of the illness.

Adaptation, Psychological↗
PubMed2001

The effect of dissociation at encoding on intrusive memories for a stressful film.

The occurrence of memory intrusions after a trauma has been linked to peri-traumatic dissociation. In this study, we attempted to induce dissociation experimentally and investigate the impact on intrusive memories. A total of 39 undergraduates were randomly assigned to watch a stressful film under standard conditions or under a dual-task condition in which they simultaneously performed a tapping task. They rated their distress post-film and again after 2 weeks, and kept a diary of intrusive memories. Contrary to prediction, there were no differences in levels of distress or explicit memory between the two conditions, and the dual-task condition was followed by significantly fewer memory intrusions. Dual-task conditions may not provide a good analogue to naturally occurring dissociation. The possible preventive effects of the tapping task are discussed in terms of the dual-representation theory of post-traumatic stress disorder.

Adaptation, Psychological↗
PubMed2000

Fear, helplessness, and horror in posttraumatic stress disorder: investigating DSM-IV criterion A2 in victims of violent crime.

A DSM-IV diagnosis of posttraumatic stress disorder (PTSD) required for the first time that individuals must report experiencing intense fear, helplessness, or horror at the time of the trauma. In a longitudinal study of 138 victims of violent crime, we investigated whether reports of intense trauma-related emotions characterized individuals who, after 6 months, met criteria for PTSD according to the DSM-III-R. We found that intense levels of all 3 emotions strongly predicted later PTSD. However, a small number of those who later met DSM-III-R or ICD criteria for PTSD did not report intense emotions at the time of the trauma. They did, however, report high levels of either anger with others or shame.

Adolescent↗
PubMed2000

Predicting PTSD symptoms in victims of violent crime: the role of shame, anger, and childhood abuse.

To examine the role of cognitive-affective appraisals and childhood abuse as predictors of crime-related posttraumatic stress disorder (PTSD) symptoms, 157 victims of violent crime were interviewed within 1 month post-crime and 6 months later. Measures within 1 month post-crime included previous physical and sexual abuse in childhood and responses to the current crime, including shame and anger with self and others. When all variables were considered together, shame and anger with others were the only independent predictors of PTSD symptoms at 1 month, and shame was the only independent predictor of PTSD symptoms at 6 months when 1-month symptoms were controlled. The results suggest that both shame and anger play an important role in the phenomenology of crime-related PTSD and that shame makes a contribution to the subsequent course of symptoms. The findings are also consistent with previous evidence for the role of shame as a mediator between childhood abuse and adult psychopathology.

Adolescent↗
PubMed2000

Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults.

Meta-analyses were conducted on 14 separate risk factors for posttraumatic stress disorder (PTSD), and the moderating effects of various sample and study characteristics, including civilian/military status, were examined. Three categories of risk factor emerged: Factors such as gender, age at trauma, and race that predicted PTSD in some populations but not in others; factors such as education, previous trauma, and general childhood adversity that predicted PTSD more consistently but to a varying extent according to the populations studied and the methods used; and factors such as psychiatric history, reported childhood abuse, and family psychiatric history that had more uniform predictive effects. Individually, the effect size of all the risk factors was modest, but factors operating during or after the trauma, such as trauma severity, lack of social support, and additional life stress, had somewhat stronger effects than pretrauma factors.

Acute Disease↗
PubMed2000

The London Depression Intervention Trial. Randomised controlled trial of antidepressants v. couple therapy in the treatment and maintenance of people with depression living with a partner: clinical outcome and costs.

BACKGROUND: Relapse of depression is associated with a criticising attitude of the patient's partner. AIMS: To compare the relative efficacy and cost of couple therapy and antidepressant drugs for the treatment and maintenance of people with depression living with a critical partner. METHOD: A randomised controlled trial of antidepressant drugs v. couple therapy. The subjects were 77 people meeting criteria for depression living with a critical partner. RESULTS: Drop-outs were 56.8% [corrected] from drug treatment and 15% from couple therapy. Subjects' depression improved in both groups, but couple therapy showed a significant advantage, according to the Beck Depression Inventory, both at the end of treatment and after a second year off treatment. Adding the costs of the interventions to the costs of services used showed there was no appreciable difference between the two treatments. CONCLUSIONS: For this group couple therapy is much more acceptable than antidepressant drugs and is at least as efficacious, if not more so, both in the treatment and maintenance phases. It is no more expensive overall.

Adult↗
PubMed2000

The timing, triggers and qualities of recovered memories in therapy.

OBJECTIVES: To report descriptive data on memory recovery of traumatic material including: degree of prior amnesia, triggers to recovery, qualities of the memory and length of time taken to recover different types of memory. DESIGN: British Psychological Society practitioners who reported having clients with recovered memories in a previous large-scale survey were contacted for an indepth interview. They each provided information on up to three such clients. METHODS: From telephone interviews with 108 therapists, we elicited 236 detailed accounts of clients recovering a traumatic memory. Interviews were semistructured with investigator-based ratings. RESULTS: The degree of amnesia varied widely according to therapists: some clients had prior total amnesia, others a prior vague sense or suspicion, and others prior partial memories. Time in therapy before first recall was longer for memories involving child sexual abuse than for memories of other traumas. The majority of the memories, but not all, were similar to those reported by patients with post-traumatic stress disorder: they were fragmented, accompanied by high levels of emotion, and experienced as a reliving of the original event. CONCLUSIONS: On the basis of current understanding of memory processes, several mechanisms may be needed to explain all the data, including disruptions to the encoding and retrieval of traumatic events and errors in the attribution of the source of specific memories. It will be important to confirm these findings by interviewing clients themselves.

Adult↗
PubMed2000

Emotional disclosure in school children.

