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This article reviews the literature on prevalence, associated features, assessment, and treatment of intrusive symptoms associated with posttraumatic stress disorder (PTSD). Research indicates that among trauma survivors, intrusive thoughts and imagery are quite common and distressing. It appears that early intrusions may be predictive of long-term distress and that avoidance and suppression can maintain intrusions. The treatment outcome literature for PTSD indicates that current cognitive behavioral treatments are effective in reducing intrusions. New data from a recent treatment outcome study for PTSD with comorbid panic attacks, using Multiple Channel Exposure Therapy, also suggest that this treatment is effective in significantly reducing intrusions.
Keywords: posttraumatic stress disorder; trauma; intrusive thoughts; cognitivebehavioral therapy
Posttraumatic stress disorder (PTSD) as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994) is the development of symptoms of re-experiencing, avoidance, and increased arousal following exposure to a traumatic event. Intrusive symptoms, such as repetitive thoughts, images, memories, or impulses related to the trauma that are usually uncontrollable and/or unwanted are included in the symptom category of re-experiencing. Intrusive thoughts have been linked with subjective and psychophysiological disturbances (e.g., Horowitz, 1969; Rachman, 1981) and are predictive of the development and maintenance of PTSD (e.g., Davidson & Baum, 1993). We will present a review of literature related to intrusive thoughts in PTSD, present theories of PTSD and how intrusive thoughts relate to these theories, and present PTSD treatments and discuss how these treatments impact intrusive thoughts. Finally, future directions for research in the area of intrusive thoughts in PTSD are discussed.
Characteristics of Intrusive Thoughts in PTSD
The term "intrusive thoughts" may be misleading in that the term "thoughts" may imply only lexical cognitions. However, intrusive thoughts encompass a broader realm of experiences, including images, memories, and impulses, as well as lexical cognitions. In fact, evidence suggests that images are more common than thoughts or purely lexical cognitions (Ehlers & Steil, 1995).
Reynolds and Brewin (1999) found that PTSD intrusive thoughts typically contain content of personal illness or injury, or personal assault. De Silva and Marks (1998) proposed that individuals also experience intrusive thoughts that are not memories of the traumatic event; rather, they are questions about the event. These thoughts fall into three...