Transcript No Slide Title - Good Medicine

trauma memories & social anxiety
 intrusive ‘images’ are very commonly associated with anxiety
provoking situations for people with social anxiety disorder.
 these images are often visual but may also occur as an internal
felt-sense or via other (often multiple) sensory channels.
 intrusive visual images of social situations are typically from
an ‘observer’ rather than from a ‘first person’ perspective.
 the majority of subjects can link intrusive images to early
memories when typically the social anxiety disorder first
became particularly troublesome.
 holding the intrusive negative image (instead of a neutral or
positive image) aggravates symptoms (feelings, attentional
biases & mis-estimations) and performance – as judged by
the subject, others involved socially, & by external observers
 non socially anxious subjects also have their performance
disrupted if trained to hold negative rather than neutral images
of their performance
clinical implications 2
 educate socially anxious subjects about the frequency, type,
importance, origins, effects, and management of images.
 emotional processing of associated early memories is likely
to be helpful in its own right and may guide the nature of
subsequent coping image work.
 consider training social anxiety sufferers to hold
coping rather than negative images before and
during social challenges.
 it is reasonable to encourage these coping
‘images’
to involve a variety of sensory channels
for
example visual, felt-sense & auditory.
 coping visual images should be from a ‘first
person’ rather than an ‘observer’ perspective.
 try training preparatory coping images (guided or self-directed)
as a sequence involving experiencing initial difficulties, but
progressively mastering the social interaction with eventual
successful outcome.
trauma memories & agoraphobia
 when questioned, all of a group of 20 agoraphobics – but none
of a group of 20 matched controls – reported having distinct
recurrent intrusive ‘images’ in agoraphobic situations.
 most intrusive ‘images’ involved several sensory modalities such
as vision, internal ‘felt-sense’, sound, touch, smell & taste (note
vision wasn’t always present as a component).
 on discussion, all subjects linked an aversive memory to the
intrusive ‘image’, but only 15% (3/20) reported having thought
about the content of the memory prior to the interview.
 the mean age at the time of the memory was 14.3 years.
 75% (15/20) of the subjects believed the memory affected their
anxiety in agoraphobic situations.
 common themes with both intrusive images and associated
memories were of catastrophic danger and of a negative view of
self (such as the self intimidated, humiliated and misunderstood).
Day SJ, Holmes EA & Hackmann, A. Occurrence of imagery and its link
with early memories in agoraphobia. Memory 2004; 12(4): 416-27
clinical implications 3
 when asking about intrusive ‘images’ in agoraphobia (or other
psychological disorders) it may be worth getting the sufferer to
imagine (or actually revisit) an upsetting episode
 note that recurrent intrusive images can come
visually or as a internal felt-sense or via other
(often
multiple) sensory channels
 although on questioning the majority of subjects
can link this intrusive image to an early memory,
they
may well not have made this link before
 subjects often recognize quite readily that the
image tends to aggravate their symptoms
 exploring the meaning and beliefs around the image and
memory may well make good sense
trauma memories & OCD
 of 34 inpatients with OCD, 71% (24/34) reported that they
had
intrusive visual images when their OCD was really bad.
 for patients with visual images, 33% (8/24) recognized their
images as memories of actual aspects of earlier traumas.
 when the remaining 16 patients with visual images
were asked about their earliest recollection of having
had similar sensations and feelings, 94% (15/16)
could identify a particular traumatic experience that
was linked to the visual image.
 the perceived similarity between the visual image & the
memory of the traumatic experience was very high, both in terms
of sensory characteristics and in terms of interpersonal meanings.
 it seems likely that many of the 29% (10/34), who did not
report intrusive visual images, might have reported ‘images’
if questioned about felt-sense and other sensory channels.
Speckens A, Ehlers A, et al Imagery and early traumatic memories in obsessive
compulsive disorder. BABCP Annual Conference Abstracts: p.44. York, 2003
trauma memories & other disorders
 Hinrichson H, Morrison T, et al. Triggers of vomiting in bulimic
disorders: the roles of core beliefs and imagery. BABCP Annual
Conference Abstracts: page 8. York, 2003.
 Cooper M, and Turner H. The effect of using imagery to modify core
beliefs in bulimia nervosa: an experimental pilot study. BABCP
Annual Conference Abstracts: pp 8-9. York, 2003.
 Osman S, Cooper M, et al. Spontaneously occurring images and
early memories in people with body dysmorphic disorder. Memory
2004; 12(4): 428-36
 Brewin CR, Watson M, et al. Memory processes & course of anxiety
and depression in cancer patients. Psychol Med 1998; 28: 219-24.
 Finkenauer C, and Rimé B. Keeping emotional memories secret:
health and subjective well-being when emotions are not shared.
Journal of Health Psychology 1998; 3(1): 47-58.
 Morrison A. Trauma and psychosis: cause, consequence, common
processes and clinical implications. BABCP Annual Conference
Abstracts: p 21. York, 2003.