Mental Imagery and Post-Traumatic Stress Disorder: A Neuroimaging and Experimental Psychopathology Approach to Intrusive Memories of Trauma

Abstract

This hypothesis and theory paper presents a pragmatic framework to help bridge the clinical presentation and neuroscience of intrusive memories following psychological trauma. Intrusive memories are a hallmark symptom of post-traumatic stress disorder (PTSD). However, key questions, including those involving etiology, remain. In particular, we know little about the brain mechanisms involved in why only some moments of the trauma return as intrusive memories while others do not. We first present an overview of the patient experience of intrusive memories and the neuroimaging studies that have investigated intrusive memories in PTSD patients. Next, one mechanism of how to model intrusive memories in the laboratory, the trauma film paradigm, is examined. In particular, we focus on studies combining the trauma film paradigm with neuroimaging. Stemming from the clinical presentation and our current understanding of the processes involved in intrusive memories, we propose a framework in which an intrusive memory comprises five component parts; autobiographical (trauma) memory, involuntary recall, negative emotions, attention hijacking, and mental imagery. Each component part is considered in turn, both behaviorally and from a brain imaging perspective. A mapping of these five components onto our understanding of the brain is described. Unanswered questions that exist in our understanding of intrusive memories are considered using the proposed framework. Overall, we suggest that mental imagery is key to bridging the experience, memory, and intrusive recollection of the traumatic event. Further, we suggest that by considering the brain mechanisms involved in the component parts of an intrusive memory, in particular mental imagery, we may be able to aid the development of a firmer bridge between patients’ experiences of intrusive memories and the clinical neuroscience behind them.

Common circuit or paradigm shift? The functional brain in emotional scene perception and emotional imagery

“…Emotional imagery is a key induction context when investigating individual differences in emotionality, such as posttraumatic stress disorder (PTSD; e.g. Clark & Mackay, ), since developing a script that describes a personally relevant traumatic event can often target the trauma more precisely than seeking to find an appropriate scene. Early PET studies reported differences in functional activity based on whether narrative imagery involved personally relevant (autobiographical) or “standard” (fictitious) scenes, with personally relevant scenes prompting a significant amygdala activation (Fink et al, ; Markowitsch et al, ).…”

“…Emotional imagery is a key induction context when investigating individual differences in emotionality, such as posttraumatic stress disorder (PTSD; e.g. Clark & Mackay, 2015), since developing a script that describes a personally relevant traumatic event can often target the trauma more precisely than seeking to find an appropriate scene. Early PET studies reported differences in functional activity based on whether | 3 of 14 SAMBUCO et Al.…”

Structural brain differences predict early traumatic memory processing

“…Diagnosis criteria for PTSD include both an immediate exposure to a traumatic event and also witnessing trauma (American Psychiatric Association, ). To examine early PTSD‐like symptoms, the trauma film paradigm is an ideal model to bridge the gap between nonclinical and clinical samples based on its strongly controllable setting (Clark & Mackay, ).…”

Mental Imagery and its Relevance for Psychopathology and Psychological Treatment in Children and Adolescents: a Systematic Review

“…The potentially important role of negative MI as a maintenance factor of psychological disorders has been supported in studies with adults suffering from PTSD (Clark and Mackay 2015;Cockerham et al 2016;Morina et al 2013), obsessive-compulsive disorder (OCD; Da Silva 1986;Rachman 2007;Speckens et al 2007), social anxiety disorder (SAD, e.g., Hackmann et al 2000), agoraphobia (Day et al 2004), body dysmorphic disorders (Osman et al 2004), and depression (Holmes et al 2008;Morina et al 2011). The negative mental images may influence both behavior and cognitions.…”