Biomedical subjects

Chris R Brewin

Publications and source records attributed to Chris R Brewin.

16 recordsLinked to original sources

PubMed2006

Understanding cognitive behaviour therapy: A retrieval competition account.

Vulnerability to emotional disorders is thought to lie in memory representations (e.g. negative self-schemas) that are activated by triggering events and maintain negative mood. There has been considerable uncertainty about how the influence of these representations can be altered, prompted in part by the development of new metacognitive therapies. This article reviews research suggesting there are multiple memories involving the self that compete to be retrieved. It is proposed that CBT does not directly modify negative information in memory, but produces changes in the relative activation of positive and negative representations such that the positive ones are assisted to win the retrieval competition. This account is related to the treatment of common symptoms typical of emotional disorders, such as phobic reactions, rumination, and intrusive images and memories. It is shown to provide a parsimonious set of principles that have the potential to unify traditional and more modern variants of CBT.

Affective Symptoms↗

PubMed2006

The organisation and content of trauma memories in survivors of road traffic accidents.

We investigated the trauma narratives of 131 road traffic accident survivors prospectively, at 1 week, 6 weeks, and 3 months post-trauma. At 1 and 6 weeks, narratives of survivors with acute stress disorder (ASD) or post-traumatic stress disorder (PTSD) were less coherent and included more dissociation content. By 3 months, their narratives also contained more repetition, more non-consecutive chunks, and more sensory words. Traumatic brain injury was associated with a separate characteristic, confusion, at all three time points. Three aspects of narrative organisation at 1 week--repetition, non-consecutive chunks, and coherence--predicted PTSD severity at 3 months after controlling for initial symptoms. The results suggest both a strong concurrent and predictive relationship between narrative disorganisation and ASD/PTSD but that as people recover from ASD, their narratives do not necessarily become less disorganised.

Accidents, Traffic↗

PubMed2005

Psychological and behavioural reactions to the bombings in London on 7 July 2005: cross sectional survey of a representative sample of Londoners.

OBJECTIVES: To assess the impact of the bombings in London on 7 July on stress levels and travel intentions in London's population. DESIGN: A cross sectional telephone survey using random digit dialling was conducted to contact a representative sample of adults. Respondents were asked to participate in an interview enquiring about current levels of stress and travel intentions. SETTING: Interviews took place between 18 and 20 July. PARTICIPANTS: 1010 participants (10% of the eligible people we contacted) completed the interviews. MAIN OUTCOME MEASURES: Main outcomes were presence of substantial stress, measured by using an identical tool to that used to assess the emotional impact of 11 September 2001 in the US population, and intention to travel less on tubes, trains, and buses, or into central London, once the transport network had returned to normal. RESULTS: 31% of Londoners reported substantial stress and 32% reported an intention to travel less. Among other things, having difficulty contacting friends or family by mobile phone (odds ratio 1.7, 95% confidence interval 1.1 to 2.7), having thought you could have been injured or killed (3.8, 2.4 to 6.2), and being Muslim (4.0, 2.5 to 6.6) were associated with a greater presence of substantial stress, whereas being white (0.3, 0.2 to 0.4) and having previous experience of terrorism (0.6, 0.5 to 0.9) were associated with reduced stress. Only 12 participants (1%) felt that they needed professional help to deal with their emotional response to the attacks. CONCLUSIONS: Although the psychological needs of those intimately caught up in the attacks will require further assessment, we found no evidence of a widespread desire for professional counselling. The attacks have inflicted disproportionately high levels of distress among non-white and Muslim Londoners.

Adolescent↗

PubMed2005

The influence of a visuospatial grounding task on intrusive images of a traumatic film.

Nonclinical participants watched a trauma film under two processing conditions. During part of the film participants carried out a concurrent visuospatial grounding task consisting of the construction of shapes out of plasticine (modelling clay), while the rest of the film constituted a control, no task condition. The visuospatial task was predicted to selectively compete for processing resources required for intrusive image formation. As predicted, spontaneous intrusive images during the succeeding week were significantly less common from those parts of the film that coincided with the concurrent task. The task had no effect on levels of distress or peritraumatic dissociation, consistent with the hypothesis that intrusions were reduced because the task competed for resources necessary for encoding into an image-based memory system.

Accidents, Traffic↗

PubMed2005

Feared identity and obsessive-compulsive disorder.

We tested predictions from cognitive-behavioural theory that people with obsessive-compulsive disorder (OCD) regard their intrusions as revealing unacceptable aspects of their character. We compared an OCD sample with anxious controls (AC) and non-anxious controls (NAC) on a measure of the extent to which intrusions led to negative inferences about the self, assessed the discrepancy between their actual and feared self, and recorded the traits making up the feared self. The OCD sample did not differ from AC on self-discrepancies, but did differ from both control groups on the measure of negative inferences about the self. In addition, the feared self of the OCD sample was significantly more likely to consist of bad and immoral traits.

