Biomedical subjects

Michelle L Moulds

Publications and source records attributed to Michelle L Moulds.

14 recordsLinked to original sources

PubMed2006

Cognitive avoidance of intrusive memories: recall vantage perspective and associations with depression.

Although recent research demonstrates that intrusive memories represent an overlapping cognitive feature of depression and post-traumatic stress disorder (PTSD), there is still a general paucity of research investigating the prevalence and maintenance of intrusive memories in depression. The current study investigated the association between a range of cognitive avoidant mechanisms that characterize PTSD samples (i.e., suppression, rumination, emotional detachment, and an observer vantage perspective) and intrusive memories of negative autobiographical events in relation to dysphoria. Hypotheses were based on the proposition that employment of these cognitive mechanisms would hinder the emotional processing of the negative event, thus contributing to the maintenance of intrusions. Results supported an association between negative intrusive memories, dysphoria, and avoidant mechanisms. Significant differences were also found between field and observer memories and measures of emotional detachment and rumination. Implications relating to intrusive memory maintenance and treatment approaches are discussed.

Adolescent↗

PubMed2006

The relationship between rumination, avoidance and depression in a non-clinical sample.

Recent commentaries have proposed conceptualizations of rumination in terms of both cognitive and behavioral avoidance. This study examined the relationship between rumination, avoidance and depression using a newly developed self-report measure of avoidance in depression, the Cognitive-Behavioral Avoidance Scale (CBAS) [Ottenbreit, N.D., & Dobson, K.S. (2004). Avoidance and depression: The construction of the cognitive-behavioral avoidance scale. Behaviour Research and Therapy, 42, 293-313]. A non-clinical sample (N=104) of undergraduate students completed self-report measures of depression, anxiety, rumination and avoidance. Rumination, avoidance and depression were all significantly correlated. Rumination and behavioral avoidance remained intercorrelated when anxiety was controlled, confirming an association that is independent of anxiety. By contrast, the relationship between cognitive avoidance and rumination disappeared when anxiety was partialled out. Notably, avoidance predicted unique variance in depression scores, over and above anxiety and rumination. Consistent with the proposal of Ottenbreit and Dobson [Avoidance and depression: The construction of the cognitive-behavioral avoidance scale. Behaviour Research and Therapy, 42, 293-313], our findings support the value of clinicians and psychopathologists giving consideration to avoidance in their conceptualization of depression.

Adaptation, Psychological↗

PubMed2006

The role of negative interpretations of intrusive memories in depression.

BACKGROUND: Recent investigations have shown that intrusive memories of negative past events, the hallmark symptom of posttraumatic stress disorder (PTSD), are also commonly experienced in depression. This study explored whether Ehlers and Steil's [Ehlers, A., Steil, R., 1995. Maintenance of intrusive memories in posttraumatic stress disorder: a cognitive approach. Behavioural and Cognitive Psychotherapy, 23, 217-249] model of PTSD maintenance, which focuses on the role played by negative interpretations of intrusive symptoms in the persistence of PTSD, also describes processes that operate in depression. METHODS: Eighty-four undergraduate students were interviewed to identify the presence of intrusive memories in the previous week. Participants who reported an intrusive memory were administered self-report questionnaires that indexed cognitive and affective responses to the memory. RESULTS: Negative interpretations of intrusive memories were significantly correlated with cognitive avoidance (particularly rumination) and depression severity, after controlling for intrusion frequency and severity of memory content. Negative meaning was the strongest predictor of depression, explaining variance over and above intrusion frequency. Ruminative responses to intrusions were highly correlated with depression. LIMITATIONS: The use of an unselected student sample. CONCLUSIONS: The demonstrated utility of Ehlers and Steil's [Ehlers, A., Steil, R., 1995. Maintenance of intrusive memories in posttraumatic stress disorder: A cognitive approach. Behavioural and Cognitive Psychotherapy, 23, 217-249] model of PTSD to account for one aspect of depression maintenance supports recent commentaries [Harvey, A.G., Watkins, E., Mansell, W., Shafran, R., 2004. Cognitive behavioural processes across psychological disorders: A transdiagnostic approach to research and treatment. New York: Oxford University Press] that call for a transdiagnostic approach to understanding the cognitive and behavioural processes that underpin psychological disorders.

Adolescent↗

PubMed2006

The effect of practice on recall of negative material in dysphoria.

BACKGROUND: Little is known of the impact of repeated retrieval of negative material on the content of what depressed individuals remember. On the premise that high dysphoric individuals possess: (i) a tendency to ruminate, and (ii) deficient inhibition of negative material, we hypothesized that they would demonstrate less inhibition of unpracticed and non-practiced negative material. METHODS: High and low dysphoric participants' memory for practiced, unpracticed and non-practiced negative and neutral words was tested with the retrieval-induced forgetting (RIF) paradigm. RESULTS: Across participants, RIF was observed for neutral words. In both groups, there was no difference between the recall of unpracticed and non-practiced negative words. LIMITATIONS: Use of a non-clinical sample. CONCLUSIONS: Findings are discussed in the context of methodological suggestions about how future studies could enhance the applicability of the RIF procedure to investigate the impact of ruminative rehearsal.

