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Low levels of estradiol in women have been associated with impaired fear extinction recall, with suggestions this may promote the return of fear and heighten the female vulnerability for anxiety disorders. A particularly important measure for the return of fear is reinstatement, but no human studies to date have examined the impact of estradiol on fear reinstatement. Forty-two healthy females completed a differential fear conditioning, extinction and reinstatement task with skin conductance response (SCR) amplitude indexing level of conditioned fear. Saliva samples were taken to measure estradiol and progesterone. To examine fear reinstatement, SCR amplitude was compared between the last trial of the late extinction phase to the first re-extinction trial following the unsignaled presentation of two aversive electric shocks. No significant effects of estradiol were found for acquisition of fear conditioning or fear extinction learning. Lower estradiol predicted a significantly larger generalized SCR amplitude at re-extinction (post-reinstatement) in women. This provides novel evidence suggesting a protective role of estradiol in potentially reducing the relapse of fear following re-exposure to aversive stimuli, although further research is necessary in clinical populations to clarify this effect., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Cognitive models of posttraumatic stress disorder (PTSD) propose that overgeneralized beliefs involving lack of control are important to development and maintenance of the disorder. In the absence of a strong evidence base regarding controllability in PTSD, we examined whether PTSD was associated with increased sensitivity to alterations in controllability over stressful stimuli. Participants with (PTSD+, n = 113) and without (PTSD-, n = 115) symptoms were recruited from a crowdsourcing platform and randomized to receive either Controllable aversive noise, Uncontrollable aversive noise, or No noise before completing a subsequent aversive noise task in which all participants lost control over aversive noise. Participants then completed an avoidance task that assessed the delay between selecting and viewing a potentially distressing stimulus. PTSD+, but not PTSD-, participants who initially had control over an aversive noise but then lost the control were more avoidant of subsequent distress than those who either did not previously have control over the noise or was not exposed to the noise. Importantly, this pattern was evident in females but not males. These results highlight that people with PTSD are vulnerable to the adverse effects of losing control, and this can contribute to avoidance. The findings that this vulnerability is heightened in females may shed light on the greater risk of females to develop PTSD., Competing Interests: Declaration of competing interest No authors are declaring a conflict of interest., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Prolonged Grief (PG) is recognized as a potentially debilitating post-bereavement syndrome. Theoretical models of PG highlight the importance of both approach and avoidance behaviours in maintaining the syndrome. Research to date has focussed primarily on investigating avoidance in response to loss reminders. Comparatively few studies have indexed approach behaviours in PG. We use a quasi-experimental paradigm to simultaneously examine approach and avoidance behaviours to reminders of the deceased. Fifty-five bereaved individuals with and without PG responded to stimuli showing the deceased's name, an attachment figure's name, a neutral name, or a letter string, by pulling or pushing a joystick according to a whether the stimuli was a word or not. Concurrent visual feedback created the illusion that the images were either approaching or receding from the participant. Participants with PG were quicker to pull than push the three name stimuli, with quicker pulling of the deceased and attachment name than the neutral name. Non-PG participants responded more quickly to the attachment name but evidenced no relative approach or avoidance of any stimuli. Findings provide behavioural evidence about approach behaviour in PG, and are discussed with references to models that recognise the role of yearning for the deceased in PG., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Fear reinstatement is one of several paradigms designed to measure fear return following extinction, as a laboratory model for the relapse of Posttraumatic Stress Disorder (PTSD) symptoms. Sleep is a key factor in emotional memory consolidation, and here we examined the relationship between sleep quality and fear reinstatement in PTSD, relative to trauma-exposed and non-exposed controls. The Pittsburgh Sleep Quality Index (PSQI) was used as a subjective measure of sleep quality, and skin conductance responses (SCR) and unconditioned stimulus (US)-expectancy ratings were used to index threat responses during a differential fear conditioning, extinction, and reinstatement paradigm. There were no significant between-group differences in the reinstatement of conditioned responding. Sleep disturbance and sleep onset latency were significant moderators between reinstatement of fear and PTSD symptom severity, such that there was a positive relationship between PTSD symptoms and fear reinstatement for higher levels - but not lower levels - of sleep disturbance and sleep onset latency. To our knowledge, this is the first study to investigate PTSD-specific reinstatement patterns and sleep as a boundary condition of reinstatement. Future research using polysomnographic measures of sleep-wave architecture may further clarify the relationship between fear reinstatement and sleep quality in clinical samples with PTSD relative to controls., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Although peritraumatic dissociation predicts subsequent posttraumatic stress disorder (PTSD), little is understood about the mechanism of this relationship. This study examines the role of panic during trauma in the relationship between peritraumatic dissociation and subsequent PTSD. Randomized eligible admissions to 4 major trauma hospitals across Australia (n=244) were assessed during hospital admission and within one month of trauma exposure for panic, peritraumatic dissociation and PTSD symptoms, and subsequently re-assessed for PTSD three months after the initial assessment (n=208). Twenty (9.6%) patients met criteria for PTSD at 3-months post injury. Structural equation modeling supported the proposition that peritraumatic derealization (a subset of dissociation) mediated the effect of panic reactions during trauma and subsequent PTSD symptoms. The mediation model indicated that panic reactions are linked to severity of subsequent PTSD via derealization, indicating a significant indirect relationship. Whereas peritraumatic derealization is associated with chronic PTSD symptoms, this relationship is influenced by initial acute panic responses., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

