Attempting suppression of traumatic memories over extended periods in acute stress disorder

doi:10.1016/S0005-7967(99)00120-5

Behaviour Research and Therapy

Volume 38, Issue 9, 1 September 2000, Pages 899-907

https://doi.org/10.1016/S0005-7967(99)00120-5 Get rights and content

Abstract

This study investigated the influence of attempted suppression and thought control strategies on traumatic memories. Survivors of civilian trauma with acute stress disorder (ASD; n=20) and without ASD (n=20) monitored their trauma-related thoughts for three 24-h periods. In period 1, participants were instructed to think about anything. In period 2, participants were administered suppression or nonsuppression instructions relating to thoughts of the trauma. In period 3, participants were again instructed to think about anything. The results revealed no evidence for an increase in trauma-related thoughts following suppression instructions. Punishment and worry thought control strategies correlated significantly with both anxiety and suppression ratings. Frequency of intrusions was associated with a distraction cognitive strategy. These findings point to the importance of traumatised individuals' cognitive strategies in mediating the management and occurrence of posttraumatic intrusions.

Introduction

The thought suppression paradigm provides one means of experimentally investigating the maintenance of psychopathological intrusions (Salkovskis, 1989). Consistent with this proposal, recent research has found that attempted suppression of naturally occurring negative intrusions results in an increase of the suppressed thoughts (McNally and Ricciardi, 1996, Salkovskis and Campbell, 1994, Trinder and Salkovskis, 1994). The role of attempted suppression in clinical conditions is questionable, however, because one study of spider phobics and controls found that whereas attempted suppression was associated with an increase in spider-related thoughts, the contribution of attempted suppression to the number of spider-related thoughts was relatively minimal (Muris, Merckelbach, Horselenberg, Sijsenaar & Leeuw, 1997).

One clinical domain that is characterised by intrusions is posttraumatic stress. In an initial study of thought suppression in acute stress disorder (ASD), Harvey and Bryant (1998) found that individuals with ASD reported an increase in traumatic memories following attempted suppression; this pattern was not evident in non-ASD subjects or ASD nonsuppressors. A similar result was found by Shipherd and Beck (1999) in their study of rape-related PTSD. These studies were limited, however, by their investigation of intrusive thoughts over periods of less than 10 min. These designs lack ecological validity because traumatised individuals typically avoid their memories over extended periods. In one study of attempted suppression over a four-day period, Trinder and Salkovskis (1994) found that suppressors reported more target thoughts and greater discomfort than subjects who only monitored their thoughts or actively thought about them.

The present study replicated and extended the study by Harvey and Bryant (1998) by requiring ASD and non-ASD subjects to either suppress or not suppress traumatic memories over 24-h, rather than 5-min periods. It also indexed the role of subjects' cognitive coping styles in attempted suppression. Previous findings have suggested that attempted suppression may play a subservient role to subjects' rehearsed avoidance strategies (Kelly & Kahn, 1994). On the basis that ASD subjects are characterised by worry and punishment strategies (Warda & Bryant, 1998), we predicted that these avoidant cognitive strategies would play a significant role in mediating attempted suppression.

Section snippets

Participants

Participants were survivors of motor vehicle accidents (n=21), industrial accidents (n=6) or nonsexual assaults (n=13) who were referred to a large trauma hospital. Participants were excluded if they had sustained a traumatic brain injury, displayed poor English, or were using prescribed narcotic analgesia (with the exception of codeine) at the time of the study. Participants were allocated to the ASD group if they satisfied all DSM-IV criteria, and to the non-ASD group if they did not meet the

Participant characteristics

Table 1 presents the mean scores for participant characteristics. Separate 2 (diagnosis)×2 (suppression) analyses of variance (ANOVA) indicated no effect for age, and significant effects for diagnosis for trauma-assessment interval, F(1, 36)=11.00, p<0.01, length of hospitalisation, F(1, 36)=4.95, p<0.05, ASDI score, F(1, 36)=175.67, p<0.001, trauma severity score, F (1, 36)=7.76, p<0.01, IES-intrusion, F(1, 36)=53.20, p<0.001, IES-avoidance, F(1, 36)=106.09, p<0.001, BDI, F (1, 36)=27.47, p