Adolescent↗

PubMed2005

Systematic review of screening instruments for adults at risk of PTSD.

The development of effective methods of screening for posttraumatic stress disorder (PTSD) is important in the context of mass trauma, the geographical dispersion of victims, and the restricted availability of specialists in psychological trauma. The review focused on published English-language screening instruments for civilian PTSD consisting of 30 items or fewer and validated against structured clinical interviews. Thirteen instruments were identified meeting these criteria, all consisting of symptoms of traumatic stress. The review concluded that the performance of some currently available instruments is near to their maximal potential effectiveness, and that instruments with fewer items, simpler response scales, and simpler scoring methods perform as well as if not better than longer and more complex measures.

Humans↗

PubMed2005

Traumatic brain injury, dissociation, and posttraumatic stress disorder in road traffic accident survivors.

This study investigated the symptom profiles of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) in participants who did and did not sustain traumatic brain injury (TBI), following a road traffic accident. The participants were assessed at three time points: as soon as possible posttrauma as well as at 6 weeks and 3 months posttrauma. At the first assessment, fewer participants from the TBI group recalled feeling fear and helplessness at the time of the trauma, fewer TBI participants reported recurrent intrusive thoughts and images, and more TBI participants reported dissociation since the trauma, relative to the non-TBI group. At the second assessment, fewer participants from the TBI group recalled feeling intense helplessness at the time of the trauma. Fewer TBI participants also reported reliving and physiological reactions on trauma reminders relative to the non-TBI group. At 3 months posttrauma, there was no difference in PTSD symptom profile between non-TBI and TBI groups. Our findings indicate that the presence of TBI is likely to influence the distribution of certain symptoms, but need not be a significant barrier to diagnosing ASD and PTSD.

Accidents, Traffic↗

PubMed2005

Working memory capacity and suppression of intrusive thoughts.

We sought to show that individual differences in working memory capacity are related to the ability to intentionally suppress personally relevant intrusive thoughts, and that this effect cannot be explained by differences in negative mood. Sixty participants identified their most frequent intrusive thought and then completed a thought suppression task. Better performance on a measure of working memory capacity (OSPAN) was related to having fewer intrusions in the suppression condition but was unrelated to number of intrusions in the expression condition, suggesting a specific association with attempts to inhibit unwanted thoughts. In contrast, a more negative mood was related to having more intrusions in both conditions, suggestive of a more general influence on the accessibility of unwanted thoughts. Working memory capacity was not associated with negative mood or with the frequency of intrusive thoughts reported in everyday life. The findings extend previous results to the domain of personally relevant intrusive thoughts and support the idea that individual differences in the cognitive abilities supporting inhibitory mechanisms are relevant to clinical conditions such as obsessive-compulsive disorder and posttraumatic stress disorder.

Adolescent↗

PubMed2005

Risk factor effect sizes in PTSD: what this means for intervention.

This paper reviews evidence concerning the major risk factors for posttraumatic stress disorder. Although there are a number of consistent risk factors, their effects tend to be small and to vary according to the nature of the study. This suggests that they are not well suited to identifying individuals who require early intervention following a traumatic event. In contrast, methods based on symptom reports offer a much more sensitive and practicable approach to screening. A recent instrument, the Trauma Screening Questionnaire, is brief, simple to administer, and highly efficient at identifying survivors in need of intervention.

Humans↗

PubMed2004

A comparison of flashbacks and ordinary autobiographical memories of trauma: content and language.

We investigated hypotheses derived from the dual representation theory of posttraumatic stress disorder, which proposes that flashbacks and ordinary memories of trauma are supported by different types of representation. Sixty-two participants meeting diagnostic criteria for posttraumatic stress disorder completed a detailed written trauma narrative, and afterwards identified those sections in the narrative that had been written in flashback and ordinary memory periods. As predicted, flashback periods were characterised by greater use of detail, particularly perceptual detail, by more mentions of death, more use of the present tense, and more mention of fear, helplessness, and horror. In contrast, ordinary memory sections were characterised by more mention of secondary emotions such as guilt and anger.

Adult↗

PubMed2004

Trauma films, information processing, and intrusive memory development.

