Trauma Memory Processing in Posttraumatic Stress Disorder Psychotherapy: A Unifying Framework

Abstract

Trauma memory processing (TMP) is an empirically supported approach to psychotherapy for posttraumatic stress disorder (PTSD). However, TMP is not a single, uniform intervention but instead a paradigm that can be operationalized through a variety of component procedures that have not been systematically elucidated and formally tested. Based on findings from phenomenological/structural and neuroimaging research, a central feature of PTSD is theorized to be the involuntary immersion in trauma memories with diminished awareness or negative appraisals of self and current context. Such intrusive reexperiencing—which is epitomized by, but not limited to, flashbacks—is postulated to underlie PTSD's avoidance, altered emotions and cognitions, dissociative, and hyperarousal/hypervigilance symptoms; it is thus a logical target for TMP. The varied approaches to TMP for PTSD are conceptualized as having the common goal of activation of the neural networks in the brain that underlie two key capacities disrupted by intrusive reexperiencing in PTSD: intentional self‐referential retrieval of memories and suppression of memory retrieval. Therefore, TMP is postulated to involve two core functions (purposeful reflective remembering and memory awareness in situ) and three essential types (in vivo, imaginal, and cognitive reappraisal). Several implications of this framework for clinical practice and research on TMP for PTSD are discussed.

Adverse and benevolent childhood experiences in Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD): implications for trauma-focused therapies

“…Further, the statistical mediation by lifetime polytraumatisation, which was associated with both childhood adversity and adult PTSD symptoms, suggests that childhood adversity may be linked to adult PTSD symptoms as a result of polyvictimization in childhood and adolescence (Finkelhor, Ormrod, & Turner, 2007a ) or re-victimization across the lifespan (Finkelhor, Ormrod, & Turner, 2007b ; Ports, Ford, & Merrick, 2015 ). Thus, treatment for PTSD with adults who have experienced extensive childhood adversity may be optimized by using approaches to trauma memory processing that address not only memories of specific focal traumatic events but also the impact of cumulative exposure to multiple types of traumatisation that occurred in adulthood as well as in childhood (Ford, 2018 ).…”

Comorbidity of developmental trauma disorder (DTD) and post-traumatic stress disorder: findings from the DTD field trial

“…However, it is important to note that traumafocused treatment may be beneficial with clients who have a history of exposure to traumatic stressors and do not meet criteria for PTSD but are experiencing emotional or behavioural symptoms that may be related to or exacerbated by their trauma history (Ford, 2018). Trauma exposure is a well-documented antecedent of many childhood psychiatric disorders (D'Andrea et al, 2012), so it is important not to overlook the potential impact of trauma history in conducting assessment and providing treatment with children and adolescents who are identified with disorders other than PTSD or DTD.…”

Progress and Limitations in the Treatment of Complex PTSD and Developmental Trauma Disorder

“…Including trauma memory processing in the treatment of cPTSD or DTD is indicated when PTSD intrusive re-experiencing, avoidance, or hyperarousal/ hypervigilance symptoms cause impairment. Trauma memory processing also should be considered an option for DSO and DTD even when PTSD symptoms are absent or minimal, based on a re-conceptualization of trauma memory processing derived from neurobiological and phenomenological research [51].…”

“…(2013). Treating complex traumatic stress disorders in children and adolescents [16•] verbal labeling and expression of emotions, and self-reflective processing of the meaning of emotions [15,51]. Developing and maintaining a therapeutic alliance based on active partnering, affirming, and nonjudgmental empathic attunement with the client [60] also is viewed as providing adults with cPTSD with modeling and co-regulation that can specifically enhance emotion regulation [13].…”