Future Thinking in PTSD and Grief
Brown, A.D., et al. (2011).Overgeneralized autobiographical memory and future thinking in combat veterans with posttraumatic stress disorder. Journal of Behavior Therapy and Experimental Psychiatry.
Maccallum, F., & Bryant, R.A. (2011). Imagining the future in complicated grief. Depression and Anxiety, 28, 658-65.
Brown, A.D., Dorfman, M.L., Marmar, C.R., & Bryant, R.A. (2012). The impact of perceived self-efficacy on mental time travel. Consciousness and Cognition, 21, 299-306.
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As we have discussed in lecture, it is evident that there is a correlation between autobiographical memory and self-identity. Human beings have the tendency to imagine their future self as more favorable than their current self. However, as we explored, people presenting with PTSD expect to function more poorly in the future. Further explored in the Maccallum and Bryant article ‘Imagining the Future in Complicated Grief’, this point that autobiographical memory will effect future thinking is upheld. In complicated grief (CG), chronic and debilitating bereavement, patients were also less likely to imagine specific future events relating to their life. Additionally, and similar to PTSD patients, the inability to recall specific future events with the use of autobiographical memory greatly effects successful coping with grief. Patients recall feeling “stuck” in their grief. In my conference project I am exploring child focused bereavement counseling groups. I question if counselors running these groups ever consider this idea of autobiographical memory and if and how they differ between children and adults. Can skills to enhance children’s autobiographical memory alleviate suffering during bereavement?
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The ability to recall past events or re-live episodes from the past, and imagine and experience future events occurs in our every day life. According to Brown et al. (2011), the point to where an individual recalls the past or imagines the future with episodic specificity and their social problem solving skills will vary depending with one’s perspective of self identity. In the article there is also a mention of self memory system. Autobiographical memories are recalled within the context of self-memory system to support the working self that has an active representation of ones current and future goals. Studies shows that the abilitiy to retrieve autobiographical memory is determined by ones current state of mind. However, CBT has taken part in changing maladaptive views of one’s self, individuals with depression and PTSD show increase autobiographical memory specifity. According to Maccallum & Bryant (2011), individuals with complicated grief (CG) have a difficult time recalling specific autobiographical memory and imagining future. CG patients do not share specific positive memories in the future. They relate their future memory with loss and grief. The poor ability to recall a specific memory impairs the ability to imagine a specific future event. According to Conway and Pleydell-Pearce, there can be strategies that can develop different perspective of the self in the future, which is not focused on loss, and it can result in reducing the grief and the grief related memories in the future. Thus, there is a link between the how one views oneself and autobiographical memory.
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As we have read, PTSD is one of the most common disorders following trauma, and while it had led to affected individuals overgeneralizing past memories; it has been seen to have an impact on the retrieval of specific personal visions of their futures. With respect to negative thoughts, the ability for individuals (with PTSD) to imagine the future was higher when compared to those without PTSD; and with lower positive thoughts in all. Responses to positive ideas about the future therefore proved to be shortened. Tulving (2002) notes that the ability for an individual to retrieve specific memories from one’s past is a crucial factor in determining one’s vision of the future, a known as “mental time travel”.
I think it is very interesting that one of the symptoms of PTSD is the sense of foreshortened future. Already, individuals with PTSD have a negative outlook on life, and when they interact with positive individuals, they sense the distance, and see it as something they would like to become. I see this as important because it focuses on the victims’ thought pattern and processing as a crucial determinant in the way they approach/see the future; it is very different from ours. The way that we view ourselves is key in every interaction. Because individuals see themselves as a victim, they do not see themselves as a significant part of their future. I mean, individuals are left unable to plan for a future; they are left with generalized and blurred thoughts about the rest of their life.
The notion of what has happened in the past and not letting it define you in the future is fitting in this situation. Individuals do not necessarily have to be defined by the trauma, as important as it is. It is dismal, individuals should have an equal chance at a successful and positive future. This is obviously, and has proven to not be as easy as it sounds, because conditions of depression, for example, and closely linked to individuals with PTSD. Individuals must believe that positive thoughts can help them, and that learning to think positive thoughts and feelings can change their lives and heal trauma successfully. This could be beneficial for both the effects of PTSD, past memory recollection and generalization, and the future, no matter how many times one may come close to giving up.