This study investigated the relationship between autobiographical memory and goals in complicated grief (CG). Twenty-four individuals with CG and 21 bereaved individuals without CG completed an autobiographical memory task and a personal goals task. CG participants were more likely to recall memories related to their loss, particularly in response to negative cues. There was a positive relationship between the proportion of loss-related memories recalled and the proportion of grief-related goals held by individuals after controlling for symptom level. Individuals with CG also showed impaired retrieval of specific autobiographical memories in response to both positive and negative cues. These results suggest that CG is characterised by impaired and biased retrieval of specific autobiographical memories. These patterns are consistent with propositions stemming from the self-memory models of autobiographical memory., (2010 Elsevier Ltd. All rights reserved.)

There is increasing attention to the mechanisms underpinning maladaptive responses to bereavement. This study indexed self-defining memories in bereaved individuals with and without complicated grief (CG). Participants with and without complicated grief (N=40) were asked to describe three self-defining memories. Results showed that CG participants provided more self-defining memories involving the deceased. Both groups were equally likely to report their loved one's death as a self-defining moment, however, the no-CG group showed more evidence of benefit finding in their memory narratives and experienced less negative emotion on recall. The findings suggest that CG is associated with distinctive patterns of autobiographical memory that are linked to self-identity. The pattern is consistent with self-memory system models of autobiographical remembering, and suggests that grieving individuals who experience ongoing yearning for their loved one view their self-identity as more closely linked to the deceased are more distressed by memories involving the loss.

This study investigated the relationship between overgeneral autobiographical memory and social problem solving in posttraumatic stress disorder (PTSD). Civilian trauma survivors with and without PTSD (N=41) provided autobiographical memories of events in response to positive and negative cue words. Participants also completed the means-end problem-solving (MEPS) procedure. PTSD participants reported more overgeneral memories, regardless of cue valence, than non-PTSD participants. Individuals with PTSD also displayed poorer problem solving than those without PTSD. Overgeneral autobiographical memory was strongly associated with deficits in problem solving. This study suggests that deficient problem solving in PTSD is associated with impaired retrieval of specific autobiographical memories.

Although overgeneral retrieval of autobiographical memories has been repeatedly demonstrated in posttraumatic stress disorder (PTSD), no studies have indexed overgeneral retrieval before and after treatment of PTSD. Autobiographical memory was assessed in PTSD participants (n=20) prior to commencing cognitive behaviour therapy and 6 months after therapy completion. Fifteen participants completed both assessments. Improvement in PTSD symptoms was significantly associated with improved retrieval of specific memories and decreased retrieval of categoric memories in response to positive cues. These data suggest that symptom reduction during treatment of PTSD leads to greater access to specific memories of positive experiences.

Two studies investigated the effects of rumination on the retrieval of autobiographical memories in high-depressed and low-depressed individuals. Experiment 1 administered either a rumination or distraction task prior to a cued autobiographical memory task. High-depressed participants recalled more overgeneral memories following rumination relative to distraction, whereas experimental inductions did not influence low-depressed participants. Experiment 2 administered either a positive or negative rumination task prior to a cued autobiographical memory task. Negatively valenced rumination led high-depressed participants to recall more overgeneral memories than positively valenced rumination; this effect was not observed in low-depressed participants. These findings accord with the proposal that rumination is a mediating mechanism in the retrieval of overgeneral memories, and extends this proposal by indicating that negatively valenced ruminative content is particularly instrumental in inducing overgeneral retrieval.

This study investigated the predictors of posttraumatic stress disorder (PTSD) in children following a diagnosis of traumatic injury. Children (N=76) aged between 7 and 13 who were admitted to hospital following injury were assessed within a month of trauma for acute stress disorder (ASD), negative appraisals, as well as parental stress reactions. Children (N=62) were re-assessed 6-months later for PTSD and negative appraisals. The majority of the variance of chronic posttraumatic stress was accounted for by negative appraisals about future harm. This study supports cognitive models of PTSD, and suggests that younger children who exaggerate their vulnerability after trauma exposure are high risk for PTSD after trauma.

