Mental Imagery and Post-Traumatic Stress Disorder: A Neuroimaging and Experimental Psychopathology Approach to Intrusive Memories of Trauma

This hypothesis and theory paper presents a pragmatic framework to help bridge the clinical presentation and neuroscience of intrusive memories following psychological trauma. Intrusive memories are a hallmark symptom of post-traumatic stress disorder (PTSD). However, key questions, including those involving etiology, remain. In particular, we know little about the brain mechanisms involved in why only some moments of the trauma return as intrusive memories while others do not. We first present an overview of the patient experience of intrusive memories and the neuroimaging studies that have investigated intrusive memories in PTSD patients. Next, one mechanism of how to model intrusive memories in the laboratory, the trauma film paradigm, is examined. In particular, we focus on studies combining the trauma film paradigm with neuroimaging. Stemming from the clinical presentation and our current understanding of the processes involved in intrusive memories, we propose a framework in which an intrusive memory comprises five component parts; autobiographical (trauma) memory, involuntary recall, negative emotions, attention hijacking, and mental imagery. Each component part is considered in turn, both behaviorally and from a brain imaging perspective. A mapping of these five components onto our understanding of the brain is described. Unanswered questions that exist in our understanding of intrusive memories are considered using the proposed framework. Overall, we suggest that mental imagery is key to bridging the experience, memory, and intrusive recollection of the traumatic event. Further, we suggest that by considering the brain mechanisms involved in the component parts of an intrusive memory, in particular mental imagery, we may be able to aid the development of a firmer bridge between patients’ experiences of intrusive memories and the clinical neuroscience behind them.

Related papers:

title: Intrusive images and "hotspots" of trauma memories in Posttraumatic Stress Disorder: an exploratory investigation of emotions and cognitive themes.
abstract: This study aimed to investigate the emotions and cognitions contained in "hotspots" of memory for trauma, as well as their associated images. Thirty-two participants at a specialist outpatient trauma clinic had experienced a range of traumatic events and met diagnostic criteria for Posttraumatic Stress Disorder (PTSD). Data were collected within an agreed protocol, involving reliving therapy. Patients described the different intrusive images of the trauma that they were re-experiencing. Their reports of cognitions and emotions during "hotspots" in their memory of the traumatic experience were recorded as part of reliving therapy. Hotspots refer to moments of peak emotional distress during the event. There was a high degree of match reported between intrusive images and hotspots. The cognitive and emotional contents of hotspots were qualitatively analysed into themes. The relative of frequency of these peritraumatic themes is presented. The exploratory findings are discussed with respect to our understanding and treatment of intrusive imagery in PTSD.

title: Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma.
abstract: The study estimates the relative importance of specific types of traumas experienced in the community in terms of their prevalence and risk of leading to posttraumatic stress disorder (PTSD).



A representative sample of 2181 persons in the Detroit area aged 18 to 45 years were interviewed by telephone to assess the lifetime history of traumatic events and PTSD, according to DSM-IV. Posttraumatic stress disorder was assessed with respect to a randomly selected trauma from the list of traumas reported by each respondent, using a modified version of the Diagnostic Interview Schedule, Version IV, and the World Health Organization Composite International Diagnostic Interview.



The conditional risk of PTSD following exposure to trauma was 9.2%. The highest risk of PTSD was associated with assaultive violence (20.9%). The trauma most often reported as the precipitating event among persons with PTSD (31% of all PTSD cases) was sudden unexpected death of a loved one, an event experienced by 60% of the sample, and with a moderate risk of PTSD (14.3%). Women were at higher risk of PTSD than men, controlling for type of trauma.



The risk of PTSD associated with a representative sample of traumas is less than previously estimated. Previous studies have overestimated the conditional risk of PTSD by focusing on the worst events the respondents had ever experienced. Although recent research has focused on combat, rape, and other assaultive violence as causes of PTSD, sudden unexpected death of a loved one is a far more important cause of PTSD in the community, accounting for nearly one third of PTSD cases.

title: Unwanted memories of assault: what intrusion characteristics are associated with PTSD?
abstract: Intrusive memories are common in the immediate aftermath of traumatic events, but neither their presence or frequency are good predictors of the persistence of posttraumatic stress disorder (PTSD). Two studies of assault survivors, a cross-sectional study (N=81) and a 6-month prospective longitudinal study (N=73), explored whether characteristics of the intrusive memories improve the prediction. Intrusion characteristics were assessed with an Intrusion Interview and an Intrusion Provocation Task. The distress caused by the intrusions, their "here and now" quality, and their lack of a context predicted PTSD severity. The presence of intrusive memories only explained 9% of the variance of PTSD severity at 6 months after assault. Among survivors with intrusions, intrusion frequency only explained 8% of the variance of PTSD symptom severity at 6 months. Nowness, distress and lack of context explained an additional 43% of the variance. These intrusion characteristics also predicted PTSD severity at 6 months over and above what could be predicted from PTSD diagnostic status at initial assessment. Further predictors of PTSD severity were rumination about the intrusive memories, and the ease and persistence with which intrusive memories could be triggered by photographs depicting assaults. The results have implications for the early identification of trauma survivors at risk of chronic PTSD.

title: "I wouldn't start from here"--an alternative perspective on PTSD from the ICD-11: comment on Friedman (2013).
abstract: This commentary briefly summarizes some of the criticism directed at the diagnosis of posttraumatic stress disorder (PTSD) according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) including the issues of complexity and comorbidity, and offers a rationale for attempting a simpler approach to diagnosis that can be used in minimally resourced, non-English-speaking countries. Rather than describe comprehensively the features of PTSD, the World Health Organization in its upcoming edition of the International Classification of Diseases has opted to define a much smaller number of symptoms that will effectively discriminate PTSD from other related conditions. Parallel research on the two approaches to diagnosis promises to add greatly to our understanding of the condition.