Recent research with adults by Pennebaker and his colleagues has found that emotional disclosure through writing about stressful events appears to have significant benefits in terms of psychological and physical health outcomes. This report describes a controlled trial of emotional disclosure, adapted for school children, with the major hypothesis that the repeated description of negative events will have beneficial effects on measures of mental health, attendance, and school performance. The sample consisted of children aged 8-13 years from four schools, a primary and a secondary school both from a suburban and an inner-city area. Children were randomly assigned to one of three conditions: writing about negative events, writing about nonemotional events, and a non-writing control group. Children in all groups were seen four times during a single week and were then followed up after 2 months with measures of health and school performance. The intervention was well received by both schools and children, and the scripts written by the emotional and nonemotional writing groups differed in content in the predicted ways. Contrary to expectation, there was little evidence of a specific effect of emotional disclosure, and several possible reasons for this are discussed. Nevertheless, there was a general reduction in symptom measures, indicating that children may have benefited from their involvement in the study. Although there are several possible explanations for our findings, they indicate that it is both feasible and potentially valuable to give children opportunities to engage in discussion about sources of stress and their reactions to them.

Affect↗
PubMed1999

Intrusive memories in depression and posttraumatic stress disorder.

This study compared the stressors and consequent intrusive memories reported by matched samples of patients with posttraumatic stress disorder (PTSD) and major depression. Although intrusive memories were slightly more common among PTSD patients, both quantitative and qualitative measures revealed few differences between the groups. PTSD patients were more likely to have experienced personal illness or assault, and depressed patients family deaths and illness, and interpersonal events. Factor analysis of the associated emotions and memory characteristics suggested the existence of specific links between fear and reliving, and helplessness and out-of-body experiences. Possible inhibitory relationships between fear and sadness, and between guilt and anger, were also noted.

Adult↗
PubMed1999

A randomized controlled trial of individual psychological debriefing for victims of violent crime.

BACKGROUND: It has been suggested that giving people the opportunity talk about a traumatic experience may prevent the development of later disorder. We tested the efficacy of two brief interventions, education and psychological debriefing, designed to prevent adverse psychological reactions to criminal victimization. METHODS: Individuals who had been the victims of a violent crime within the past month were written to and invited to take part in a study of their attitudes to crime and punishment: 2161 were contacted and 243 replied, of whom 157 were eligible and were randomly assigned either to an education condition, to a psychological debriefing plus education condition, or to an assessment only condition. Education involved providing information about normal post-traumatic reactions. Debriefing involved in-depth probing about events, thoughts and feelings experienced during the crime. Subjects were recruited from police and hospital sources and interviewed in their own homes: 138 were followed up at 6 months, and 92 at 11 months. RESULTS: Outcome was assessed using a DSM-III-R diagnosis of PTSD, the Post-traumatic Symptom Scale, the Impact of Event Scale and the Beck Depression Inventory. All groups improved over time but there were no between-group differences. CONCLUSIONS: No evidence was found to support the efficacy of brief one-session interventions for preventing post-traumatic symptoms in individual victims of violent crime.

Adolescent↗
PubMed1999

Effects of mode of writing on emotional narratives.

The authors hypothesized that writing longhand about a stressful experience, compared to typing, arouses greater negative emotion. Eighty college students were randomly assigned to describe either a neutral or stressful topic by typing or writing longhand, in a 2 x 2 factorial design. Students describing the stressful topic, compared to the neutral topic, wrote for a longer period, used more words, and reported greater negative and less positive affect. Consistent with prediction, writing about a stressful experience longhand induced greater negative affect than typing, and led to more self-rated disclosure. These findings suggest a method whereby therapists can help patients control their levels of negative affect when producing a trauma narrative.

Adult↗
PubMed1999

Autobiographical memory processes and the course of depression.

The authors report a 6-month follow-up study of clinically depressed patients. At baseline, 2 indexes of autobiographical memory functioning were assessed: the presence of spontaneous intrusive memories of stressful life events and performance on the Autobiographical Memory Test (J. M. G. Williams & K. Broadbent, 1986), which measures overgeneral memory. The index of overgeneral memory was associated with greater levels of spontaneous intrusion of stressful memories. Overgeneral memory did not predict outcome, but depression at follow-up was predicted by the amount of intrusion and avoidance of stressful memories, even after controlling for initial severity of psychiatric symptoms.

Aged↗
PubMed1999

Acute stress disorder and posttraumatic stress disorder in victims of violent crime.

OBJECTIVE: In a group of crime victims recruited from the community, the authors investigated the ability of both a diagnosis of acute stress disorder and its component symptoms to predict posttraumatic stress disorder (PTSD) at 6 months. METHOD: A mixed-sex group of 157 victims of violent assaults were interviewed within 1 month of the crime. At 6-month follow-up 88% were reinterviewed by telephone and completed further assessments generating estimates of the prevalence of PTSD. RESULTS: The rate of acute stress disorder was 19%, and the rate of subsequent PTSD was 20%. Symptom clusters based on the DSM-IV criteria for acute stress disorder were moderately strongly interrelated. All symptom clusters predicted subsequent PTSD, but not as well as an overall diagnosis of acute stress disorder, which correctly classified 83% of the group. Similar predictive power could be achieved by classifying the group according to the presence or absence of at least three reexperiencing or arousal symptoms. Logistic regression indicated that both a diagnosis of acute stress disorder and high levels of reexperiencing or arousal symptoms made independent contributions to predicting PTSD. CONCLUSIONS: This exploratory study provides evidence for the internal coherence of the new acute stress disorder diagnosis and for the symptom thresholds proposed in DSM-IV. As predicted, acute stress disorder was a strong predictor of later PTSD, but similar predictive power may be possible by using simpler criteria.

Acute Disease↗