Memory and trauma

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Memory and trauma is the deleterious effects that physical or psychological trauma has on memory.

Contents

Memory is defined by psychology as the ability of an organism to store, retain, and subsequently retrieve information. When an individual experiences a traumatic event, whether physical or psychological trauma, their memory can be affected in many ways. For example, trauma might affect their memory for that event, memory of previous or subsequent events, or thoughts in general. Additionally, It has been observed that memory records from traumatic events are more fragmented and disorganized than recall from non traumatic events. [1] Comparison between narrative of events directly after a traumatic event versus after treatment indicate memories can be processed and organized and that this change is associated with decrease in anxiety related symptoms. [2]

Physical trauma

When people experience physical trauma, such as a head injury in a car accident, it can result in effects on their memory. The most common form of memory disturbance in cases of severe injuries or perceived physical distress due to a traumatic event is post-traumatic stress disorder, [3] discussed in depth later in the article.

Traumatic brain injury

Damage to different areas of the brain can have varied effects on memory. The temporal lobes, on the sides of the brain, contain the hippocampus and amygdala, and therefore have a lot to do with memory transition and formation. Patients who have had injury to this area have experienced problems creating new long-term memories. For example, the most studied individual in the history of brain research, HM, retained his previously stored long-term memory as well as functional short-term memory, but was unable to remember anything after it was out of his short-term memory. [4] A patient whose fornix was damaged bilaterally developed severe anterograde amnesia but no effect on any other forms of memory or cognition. [5]

Brain trauma

In addition to physical damage to the brain as a result of mechanical injury, there are other changes in the brain that can be observed. Neuroimaging studies on PTSD repeatedly identify key structures associated with pathology development. [6] The structures observed to change are the amygdala, Anterior Cingulate Cortex (ACC), Pre Frontal Cortex (PFC), insula, and hippocampus. [6] These parts of the brain are most affected because they contribute to the feeling and actions associated with fear, clear thinking, decision making and memory. [7] As a result of individual changes within different brain structures communication and regulation within structures is also impacted. [6]

Amygdala

The Amygdala is known as the "fear center of the brain," and is thought to be activated and regulated in response to stressful situations marked with perceived heightened stimulation. Specifically, the Amygdala is responsible for identifying threats of danger to self and safety. [8] Consistent exposure to trauma and or stress, may lead to over-perception and heighten responsibility and sensitivity to threat. [6] Increased activation in the fear center can impact communication with other circuits in the brain structure including connections between the PFC, amygdala, and hippocampus [6] which can in turn affect how memory are stored by the hippocampus. It is important to note that the amygdala does not fully develop until the late 20's and stress experienced prior to that age may have more extensive impact compared to stress experienced after amygdala is fully developed. [9]

Pre-frontal cortex

The PFC is a brain structure responsible for executive functioning skills. Included in executive function abilities are emotional regulation, impulse control, mental cognition, and working memory among many other abilities.The PFC is also in charge of modulating response from the Amygdala. However, during high-stress situations, the Amygdala can suppress higher thinking functions of the PFC. [8] Some PFC functions that may be impacted during traumatic stress include; failure of emotion reappraisal, heightened salience of emotional stimuli, failure to inhibit neuro-endocrine response to threat stimuli, inability to maintain or use extinction of conditioned fear. [6] ). People who have experienced trauma, especially chronic and ongoing trauma, may be observed to have under-activation of multiple parts of the PFC. [8] Under activation of the PFC can lead to decreased modulation of the amygdala during a stress response. [6] The PFC in most vulnerable to the effects of stress during adolescent and a traumatic event during this time period would have more extensive changes than stress experience when the PFC is fully developed around the mid 20's. [9]

Hippocampus

The hippocampus is considered the memory center for the brain and is responsible for storing, encoding, retrieving, and reconsolidating memories. [8] Studies indicate that people who have PTSD may have a "shrunken" hippocampus, some estimates indicate that there may be up to a decrease in a range of 5-26%. [10] However, there are alternative explanations to account for the observed decreased hippocampus volume. One study by Gilbertson et al. (2002), suggests that perhaps decrease hippocampal volume may be a pre-existing factor that may predispose people for the development of PTSD. [11] There are conflicting interpretation in understanding if decreased hippocampal volumes are a consequence or a pre-existing vulnerability associated with PTSD. [11] [10] While it is unclear if decreased hippocampal volume is evident as a consequence or prior to the traumatic event; there are numerous studies that indicate the hippocampus in under active during traumatic events and potentially also under-active after the event as well. [6] [8] [10] [11] An underactive or dysregulated Hippocampus has many clinical implications including in areas of neurogenesis, disturbances to organization of memory, and ability to impact other endocrine functions such as a stress-response. [8] [12] [13]

The hippocampus is a major site of neurogenesis, it is where new neurons are born, impact to neurogenesis can have multiple implications. Some studies suggest that blocking of neurogenesis may have the ability to block the efficacy of anti-depressants which are used to treat symptoms of depression. [12] According to the DSM-5 there is comorbidity among depression and PTSD. In addition to comorbidity rates, the symptoms of PTSD and Major Depression Disorder (MDD) also have some overlap. Specifically, both list negative alteration in mood and cognitive disturbances as a symptom, underlying the idea of a "c" factor or a cognitive dysfunction that can be seen as a transdiagnostic dimension of psychopathology. [14] Trauma can impact the hippocampus and may have global implications in mood and symptom progression through the impacts on neurogenesis. [12]

Changes to the hippocampus also may have impact to a person's ability to recall the traumatic experience [8] and produce a trauma narrative . [1] There have been studies that further expand on how trauma can impact victims ability to recall traumatic events. [1] [2] These memory difficulties in identifying, labeling, and completely processing the traumatic event can be targets for treatment through psychotherapy. [15] The age of a person when they experience a traumatic event can also modulate the effects of the hippocampus. [9] Particularly, the hippocampus is developing from birth to age 2 and is most vulnerable to the effects of stress during this time period. [9] During adolescence the hippocampus is fully organized and less vulnerable to the effects of stress. [9]

The hippocampus also has connections with the body's stress response system. [10] The hippocampus is responsible for the negative feedback regulation of the Hypothalamic- pituitary-adrenal axis. [13] Failure to regulate stress response through the HPA axis can have long-term health effects through the experience of chronic stress. [13]

Interpersonal trauma

Interpersonal trauma is psychological trauma resulting from adverse interactions between people. Interpersonal trauma could include sexual violence, domestic violence, and abuse in childhood. People in these instances present with PTSD, often with more complex features. [16] [17] Interpersonal trauma continues to be a significant public health problem in the United States, contributing to significant psychological distress and functional impairment. [18] [19] [20]

Sexual violence victims are predominantly women. When interviewing women who had been sexually abused in childhood, Williams [21] found that 38% of women had no recollection of the abuse in later adulthood. While those who experienced a singular traumatic event (e.g., witnessing the death of a parent) were better able to remember the traumatic experience. These results indicate that repeated traumatic experiences are more likely to be repressed than those that occurred only once.