title: A cognitive model of posttraumatic stress disorder.
abstract: Posttraumatic stress disorder (PTSD) is a common reaction to traumatic events. Many people recover in the ensuing months, but in a significant subgroup the symptoms persist, often for years. A cognitive model of persistence of PTSD is proposed. It is suggested that PTSD becomes persistent when individuals process the trauma in a way that leads to a sense of serious, current threat. The sense of threat arises as a consequence of: (1) excessively negative appraisals of the trauma and/or its sequelae and (2) a disturbance of autobiographical memory characterised by poor elaboration and contextualization, strong associative memory and strong perceptual priming. Change in the negative appraisals and the trauma memory are prevented by a series of problematic behavioural and cognitive strategies. The model is consistent with the main clinical features of PTSD, helps explain several apparently puzzling phenomena and provides a framework for treatment by identifying three key targets for change. Recent studies have provided preliminary support for several aspects of the model.

title: “Hotspots” in trauma memories in the treatment of post-traumatic stress disorder: A replication
abstract: “Hotspots” refer to memories of detailed moments of peak emotional distress during a traumatic event. This study investigates hotspot frequency, and the emotions and cognitions contained in hotspots of memory for trauma, to replicate a previous study in this area (Holmes, Grey, & Young, 2005). Participants were patients receiving treatment for post-traumatic stress disorder (PTSD) at a specialist outpatient clinic after experiencing a range of traumatic events. The main finding was that, after fear, the most common emotions reported were anger and sadness. Cognitions related to psychological threat to the self were more common than those related to physical threat.

title: A cognitive neuroscience account of posttraumatic stress disorder and its treatment.
abstract: Recent research in the areas of animal conditioning, the neural systems underlying emotion and memory, and the effect of fear on these systems is reviewed. This evidence points to an important distinction between hippocampally-dependent and non-hippocampally-dependent forms of memory that are differentially affected by extreme stress. The cognitive science perspective is related to a recent model of posttraumatic stress disorder, dual representation theory, that also posits separate memory systems underlying vivid reexperiencing versus ordinary autobiographical memories of trauma. This view is compared with other accounts in the literature of traumatic memory processes in PTSD, and the contrasting implications for therapy are discussed.

title: Neurocircuitry Models of Posttraumatic Stress Disorder and Extinction: Human Neuroimaging Research—Past, Present, and Future
abstract: The prevailing neurocircuitry models of anxiety disorders have been amygdalocentric in form. The bases for such models have progressed from theoretical considerations, extrapolated from research in animals, to in vivo human imaging data. For example, one current model of posttraumatic stress disorder (PTSD) has been highly influenced by knowledge from rodent fear conditioning research. Given the phenomenological parallels between fear conditioning and the pathogenesis of PTSD, we have proposed that PTSD is characterized by exaggerated amygdala responses (subserving exaggerated acquisition of fear associations and expression of fear responses) and deficient frontal cortical function (mediating deficits in extinction and the capacity to suppress attention/response to trauma-related stimuli), as well as deficient hippocampal function (mediating deficits in appreciation of safe contexts and explicit learning/memory). Neuroimaging studies have yielded convergent findings in support of this model. However, to date, neuroimaging investigations of PTSD have not principally employed conditioning and extinction paradigms per se. The recent development of such imaging probes now sets the stage for directly testing hypotheses regarding the neural substrates of fear conditioning and extinction abnormalities in PTSD.

title: Visual imagery and perception in posttraumatic stress disorder. A positron emission tomographic investigation.
abstract: Relative regional cerebral blood flow (rCBF) changes were measured in Vietnam combat veterans with and without posttraumatic stress disorder (PTSD) during exposure to combat-related stimuli.



Positron emission tomography was used to measure rCBF in 7 combat veterans with PTSD (PTSD group) and 7 healthy combat veterans (control group) who viewed and generated visual mental images of neutral, negative, and combat-related pictures.



Unlike control subjects, subjects with PTSD had increased rCBF in ventral anterior cingulate gyrus and right amygdala when generating mental images of combat-related pictures; when viewing combat pictures, subjects with PTSD showed decreased rCBF in Broca's area.



Results suggest that ventral anterior cingulate gyrus and right amygdala play a role in the response of combat veterans with PTSD to mental images of combat-related scenes. Reexperiencing phenomena of PTSD, which often involve emotional visual mental imagery, may be likewise associated with increased rCBF in these regions.

title: A review of neuroimaging studies in PTSD: heterogeneity of response to symptom provocation.
abstract: Different experiential, psychophysiological, and neurobiological responses to traumatic symptom provocation in posttraumatic stress disorder (PTSD) have been reported in the literature. Two subtypes of trauma response have been hypothesized, one characterized predominantly by hyperarousal and the other primarily dissociative, each one representing unique pathways to chronic stress-related psychopathology. Recent PTSD neuroimaging findings in our own laboratory support this notion and are consistent with the view that grouping all PTSD subjects, regardless of their different symptom patterns, in the same diagnostic category may interfere with our understanding of posttrauma psychopathology. This review will integrate findings of different experiential, psychophysiological, and neurobiological responses to traumatic symptom provocation with the clinical symptomatology and the neurobiology of PTSD.

title: Functional neuroimaging studies in posttraumatic stress disorder: review of current methods and findings
abstract: Posttraumatic stress disorder (PTSD) is an anxiety disorder associated with changes in neural circuitry involving frontal and limbic systems. Altered metabolism in these brain structures after a traumatic event is correlated to PTSD. Developments in the field of neuroimaging have allowed researchers to look at the structural and functional properties of the brain in PTSD. Despite the relative novelty of functional imaging and its application to the field of PTSD, numerous publications have brought to light several of the circuits implied in this disorder. This article summarizes the findings with regard to PTSD in the functional imaging techniques of single‐photon emission computed tomography (SPECT), positron emission tomography (PET), and functional magnetic resonance imaging (fMRI). Furthermore, we discuss strengths and weaknesses of the various techniques and studies. Finally, we explore the future potential of functional neuroimaging studies in PTSD. Depression and Anxiety 24:202–218, 2007.

