How Expectations Shape the Formation of Intrusive Memories: An Experimental Study Using the Trauma Film Paradigm

Abstract

Background Although intrusions are the hallmark symptom of posttraumatic stress disorder, there is still limited knowledge about the processes that contribute to the development of intrusions. Here, we used the well-established trauma film paradigm (TFP) to investigate how expectations about the intensity and controllability of intrusions influence their occurrence. Methods 90 healthy participants underwent the TFP before they were randomized to one of three conditions manipulating their expectations about intrusions: positive expectations group; negative expectations group; control group. The primary outcome was the frequency and severity of intrusive memories as assessed with an intrusion diary over seven days. Results The TFP was well implemented, as indicated by significant post-film anxiety and a substantial number of intrusions reported for the subsequent week. The three groups did not differ in their expectations about intrusions and, relatedly, in their experience of intrusions. A mediation analysis revealed that the influence of post-film anxiety on intrusive memories was fully mediated by expectations. Conclusions Despite the failure of the expectation manipulation, the results of the mediation analysis support the hypothesis that post-film expectations influence the formation of intrusive memories, suggesting that intrusions may result from maladaptive dynamics between emotional and cognitive processes following trauma(like) experiences.

The relationship between multiple traumatic events and the severity of posttraumatic stress disorder symptoms – evidence for a cognitive link

“…Specifically, our findings indicate that the relationship between dysfunctional general cognitions and PTSD symptoms is (partially) mediated through dysfunctional situational expectations and both types of cognitions are the link through which multiple traumatic events are associated with PTSD symptoms. The importance of situational expectations as highlighted in the present research is in line with recent predictive processing approaches to PTSD (Kube et al, 2020 ; Linson & Friston, 2019 ; Wilkinson et al, 2017 ) and with evidence from experimental work, showing that negative expectations about the occurrence of intrusive memories increase their likelihood of occurrence (Herzog et al, 2022 ; Kube et al, 2022 ).…”

“…For instance, recent research has shown that negative expectations about the frequency and severity of intrusive memories (i.e. involuntary distressing thoughts or mental images in relation to traumatic events) influence the actual occurrence of intrusions (Herzog et al, 2022 ; Kube et al, 2022 ).…”

Assessing Dysfunctional Expectations in Posttraumatic Stress Disorder: Development and Validation of the Posttraumatic Expectations Scale (PTES)

“…Although meta-analyses and systematic reviews of randomized-controlled trials (RCTs; Bisson et al, 2007; Cusack et al, 2016; Ehlers et al, 2010) and practice-based studies (Herzog et al, 2022) indicate the general efficacy of psychotherapy (especially individual trauma-focused CBT in PTSD patients with moderate to large effect sizes across various settings, non-response rates and dropout rates are relatively high (Bradley et al, 2005; Schottenbauer et al, 2008). Therefore, there is space for optimizing the effects of psychotherapy in the treatment of PTSD.…”

“…Hence, they shape perception toward the continued experience of threat, much like a self-fulfilling prophecy (Kube et al, 2020; Linson & Friston, 2019). Indeed, findings of an empirical study using the trauma film paradigm suggest that expectations might play an important role in the development of intrusive memories (Herzog et al, 2022)—the hallmark symptom of PTSD (Brewin, 2015; Iyadurai et al, 2019; Yehuda et al, 2015).…”

Negative expectations regarding interpersonal interactions in daily life are associated with subclinical depressive symptoms in a student sample: A prospective experience sampling study

“…Situation-specific expectations have been studied in different contexts, such as expectations about one's performance in a task (Kube et al, 2019b), the ability to regulate emotions (Kube et al, 2017), or the intensity and controllability of intrusions (Herzog et al, 2022). Expectations that received very limited empirical attention so far (D'Astolfo et al, 2020) are situation-specific expectations about interpersonal interactions.…”