Discussion

Whereas ASD participants reported employing more punishment and worry cognitive strategies to control their thoughts, non-ASD participants used more social control. This finding supports previous reports of the tendency for ASD participants to use punishment and worry for controlling trauma-related thoughts (Warda & Bryant, 1998), and is consistent with the prevalence of these strategies in other anxiety disorders (Amir et al., 1997, Wells and Davies, 1994). Use of punishment and worry

Acknowledgements

This research was supported by the National Health and Medical Research Council. We are grateful to Michelle Moulds for assistance in data collection

References (18)

D.M. Clark et al.
An experimental investigation of thought suppression
Behaviour Research and Therapy
(1991)
D.M. Clark et al.
A further experimental investigation of thought suppression
Behaviour Research and Therapy
(1993)
A.G. Harvey et al.
Attempted thought suppression in acute stress disorder
Behaviour Research and Therapy
(1998)
P. Muris et al.
Thought suppression in spider phobics
Behaviour Research and Therapy
(1997)
P.M. Salkovskis et al.
Thought suppression induces intrusion in naturally occurring negative intrusive thoughts
Behaviour Research and Therapy
(1994)
P.M. Salkovskis
Cognitive-behavioural factors and the persistence of intrusive thoughts in obsessional problems
Behaviour Research and Therapy
(1989)
J.C. Shipherd et al.
The effects of suppressing trauma-related thoughts on women with rape-related posttraumatic stress disorder
Behaviour Research and Therapy
(1999)
H. Trinder et al.
Personally relevant intrusions outside the laboratory: long-term suppression increases intrusion
Behaviour Research and Therapy
(1994)
G. Warda et al.
Thought control strategies in acute stress disorder
Behaviour Research and Therapy
(1998)

There are more references available in the full text version of this article.

Cited by (48)