title: Functional neuroimaging studies of post-traumatic stress disorder
abstract: Post-traumatic stress disorder (PTSD) is a significant problem that can affect individuals who have been exposed to a traumatic event or events, such as combat, violent crime or childhood abuse. Over the past several years, neuroimaging studies of PTSD have focused on elucidating the brain circuits that mediate this disorder. In this article, we will briefly introduce some of the methods used in functional neuroimaging studies of PTSD. We will then review functional neuroimaging studies that have reported significant findings in the amygdala, medial prefrontal cortex, hippocampus and insula. Finally, we will suggest future directions for research.

title: A causal model of post-traumatic stress disorder: disentangling predisposed from acquired neural abnormalities
abstract: Discriminating neural abnormalities into the causes versus consequences of psychopathology would enhance the translation of neuroimaging findings into clinical practice. By regarding the traumatic encounter as a reference point for disease onset, neuroimaging studies of post-traumatic stress disorder (PTSD) can potentially allocate PTSD neural abnormalities to either predisposing (pre-exposure) or acquired (post-exposure) factors. Based on novel research strategies in PTSD neuroimaging, including genetic, environmental, twin, and prospective studies, we provide a causal model that accounts for neural abnormalities in PTSD, and outline its clinical implications. Current data suggest that abnormalities within the amygdala and dorsal anterior cingulate cortex represent predisposing risk factors for developing PTSD, whereas dysfunctional hippocampal-ventromedial prefrontal cortex (vmPFC) interactions may become evident only after having developed the disorder.

title: Neuroimaging Studies of Emotional Responses in PTSD
abstract: Neuroimaging research offers a powerful and noninvasive means to understand healthy as well as dysregulated emotional processing in healthy subjects and PTSD patients. Functional neuroimaging findings suggest specific roles for subregions of the medial prefrontal (mPFC), orbito frontal (OFC), anterior cingulate (ACC), and insular cortices as well as the sublenticular extended amygdala (SLEA) and hippocampus in various components of emotional processing. Some of the same regions appear to be associated with emotional response to trauma, and with symptom formation in PTSD. Neuroimaging findings of emotional processing in healthy subjects and PTSD patients are discussed, addressing the specific roles of cortical regions like mPFC, ACC, and insula, and their potential contribution to PTSD pathophysiology. Processes of cognitive–emotional interactions and social emotions are discussed in an attempt to synthesize the prefrontal findings in healthy subjects and PTSD patients. Further links between functional neuroanatomy of emotional responses and neuroendocrine stress regulation are proposed.

title: Intrusive Images in Psychological Disorders
abstract: Involuntary images and visual memories are prominent in many types of psychopathology. Patients with posttraumatic stress disorder, other anxiety disorders, depression, eating disorders, and psychosis frequently report repeated visual intrusions corresponding to a small number of real or imaginary events, usually extremely vivid, detailed, and with highly distressing content. Both memory and imagery appear to rely on common networks involving medial prefrontal regions, posterior regions in the medial and lateral parietal cortices, the lateral temporal cortex, and the medial temporal lobe. Evidence from cognitive psychology and neuroscience implies distinct neural bases to abstract, flexible, contextualized representations (C-reps) and to inflexible, sensory-bound representations (S-reps). We revise our previous dual representation theory of posttraumatic stress disorder to place it within a neural systems model of healthy memory and imagery. The revised model is used to explain how the different types of distressing visual intrusions associated with clinical disorders arise, in terms of the need for correct interaction between the neural systems supporting S-reps and C-reps via visuospatial working memory. Finally, we discuss the treatment implications of the new model and relate it to existing forms of psychological therapy.

title: Episodic memory, perceptual memory, and their interaction: foundations for a theory of posttraumatic stress disorder.
abstract: A number of autobiographical memory theories and clinical theories of posttraumatic stress disorder (PTSD) make claims that are different from standard views of memory and have been the subject of controversy. These claims include the existence of a long-term perceptual memory system supporting conscious experience separate to episodic memory; greater involvement of perceptual memory in the response to emotion-laden and personally meaningful events; increased perceptual memory intrusions accompanied by impaired episodic memory for the traumatic event among PTSD patients; and a lack of association, or inverse association, between indices of voluntary recall and involuntary images relating to the same traumatic materials. In this article I review current research on perceptual memory, which supports the presence of long-term representations that are selective or incomplete reflections of sensory input. The functional independence of perceptual and episodic memory is illustrated by research on verbal overshadowing but is most clearly exemplified by the strong evidence in favor of enhanced perceptual memory and impaired episodic memory in PTSD. Theoretical predictions concerning the relation between perceptual priming and the development of intrusive images, the effect of verbal versus visuospatial secondary tasks on intrusive trauma images, and the independence of voluntary and involuntary memory for the same materials have garnered widespread support. Reasons for the continuing controversy over traumatic memory are discussed, and some implications of the review for general theories of recall and recognition, clinical theories of PTSD, and "special mechanism" views of memory are set out.

title: A symptom provocation study of posttraumatic stress disorder using positron emission tomography and script-driven imagery.
abstract: Previous studies have used symptom provocation and positron emission tomography to delineate the brain systems that mediate various anxiety states. Using an analogous approach, the goal of this study was to measure regional cerebral blood flow changes associated with posttraumatic stress disorder (PTSD) symptoms.