The World Health Organization has identified that one in three women are victims of intimate partner violence. Exposure to intimate partner violence results in many adverse psychological and neurological outcomes. [22] [23] Strangulation is common in interpersonal violence, causing cerebral dysfunction and leading to memory impairment. Initial consequences of strangulation could be loss of consciousness and mild brain injury, while long-term residual problems include neurological impairment. [24] In a meta-analysis of primarily self-report responses from a female sample, women exposed to intimate partner violence are prone to experiencing loss of consciousness, mild brain injury, motor and speech disparities, memory loss, and lack of help-seeking behavior. [22]

Treatment

Individuals with a history of interpersonal trauma would benefit from psychoeducation concentrating on the manifestations of PTSD symptoms and trauma's consequences on memory may be beneficial. Some treatment approaches for survivors of interpersonal trauma also focus on memory restructuring. Trauma symptoms aid in preserving impaired memory; thus, restructuring memories through several possible treatment modalities can be advantageous in treating the trauma symptoms and patients' cognitions. These modalities include learning to address trauma memories by specifying triggers, re-conditioning flashbacks, and engaging in narrative restructuring. [25] [26] Additionally, some treatments aim to restructure memory through imagery and nightmare rescripting exercises. One consideration for therapists when suggesting memory restructuring to patients is the possible impact of prolonged exposure during treatment. Patients are required to describe trauma memories in great detail (e.g., imagery rescripting), which could lead to re-traumatization.

Psychological trauma

Relevant memory

Of the different aspects of memory – working, short-term, long-term, etc. – the one most commonly affected by psychological trauma is long-term memory. [27] Missing memories, changes to memory, intensified memories – all are cases of manipulations of long-term memory. Within the construct of long-term memory, trauma has been shown to alter implicit and explicit memory. [28] For example, sexual abuse victims with PTSD have been shown to present with explicit memory deficits. [28] These alterations can even occur in individuals who did not develop PTSD from trauma exposure. [28]

Physical aspect

Long-term memory is associated with many different areas of the brain including the hippocampus, amygdala, thalamus and hypothalamus, peripheral cortex and temporal cortex. The hippocampus and amygdala have been connected with transference of memory from short-term memory to long-term memory. [29] Thalamus and hypothalamus, located in the forebrain, are part of the limbic system; they are responsible for regulating different hormones and emotional and physical reactions to situations, including emotional stress or trauma. The thalamus is also related to reception of information and transferring the information, in the case of memories, to the cerebral cortex.

Physical effects

Psychological trauma has great effects on physical aspects of patients' brains, to the point that it can have detrimental effects akin to actual physical brain damage. The hippocampus is involved in the transference of short-term memories to long-term memories and is especially sensitive to stress. Stress causes glucocorticoids (GCs), adrenal hormones, to be secreted and sustained exposure to these hormones can cause neural degeneration. The hippocampus is a principal target site for GCs and therefore experiences a severity of neuronal damage that other areas of the brain do not. [30] In severe trauma patients, especially those with post-traumatic stress disorder, the medial prefrontal cortex is volumetrically smaller in size than normal and is hyporesponsive when performing cognitive tasks, which could be a cause of involuntary recollection (intrusive thoughts). [31] The medial prefrontal cortex controls emotional responsiveness and conditioned fear responses to fear-inducing stimuli by interacting with the amygdala. In those cases, the metabolism in some parts of the medial prefrontal cortex didn't activate as they were supposed to when compared to those of a healthy subject.

Psychological effects

As with many areas of psychology, most of these effects are under constant review, trial, and dissent within the scientific world regarding the validity of each topic.

Repressed memory

Perhaps one of the most controversial and well-known of the psychological effects trauma can have on patients is repressed memory. The theory/reality of repressed memory is the idea that an event is so traumatic, that the memory was not forgotten in the traditional sense, or kept secret in shame or fear, but removed from the conscious mind, still present in the long-term memory but hidden from the patient's knowledge. [32] Sigmund Freud originated the concept of repression and theorized that individuals had full control over this repression. In fact, he refers to them as defense mechanisms that individual uses to keep themselves safe from negative consequences. Despite purposefully repressing these memories, Freud believed they still affect the individual unconsciously and, in some cases, will be brought back into one's recollection. [33] Since Freud’s original conception of repression, much has changed and been debated across the field of psychology. In the eyes of critics of repressed memory, it is synonymous with false memory; however its proponents will argue that these people truly did have traumatic experiences.

Repressed memories and the impact of childhood trauma on memory are significant to note, as childhood sexual assault prosecutions may take place years after an alleged sexual assault. [34] Maltreatment causes impairments or distortions in cognitive, emotional processes, neurobiology, and brain development which might affect memory. [35] [36] Repressed memories of interpersonal violence during childhood have been explored in longitudinal research. Findings suggest that adults’ ability to recall from long-term memory instances of childhood maltreatment depends on numerous factors. Factors include individual differences and development, the overall impact of the traumatic experience, and the modality interviewers use to assess adult childhood trauma. For example, the more significant the impact of childhood maltreatment is, the more accurate adult long-term memory of the events recall may be. [34] Additional predictors of long-term memory of child maltreatment are the form of abuse and the age of onset. Research shows that being older when traumatic events occur correlates with a more accurate memory. [37]

Intrusive thoughts

Intrusive thoughts are defined as unwelcome, involuntary thoughts, images or unpleasant ideas that may become obsessions, are upsetting or distressing, and can be difficult to be free of and manage. In patients who have suffered from traumatic events, especially those with post-traumatic stress disorder, depression or obsessive-compulsive disorder, the thoughts are not as easy to ignore and can become troubling and severe. These thoughts are not typically acted on; the obsession of the thoughts usually comes from intense guilt, shame or anxiety relating to the fact that the patient is having the thoughts to begin with, so they are unlikely to actually act on things they feel so badly about. In trauma patients, the intrusive thoughts are typically memories from traumatic experiences that come at unexpected and unwanted times. The primary difference from other intrusive thoughts for patients is that the memories are real rather than imagined.