Adult↗

PubMed2005

Hypnotherapy and cognitive behaviour therapy of acute stress disorder: a 3-year follow-up.

The long-term benefits of cognitive behaviour therapy (CBT) for trauma survivors with acute stress disorder were investigated by assessing patients 3 years after treatment. Civilian trauma survivors (n=87) were randomly allocated to six sessions of CBT, CBT combined with hypnosis, or supportive counselling (SC), 69 completed treatment, and 53 were assessed 2 years post-treatment for post-traumatic stress disorder (PTSD) with the Clinician-Administered PTSD Scale. In terms of treatment completers, 2 CBT patients (10%), 4 CBT/hypnosis patients (22%), and 10 SC patients (63%) met PTSD criteria at 2-years follow-up. Intent-to-treat analyses indicated that 12 CBT patients (36%), 14 CBT/hypnosis patients (46%), and 16 SC patients (67%) met PTSD criteria at 2-year follow-up. Patients who received CBT and CBT/hypnosis reported less re-experiencing and less avoidance symptoms than patients who received SC. These findings point to the long-term benefits of early provision of CBT in the initial month after trauma.

Adolescent↗

PubMed2005

In vivo flooding for anxiety disorders: proposing its utility in the treatment posttraumatic stress disorder.

Exposure techniques have now been used in the treatment of anxiety disorders for several decades. Although such techniques are a dominant feature of current therapies for disorders such as posttraumatic stress disorder and acute stress disorder, examination of their relative merits has been less studied. The purpose of this review is to suggest the usefulness of in vivo flooding in the treatment of posttraumatic stress. We discuss the relevant exposure literature by briefly examining the efficacy of these techniques in the treatment of anxiety. The theoretical and methodological limitations of investigations to date of exposure methods that have been used in posttraumatic stress treatment studies are then reviewed. We highlight the fact that in vivo flooding, an exposure technique that has been used to treat some anxiety-based disorders, has received scant clinical and research attention as a treatment for posttraumatic stress. A case is made for further study of in vivo flooding in the treatment of posttraumatic stress.

Anxiety Disorders↗

PubMed2005

Physiological arousal and dissociation in acute trauma victims during trauma narratives.

The aim of the present study was to examine whether the finding of suppressed physiological activity in dissociative rape-trauma victims (Griffin, Resick, & Mechanic, 1997) was replicable in a nonsexual assault trauma group. A sample of 17 high-dissociating (HD) participants and 18 low-dissociating (LD) participants who had experienced a motor vehicle accident or physical assault described their trauma while skin conductance, heart rate activity, and self-reported mood were recorded. HD individuals demonstrated a trend for elevated heart rate during the experiment compared with LD participants, but both groups displayed comparable skin-conductance levels. Curve estimation analysis indicated that the two groups had a similar pattern of physiological responding during the trauma narratives. These findings challenge the notion that dissociative reactions are associated with reduced psychophysiological arousal after trauma.

Accidents, Traffic↗

PubMed2005

An investigation of retrieval inhibition in acute stress disorder.

Acute stress disorder is characterized by dissociative responses that are theorized to result in deficient encoding and retrieval of trauma-related material. This study examined retrieval inhibition using the list method of the directed forgetting paradigm in traumatized individuals with acute stress disorder (ASD; n = 14), no ASD (n = 14), and a nontraumatized control group (n = 15). Participants were presented with a list of intermixed positive, neutral, and trauma-related words. Instructions to forget that list and instead remember a second list were then given, and a new list presented. ASD participants exhibited poorer recall of to-be-forgotten trauma words than the non-ASD and control groups. The ASD group also demonstrated deficient recognition of to-be-remembered and to-be-forgotten positive words. Severity of acute posttraumatic stress response was associated with retrieval impairments. The cumulative findings suggest that ASD is associated with impoverished memory for trauma-related and positive material.

Accidents, Traffic↗

PubMed2005

The additive benefit of hypnosis and cognitive-behavioral therapy in treating acute stress disorder.