Eight patients with PTSD, screened as physiologically responsive to a script-driven imagery symptom provocation paradigm, were exposed sequentially to audiotaped traumatic and neutral scripts in conjunction with positron emission tomography. Heart rate and subjective measures of emotional state were obtained for each condition. Statistical mapping techniques were used to determine locations of significant brain activation.



Increases in normalized blood flow were found for the traumatic as compared with control conditions in right-sided limbic, paralimbic, and visual areas; decreases were found in left inferior frontal and middle temporal cortex.



The results suggest that emotions associated with the PTSD symptomatic state are mediated by the limbic and paralimbic systems within the right hemisphere. Activation of visual cortex may correspond to the visual component of PTSD reexperiencing phenomena.

title: Regional cerebral blood flow during script-driven imagery in childhood sexual abuse-related PTSD: A PET investigation.
abstract: The purpose of this study was to determine whether anterior limbic and paralimbic regions of the brain are differentially activated during the recollection and imagery of traumatic events in trauma-exposed individuals with and without posttraumatic stress disorder (PTSD).



Positron emission tomography (PET) was used to measure normalized regional cerebral blood flow (CBF) in 16 women with histories of childhood sexual abuse: eight with current PTSD and eight without current PTSD. In separate script-driven imagery conditions, participants recalled and imagined traumatic and neutral autobiographical events. Psychophysiologic responses and subjective ratings of emotional state were measured for each condition.



In the traumatic condition versus the neutral control conditions, both groups exhibited regional CBF increases in orbitofrontal cortex and anterior temporal poles; however, these increases were greater in the PTSD group than in the comparison group. The comparison group exhibited regional CBF increases in insular cortex and anterior cingulate gyrus; increases in anterior cingulate gyrus were greater in the comparison group than in the PTSD group. Regional CBF decreases in bilateral anterior frontal regions were greater in the PTSD group than in the comparison group, and only the PTSD group exhibited regional CBF decreases in left inferior frontal gyrus.



The recollection and imagery of traumatic events versus neutral events was accompanied by regional CBF increases in anterior paralimbic regions of the brain in trauma-exposed individuals with and without PTSD. However, the PTSD group had greater increases in orbitofrontal cortex and anterior temporal pole, whereas the comparison group had greater increases in anterior cingulate gyrus.

title: Regional cerebral blood flow correlated with flashback intensity in patients with posttraumatic stress disorder
abstract: Nuclear imaging studies have examined cerebral blood flow (rCBF) in subjects with posttraumatic stress disorder (PTSD) using symptom evocation paradigms. To date, no such studies have investigated rCBF as related to subjects' reports of flashback intensity.



Subjects with varying traumatic histories and longstanding PTSD were studied using [15O]-H2O positron emission tomography with an auditory script of their traumatic event. Eight subjects had three resting scans followed by their script and additional scans. Heart rate responses as well as the presence of flashbacks and their intensity were recorded. rCBF was correlated with flashback intensity in each subject's scan. Combined analysis of all subjects' data yielded common regions related to the flashback experience.



rCBF correlated directly with flashback intensity in the brainstem, lingula, bilateral insula, right putamen and left hippocampal and perihippocampal, somatosensory and cerebellar regions. Inverse correlations with rCBF were found in bilateral dorsolateral prefrontal, right fusiform and right medial temporal cortices.



This study correlated flashback intensity and rCBF in a group of patients with chronic PTSD suggesting involvement of brainstem, and areas associated with motor control, complex visual/spatial cues and memory.

title: Alteration of corticothalamic perfusion ratios during a PTSD flashback
abstract: We performed a single photon emission computed tomography (SPECT) study of patients with posttraumatic stress disorder (PTSD) by measuring changes in regional cerebral blood flow (rCBF) during provocation by combat stimuli. A single patient experienced an actual flashback following exposure to combat sounds, exhibiting tearfulness, diaphoresis, tachypnea, and severe agitation. Results from his SPECT study demonstrated a dramatically altered ratio of cortical to subcortical perfusion during the flashback but not during the control scan. This altered pattern, which showed a peak of activity in the thalamus, was not consistent with global rCBF changes induced by hyperventilation. The perfusion pattern during the patient's control scan was qualitatively indistinguishable from any of the SPECT scans obtained for the other patients. This single case suggests a possible role for corticothalamic dysfunction in flashbacks. Depression and Anxiety 4:146–150, 1996/1997.

title: Inducing and modulating intrusive emotional memories: a review of the trauma film paradigm.
abstract: Highly affect-laden memory intrusions are a feature of several psychological disorders with intrusive images of trauma especially associated with post-traumatic stress disorder (PTSD). The trauma film paradigm provides a prospective experimental tool for investigating analogue peri-traumatic cognitive mechanisms underlying intrusion development. We review several historical papers and some more recent key studies that have used the trauma film paradigm. A heuristic diagram is presented, designed to simplify predictions about analogue peri-traumatic processing and intrusion development, which can also be related to the processing elements of recent cognitive models of PTSD. Results show intrusions can be induced in the laboratory and their frequency amplified/attenuated in line with predictions. Successful manipulations include competing task type (visuospatial vs. verbal) and use of a cognitive coping strategy. Studies show that spontaneous peri-traumatic dissociation also affects intrusion frequency although attempts to manipulate dissociation have failed. It is hoped that further use of this paradigm may lead to prophylactic training for at risk groups and an improved understanding of intrusions across psychopathologies.

title: Trauma films, information processing, and intrusive memory development.
abstract: 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.