Psychopathology and thought suppression: A quantitative review
2012, Clinical Psychology Review
Recent theories of psychopathology have suggested that thought suppression intensifies the persistence of intrusive thoughts, and proposed that difficulty with thought suppression may differ between groups with and without psychopathology. The current meta-analytic review evaluates empirical evidence for difficulty with thought suppression as a function of the presence and specific type of psychopathology. Based on theoretical proposals from the psychopathology literature, diagnosed and analogue samples were expected to show greater recurrence of intrusive thoughts during thought suppression attempts than non-clinical samples. However, results showed no overall differences in the recurrence of thoughts due to thought suppression between groups with and without psychopathology. There was, nevertheless, variation in the recurrence of thoughts across different forms of psychopathology, including relatively less recurrence during thought suppression for samples with symptoms of Obsessive-Compulsive Disorder, compared to non-clinical samples. However, these differences were typically small and provided only mixed support for existing theories. Implications for cognitive theories of intrusive thoughts are discussed, including proposed mechanisms underlying thought suppression.
Cognitive-behavioral coping strategies associated with combat-related PTSD in treatment-seeking OEF-OIF Veterans
2011, Psychiatry Research
Citation Excerpt :
Compared to OEF–OIF Veterans who did not screen positive for PTSD, those with a positive screen were more likely report using worry, self-punishment, social control, and behavioral distraction thought control strategies, and avoidance coping strategies to manage unwanted thoughts, feelings, and situations. This finding replicates and extends a growing body of research suggesting that strategies such as worry, self-punishment, and experiential avoidance are commonly employed to manage unwanted thoughts by individuals with PTSD (Roussis and Wells, 2008; Bennett et al., 2009; Scarpa et al., 2009), as well as several other psychiatric conditions (Amir et al., 1997; Warda and Bryant, 1998; Reynolds and Wells, 1999; Blalock and Joiner, 2000; Guthrie and Bryant, 2000; Morrison and Wells, 2000; Rassin et al., 2000; Rosenthal et al., 2006; Roussis and Wells, 2008; Barahmand, 2009). Consistent with cognitive therapy models (Wells, 2000), results of the current study suggest that OEF–OIF Veterans with PTSD are more likely than those without PTSD to engage in maladaptive cognitive-behavioral coping strategies that may decrease the cognitive flexibility needed for adaptive processing and recovery from trauma.
Posttraumatic stress disorder (PTSD) is associated with intrusive trauma-related thoughts and avoidance behaviors that contribute to its severity and chronicity. This study examined thought control and avoidance coping strategies associated with both a probable diagnosis and symptom severity of combat-related PTSD in a sample of 167 treatment-seeking Operations Enduring Freedom and Iraqi Freedom (OEF–OIF) Veterans. Within one year of returning from deployment, Veterans completed a survey containing measures of combat exposure, coping strategies, psychopathology, and postdeployment social support. Veterans with a positive screen for PTSD scored higher than Veterans without a positive screen for PTSD on measures of worry, self-punishment, social control, behavioral distraction, and avoidance coping strategies. Worry and social avoidance coping were positively related to PTSD symptoms, and greater perceptions of understanding from others were negatively related to these symptoms. A structural equation model revealed that scores on a measure of postdeployment social support were negatively associated with scores on measures of maladaptive cognitive coping (i.e., worry, self-punishment) and avoidance coping (social and non-social avoidance coping) strategies, which were positively associated with combat-related PTSD symptoms. These results suggest that maladaptive thought control and avoidance coping may partially mediate the relation between postdeployment social support and combat-related PTSD symptoms in treatment-seeking OEF–OIF Veterans. Consistent with cognitive therapy models, these findings suggest that interventions that target maladaptive coping strategies such as worry, self-punishment, and social avoidance, and that bolster social support, most notably understanding from others, may help reduce combat-related PTSD symptoms in this population.
Sleep quality in treatment-seeking veterans of Operations Enduring Freedom and Iraqi Freedom: The role of cognitive coping strategies and unit cohesion
2010, Journal of Psychosomatic Research
Citation Excerpt :
Maladaptive cognitive coping strategies, such as worry and fear of loss of vigilance, were associated with increased sleep difficulties. This finding replicates previous research suggesting that maladaptive cognitive coping strategies are more commonly employed by individuals with such psychiatric conditions as PTSD [34,35], acute stress disorder [36,37], generalized anxiety disorder [38], and major depression [38,39]. It extends these findings to suggest that worry and fear of loss of vigilance, which is related to a perceived loss of self-protection and the ability to respond optimally to threatening stimuli [16], are associated with sleep difficulties in OEF–OIF veterans.
Sleep difficulties are common in individuals exposed to stress or trauma, and maladaptive cognitive coping strategies, such as worry and fear of losing vigilance, as well as low social support, may further impair sleep quality. This study examined the severity and correlates of sleep difficulties in a sample of treatment-seeking veterans of Operations Enduring Freedom and Iraqi Freedom (OEF–OIF).