This research represents the first controlled treatment study of hypnosis and cognitive- behavioral therapy (CBT) of acute stress disorder (ASD). Civilian trauma survivors (N=87) who met criteria for ASD were randomly allocated to 6 sessions of CBT, CBT combined with hypnosis (CBT-hypnosis), or supportive counseling (SC). CBT comprised exposure, cognitive restructuring, and anxiety management. CBT-hypnosis comprised the CBT components with each imaginal exposure preceded by a hypnotic induction and suggestions to engage fully in the exposure. In terms of treatment completers (n=69), fewer participants in the CBT and CBT-hypnosis groups met criteria for posttraumatic stress disorder at posttreatment and 6-month follow-up than those in the SC group. CBT-hypnosis resulted in greater reduction in reexperiencing symptoms at posttreatment than CBT. These findings suggest that hypnosis may have use in facilitating the treatment effects of CBT for posttraumatic stress.

Adolescent↗

PubMed2003

Cognitive behaviour therapy of acute stress disorder: a four-year follow-up.

The aim of this study was to index the long-term benefits of early provision of cognitive behavior therapy to trauma survivors with acute stress disorder. Civilian trauma survivors (n = 80) with acute stress disorder were randomly allocated to either cognitive behavior therapy (CBT) or supportive counseling (SC) - 69 completed treatment, and 41 were assessed four years post-treatment for post-traumatic stress disorder (PTSD) with the Clinician Administered PTSD Scale. Two CBT patients (8%) and four SC patients (25%) met PTSD criteria at four-year follow-up. Patients who received CBT reported less intense PTSD symptoms, and particularly less frequent and less avoidance symptoms, than patients who received SC. These findings suggest that early provision of CBT in the initial month after trauma has long-term benefits for people who are at risk of developing PTSD.

Adult↗

PubMed2003

Acute psychophysiological arousal and posttraumatic stress disorder: a two-year prospective study.

This study investigated the role of acute arousal in the development of posttraumatic stress disorder (PTSD). Hospitalized motor vehicle accident survivors (n = 146) were assessed for acute stress disorder (ASD) within 1 month of the trauma, 6 months later, and reassessed for PTSD 2 years posttrauma (n = 87). Heart rates (HR) were assessed on the day of hospital discharge. Participants who had PTSD 2 years posttrauma had higher HR at hospital discharge than those without PTSD. A diagnosis of ASD or a resting HR of 95 beats per minute had moderate sensitivity (74%) and specificity (91%) in predicting PTSD. These findings suggest that caution is required in using acute HR as a predictor of longer-term PTSD following trauma.

Accidents, Traffic↗

PubMed2003

Imaginal exposure alone and imaginal exposure with cognitive restructuring in treatment of posttraumatic stress disorder.

This study investigated the extent to which providing cognitive restructuring (CR) with prolonged imaginal exposure (IE) would lead to greater symptom reduction than providing IE alone for participants with posttraumatic stress disorder (PTSD). Fifty-eight civilian survivors of trauma with PTSD were randomly allocated to IE/CR, IE, or supportive counseling (SC). Treatment involved 8 individual weekly sessions with considerable homework. Independent assessments were conducted pretreatment, posttreatment, and at 6-month follow-up. IE/CR and IE resulted in reduced PTSD and depression compared with SC at posttreatment and follow-up. Further, IE/CR participants had greater reductions in PTSD and maladaptive cognitive styles than IE participants at follow-up. These findings suggest that providing CR in combination with IE may enhance treatment gains.

Adolescent↗

PubMed2003

Hypnotizability and posttraumatic stress disorder: a prospective study.

Although there is converging evidence that posttraumatic stress disorder (PTSD) is associated with higher levels of hypnotizability, there are no studies concerning the stability of hypnotizability levels following trauma. Acutely traumatized participants with acute stress disorder (N = 45) were administered the Stanford Hypnotic Clinical Scale (SHCS) within 4 weeks of their trauma. Participants were subsequently administered a brief cognitive-behavior therapy program. Six months after treatment, participants were re-assessed with the SHCS. Although SHCS scores were generally stable (r = .47), two thirds of participants responded differently across the 2 assessments. Increased SHCS scores at the second assessment were correlated with elevated PTSD avoidance scores. This finding suggests that elevated hypnotizability in PTSD populations may not be entirely stable and may be associated with specific PTSD responses.

Adolescent↗

PubMed2002

Directed forgetting in acute stress disorder.

The rationale underpinning the diagnosis of acute stress disorder is that cognitive mechanisms result in avoidant processing of aversive experiences. This study investigated acutely traumatized participants with either acute stress disorder (ASD; n = 15) or no ASD (n = 14) and nontraumatized comparison participants (n = 16). Participants were administered intermixed presentations on a computer screen of positive, neutral, and trauma-related words that were followed by instructions to either remember or forget each word. On a subsequent recall test, ASD participants displayed poorer recall of to-be-forgotten trauma-related words than did non-ASD participants. Severity of psychopathology was negatively correlated with to-be-remembered positive words. These findings are consistent with the proposal that people who develop ASD display an aptitude for superior forgetting of aversive material.

Acute Disease↗