title: Count out your intrusions: Effects of verbal encoding on intrusive memories
abstract: Peri-traumatic information processing is thought to affect the development of intrusive trauma memories. This study aimed to replicate and improve the study by Holmes, Brewin, and Hennessy (2004,  on the role of peri-traumatic verbal processing in analogue traumatic intrusion development. Participants viewed an aversive film under one of three conditions: counting backwards in 3s (“verbal interference”), verbalising emotions and thoughts (“verbal enhancement”), or without an extra task. A dual-process account of PTSD would predict that verbal interference would increase intrusion frequency compared to no task, whereas verbal enhancement would lead to a decrease. In contrast, mainstream memory theory predicts a decrease in intrusion frequency from any concurrent task that diverts attention away from the trauma film. The main finding was that the verbal interference task led to a decrease in intrusive memories of the film compared to the other two conditions. This finding does not support a dual-process account of PTSD, but is in line with general theories of memory and attention.

title: Mental- and Physical-Health Effects of Acute Exposure to Media Images of the September 11, 2001, Attacks and the Iraq War
abstract: Millions of people witnessed early, repeated television coverage of the September 11 (9/11), 2001, terrorist attacks and were subsequently exposed to graphic media images of the Iraq War. In the present study, we examined psychological- and physical-health impacts of exposure to these collective traumas. A U.S. national sample (N = 2,189) completed Web-based surveys 1 to 3 weeks after 9/11; a subsample (n = 1,322) also completed surveys at the initiation of the Iraq War. These surveys measured media exposure and acute stress responses. Posttraumatic stress symptoms related to 9/11 and physician-diagnosed health ailments were assessed annually for 3 years. Early 9/11- and Iraq War–related television exposure and frequency of exposure to war images predicted increased posttraumatic stress symptoms 2 to 3 years after 9/11. Exposure to 4 or more hr daily of early 9/11-related television and cumulative acute stress predicted increased incidence of health ailments 2 to 3 years later. These findings suggest that exposure to graphic media images may result in physical and psychological effects previously assumed to require direct trauma exposure.

title: Media’s role in broadcasting acute stress following the Boston Marathon bombings
abstract: Media coverage of collective traumas may trigger psychological distress in individuals outside the directly affected community. We examined whether repeated media exposure to the Boston Marathon bombings was associated with acute stress and compared the impact of direct exposure (being at/near the bombings) vs. media exposure (bombing-related television, radio, print, online, and social media coverage) on acute stress. We conducted an Internet-based survey 2–4 wk postbombings with a nationally representative sample and representative subsamples from Boston and New York (4,675 adults). Repeated bombing-related media exposure was associated with higher acute stress than was direct exposure. Media coverage following collective traumas can diffuse acute stress widely. This unique study compares the impact of direct vs. indirect media-based community trauma exposure on acute stress responses. We compared the impact of media vs. direct exposure on acute stress response to collective trauma. We conducted an Internet-based survey following the Boston Marathon bombings between April 29 and May 13, 2013, with representative samples of residents from Boston (n = 846), New York City (n = 941), and the remainder of the United States (n = 2,888). Acute stress symptom scores were comparable in Boston and New York [regression coefficient (b) = 0.43; SE = 1.42; 95% confidence interval (CI), −2.36, 3.23], but lower nationwide when compared with Boston (b = −2.21; SE = 1.07; 95% CI, −4.31, −0.12). Adjusting for prebombing mental health (collected prospectively), demographics, and prior collective stress exposure, six or more daily hours of bombing-related media exposure in the week after the bombings was associated with higher acute stress than direct exposure to the bombings (continuous acute stress symptom total: media exposure b = 15.61 vs. direct exposure b = 5.69). Controlling for prospectively collected prebombing television-watching habits did not change the findings. In adjusted models, direct exposure to the 9/11 terrorist attacks and the Sandy Hook School shootings were both significantly associated with bombing-related acute stress; Superstorm Sandy exposure wasn't. Prior exposure to similar and/or violent events may render some individuals vulnerable to the negative effects of collective traumas. Repeatedly engaging with trauma-related media content for several hours daily shortly after collective trauma may prolong acute stress experiences and promote substantial stress-related symptomatology. Mass media may become a conduit that spreads negative consequences of community trauma beyond directly affected communities.

title: Can Playing the Computer Game “Tetris” Reduce the Build-Up of Flashbacks for Trauma? A Proposal from Cognitive Science
abstract: Flashbacks are the hallmark symptom of Posttraumatic Stress Disorder (PTSD). Although we have successful treatments for full-blown PTSD, early interventions are lacking. We propose the utility of developing a ‘cognitive vaccine’ to prevent PTSD flashback development following exposure to trauma. Our theory is based on two key findings: 1) Cognitive science suggests that the brain has selective resources with limited capacity; 2) The neurobiology of memory suggests a 6-hr window to disrupt memory consolidation. The rationale for a ‘cognitive vaccine’ approach is as follows: Trauma flashbacks are sensory-perceptual, visuospatial mental images. Visuospatial cognitive tasks selectively compete for resources required to generate mental images. Thus, a visuospatial computer game (e.g. “Tetris”) will interfere with flashbacks. Visuospatial tasks post-trauma, performed within the time window for memory consolidation, will reduce subsequent flashbacks. We predicted that playing “Tetris” half an hour after viewing trauma would reduce flashback frequency over 1-week.  The Trauma Film paradigm was used as a well-established experimental analog for Post-traumatic Stress. All participants viewed a traumatic film consisting of scenes of real injury and death followed by a 30-min structured break. Participants were then randomly allocated to either a no-task or visuospatial (“Tetris”) condition which they undertook for 10-min. Flashbacks were monitored for 1-week. Results indicated that compared to the no-task condition, the “Tetris” condition produced a significant reduction in flashback frequency over 1-week. Convergent results were found on a clinical measure of PTSD symptomatology at 1-week. Recognition memory between groups did not differ significantly.  Playing “Tetris” after viewing traumatic material reduces unwanted, involuntary memory flashbacks to that traumatic film, leaving deliberate memory recall of the event intact. Pathological aspects of human memory in the aftermath of trauma may be malleable using non-invasive, cognitive interventions. This has implications for a novel avenue of preventative treatment development, much-needed as a crisis intervention for the aftermath of traumatic events.