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Throughout lectures and readings, I became fascinated with how one’s self efficacy affects their memory and how that memory affects problem solving and future planning. One with lower self efficacy has trouble retrieving specific, positive past memories while those with high self efficacy have no such problem. The correlation between how one’s self efficacy can affect memory retrieval is fascinating as it seems that changing your outlook can change the way you think and solve problems. However, this idea cannot be confused with the general statement, “you should snap out of it,” often told to people displaying symptoms of PTSD and other mental disorders. In the study, “perceived self efficacy on memory for aversive experiences,” all it took was to tell one group that they had great coping skills to affect their outlook and positively affect the retrieval of episodic memories. Often times, in cognitive behavioral therapy, the change in perspective and rationalization of the negative thoughts can elevate anxiety and give the patient a better perspective on the world. I wonder then if exposure to their more positive memories of the past by a therapist would alter their efficacy. Could being reminded of those episodic and feeding positive memories of the past, could we alter someone’s self efficacy? Could these essentially implanted episodic memories affect your views on the future and on your present problem solving skills?
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The article The Impact of Perceived Self-Efficacy on Mental Time Travel and Social Problem Solving makes a well-supported argument that the ability to autobiographically recall specific events from the past and imagine one’s future is directly related to one’s self-efficacy, which is directly related to ones self-identity and social problem solving. I’ve been able to experience the relationship between these concepts in my own life. There have certain periods of my life (which can last weeks to even a couple of months) when my self-efficacy has been rather low and I was unable to imagine even a near future for myself. My ability to recall specific details of my life would waiver along with the certainty of who I was. However, I would always bounce back to a higher level of self-efficacy and just shrug it off as common college student anxiety. I would tell myself that all college students worry about these things every now and again so I shouldn’t get too hung up about it. Self-assessment is necessary, but it shouldn’t be depressive. What I am suggesting is that the results of this article might not be permanent even for the test subjects. Because of our surroundings, we humans tend to compare ourselves to those around us and reassess all the time. This can cause our own perceptions of our identities to change rapidly from time to time. Thus, it might be social surroundings that cause low self-efficacy and feed the lack of ability to solve social problems, creating a vicious loop for the more drastically affected. For others, such as myself, it might only be slight and connected more to common anxieties.
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The readings this week, brought a new aspect of the memory-PTSD relationship to light. The readings highlight the importance of further memory studies to help PTSD patients. In ‘Overgeneralized autobiographical memory and future thinking in combat veterans with posttraumatic stress disorder’ by Brown et al, the results of the experiment showed that there is an overlap between autobiographical memories and the mechanism that helps us imagine our future. People with PTSD were more likely to think of over general autobiographical memories and future events. They were also more likely to include events or information from combat, in their future imagined events. In ‘The Impact of Percieved Self-Efficacy on Mental Time Travel and Social Problem Solving’ by Brown et al, it is mentioned how Mental Time Travel (MTT), ‘‘the process by which one can recall and re-experience episodes from our past or pre-experience our lives in the future’’ can also be an important tool in the way a person addresses and solves problems.
These results show the important part memory plays in our day-to-day lives, what we know about ourselves is through our memories of experiences, and when that mechanism is altered to only bring out disturbing memories, it can change the way we view our capabilities and therefore our future. This in turn can make us have overgeneralized thoughts for our future, which our not truly a part of the persons’ personality or capabilities.