Emotion

Emotion is a large part of trauma, especially near death experiences. The effect emotions have on memory in different instances is an integral part of the effect of trauma on memory. Emotional events tend to be recalled with more frequency and clarity than memories not associated with extreme emotions. [38] Typically traumatic events, such as physical attack or sexual abuse, are interrelated with strong negative emotions, causing these memories to be very strong and more easily recalled than memories not associated with similar emotions, or even those connected to positive emotions. Emotion's strong connection with memory also has to do with how much attention or focus an individual has on the event. If they are heavily emotionally involved in the event, a lot of their attention is directed at what's happening, rendering it a stronger memory. It is also the case with emotionally aroused situations that even if attention is limited, it is more likely that a memory associated with the strong emotion will remain as opposed to some neutral stimulus. This increase in attention and encoding is due to the activation of the prefrontal-hippocampal-amygdala complex and results in improvement in later memories. [39] Chemically, this is because the emotional and physical stress caused by traumatic events creates an almost identical stimulation in the brain to the physiological condition that heightens memory retention. It excites the neuron-chemical activity centers of the brain that affects memory encoding and recollection. [40] This reaction has been enforced by evolution as learning from high-stress environments is necessary in "fight or flight" decisions that characterize human survival.

Implications in neuropsychological testing and treatment

It is common to see mild and subtle neurocognitive deficits in adults with PTSD across differing trauma types. Research typically breaks down the assessment of neurocognitive function into nine cognitive domains. These domains include attention/working memory, executive functions, verbal learning, verbal memory, visual learning, visual memory, language, speed of information processing, and visuospatial abilities. [41] One study highlights the discrepancy in sustained attention, working memory, and verbal memory among veterans with PTSD compared to the neurotypical control group. [42]

Verbal and visual memory

Verbal memory is a recollection of verbally presented information. Several neuropsychological assessments can be administered to assess verbal memory, such as the Boston Naming Test (BNT), California Verbal Learning Test (CVLT), and the Logical Memory II subtest of the Wechsler Memory Scale-III (WMS-III). Neuropsychological assessments for verbal memory typically include learning a list of words or a story and then performing recall. Performance on assessments of verbal memory demonstrates an individual’s ability to encode said material in memory. [43] By comparison, visual memory is recalling what has been observed or seen. [44]

It is typical for visual memory to remain intact, while verbal memory does not. This may explain why verbal trauma narratives are often disorganized, incoherent, or fragmented. While completing declarative verbal memory tasks, some individuals with PTSD illustrated anterograde memory difficulties and low encoding and storage. Research findings suggest this may be due to complications from PTSD symptoms, [45] which may result from reduced left hippocampal gray matter density. [46] Research suggests that this could have significant implications for an individual with PTSD’s responsiveness to cognitive behavioral therapy because verbal memory impairment may impact spoken or written recall of trauma memories. [47] [48]

Attention and working memory

In response to cognitive tasks, neuroimaging supports the notion that individuals with PTSD evoke a hypoactive response in both attention and working memory. [41] MRI results have shown significantly reduced gray matter density clusters in the anterior cingulate cortex, ventromedial prefrontal cortex, and left hippocampus. This area of the brain is typically involved in fear processing, emotion regulation, memory encoding, and retrieval; as such, damage to this area of the brain can lead to functional discrepancies. These brain structures support cognitive constructs such as attentional switching, information processing speed, and working memory. [49] Hypervigilance is a commonly experienced symptom of PTSD, which indicates a dysfunction in attention processing manifested as a high-attention-bias toward possible environmental threats that is distracting or otherwise problematic in an individual’s day to day life. [41]

Post-traumatic stress disorder

Post-traumatic stress disorder is a psychological disorder (in the same category as: reactive attachment disorder, disinhibited social engagement disorder, acute stress disorder and adjustment disorders) caused by exposure to a terrifying event or ordeal involving the occurrence or threat of physical harm or where a person learns these terrible events happened to a close family member or someone whom they care about. It is one of the most severe and well-known of the different types of psychological trauma, mostly due to its prevalence in war veterans. It can manifest itself as early as after the first year of life. [50] Typically symptoms include avoidance of reminders of the traumatic event or mention thereof, irritability, trouble sleeping, emotional numbness and exaggerated reactions to surprises. One of the most common and powerful symptoms, is the recurrence of random intense memories from the event (intrusive thoughts). This can manifest itself in different ways such as flashbacks of the event and unwanted thoughts about the trauma (e.g. "why did this happen to me?"). [32] PTSD patients who have gone through different traumatic experiences will have small variances in their symptoms, mostly insignificant. For example, PTSD patients who were rape victims will have aversion to words such as touch and dirty while patients who were in a fire or war experience will respond similarly to words like burn or fight. [32]

The stress of PTSD can have an adverse effect on memory. [51] Specifically, this can have severe effects on the hippocampus, [52] including decrease in hippocampus volume, [53] causing problems with transferring short-term to long-term memory, and with the formation of short-term memories. [54] [55] To expand on the relationship between PTSD and hippocampal volume, one meta-analysis found that individuals diagnosed with PTSD have significantly smaller hippocampi volumes compared to controls. [56] Another meta-analysis found that in adults who experienced childhood trauma, the hippocampi were smaller than control hippocampi. [57] In a broad overview, individuals with PTSD who have impairments to their memory generally have this impairment in their verbal memory, [58] more so than their visual memory. [59]

Though studies show that there is no singular way in which patients' memories are affected by PTSD, [60] North Korean refugees with PTSD were found to have generally lower scores on memory tests than control groups of refugees without PTSD. The early presentation of memory impairment compared to complications with other cognitive functions may be due to dysfunction in the hippocampus. [61]

World War II (WWII) contributed to an abundance of PTSD cases today. Many of the patients diagnosed with PTSD after WWII did not have memories of the traumatic events yet had symptoms like hysteria. The amnesia can be attributed to Freud’s theory of repression which suggests that individuals repress their memories to keep themselves safe from further harm/consequences. Stricker et al. [62] (2017) furthered this idea through research that demonstrated higher rates of cognitive impairment (e.g., executive functioning, attention, working memory, and processing speed) in individuals diagnosed with PTSD, like service members or veterans. Memory and learning ability were the most affected areas. More specifically, veterans had a more difficult time with initial learning and encoding the information than recalling it at a later time.