title: Pre-stressor cognitive control is related to intrusive cognition of a stressful film.
abstract: It has been suggested that relatively weak cognitive control existing prior to a stressful event may be associated with intrusive memories of that stressor afterwards. We explored this in two analog studies employing unselected participants who saw an emotional film fragment and completed behavioral (i.e., color-naming interference [CNI]) and self-report indices of intrusions. Prior to film presentation, several cognitive control tests were administered. Study 1 showed that better updating/monitoring was linked to less CNI from negative film-related words. However, better updating/monitoring was associated with more diary reports of intrusive memories. Study 2 showed that a better resistance to pro-active interference (PI) predicted less self-reported film-related intrusive cognition after 24h. However, after this delay, both self-reported intrusions and CNI were not related to updating/monitoring. Taken together, the results suggest that a specific pre-existing cognitive control function (i.e., resistance to PI) may be involved in the regulation of post-stressor intrusive memory phenomena.

title: The neural basis of flashback formation: the impact of viewing trauma
abstract: Psychological traumatic events, such as war or road traffic accidents, are widespread. A small but significant proportion of survivors develop post-traumatic stress disorder (PTSD). Distressing, sensory-based involuntary memories of trauma (henceforth ‘flashbacks’) are the hallmark symptom of PTSD. Understanding the development of flashbacks may aid their prevention. This work is the first to combine the trauma film paradigm (as an experimental analogue for flashback development) with neuroimaging to investigate the neural basis of flashback aetiology. We investigated the hypothesis that involuntary recall of trauma (flashback) is determined during the original event encoding.  A total of 22 healthy volunteers viewed a traumatic film whilst undergoing functional magnetic resonance imaging (fMRI). They kept a 1-week diary to record flashbacks to specific film scenes. Using a novel prospective fMRI design, we compared brain activation for those film scenes that subsequently induced flashbacks with both non-traumatic control scenes and scenes with traumatic content that did not elicit flashbacks (‘potentials’).  Encoding of scenes that later caused flashbacks was associated with widespread increases in activation, including in the amygdala, striatum, rostral anterior cingulate cortex, thalamus and ventral occipital cortex. The left inferior frontal gyrus and bilateral middle temporal gyrus also exhibited increased activation but only relative to ‘potentials’. Thus, these latter regions appeared to distinguish between traumatic content that subsequently flashed back and comparable content that did not.  Results provide the first prospective evidence that the brain behaves differently whilst experiencing emotional events that will subsequently become involuntary memories – flashbacks. Understanding the neural basis of analogue flashback memory formation may aid the development of treatment interventions for this PTSD feature.

title: First steps in using machine learning on fMRI data to predict intrusive memories of traumatic film footage
abstract: After psychological trauma, why do some only some parts of the traumatic event return as intrusive memories while others do not? Intrusive memories are key to cognitive behavioural treatment for post-traumatic stress disorder, and an aetiological understanding is warranted. We present here analyses using multivariate pattern analysis (MVPA) and a machine learning classifier to investigate whether peri-traumatic brain activation was able to predict later intrusive memories (i.e. before they had happened). To provide a methodological basis for understanding the context of the current results, we first show how functional magnetic resonance imaging (fMRI) during an experimental analogue of trauma (a trauma film) via a prospective event-related design was able to capture an individual's later intrusive memories. Results showed widespread increases in brain activation at encoding when viewing a scene in the scanner that would later return as an intrusive memory in the real world. These fMRI results were replicated in a second study. While traditional mass univariate regression analysis highlighted an association between brain processing and symptomatology, this is not the same as prediction. Using MVPA and a machine learning classifier, it was possible to predict later intrusive memories across participants with 68% accuracy, and within a participant with 97% accuracy; i.e. the classifier could identify out of multiple scenes those that would later return as an intrusive memory. We also report here brain networks key in intrusive memory prediction. MVPA opens the possibility of decoding brain activity to reconstruct idiosyncratic cognitive events with relevance to understanding and predicting mental health symptoms.

title: Solving the mystery of intrusive flashbacks in posttraumatic stress disorder: comment on Brewin (2014).
abstract: In the light of current controversy about the nature of intrusions in posttraumatic stress disorder (PTSD), the review by Brewin (2014) is timely and important. It will undoubtedly stimulate further research and guide researchers' quests for understanding the nature of flashbacks in PTSD. In this commentary, I briefly summarize and discuss key points made by Brewin and elaborate on some of the reasons behind the controversy. For example, the terms involuntary autobiographical memories, intrusive memories, and flashbacks are often used interchangeably. I propose a taxonomy revealing the key differences across these forms of memory. If flashbacks are characteristic of patients with PTSD only, it is essential that more research targeting this population is conducted with a variety of methods. Finally, some new avenues for research to study intrusive memories and flashbacks in PTSD, using a diary method and modified trauma film paradigm, are described.

title: A memory-based model of posttraumatic stress disorder: evaluating basic assumptions underlying the PTSD diagnosis.
abstract: In the mnemonic model of posttraumatic stress disorder (PTSD), the current memory of a negative event, not the event itself, determines symptoms. The model is an alternative to the current event-based etiology of PTSD represented in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev. The model accounts for important and reliable findings that are often inconsistent with the current diagnostic view and that have been neglected by theoretical accounts of the disorder, including the following observations. The diagnosis needs objective information about the trauma and peritraumatic emotions but uses retrospective memory reports that can have substantial biases. Negative events and emotions that do not satisfy the current diagnostic criteria for a trauma can be followed by symptoms that would otherwise qualify for PTSD. Predisposing factors that affect the current memory have large effects on symptoms. The inability-to-recall-an-important-aspect-of-the-trauma symptom does not correlate with other symptoms. Loss or enhancement of the trauma memory affects PTSD symptoms in predictable ways. Special mechanisms that apply only to traumatic memories are not needed, increasing parsimony and the knowledge that can be applied to understanding PTSD.