A total of 167 OEF–OIF veterans seeking behavioral or primary care services completed a questionnaire containing measures of sleep quality, combat exposure, psychopathology, fear of loss of vigilance, cognitive coping strategies, and unit and postdeployment social support within 1 year of returning from deployment.
Mean Pittsburgh Sleep Quality Inventory scores in the full sample were indicative of severely impaired sleep. Posttraumatic stress disorder (PTSD) was associated with increased sleep difficulties, most notably sleep disturbances, daytime dysfunction, and sleep quality. Hierarchical regression analysis in the full sample revealed that PTSD symptoms and scores on measures of worry and fear of loss of vigilance were positively associated with sleep difficulties and that scores on a measure of unit member support were negatively associated with sleep difficulties. Among veterans with PTSD, fear of loss of vigilance was positively associated with sleep difficulties and cognitive distraction and unit member support were negatively associated with sleep difficulties.
Treatment-seeking OEF–OIF veterans report severe sleep difficulties, with more pronounced impairment in veterans with PTSD. The results of this study suggest that interventions to mitigate worry and fear of loss of vigilance and to enhance perceived unit member support may be helpful in reducing sleep difficulties following return from deployment in this population.
The Influence of Thought Suppression and Cognitive Load on Intrusions and Memory Processes Following an Analogue Stressor
2009, Behavior Therapy
Ironic Process Theory and the role of thought suppression have been used in part to explain the phenomenon of intrusive memories in various disorders, including posttraumatic stress disorder. How thought suppression interacts with other cognitive processes believed to be instrumental in the development of traumatic intrusive memory is unclear. In an analogue study, thought suppression and cognitive processing was manipulated in 4 experimental groups after participants (n = 80) viewed a trauma film. The impact of suppression was examined in relation to self-reported intrusive experiences as well as via more objective methods (word stem and dot probe tasks) to assess potential preferential encoding of negative material. Cognitive load appeared to undermine thought suppression ability, with these participants experiencing more intrusions over the week relative to participants in all other conditions. This group also showed greater priming to negative film-related words, and both suppression groups demonstrated enhanced memory for film-related content on recognition testing. Thought suppression mediated the relationship between negative interpretations of initial intrusions and later intrusions experienced over the week. The findings are discussed in the context of ironic process theory and cognitive models of posttraumatic stress.
Managing unwanted intrusive thoughts in obsessive-compulsive disorder: Relative effectiveness of suppression, focused distraction, and acceptance
2009, Behaviour Research and Therapy
Citation Excerpt :
Moreover, when thoughts are associated with unpleasant emotions, people are likely to engage in chronic thought suppression (Wegner & Zanakos, 1994). The counterproductive effects of thought suppression have been observed in experimental studies of UITs (see review by Rassin, 2005), posttraumatic stress disorder (Shipherd & Beck, 1999), acute stress disorder (Guthrie & Bryant, 2000; Harvey & Bryant, 1998) and depression (Dalgleish & Yiend, 2006; Wenzlaff & Bates, 1998; Wenzlaff & Eisenberg, 2001; Wenzlaff, Meir, & Salas, 2002; Wenzlaff, Wegner, & Roper, 1988). These studies suggest that although suppression may seem to be an effective solution, it can have profound and unexpected consequences for the psychological influences of the unwanted thoughts.
Suppression is one of various mental control techniques that people may use to manage unwanted thoughts. Evidence suggests that it is at best unsustainable and at worst counterproductive. This leads to the question: If suppression is a futile way to respond to unwanted, intrusive thoughts, what is a more effective alternative? In the current study, we evaluated the relative effectiveness of suppression and two alternative mental control techniques—focused distraction and acceptance—on the frequency of intrusions and distress associated with them. Results support the claim that suppression is a counterproductive technique for dealing with unwanted, intrusive thoughts in OCD. However, the harmfulness of suppression was reflected primarily in the magnitude of distress and not in intrusion frequency. Focused distraction and acceptance were the more effective techniques for managing clinically significant intrusive thoughts. We discuss implications for the cognitive treatment for OCD.
Acute Stress Disorder Consequent to Motor Vehicle Collisions
2008, Motor Vehicle Collisions: Medical, Psychosocial, and Legal Consequences
This chapter focuses on the assessment and management of acute stress reactions occurring within 2 days to 4 weeks following a traumatic motor vehicle collision (MVC). The diagnosis of acute stress disorder (ASD) is used to describe posttraumatic stress reactions that occur in the initial month after a trauma. A major reason for the inclusion of this diagnosis is that the 1-month minimum duration criterion of posttraumatic stress disorder (PTSD) precludes description of the distress experienced in the initial weeks after a trauma. A second rationale is its purported capacity to identify recent trauma survivors who will subsequently develop PTSD. Since the inception of the ASD diagnosis, considerable research has been conducted on ASD in the context of MVCs. Theoretical models, assessment strategies, treatment literature, and comorbid issues and forensic aspects related to ASD after MVCs are discussed.

View all citing articles on Scopus

View full text