This study investigated the relationship between memory vantage point and avoidance following trauma. Sixty trauma survivors with differing levels of avoidance were interviewed about the vantage point of their memory for trauma, a positive memory, and a neutral memory. Avoidant individuals were more likely to remember their trauma from an observer perspective than individuals with a lower level of avoidance. Avoidance did not influence vantage point for positive or neutral memories. These data support the proposal that adoption of the observer vantage point for trauma memories may serve an avoidant function for people affected by trauma.

Although time distortion is commonly reported during a traumatic experience, there is little research addressing the phenomenon. This study investigated the role of affect in time perception in a very stressful experience by indexing novice tandem skydivers' (N=76) levels of fear and excitement before the skydive and soon after landing. Estimations of how long skydivers thought their experience lasted were obtained after landing. Whereas increased fear was associated with the perception of time passing slowly, increased excitement was associated with the perception of time passing quickly. These data support models of time perception based on avoidance and approach motivations influencing time distortion.

Ironic control theory proposes that suppressing thoughts leads to increased occurrence of the suppressed thought because monitoring for the unwanted thought leads to intrusions. This study investigated the influence of suppressing unwanted thoughts on dream content. One hundred participants who had high or low levels of tendency to suppress unwanted thoughts nominated an intrusive thought, and half of the participants were instructed to suppress that thought for 5 min prior to sleeping. Participants completed a dream diary upon waking, which was subsequently rated by independent raters for dream content. In terms of the 79 participants who reported dreaming, more high suppressors who were instructed to suppress dreamt about the intrusive thought than high suppressors in the control condition. There was no difference between low suppressors in the suppression and control conditions. These results suggest that dream content can be influenced by attempted suppression prior to sleep, and this is particularly apparent in people with a tendency to suppress unwanted thoughts.

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.

This study examined the prevalence of peritraumatic and persistent panic symptoms following trauma. Survivors of civilian trauma (n=30) with either acute stress disorder (ASD) or no acute stress disorder (non-ASD) were administered the Panic Module of the Structured Clinical Interview for DSM-IV (SCID). Participants also completed the Impact of Event Scale, Acute Stress Disorder Scale, Beck Depression Inventory, Beck Anxiety Inventory, and the Anxiety Sensitivity Index. Panic attacks were experienced by 77% of participants during their trauma, and 47% reported recurrent panic attacks post-trauma. ASD participants demonstrated more panic symptoms during and after their trauma than non-ASD participants. Posttraumatic panic was most strongly associated with anxiety sensitivity. These findings are discussed in terms of cognitive factors that may mediate posttrauma panic and treatment implications for managing posttraumatic anxiety. There is increasing evidence that panic attacks play a role in psychopathological response to trauma. A significant proportion of people with panic disorder report a history of trauma (). Moreover, two-thirds of trauma survivors report panic attacks within the previous 2 weeks (). There is also evidence that people with posttraumatic stress disorder (PTSD) display elevated levels of anxiety sensitivity (). Recent attention has focused on acute panic reactions because of proposals that panic during trauma may condition trauma-related cues to subsequent panic (). There is evidence that panic attacks occur in 53-90% of trauma survivors during the traumatic experience (). Further, people with acute stress disorder (ASD) are more likely to report peritraumatic panic attacks than non-ASD individuals. ASD is a useful framework in which to investigate the role of panic in posttraumatic stress because ASD describes acute responses to trauma that are strongly predictive of chronic PTSD (). This study investigated the relationship between peritraumatic panic and ongoing panic attacks following trauma. Specifically, we indexed panic attacks during trauma and subsequent to trauma in trauma survivors with and without ASD. We also indexed the extent to which distorted interpretations about somatic sensations may be associated with panic attacks following trauma. We considered that the strong evidence that maladaptive appraisals of somatic sensations mediate panic () is directly relevant to posttraumatic panic. We hypothesized that ASD participants would report more peritraumatic and persistent panic than non-ASD participants, and that this panic would be associated with dysfunctional interpretations about somatic stimuli.

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.

Peritraumatic dissociation describes alterations in awareness that occur during or immediately after a trauma. This study investigated a simulated form of peritraumatic dissociation by indexing the responses of skydivers (N=100) who were participating in their first skydive. Prior to jumping, participants completed the Beck anxiety inventory, the Tellegen absorption scale, and ratings of predictability and uncontrollability. Immediately after the jump, they completed the peritraumatic dissociative experiences questionnaire and the physical reactions scale. Responses indicated that the skydive elicited extreme anxiety, hyperarousal, and peritraumatic dissociation in a significant proportion of skydivers. Multiple regression analyses indicated that hyperarousal, and to a lesser extent anxiety, were strongly predictive of peritraumatic dissociative reactions. These results are discussed in terms of proposals that peritraumatic dissociation is mediated by hyperarousal.