title: What is autobiographical memory
abstract: The purpose of this chapter is ( a ) to describe the forms of autobiographical memory and contrast them with other forms of memory; ( b ) to give a theoretical account of autobiographical memory in terms of the self; (c) to argue for the importance of phenomenal reports in the study of autobiographical memory; ( d ) to examine some of the experimental findings on autobiographical memory in the context of this analysis; ( e ) to give a detailed account of personal memory, one of the important forms of autobiographical memory; and ( f ) to outline a partially reconstructive view of personal memory.  The study of autobiographical memory is one of the least well-developed areas in the study of human memory; there is considerable divergence both in what is being investigated and in the terminology used to describe what is being investigated. There is still much work to be done in describing and classifying the basic phenomena in the area. In order to gain an immediate impression of the complexities involved in studying this topic, I want to examine a concrete example. Currently the most popular technique for studying autobiographical memory is a method developed by Sir Francis Galton (1879 a , 1879 b ) in which the subject is presented with a word and asked to find a memory related to that word. This simple task nicely reveals one of the major problems that will be addressed in this chapter – the multiple forms of autobiographical and non-autobiographical memory.

title: Event-related fMRI studies of episodic encoding and retrieval: Meta-analyses using activation likelihood estimation
abstract: The recent surge in event-related fMRI studies of episodic memory has generated a wealth of information about the neural correlates of encoding and retrieval processes. However, interpretation of individual studies is hampered by methodological differences, and by the fact that sample sizes are typically small. We submitted results from studies of episodic memory in healthy young adults, published between 1998 and 2007, to a voxel-wise quantitative meta-analysis using activation likelihood estimation [Laird, A. R., McMillan, K. M., Lancaster, J. L., Kochunov, P., Turkeltaub, P. E., & Pardo, J. V., et al. (2005). A comparison of label-based review and ALE meta-analysis in the stroop task. Human Brain Mapping, 25, 6-21]. We conducted separate meta-analyses for four contrasts of interest: episodic encoding success as measured in the subsequent-memory paradigm (subsequent Hit vs. Miss), episodic retrieval success (Hit vs. Correct Rejection), objective recollection (e.g., Source Hit vs. Item Hit), and subjective recollection (e.g., Remember vs. Know). Concordance maps revealed significant cross-study overlap for each contrast. In each case, the left hemisphere showed greater concordance than the right hemisphere. Both encoding and retrieval success were associated with activation in medial-temporal, prefrontal, and parietal regions. Left ventrolateral prefrontal cortex (PFC) and medial-temporal regions were more strongly involved in encoding, whereas left superior parietal and dorsolateral and anterior PFC regions were more strongly involved in retrieval. Objective recollection was associated with activation in multiple PFC regions, as well as multiple posterior parietal and medial-temporal areas, but not hippocampus. Subjective recollection, in contrast, showed left hippocampal involvement. In summary, these results identify broadly consistent activation patterns associated with episodic encoding and retrieval, and subjective and objective recollection, but also subtle differences among these processes.

title: Executive Control during Episodic Retrieval Multiple Prefrontal Processes Subserve Source Memory
abstract: During recognition, one may sense items as familiar (item memory) and additionally recollect specific contextual details of the earlier encounters (source memory). Cognitive theory suggests that, unlike item memory, source memory requires controlled cue specification and monitoring processes. Functional imaging suggests that such processes may depend on left prefrontal cortex (PFC). However, the nature and possible anatomical segregation of these processes remains unknown. Using functional magnetic resonance imaging, we isolated distinct response patterns in left PFC during source memory consistent with semantic analysis/cue specification (anterior ventrolateral), recollective monitoring (posterior dorsolateral and frontopolar), and phonological maintenance/rehearsal (posterior ventrolateral). Importantly, cue specification and recollective monitoring responses were not seen during item memory and were unaffected by retrieval success, demonstrating that the mere attempt to recollect episodic detail engages multiple control processes with different left PFC substrates.

title: Domain-general and domain-sensitive prefrontal mechanisms for recollecting events and detecting novelty.
abstract: Recollecting the past and discriminating novel from familiar memoranda depend on poorly understood prefrontal cortical (PFC) mechanisms hypothesized to vary according to memory task (e.g. recollection versus novelty detection) and domain of targeted memories (e.g. perceptual versus conceptual). Using event-related fMRI, we demonstrate that recollecting conceptual or perceptual details surrounding object encounters similarly recruits left frontopolar and posterior PFC compared with detecting novel stimuli, suggesting that a domain-general control network is engaged during contextual remembering. In contrast, left anterior ventrolateral PFC coactivated with a left middle temporal region associated with semantic representation, and right ventrolateral PFC with bilateral occipito-temporal cortices associated with representing object form, depending on whether recollections were conceptual or perceptual. These PFC/posterior cortical dissociations suggest that during recollection, lateralized ventrolateral PFC mechanisms bias posterior conceptual or perceptual feature representations as a function of memory relevance, potentially improving the gain of bottom-up memory signals. Supporting this domain-sensitive biasing hypothesis, novelty detection also recruited right ventrolateral PFC and bilateral occipito-temporal cortices compared with conceptual recollection, suggesting that searching for novel objects heavily relies upon perceptual feature processing. Collectively, these data isolate task- from domain-sensitive PFC control processes strategically recruited in the service of episodic memory.