Moradi et al. ( [63] 1999) attributes the memory loss associated with PTSD to "intrusion, avoidance, and hyperarousal symptoms." These symptoms are thought to interrupt performance memory. Additionally, the loss of memory was attributed to a smaller hippocampus in those with PTSD, as the hippocampus is responsible for memory functioning.

Effects of memory impairment on PTSD treatment response

Memory is a vital predictive factor in a positive response to cognitive behavioral therapy for individuals with a trauma history. Specifically, the more intact their verbal memory functioning, the greater the positive predictive outcomes are for treatment response. [48] Additionally, treatment impacts highlight the bidirectional relationship between neurocognitive functioning and trauma symptom preservation. Several studies have associated improved PTSD symptoms with receiving a treatment that enhances cognitive inhibition. Some research supports EMDR and brief eclectic therapy as possible treatment modalities that can intercede verbal memory, processing speed, and executive functioning in individuals with PTSD symptoms. Memory performance improves alongside a reduction in PTSD symptoms, [64] which indicates that some effects of PTSD on memory may be reversible upon symptom improvement. For example, patients who exhibited a positive treatment response showed improved verbal memory and increased hippocampal volume. [65]

See also

Related Research Articles

<span class="mw-page-title-main">Hippocampus</span> Vertebrate brain region involved in memory consolidation

The hippocampus is a major component of the brain of humans and other vertebrates. Humans and other mammals have two hippocampi, one in each side of the brain. The hippocampus is part of the limbic system, and plays important roles in the consolidation of information from short-term memory to long-term memory, and in spatial memory that enables navigation. The hippocampus is located in the allocortex, with neural projections into the neocortex, in humans as well as other primates. The hippocampus, as the medial pallium, is a structure found in all vertebrates. In humans, it contains two main interlocking parts: the hippocampus proper, and the dentate gyrus.

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

<span class="mw-page-title-main">Fear conditioning</span> Behavioral paradigm in which organisms learn to predict aversive events

Pavlovian fear conditioning is a behavioral paradigm in which organisms learn to predict aversive events. It is a form of learning in which an aversive stimulus is associated with a particular neutral context or neutral stimulus, resulting in the expression of fear responses to the originally neutral stimulus or context. This can be done by pairing the neutral stimulus with an aversive stimulus. Eventually, the neutral stimulus alone can elicit the state of fear. In the vocabulary of classical conditioning, the neutral stimulus or context is the "conditional stimulus" (CS), the aversive stimulus is the "unconditional stimulus" (US), and the fear is the "conditional response" (CR).

Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences. It must be understood by the affected person as directly threatening the affected person or their loved ones with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se. Examples include violence, rape, or a terrorist attack.

In neurology, retrograde amnesia (RA) is the inability to access memories or information from before an injury or disease occurred. RA differs from a similar condition called anterograde amnesia (AA), which is the inability to form new memories following injury or disease onset. Although an individual can have both RA and AA at the same time, RA can also occur on its own; this 'pure' form of RA can be further divided into three types: focal, isolated, and pure RA. RA negatively affects an individual's episodic, autobiographical, and declarative memory, but they can still form new memories because RA leaves procedural memory intact. Depending on its severity, RA can result in either temporally graded or more permanent memory loss. However, memory loss usually follows Ribot's law, which states that individuals are more likely to lose recent memories than older memories. Diagnosing RA generally requires using an Autobiographical Memory Interview (AMI) and observing brain structure through magnetic resonance imaging (MRI), a computed tomography scan (CT), or electroencephalography (EEG).

Acute stress reaction and acute stress disorder (ASD) is a psychological response to a terrifying, traumatic or surprising experience. Combat stress reaction (CSR) is a similar response to the trauma of war. The reactions may include but are not limited to intrusive or dissociative symptoms, and reactivity symptoms such as avoidance or arousal. It may be exhibited for days or weeks after the traumatic event. If the condition is not correctly addressed, it may develop into post-traumatic stress disorder (PTSD).

Explicit memory is one of the two main types of long-term human memory, the other of which is implicit memory. Explicit memory is the conscious, intentional recollection of factual information, previous experiences, and concepts. This type of memory is dependent upon three processes: acquisition, consolidation, and retrieval.

A flashback, or involuntary recurrent memory, is a psychological phenomenon in which an individual has a sudden, usually powerful, re-experiencing of a past experience or elements of a past experience. These experiences can be frightful, happy, sad, exciting, or any number of other emotions. The term is used particularly when the memory is recalled involuntarily, especially when it is so intense that the person "relives" the experience, and is unable to fully recognize it as memory of a past experience and not something that is happening in "real time".

Dissociative disorders (DDs) are a range of conditions characterized by significant disruptions or fragmentation "in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior." Dissociative disorders involve involuntary dissociation as an unconscious defense mechanism, wherein the individual with a dissociative disorder experiences separation in these areas as a means to protect against traumatic stress. Some dissociative disorders are caused by major psychological trauma, though the onset of depersonalization-derealization disorder may be preceded by less severe stress, by the influence of psychoactive substances, or occur without any discernible trigger.

Memory disorders are the result of damage to neuroanatomical structures that hinders the storage, retention and recollection of memories. Memory disorders can be progressive, including Alzheimer's disease, or they can be immediate including disorders resulting from head injury.

<span class="mw-page-title-main">Involuntary memory</span> Memory triggered by an environmental cue

Involuntary memory, also known as involuntary explicit memory, involuntary conscious memory, involuntary aware memory, madeleine moment, mind pops and most commonly, involuntary autobiographical memory, is a sub-component of memory that occurs when cues encountered in everyday life evoke recollections of the past without conscious effort. Voluntary memory, its opposite, is characterized by a deliberate effort to recall the past.