This study investigated the role of panic symptoms that occur during trauma and subsequent acute stress disorder (ASD). Civilian trauma (N=51) survivors with either acute stress disorder (ASD), subclinical ASD, or no acute stress disorder (non-ASD) were administered the Acute Stress Disorder Scale, Impact of Event Scale, Beck Anxiety Inventory, Beck Depression Inventory, and the Anxiety Sensitivity Index (ASI). Participants also completed the Physical Reactions Scale to index panic symptoms that occurred during their trauma. Overall, 53% of participants reported panic attacks during their trauma. ASD and subclinical ASD participants reported more peritraumatic panic symptoms, and higher ASI scores, than non-ASD participants. These findings are consistent with the notion that peritraumatic panic may be related to subsequent posttraumatic stress, and suggest that modification of maladaptive beliefs about physical sensations should be addressed in posttraumatic therapy.

Cognitive bias was investigated in acutely traumatised civilians with either acute stress disorder (ASD; n = 26) or no ASD (n = 24). Participants completed the Acute Stress Disorder Interview, the Beck Depression Inventory, the Beck Anxiety Inventory (BAI), the Impact of Event Scale (IES), and an Event Probability Questionnaire and an Event Cost Questionnaire that comprised items pertaining to (a) external harm, (b) somatic sensations and (c) social events. ASD participants exaggerated both the probability of negative external harm, somatic and social events occurring, and the adverse cost of those events more than non-ASD participants. Elevated probability and cost estimates were predicted by BAI and IES-Avoidance scores, respectively. These findings are discussed in the context of different patterns observed in other anxiety disorders, and interpreted in terms of network theories of posttraumatic stress.

Intrusive trauma-related thoughts and the means to manage them are a central dynamic in posttraumatic stress. Thought control strategies were investigated in survivors of motor vehicle accidents with either acute stress disorder (ASD; n = 20) or no ASD (n = 20). Participants completed the Acute Stress Disorder Interview, the Beck Depression Inventory, the Beck Anxiety Inventory, the Impact of Event Scale, and the Thought Control Questionnaire (TCQ) within four weeks of their accident. Although distraction, social control, and reappraisal were the most common strategies in both groups, ASD participants engaged in punishment and worry more than non-ASD participants. Worry and punishment were also strongly associated with severity of intrusive, avoidance, arousal, and depressive symptoms. Findings are discussed in terms of the role of cognitive strategies in resolving posttraumatic stress.

Cognitive bias was investigated in survivors of motor vehicle accidents with either acute stress disorder (ASD; n = 17) or no ASD (n = 17). Participants completed the acute stress disorder interview, the Beck depression inventory, the Beck anxiety inventory, the impact of event scale, and a probability questionnaire (PQ) and a cost questionnaire (CQ) within four weeks of their accident. ASD participants exaggerated both the probability of negative events occurring, and the adverse cost of those events more than non-ASD participants. IES-Avoidance scores were the only significant predictors of both PQ and CQ scores. Findings are discussed in terms of the role of cognitive errors in posttraumatic adjustment.

Thought control was investigated in participants (N = 72) who were shown either a violent, humorous or neutral film and then administered either suppression or nonsuppression instructions. Following the presentation of a three minute segment from one film, participants monitored their thoughts for two 3-minute periods. In Period 1, participants were administered suppression or nonsuppression instructions relating to thoughts of the film. In Period 2, participants were instructed to think about anything. During both periods participants were instructed to press a response button if they had a trauma-related thought. Participants who viewed the violent film gave higher ratings of distress and lower pleasantness ratings than those who viewed the humorous and neutral films. Participants who were given suppression instructions demonstrated a delayed increase in trauma-related thoughts in the period subsequent to suppression across the valence conditions.

Attempted suppression of traumatic memories was investigated in survivors of motor vehicle accidents with acute stress disorder (ASD; n = 24) and without ASD (n = 24). Participants monitored their trauma-related thoughts for three 5-minute periods. In Period 1, participants were instructed to think about anything. For Period 2, participants were administered suppression or non-suppression instructions relating to thoughts of the trauma. In Period 3, participants were again instructed to think about anything. ASD participants reported higher ratings of anxiety, frequency of trauma-related thoughts, and attempted suppression of trauma-related thoughts than non-ASD participants. Participants who were given suppression instructions demonstrated a delayed increase in trauma-related thoughts in the period subsequent to suppression.

Predictors of post-traumatic intrusive symptomatology were studied in 56 motor vehicle accident (MVA) survivors 12 months after their MVA. Measures were obtained on Ss' subjective response to the trauma, objective indices of injury severity, coping response (Coping Style Questionnaire), and post-traumatic stress (Impact of Event Scale; IES). Significant levels of intrusive and avoidance symptomatology were reported by 20% of MVA survivors. An avoidant coping style and compensation accounted for 41% of variance of IES-Intrusion scores. Findings are discussed in terms of the role of avoidance behaviour in post-traumatic adjustment.