Ehlers Anke, Hackmann Ann, Michael Tanja
Department of Psychology, Institute of Psychiatry, London, UK.
Memory. 2004 Jul;12(4):403-15. doi: 10.1080/09658210444000025.
The article describes features of trauma memories in post-traumatic stress disorder (PTSD), including characteristics of unintentional re-experiencing symptoms and intentional recall of trauma narratives. Reexperiencing symptoms are usually sensory impressions and emotional responses from the trauma that appear to lack a time perspective and a context. The vast majority of intrusive memories can be interpreted as re-experiencing of warning signals, i.e., stimuli that signalled the onset of the trauma or of moments when the meaning of the event changed for the worse. Triggers of re-experiencing symptoms include stimuli that have perceptual similarity to cues accompanying the traumatic event. Intentional recall of the trauma in PTSD may be characterised by confusion about temporal order, and difficulty in accessing important details, both of which contribute to problematic appraisals. Recall tends to be disjointed. When patients with PTSD deliberately recall the worst moments of the trauma, they often do not access other relevant (usually subsequent) information that would correct impressions/predictions made at the time. A theoretical analysis of re-experiencing symptoms and their triggers is offered, and implications for treatment are discussed. These include the need to actively incorporate updating information ("I know now ...") into the worst moments of the trauma memory, and to train patients to discriminate between the stimuli that were present during the trauma ("then") and the innocuous triggers of re-experiencing symptoms ("now").
本文描述了创伤后应激障碍（PTSD）中创伤记忆的特征，包括无意的重新体验症状和对创伤叙述的有意回忆的特点。重新体验症状通常是来自创伤的感觉印象和情绪反应，似乎缺乏时间视角和背景。绝大多数侵入性记忆可被解释为对警告信号的重新体验，即那些预示着创伤开始或事件意义恶化时刻的刺激。重新体验症状的触发因素包括与创伤事件伴随线索具有感知相似性的刺激。PTSD中对创伤的有意回忆可能表现为时间顺序混乱，以及难以获取重要细节，这两者都会导致有问题的评估。回忆往往是不连贯的。当PTSD患者刻意回忆创伤的最糟糕时刻时，他们往往无法获取其他相关（通常是随后的）信息，而这些信息可以纠正当时形成的印象/预测。本文提供了对重新体验症状及其触发因素的理论分析，并讨论了其对治疗的启示。这些启示包括需要积极将更新信息（“我现在知道……”）纳入创伤记忆的最糟糕时刻，并训练患者区分创伤期间出现的刺激（“当时”）和重新体验症状的无害触发因素（“现在”）。