Post-traumatic amnesia (PTA) is a state of confusion that occurs immediately following a traumatic brain injury (TBI) in which the injured person is disoriented and unable to remember events that occur after the injury. The person may be unable to state their name, where they are, and what time it is. When continuous memory returns, PTA is considered to have resolved. While PTA lasts, new events cannot be stored in the memory. About a third of patients with mild head injury are reported to have "islands of memory", in which the patient can recall only some events. During PTA, the patient's consciousness is "clouded". Because PTA involves confusion in addition to the memory loss typical of amnesia, the term "post-traumatic confusional state" has been proposed as an alternative.

Amnesia is a deficit in memory caused by brain damage or brain diseases, but it can also be temporarily caused by the use of various sedative and hypnotic drugs. The memory can be either wholly or partially lost due to the extent of damage that is caused.

<span class="mw-page-title-main">Yuval Neria</span>

Yuval Neria is a Professor of Medical Psychology at the Departments of Psychiatry and Epidemiology at Columbia University Medical Center (CUMC), and Director of Trauma and PTSD Program, and a Research Scientist at the New York State Psychiatric Institute (NYSPI) and Columbia University Department of Psychiatry. He is a recipient of the Medal of Valor, Israel's highest decoration, for his exploits during the 1973 Yom Kippur War.

The management of traumatic memories is important when treating mental health disorders such as post traumatic stress disorder. Traumatic memories can cause life problems even to individuals who do not meet the diagnostic criteria for a mental health disorder. They result from traumatic experiences, including natural disasters such as earthquakes and tsunamis; violent events such as kidnapping, terrorist attacks, war, domestic abuse and rape. Traumatic memories are naturally stressful in nature and emotionally overwhelm people's existing coping mechanisms.

<span class="mw-page-title-main">Effects of stress on memory</span> Overview of the effects of stress on memory

The effects of stress on memory include interference with a person's capacity to encode memory and the ability to retrieve information. Stimuli, like stress, improved memory when it was related to learning the subject. During times of stress, the body reacts by secreting stress hormones into the bloodstream. Stress can cause acute and chronic changes in certain brain areas which can cause long-term damage. Over-secretion of stress hormones most frequently impairs long-term delayed recall memory, but can enhance short-term, immediate recall memory. This enhancement is particularly relative in emotional memory. In particular, the hippocampus, prefrontal cortex and the amygdala are affected. One class of stress hormone responsible for negatively affecting long-term, delayed recall memory is the glucocorticoids (GCs), the most notable of which is cortisol. Glucocorticoids facilitate and impair the actions of stress in the brain memory process. Cortisol is a known biomarker for stress. Under normal circumstances, the hippocampus regulates the production of cortisol through negative feedback because it has many receptors that are sensitive to these stress hormones. However, an excess of cortisol can impair the ability of the hippocampus to both encode and recall memories. These stress hormones are also hindering the hippocampus from receiving enough energy by diverting glucose levels to surrounding muscles.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

The hippocampus participates in the encoding, consolidation, and retrieval of memories. The hippocampus is located in the medial temporal lobe (subcortical), and is an infolding of the medial temporal cortex. The hippocampus plays an important role in the transfer of information from short-term memory to long-term memory during encoding and retrieval stages. These stages do not need to occur successively, but are, as studies seem to indicate, and they are broadly divided in the neuronal mechanisms that they require or even in the hippocampal areas that they seem to activate. According to Gazzaniga, "encoding is the processing of incoming information that creates memory traces to be stored." There are two steps to the encoding process: "acquisition" and "consolidation". During the acquisition process, stimuli are committed to short term memory. Then, consolidation is where the hippocampus along with other cortical structures stabilize an object within long term memory, which strengthens over time, and is a process for which a number of theories have arisen to explain the underlying mechanism. After encoding, the hippocampus is capable of going through the retrieval process. The retrieval process consists of accessing stored information; this allows learned behaviors to experience conscious depiction and execution. Encoding and retrieval are both affected by neurodegenerative and anxiety disorders and epilepsy.

Epigenetics of anxiety and stress–related disorders is the field studying the relationship between epigenetic modifications of genes and anxiety and stress-related disorders, including mental health disorders such as generalized anxiety disorder (GAD), post-traumatic stress disorder, obsessive-compulsive disorder (OCD), and more. These changes can lead to transgenerational stress inheritance.

<span class="mw-page-title-main">Post-traumatic stress disorder and substance use disorders</span> Association of PTSD and substance dependencies

Post-traumatic stress disorder (PTSD) can affect about 3.6% of the U.S. population each year, and 6.8% of the U.S. population over a lifetime. 8.4% of people in the U.S. are diagnosed with substance use disorders (SUD). Of those with a diagnosis of PTSD, a co-occurring, or comorbid diagnosis of a SUD is present in 20–35% of that clinical population.