It then becomes extremely important to address a patients’ PTSD and the memories that are constantly retrieved. One such treatment that I’ve read about is the reconsolidation of memory therapy, the goal of this treatment is to lessen the emotions attached to the memories. While this is still a new and highly criticized treatment it could be an effective treatment for PTSD patient memories. Rodriguez-ortiz et al in their book, Neural Plasticity and Memory: From Genes to Brain Imaging, explain that when a memory is recalled, its molecular trace in the brain becomes plastic. A reactivated memory then has to be re-saved or consolidated again to be stored, during this re-saving process it can be altered to make it less negatively impacting on the patient. The question of this being ethical is also something to discuss, but at the same time if this treatment were done well it could be the solution to the overgeneralization of memory problem
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This week, we read and analyzed studies about overgeneralized memories and mental time travel in relation to trauma. I found the relationship between self-efficacy and mental time travel specificity and positvity interesting. If one has high self-efficacy, he or she is more likely to retrieve episodic memories that “promote positive self-appraisals” or less likely to “ruminate about negative experiences” (Brown et al. 2011). My question is how would these findings correlate to amnesiacs? Amnesiacs wouldn’t necessarily have the choice to ruminate about positive or negative experiences; would the subject be able to mental time travel at all? How would this affect one’s ability to predict social problem solving without learning from past experiences? Specifically while I was reading these articles and listening to the lecture, I was thinking about the obvious popular culture amnesia reference: Jason Bourne. I know it is a fictional movie, but how is Bourne able to problem-solve and plan specific events for his dangerous future without any memories to “travel” back to? Did his conditioned implicit memory, constructed from years of combat training before his traumatic event and prior missions/experience, help him maintain high self-efficacy, so that he can problem solve and plan for the future?
Or was it Jason Bourne’s PTSD that allowed him to remain so combative? In Brown et al. (2012), the authors mention that “in response to neutral cue words, individuals with combat-related PTSD, compared to those without PTSD, were more likely to generate combat-related content when… imagining the future” (i.e., NYC diaster-relief aid and deployment). It would seem logical that as a government trained assassin, Bourne had to do much tactical training and combative work, which probably led to his PTSD. Did his combat-related PTSD help promote his ability to imagine the future for himself even after he developed retrograde amnesia. More generally, how does retrograde amnesia affect PTSD symptoms? Or vice versa? What’s their relationship?
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I found the revealed correlation between the recollection of autobiographical memories and ability to imagine the future interesting, but not surprising. It makes sense that the imagined future is simply a reconstruction/rearrangement of the past, as our cognitive abilities do not encompass creating entirely new material. If we have not seen it, we cannot make it up. I remember hearing that if we see unfamiliar faces in our dreams, they are still not our own construction. We may not remember seeing these people in our waking lives, but we must have at some point, as our minds lack the ability to create new faces. We might not recognize them, but that does not mean that they do not exist outside of our mental conception.
The process of imagining is not unlike that of collaging. We take bits and pieces of what we know and reorganize them until they convey something else. It is therefore not surprising that the lack of specificity in one’s autobiographical memories causes complications in his or her visualization of the future. If the past material is not there, it cannot be adapted to envision new situations. While a lack of specific details about an unpleasant past can aid one’s present self in not feeling hindered by regret or fear, such a deficiency has the potential to stunt that person’s ability to conceptualize new situations. I suppose this is the double-edged sword of our autobiographical recollection. Drawing on the past to create the future allows us to turn bad things into good things, good things into better things, etc … If we don’t remember our past, we don’t have to worry about it; but without these memories, we are cognitively limited. A critical aspect of our mental repertoire is the details of autobiographical events; without specificity, there are only so many combinations of generalities that can be reorganized so as to depict a new future. I am of the belief that we are better off taking the good with the bad and running with it as opposed to eliminating the bad and consequently limiting our ability to imagine.
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I was blown away during class when we learned about training your brain to be better at specificity for autobiographical actually showed a decrease in patients symptoms. Cognitive behavior theory, while something i never would have thought of myself, just makes so much sense as to why it works. Im excited to see how that method of therapy progresses with time and what difference it might make. While I could see how people with PTSD would have trouble looking into the future I found it interesting they also had trouble with specificity when talking of the past as well. Its interesting to me that both these subjects rely on the same parts of the brain. It makes sense to me as well though that a decrease in the size in your Hippocampus led to ones decreased ability to make future plans and consequently leaves the person living in the present. During an animal behavior class we learned there are only a few classes of birds that had spatial memory or were able to produce multiple songs and that these birds all had a larger hippocampus compared to other species.
