Positive Internal Experiences in PTSD Interventions: A Critical Review

Abstract

Evidence suggests that individuals with post-traumatic stress disorder (PTSD) symptoms exhibit deficits in positive internal experiences. This study critically reviewed empirically validated PTSD interventions to determine (1) whether positive memories, cognitions, and emotions were explicitly addressed and (2) the goals of focusing on these positive internal experiences. We selected 11 empirically validated PTSD interventions listed as “recommended/strongly recommended” in recently published reviews, reviewed existing literature for studies using these interventions ( N = 1,070), short-listed randomized controlled trial studies meeting predetermined inclusion criteria for the selected interventions (in English, developed for adults, individual therapy modality, in-person administration, tailored to PTSD; N = 47), and emailed authors ( N = 41) to obtain the unique intervention manuals. Hereby, we reviewed 13 unique empirically validated PTSD intervention manuals. Findings indicated 53.85%, 69.23%, and 69.23% of reviewed manuals explicitly discussed positive memories, emotions, and cognitions, respectively. Primarily, positive memories were integral to mechanisms underlying PTSD, a precursor to targeting negative experiences, an indicator of treatment progress, or a way to identify client problems; positive emotions were discussed when providing psychoeducation on PTSD/trauma reactions; and positive cognitions were addressed in reference to coping with negative experiences or as targets to enhance self-concept. This review demonstrates that comparatively, positive memories are infrequently elicited in the reviewed interventions; positive emotions and cognitions are explicitly referenced in two-thirds of the reviewed interventions but are included as a primary focus for therapeutic processing only in a few interventions; and eye movement desensitization and reprocessing has the most comprehensive focus on positive internal experiences.

Moderating effects of dysregulation and fear of positive emotions on the relationship between posttraumatic stress disorder symptoms and positive memory count

“…Prior research indicates that trauma‐exposed clients (Caldas, Jin, Dolan, Dranger, & Contractor, 2020) and trauma clinicians (Contractor, Caldas, Dolan, Banducci, & Jin, 2020) are willing and wish to therapeutically address positive memories in PTSD treatment. Consistent with this trend, a recent review indicated that positive memories and positive emotions are addressed as clinical targets and mechanisms in a few PTSD interventions (Contractor, Weiss, Forkus, & Keegan, in press). Further, there is considerable empirical support for memory‐focused interventions in reducing posttrauma outcomes (Hitchcock, Werner‐Seidler, Blackwell, & Dalgleish, 2017).…”

Positive memory intervention techniques: a scoping review

“…Third, this review may act as a stimulus to promote the implementation of the models that support the incorporation of positive memory techniques into conventional treatments (e.g., Contractor et al, 2018). Indeed, a recent review on PTSD interventions suggest that ∼50% of existing PTSD interventions incorporate positive memories in some manner (Contractor et al, 2020c). Finally, despite the transient effects associated with many of the reviewed techniques, the perceived non-aversive and pleasant nature of these interventions could facilitate the therapeutic process and the adherence, and strengthen the therapeutic alliance, which would optimise health benefits.…”

The role of emotion dysregulation in the association between posttraumatic stress disorder symptoms and suicidal thoughts and behaviors among veterans

“…Screening for positive emotion dysregulation among veterans presenting with PTSD symptoms might aid clinicians in better identifying individuals at high risk for STBs who may benefit from early intervention. Positive emotions (particularly their regulation) are often overlooked in clinical settings and trauma treatments (Contractor et al, 2020), despite emerging research on their role in cognitive‐behavioral treatment response (Taylor et al, 2017). This study adds to work focusing on how maladaptive responses to positive emotions underlie psychopathology (e.g., risky and health‐compromising behaviors; Weiss et al, 2018; Weiss, Schick, et al, 2019), thereby signifying a need for studies that assess the specific role of positive emotion dysregulation in treatment.…”