References

  1. 1 2 3 Foa EB (1993). "Posttraumatic stress disorder in rape victims". American Psychiatric Press Review of Psychiatry. 12: (pp. 273–303) – via Washington, D.C.: American Psychiatric Press.
  2. 1 2 Amir N, Stafford J, Freshman MS, Foa EB (April 1998). "Relationship between trauma narratives and trauma pathology". Journal of Traumatic Stress. 11 (2): 385–392. doi:10.1023/a:1024415523495. PMID   9565923. S2CID   42762378.
  3. ↑ Davidson JR (2000). "Trauma: the impact of post-traumatic stress disorder". Journal of Psychopharmacology. 14 (2 Suppl 1): S5–12. doi:10.1177/02698811000142S102. PMID   10888026. S2CID   29321438.
  4. ↑ Corkin S (February 2002). "What's new with the amnesic patient H.M.?". Nature Reviews. Neuroscience. 3 (2): 153–60. doi:10.1038/nrn726. PMID   11836523. S2CID   5429133.
  5. ↑ Calabrese P, Markowitsch HJ, Harders AG, Scholz M, Gehlen W (September 1995). "Fornix damage and memory. A case report". Cortex; A Journal Devoted to the Study of the Nervous System and Behavior. 31 (3): 555–64. doi:10.1016/s0010-9452(13)80066-4. PMID   8536482. S2CID   4478668.
  6. 1 2 3 4 5 6 7 8 Liberzon I, Sripada CS (2007). "The functional neuroanatomy of PTSD: a critical review". Stress Hormones and Post Traumatic Stress Disorder Basic Studies and Clinical Perspectives. Progress in Brain Research. Vol. 167. Elsevier. pp. 151–169. doi:10.1016/s0079-6123(07)67011-3. ISBN   978-0-444-53140-7. PMID   18037013.
  7. ↑ Bremner DJ (August 2007). "Neuroimaging in Posttraumatic Stress Disorder and Other Stress-related Disorders". Neuroimaging Clinics of North America. 17 (4): 523–538. doi:10.1016/j.nic.2007.07.003. PMC   2729089 . PMID   17983968.
  8. 1 2 3 4 5 6 7 Sweeton J (2019). Trauma treatment toolbox : 165 brain-changing tips, tools & handouts to move therapy forward. Eau Claire, WI. ISBN   978-1-68373-179-5. OCLC   1088900185.{{cite book}}: CS1 maint: location missing publisher (link)
  9. 1 2 3 4 5 Lupien SJ, McEwen BS, Gunnar MR, Heim C (June 2009). "Effects of stress throughout the lifespan on the brain, behaviour and cognition". Nature Reviews. Neuroscience. 10 (6): 434–445. doi:10.1038/nrn2639. PMID   19401723. S2CID   205504945.
  10. 1 2 3 4 Garfinkel SN, Liberzon I (June 2009). "Neurobiology of PTSD: A Review of Neuroimaging Findings". Psychiatric Annals. 39 (6): 00485713–20090527–01. doi:10.3928/00485713-20090527-01. ISSN   0048-5713.
  11. 1 2 3 Gilbertson MW, Shenton ME, Ciszewski A, Kasai K, Lasko NB, Orr SP, Pitman RK (November 2002). "Smaller hippocampal volume predicts pathologic vulnerability to psychological trauma". Nature Neuroscience. 5 (11): 1242–1247. doi:10.1038/nn958. PMC   2819093 . PMID   12379862.
  12. 1 2 3 Warner-Schmidt JL, Duman RS (2006). "Hippocampal neurogenesis: opposing effects of stress and antidepressant treatment". Hippocampus. 16 (3): 239–249. doi:10.1002/hipo.20156. PMID   16425236. S2CID   13852671.
  13. 1 2 3 Young EA, Haskett RF, Murphy-Weinberg V, Watson SJ, Akil H (August 1991). "Loss of glucocorticoid fast feedback in depression". Archives of General Psychiatry. 48 (8): 693–699. doi:10.1001/archpsyc.1991.01810320017003. PMID   1652926.
  14. ↑ Abramovitch A, Short T, Schweiger A (June 2021). "The C Factor: Cognitive dysfunction as a transdiagnostic dimension in psychopathology". Clinical Psychology Review. 86: 102007. doi:10.1016/j.cpr.2021.102007. PMID   33864968. S2CID   233291139.
  15. ↑ Norrholm SD, Jovanovic T (May 2018). "Fear Processing, Psychophysiology, and PTSD". Harvard Review of Psychiatry. 26 (3): 129–141. doi:10.1097/HRP.0000000000000189. PMID   29734227. S2CID   13691655.
  16. ↑ Karatzias T, Shevlin M, Fyvie C, Hyland P, Efthymiadou E, Wilson D, et al. (January 2017). "Evidence of distinct profiles of Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD) based on the new ICD-11 Trauma Questionnaire (ICD-TQ)" (PDF). Journal of Affective Disorders. 207: 181–187. doi:10.1016/j.jad.2016.09.032. PMID   27723542. S2CID   3825277.
  17. ↑ Powers A, Fani N, Carter S, Cross D, Cloitre M, Bradley B (2017-01-01). "Differential predictors of DSM-5 PTSD and ICD-11 complex PTSD among African American women". European Journal of Psychotraumatology. 8 (1): 1338914. doi:10.1080/20008198.2017.1338914. PMC   5475321 . PMID   28649302.
  18. ↑ Black MC, Basile KC, Breiding MJ, Ryan GW (May 2014). "Prevalence of Sexual Violence Against Women in 23 States and Two U.S. Territories, BRFSS 2005". Violence Against Women. 20 (5): 485–499. doi:10.1177/1077801214528856. PMID   24759775. S2CID   17032206.
  19. ↑ D'Andrea W, Ford J, Stolbach B, Spinazzola J, van der Kolk BA (April 2012). "Understanding interpersonal trauma in children: why we need a developmentally appropriate trauma diagnosis". The American Journal of Orthopsychiatry. 82 (2): 187–200. doi:10.1111/j.1939-0025.2012.01154.x. PMID   22506521.
  20. ↑ Coker AL, Weston R, Creson DL, Justice B, Blakeney P (December 2005). "PTSD symptoms among men and women survivors of intimate partner violence: the role of risk and protective factors". Violence and Victims. 20 (6): 625–643. doi:10.1891/0886-6708.20.6.625. PMID   16468442. S2CID   35672482.
  21. ↑ Karon, Bertram; Widener, Anmarie (August 1, 1997). "Repressed Memories and World War II: Lest We Forget!". Professional Psychology: Research and Practice. 28 (4): 338–340. doi:10.1037/0735-7028.28.4.338 – via PsycINFO.
  22. 1 2 Bichard H, Byrne C, Saville CW, Coetzer R (July 2022). "The neuropsychological outcomes of non-fatal strangulation in domestic and sexual violence: A systematic review". Neuropsychological Rehabilitation. 32 (6): 1164–1192. doi:10.1080/09602011.2020.1868537. PMID   33432860. S2CID   231587338.