One of my favorite pieces of advice in life is “fake it till you make it.” It seems silly to pretend to be better at something that you are but it really does work sometimes. That false confidence boost can make a huge difference on how a person acts which is why I though the impact of perceived self efficacy on memory to be so relevant. Its a bit like a placebo effect. If you tell someone they have an advantage they’re going to internalize it and perform better because of the lack of anxiety. I also thought that having patients recall times in their lives where they handled a stressful situation efficiently is a great idea. When depressed it easy to get mucked down with thoughts about everything that is wrong and you forget the positives. Even just the smallest positive memory that shows a person that they do have some amount of self-efficacy can be extremely encouraging. It derails the train of thought that you cant do anything right and has one take a step back to really assess themselves in a more positive manor.
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I have been thinking a lot about the role of therapy in relation to survivors of trauma. As Brown, Root, Romano, Chang and Hirstf reference at the end of their study, “greater emphasis on how individuals imagine the future, such as imagery re-scripting or future-oriented imaginal exposure techniques that aim to increase the specificity and decrease the maladaptive biases toward the future.” It reminds me of an essay by Mark Klempner titled, Interviews with Trauma Survivors. Klempfner discusses the difficulties of interviewing survivors of trauma, when the interviewee has not experienced the severe trauma themselves. “Trauma survivors live not with memories of the past, but with an event that could not and did not proceed through to its completion, has no ending, attained no closure, and therefore, as its survivors are concerned, continues into the present and is current in every respect.” The importance of using the past to inform a better future becomes more complicated when the therapist lacks the framework of understanding to help conceive of a narrative from the bottom-up. Instead, if we make use of the future–this study shows the inextricable link of the past already being used to inform the future–to re-inform the past, placing “greater emphasis on how individuals imagine the future, such as imagery re-scripting or future-oriented imaginal exposure techniques that aim to increase the specificity and decrease the maladaptive biases toward the future,” therapy becomes a platform for empowerment; the patient fights against what they could not control by re-asserting themselves as the one who can do the writing.
This need for empowerment is one of the reasons why discussing self-efficacy in the therapy sessions could end up being effective. First and foremost, this type of positive reinforcement tells the patient that the therapist can be trusted, it tells the patient that the he/she knows their trauma better than anyone else, it tells the patient that the therapist is willing to work as a partner who might actively help define future vs. past. They actively take the role of a positive figure in a present and future that emerged from traumatic experience–so long as the therapist re-asserts themselves as someone that is not defined by the trauma that might otherwise fearfully be reflected from anything and anyone. While the patient re-externalizes the memory, their increasing trust in the therapist and their work with self-efficacy might result in a domino effect that tints the world and the person with a little more trust.
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Reading the articles about the terror in Abyei and the Foreign Policy made me think a lot about war in general, not just in areas that aren’t as developed as the US. As much as the events of war leave a mark on people, sometimes war is inevitable. Unfortunately, world peace is still a distant idea, and wars definitely don’t help that, but I also feel like there’s never going to be a situation in which everyone agrees on everything. Violence is definitely not the answer, but some cases need to just to play out as they go, and progress is something that takes time to even start, not to mention grow.
What saddened me the most in reading these articles is the affects these events have on people in those areas, especially Sudan. I personally experience the war there in the sense of watching thousands of Sudanese refugees moving to Israel, and trying to fit in a completely different culture. The sadder part is that even when people manage to escape, they still get treated so badly, which is a gateway to not only sever PTSD problems which are repressed and untreated, but to crime and desperate attempts to just merely survive. The thing that worries me the most in these cases is that most of them revolve around religious and ethnicity / race problems, and there’s no solution to these problems in the near future. Not that abolishing religion is going to solve anything, but there are solutions and actions that the UN and the rest of the world can take in making the future better for everyone.
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