Memory-based psychological treatments for depression and posttraumatic stress disorder (PTSD)

 

Autobiographical memory and emotional disorder

Autobiographical memory refers to our recollection of events in our past. Disturbed patterns of autobiographical memory, particularly for emotional events, are a cardinal feature of affective disorders. These difficulties range from intrusive flashbacks of traumatic events such as war, accidents, or interpersonal violence, in sufferers of PTSD, to ruminations upon general negative autobiographical themes such as failure and worthlessness in depression. Such patterns not only define the mental lives of patients but drive the onset and maintenance of their problems. Consequently, clinical interventions that can target and reverse these maladaptive memory processes have enormous potential. One of our key research goals is therefore to elucidate the nature of autobiographical recollection in depression and PTSD, and to use these insights to refine and develop novel memory-focused treatments. Below are a couple of examples from this work.

Memory Specificity Training (MEST)

What are we investigating?

Patients with depression and PTSD find it relatively difficult to bring to mind specific, detailed auotbiographical memories of discrete emotional past events. Researc has shown that access to such memories is important in everyday mental life for problem-solving, social communication, emotional processing of distressing experiences, and future planning. Unsurprisingly then, reduced access to specific autobiographical memories disrupts day-to-day cognitive fucntioning and therefore plays a significant role in maintaining depression and in the onset of PTSD (Williams et al., 2007).

What are we doing?

These research findings suggest an elegantly simple clinical treatment for depression and PTSD  – training patients to become more specific in their emotional autobiographical recollection. Memory Specificity Training (MEST) is a 4-session group clinical intervention with precisely this aim. Patients undergoing MEST simply practice retrieving emotional and neutral specific memories to a variety of cues, both in session and at home.

What have we found?

We have conducted two clinical treatment trials of MEST. One for individuals with depression (Neshat-Doost et al., 2012) and one for individuals with PTSD. We found that MEST was successful in both cases in markedly reducing pateints’ symptoms and that the level of symptom improvement was directly related to how good they had become at retrieving specific memories.

Why is this important?

These findings are important for a number of resons. Firstly, the underline the importance for mental health of how we recollect autobiograhical memories. Secondly, MESt is a very straightforward treatment that is easy to deliver, and thus suitable for less experienced therapists, and cost-effective due to its group format. It is also suitbale for a rnage of clinical settings; for example our clinical trial with patients with PTSD was carried out in a shelter for refugees in a war zone.

 

Example references

Neshat-Doost, H.T., Dalgleish, T., Yule, W., Kalantari, M., Ahmadi, S.J., Dyregov, A., & Jobson, L. (2013). Enhancing autobiographical memory specificity through cognitive training: An intervention for depression translated from basic science. Clinical Psychological Science, 1, 84-92.

Williams, J.M.G. Barnhofer, T., Crane, C., Hermans, D., Raes, F., Watkins, E & Dalgleish, T. (2007). Autobiographical memory specificity and emotional disorder. Psychological Bulletin, 133, 122-148.

 

Trauma memories in young people with PTSD 

What are we investigating?

For sufferers of PTSD, difficulties with autobiographical remembering really focus on the trauma itself, in the form of intrusive distressing trauma memories and disjointed and confused voluntary recollection of the details of the traumatic event. These memory disturbances are often viewed by PTSD sufferers in unhelpful ways – for example, as signs of permanent mental damage and loss of cognitive control – when in fact they are very normal. Although much is understood about these processes in adults with PTSD, we know almost nothing about whether or how they operate in younger populations. For this reason, our research focus for the last 15 years, with collaborators at the Institute of Psychiatry in London and the University of Oxford, has been on trauma memories in children and adolescents. We have now reached the point where we have developed a trauma-memory based treatment for PTSD in these younger populations.

What are we doing?

Within a series of clinical trials we are comparing our memory-based treatment against usual NHS care for children of different ages who have been involved in traumas and have PTSD. Our first trial (Smith et al., 2007) showed that the treatment – trauma-focused cognitive behavior therapy (TF-CBT) – was much better at alleviating PTSD than usual NHS care in school aged children and adolescents whose PTSD was chronic (of more than 6 months duration). We are currently carrying out two further trials – one for school aged children with acute PTSD (in the first 6 months after their trauma), and another for very young children (aged 3-8 years).

Why is this important?

There are currently no standardised treatments for PTSD in children available in the UK NHS and so developing effective interventions is of vital importance for this hitherto neglected group of vulnerable individuals.

 

Example references

Dalgleish, T., Meiser-Stedman, R. & Smith, P. (2005). Cognitive aspects of posttraumatic stress reactions and their treatment in children and adolescents: An empirical review and some recommendations. Behavioural and Cognitive Psychotherapy, 33, 459-486.

Smith, P., Yule, W., Perrin, S., Tranah, T., Dalgleish, T. & Clark, D. (2007). Cognitive behavior therapy for PTSD in children and adolescents: a preliminary randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1051-1061.

Smith, P., Perrin, S., Dalgleish, T., Meiser-Stedman, R., Clark, D.M., & Yule, W. (2013). Treatment of PTSD in children and adolescents. Current Opinion in Psychiatry, 26, 66-72.