  23. ↑ "Reproductive health". www.who.int. Retrieved 2022-11-05.
  24. ↑ Banks ME (July 2007). "Overlooked but critical: traumatic brain injury as a consequence of interpersonal violence". Trauma, Violence & Abuse. 8 (3): 290–298. doi:10.1177/1524838007303503. PMID   17596346. S2CID   37348715.
  25. ↑ Dalgleish T, Navrady L, Bird E, Hill E, Dunn BD, Golden AM (April 2013). "Method-of-Loci as a Mnemonic Device to Facilitate Access to Self-Affirming Personal Memories for Individuals With Depression". Clinical Psychological Science. 1 (2): 156–162. doi:10.1177/2167702612468111. ISSN   2167-7026. S2CID   145382198.
  26. ↑ Werner-Seidler A, Dalgleish T (November 2016). "The Method of Loci Improves Longer-Term Retention of Self-Affirming Memories and Facilitates Access to Mood-Repairing Memories in Recurrent Depression". Clinical Psychological Science. 4 (6): 1065–1072. doi:10.1177/2167702615626693. ISSN   2167-7026. S2CID   113401872.
  27. ↑ Squire LS (1987). Memory and Brain. New York, New York: Oxford University Press.
  28. 1 2 3 Grégoire L, Gosselin I, Blanchette I (January 2020). "The impact of trauma exposure on explicit and implicit memory". Anxiety, Stress, and Coping. 33 (1): 1–18. doi:10.1080/10615806.2019.1664477. PMID   31507211. S2CID   202557065.
  29. ↑ Fuster JM (1995). Memory in the Cerebral Cortex: An Empirical Approach to Neural Networks in the Human and Nonhuman Primate. Cambridge, MA: The MIT Press.
  30. ↑ Uno H, Tarara R, Else JG, Suleman MA, Sapolsky RM (May 1989). "Hippocampal damage associated with prolonged and fatal stress in primates". The Journal of Neuroscience. 9 (5): 1705–11. doi:10.1523/JNEUROSCI.09-05-01705.1989. PMC   6569823 . PMID   2723746.
  31. ↑ McNally RJ (June 2006). "Cognitive abnormalities in post-traumatic stress disorder". Trends in Cognitive Sciences. 10 (6): 271–277. doi:10.1016/j.tics.2006.04.007. PMID   16697695. S2CID   17796107.
  32. 1 2 3 Loftus E, Ketcham K (1994). The Myth of Repressed Memory: False Memories and Allegations of Sexual Abuse . New York, New York: St. Martin's Press.
  33. ↑ Golding, Jonathan; Sego, Sandra; Sanchez, Rebecca; Hasemann, Dawn (December 1, 1995). "The Believability of Repressed Memories". Law and Human Behavior. 19 (6): 24. doi:10.1007/BF01499375. S2CID   144707586 – via PsycINFO.
  34. 1 2 Goodman GS, Quas JA, Goldfarb D, Gonzalves L, Gonzalez A (March 2019). "Trauma and Long-Term Memory for Childhood Events: Impact Matters". Child Development Perspectives. 13 (1): 3–9. doi: 10.1111/cdep.12307 . ISSN   1750-8592. S2CID   149619264.
  35. ↑ Loman MM, Gunnar MR (May 2010). "Early experience and the development of stress reactivity and regulation in children". Neuroscience and Biobehavioral Reviews. Special Section: Developmental determinants of sensitivity and resistance to stress: A tribute to Seymour "Gig" Levine. 34 (6): 867–876. doi:10.1016/j.neubiorev.2009.05.007. PMC   2848877 . PMID   19481109.
  36. ↑ Teicher MH, Andersen SL, Polcari A, Anderson CM, Navalta CP, Kim DM (2003). "The neurobiological consequences of early stress and childhood maltreatment". Neuroscience and Biobehavioral Reviews. 27 (1–2): 33–44. doi:10.1016/s0149-7634(03)00007-1. PMID   12732221. S2CID   15557040.
  37. ↑ Eisen ML, Goodman GS, Qin J, Davis S, Crayton J (November 2007). "Maltreated children's memory: accuracy, suggestibility, and psychopathology". Developmental Psychology. 43 (6): 1275–1294. doi:10.1037/0012-1649.43.6.1275. PMID   18020811.
  38. ↑ Cahill L, Prins B, Weber M, McGaugh JL (October 1994). "Beta-adrenergic activation and memory for emotional events". Nature. 371 (6499): 702–4. Bibcode:1994Natur.371..702C. doi:10.1038/371702a0. PMID   7935815. S2CID   4337182.
  39. ↑ Canli T, Zhao Z, Brewer J, Gabrieli JD, Cahill L (October 2000). "Event-related activation in the human amygdala associates with later memory for individual emotional experience". The Journal of Neuroscience. 20 (19): RC99. doi:10.1523/JNEUROSCI.20-19-j0004.2000. PMC   6772800 . PMID   11000199.
  40. ↑ Christianson SÅ, Loftus EF (September 1990). "Some characteristics of people's traumatic memories". Bulletin of the Psychonomic Society. 28 (3): 195–198. doi: 10.3758/BF03334001 . S2CID   144860300.
  41. 1 2 3 Scott JC, Matt GE, Wrocklage KM, Crnich C, Jordan J, Southwick SM, et al. (January 2015). "A quantitative meta-analysis of neurocognitive functioning in posttraumatic stress disorder". Psychological Bulletin. 141 (1): 105–140. doi:10.1037/a0038039. PMC   4293317 . PMID   25365762.
  42. ↑ Vasterling JJ, Duke LM, Brailey K, Constans JI, Allain AN, Sutker PB (January 2002). "Attention, learning, and memory performances and intellectual resources in Vietnam veterans: PTSD and no disorder comparisons". Neuropsychology. 16 (1): 5–14. doi:10.1037/0894-4105.16.1.5. PMID   11853357.
  43. ↑ Tatsumi IF, Watanabe M (2009). "Verbal Memory". In Binder MD, Hirokawa N, Windhorst U (eds.). Encyclopedia of Neuroscience. Berlin, Heidelberg: Springer. pp. 4176–4178. doi:10.1007/978-3-540-29678-2_6266. ISBN   978-3-540-29678-2.
  44. ↑ "APA Dictionary of Psychology". dictionary.apa.org. Retrieved 2022-11-05.
  45. ↑ Samuelson KW, Neylan TC, Metzler TJ, Lenoci M, Rothlind J, Henn-Haase C, et al. (November 2006). "Neuropsychological functioning in posttraumatic stress disorder and alcohol abuse". Neuropsychology. 20 (6): 716–726. doi:10.1037/0894-4105.20.6.716. PMC   2443729 . PMID   17100516.