Three experiments indexed the effect of various concurrent tasks, while watching a traumatic film, on intrusive memory development. Hypotheses were based on the dual-representation theory of posttraumatic stress disorder (C. R. Brewin, T. Dalgleish, & S. Joseph, 1996). Nonclinical participants viewed a trauma film under various encoding conditions and recorded any spontaneous intrusive memories of the film over the following week in a diary. Changes in state dissociation, heart rate, and mood were also measured. As predicted, performing a visuospatial pattern tapping task at encoding significantly reduced the frequency of later intrusions, whereas a verbal distraction task increased them. Intrusive memories were largely unrelated to recall and recognition measures. Increases in dissociation and decreases in heart rate during the film were also associated with later intrusions.

Adolescent↗

PubMed2003

Psychological theories of posttraumatic stress disorder.

We summarize recent research on the psychological processes implicated in posttraumatic stress disorder (PTSD) as an aid to evaluating theoretical models of the disorder. After describing a number of early approaches, including social-cognitive, conditioning, information-processing, and anxious apprehension models of PTSD, the article provides a comparative analysis and evaluation of three recent theories: Foa and Rothbaum's [Foa, E. B. & Rothbaum, B. O. (1998). Treating the trauma of rape: cognitive behavioral therapy for PTSD. New York: Guilford Press] emotional processing theory; Brewin, Dalgleish, and Joseph's [Psychological Review 103 (1996) 670] dual representation theory; Ehlers and Clark's [Behaviour Research and Therapy 38 (2000) 319] cognitive theory. We review empirical evidence relevant to each model and identify promising areas for further research.

Adaptation, Psychological↗

PubMed2003

Coexistence of posttraumatic stress disorder and traumatic brain injury: towards a resolution of the paradox.

The coexistence of posttraumatic stress disorder (PTSD) and traumatic head or brain injury (TBI) in the same individual has been proposed to be paradoxical. It has been argued that individuals who sustain a TBI and have no conscious memory of their trauma will not experience fear, helplessness and horror during the trauma, nor will they develop reexperiencing symptoms or establish the negative associations that underlie avoidance symptoms. However, single case reports and incidence studies suggest that PTSD can be diagnosed following TBI. We highlight critical issues in assessment, definitions, and research methods, and propose two possible resolutions of the paradox. One resolution focuses on ambiguity in the criteria for diagnosing PTSD. The other involves accepting that TBI patients do experience similar symptoms to other PTSD patients, but that there are crucial differences in symptom content.

Acute Disease↗

PubMed2003

Gender, social support, and PTSD in victims of violent crime.

Gender differences in social support levels and benefits were investigated in 118 male and 39 female victims of violent crime assessed for PTSD symptomatology 1 and 6 months postcrime. Within 1 month postcrime both genders reported similar levels of positive support and support satisfaction, but women reported significantly more negative responses from family and friends. Women also reported an excess of PTSD symptoms that was similar at 1 and 6 months postcrime, and negative responses mediated the relationship between gender and later symptoms. Overall negative response and support satisfaction, but not positive support, were significantly associated with PTSD symptoms. However, the effects of support satisfaction and negative response on 6-month symptoms were significantly greater for women than men. The findings are consistent with previous studies of predominantly female assault victims concerning the stronger impact of negative over positive support, and might help explain women's higher PTSD risk in civilian samples.

Adult↗

PubMed2003

Diagnostic overlap between acute stress disorder and PTSD in victims of violent crime.

OBJECTIVE: In a group of crime victims, the authors investigated overlap between acute stress disorder and posttraumatic stress disorder (PTSD) diagnoses and their relative ability to predict PTSD at 6 months. METHOD: A mixed-sex group of 157 victims of violent assault were interviewed within 1 month of the crime. At the 6-month follow-up, 87.9% were reinterviewed by telephone. RESULTS: At baseline the rate of acute stress disorder was 19.1%, the rate of PTSD was 21.0%, and the percentage agreement between them was 95.5%. The two diagnoses were equally effective predictors of PTSD 6 months later. CONCLUSIONS: The high level of overlap between acute stress disorder and PTSD calls into question whether, as presently formulated, they represent distinct diagnoses.

Adolescent↗

PubMed2002

Brief screening instrument for post-traumatic stress disorder.

BACKGROUND: Brief screening instruments appear to be a viable way of detecting post-traumatic stress disorder (PTSD) but none has yet been adequately validated. AIMS: To test and cross-validate a brief instrument that is simple to administer and score. METHOD: Forty-one survivors of a rail crash were administered a questionnaire, followed by a structured clinical interview 1 week later. RESULTS: Excellent prediction of a PTSD diagnosis was provided by respondents endorsing at least six re-experiencing or arousal symptoms, in any combination. The findings were replicated on data from a previous study of 157 crime victims. CONCLUSIONS: Performance of the new measure was equivalent to agreement achieved between two full clinical interviews.

Accidents↗