  46. ↑ Bremner JD, Randall P, Scott TM, Bronen RA, Seibyl JP, Southwick SM, et al. (July 1995). "MRI-based measurement of hippocampal volume in patients with combat-related posttraumatic stress disorder". The American Journal of Psychiatry. 152 (7): 973–981. doi:10.1176/ajp.152.7.973. PMC   3233767 . PMID   7793467.
  47. ↑ Falconer E, Allen A, Felmingham KL, Williams LM, Bryant RA (September 2013). "Inhibitory neural activity predicts response to cognitive-behavioral therapy for posttraumatic stress disorder". The Journal of Clinical Psychiatry. 74 (9): 895–901. doi:10.4088/JCP.12m08020. PMID   24107763.
  48. 1 2 Wild J, Gur RC (September 2008). "Verbal memory and treatment response in post-traumatic stress disorder". The British Journal of Psychiatry. 193 (3): 254–255. doi: 10.1192/bjp.bp.107.045922 . PMID   18757989. S2CID   699568.
  49. ↑ Bressler SL, Menon V (June 2010). "Large-scale brain networks in cognition: emerging methods and principles". Trends in Cognitive Sciences. 14 (6): 277–290. doi:10.1016/j.tics.2010.04.004. PMID   20493761. S2CID   5967761.
  50. ↑ DSM-5 Task Force (2013). Diagnostic and statistical manual of mental disorders : DSM-5 (5th ed.). Arlington, VA: American Psychiatric Association. ISBN   978-0-8904-2554-1. OCLC   830807378.{{cite book}}: CS1 maint: numeric names: authors list (link)
  51. ↑ Stricker NH, Lippa SM, Green DL, McGlynn SM, Grande LJ, Milberg WP, McGlinchey RE (October 2017). "Elevated rates of memory impairment in military service-members and veterans with posttraumatic stress disorder". Journal of Clinical and Experimental Neuropsychology. 39 (8): 768–785. doi:10.1080/13803395.2016.1264575. PMID   27976973. S2CID   205804361.
  52. ↑ Bremner DJ (2013). "The invisible epidemic: Post-Traumatic Stress Disorder, memory and the brain". The Doctor.
  53. ↑ Emdad R, Söndergaard HP (2005). "Impaired memory and general intelligence related to severity and duration of patients' disease in Type A posttraumatic stress disorder". Behavioral Medicine. 31 (2): 73–84. doi:10.3200/BMED.31.2.73-86. PMID   16130309. S2CID   40029018.
  54. ↑ Emdad R, Söndergaard HP (2006). "General intelligence and short-term memory impairments in Post Traumatic Stress Disorder patients". Journal of Mental Health. 15 (2): 205–216. doi:10.1080/09638230600608966. S2CID   144833060.
  55. ↑ Emdad R, Sondergaard HP, Theorell T (2005). "Impairments in short-term memory, and figure logic, in PTSD patients compared to healthy controls with the same ethnic background". Stress & Health. 21: 33–44. doi:10.1002/smi.1034.
  56. ↑ Smith ME (2005). "Bilateral hippocampal volume reduction in adults with post-traumatic stress disorder: a meta-analysis of structural MRI studies". Hippocampus. 15 (6): 798–807. doi:10.1002/hipo.20102. PMID   15988763. S2CID   46206070.
  57. ↑ Woon FL, Hedges DW (2008). "Hippocampal and amygdala volumes in children and adults with childhood maltreatment-related posttraumatic stress disorder: a meta-analysis". Hippocampus. 18 (8): 729–736. doi:10.1002/hipo.20437. PMID   18446827. S2CID   31931903.
  58. ↑ Johnsen GE, Asbjørnsen AE (November 2008). "Consistent impaired verbal memory in PTSD: a meta-analysis". Journal of Affective Disorders. 111 (1): 74–82. doi:10.1016/j.jad.2008.02.007. PMID   18377999.
  59. ↑ Bae SM, Hyun MH, Lee SH (April 2014). "Comparison of Memory Function and MMPI-2 Profile between Post-traumatic Stress Disorder and Adjustment Disorder after a Traffic Accident". Clinical Psychopharmacology and Neuroscience. 12 (1): 41–47. doi: 10.9758/cpn.2014.12.1.41 . PMC   4022765 . PMID   24851120.
  60. ↑ Brewin CR (2003). Posttraumatic Stress Disorder: Malady or Myth?. New Haven and London: Yale University Press.
  61. ↑ Shin JE, Choi CH, Lee JM, Kwon JS, Lee SH, Kim HC, et al. (2017). "Association between memory impairment and brain metabolite concentrations in North Korean refugees with posttraumatic stress disorder". PLOS ONE. 12 (12): e0188953. Bibcode:2017PLoSO..1288953S. doi: 10.1371/journal.pone.0188953 . PMC   5720673 . PMID   29216235.
  62. ↑ Stricker, Nikki; Lippa, Sara; Green, Deborah; McGlynn, Susan; Grande, Laura; Milberg, William; McGlinchey, Regina (September 1, 2017). "Elevated rates of memory impairment in military service-members and veterans with post-traumatic stress disorder". Journal of Clinical and Experimental Neuropsychology. 39 (8): 768–785. doi:10.1080/13803395.2016.1264575. PMID   27976973. S2CID   205804361 – via PsycINFO.
  63. ↑ Moradi, Ali; Doost, Hamid; Taghavi, Mohammad; Yule, William; Dalgleish, Tim (March 1, 1999). "Everyday Memory Deficits in Children and Adolescents with PTSD: Performance on the Rivermead Behavioral Memory Test". Journal of Child Psychology and Psychiatry. 40 (3): 357–361. doi:10.1111/1469-7610.00453. PMID   10190337 – via PsycINFO.
  64. ↑ Nijdam MJ, van der Meer CA, van Zuiden M, Dashtgard P, Medema D, Qing Y, et al. (February 2018). "Turning wounds into wisdom: Posttraumatic growth over the course of two types of trauma-focused psychotherapy in patients with PTSD". Journal of Affective Disorders. 227: 424–431. doi:10.1016/j.jad.2017.11.031. PMID   29154159.
  65. ↑ Vermetten E, Vythilingam M, Southwick SM, Charney DS, Bremner JD (October 2003). "Long-term treatment with paroxetine increases verbal declarative memory and hippocampal volume in posttraumatic stress disorder". Biological Psychiatry. 54 (7): 693–702. doi:10.1016/S0006-3223(03)00634-6. PMC   3233762 . PMID   14512209.
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