title: Two routes to emotional memory: distinct neural processes for valence and arousal.
abstract: Prior investigations have demonstrated that emotional information is often better remembered than neutral information, but they have not directly contrasted effects attributable to valence and those attributable to arousal. By using functional MRI and behavioral studies, we found that distinct cognitive and neural processes contribute to emotional memory enhancement for arousing information versus valenced, nonarousing information. The former depended on an amygdalar-hippocampal network, whereas the latter was supported by a prefrontal cortex-hippocampal network implicated in controlled encoding processes. A behavioral companion study, with a divided-attention paradigm, confirmed that memory enhancement for valenced, nonarousing words relied on controlled encoding processes: concurrent task performance reduced the enhancement effect. Enhancement for arousing words occurred automatically, even when encoding resources were diverted to the secondary task.

title: Dissociable stages of human memory consolidation and reconsolidation
abstract: Historically, the term ‘memory consolidation’ refers to a process whereby a memory becomes increasingly resistant to interference from competing or disrupting factors with the continued passage of time. Recent findings regarding the learning of skilled sensory and motor tasks (‘procedural learning’) have refined this definition, suggesting that consolidation can be more strictly determined by time spent in specific brain states such as wake, sleep or certain stages of sleep. There is also renewed interest in the possibility that recalling or ‘reactivating’ a previously consolidated memory renders it once again fragile and susceptible to interference, therefore requiring periods of reconsolidation. Using a motor skill finger-tapping task, here we provide evidence for at least three different stages of human motor memory processing after initial acquisition. We describe the unique contributions of wake and sleep in the development of different forms of consolidation, and show that waking reactivation can turn a previously consolidated memory back into a labile state requiring subsequent reconsolidation.

title: Is memory consolidation a multiple-circuit system?
abstract: How is memory stored? This important question has been the focus of ample research in the neurosciences. Memory, from the neural point of view, is considered a process by which the brain maintains stable stimuli representations for a period and, depending on how long a particular representation lasts, becomes a short-term memory (STM) or a long-term memory (LTM) (1). At the beginning of the 20th century Muller and Pilzecker proposed that new memories are fragile and consolidated over time, a theory that gave rise to the consolidation hypothesis (2). Fifty years later it was reported that an electroconvulsive shock applied after training disrupted memory and that memory disruption correlated with the interval between training and electroconvulsive shock application. As the electroconvulsive shock was longer spaced in time from training, memory impairment was reduced (2). Since then, several other researchers have shown that interfering treatments—from electroconvulsive shock to intracerebral microinjections of protein synthesis inhibitors applied after acquisition—prevent LTM storage. Consistently, LTM is not affected if the intrusive treatment is applied outside the vulnerability time window.

title: Memory: a contribution to experimental psychology.
abstract: The first scientific text on the psychology of memory. Relating retention to repetition, describing the shape of the forgetting curve, and measuring strength of association, Hermann Ebbinghaus extended the province of systematic, experimental research to the higher mental processes.

title: Involuntary Autobiographical Memories
abstract: Results from a diary study of involuntary memories are presented (14 subjects; 7 males, 7 females, average age 23 years). Virtually all of the recorded memories had identifiable cues. Memory access was biased towards (a) mood-congruent (b) recent and (c) distinctive (unusual) events. The memories were most frequently rated as emotionally positive and prior rehearsal was rated low. Also, the memories were found to influence current mood consonant with the emotional valence of the memories. Stressful and repetitive involuntary recollections—as they are observed in clinical settings subsequent to traumatic events—may be viewed as a malignant effect of normal mechanisms of involuntary memories.

title: Involuntary autobiographical memories in and outside the laboratory: How different are they from voluntary autobiographical memories?
abstract: In two studies, we compared the characteristics and retrieval times of involuntary and voluntary autobiographical memory under controlled laboratory conditions. A new laboratory task of involuntary autobiographical memories involved detecting vertical lines in a stream of stimuli with horizontal lines (an undemanding vigilance task) and recording any involuntary memories during the session. The majority of these memories were reported as being triggered by irrelevant cue phrases presented on the screen. Voluntary autobiographical memories were sampled via a standard word-cue method in Session 2. The results showed that involuntary memories were more specific and were retrieved significantly faster than voluntary memories. They were also more likely to be triggered by negative cues, whereas cue valence did not have any effect on the number of voluntary memories. Furthermore, laboratory involuntary memories did not differ from naturalistic involuntary memories recorded in a diary by the same participants (Study 2). Taken together, these results have important implications for current theories of autobiographical memory, and they open up interesting avenues for future research.

title: Intrusive images and voluntary memory for affective pictures: contextualization and dual-task interference.
abstract: The present study addressed the role of context information and dual-task interference during the encoding of negative pictures on intrusion development and voluntary recall.



Healthy participants were shown negative pictures with or without context information. Pictures were either viewed alone or concurrently with a visuospatial or verbal task. Participants reported their intrusive images of the pictures in a diary. At follow-up, perceptual and contextual memory was tested.



Participants in the context group reported more intrusive images and perceptual voluntary memory than participants in the no context group. No effects of the concurrent tasks were found on intrusive image frequency, but perceptual and contextual memory was affected according to the cognitive load of the task.



The analogue method cannot be generalized to real-life trauma and the secondary tasks may differ in cognitive load.



The findings challenge a dual memory model of PTSD but support an account in which retrieval strategy, rather than encoding processes, accounts for the experience of involuntary versus voluntary recall.

title: Brain regions supporting intentional and incidental memory: a PET study
abstract: REGIONAL brain activity associated with intentional and incidental memory retrieval was studied with PET. Previously studied and new words were presented in either an intentional or an incidental memory task. Type of task was crossed with an encoding manipulation (‘deep’ vs ‘shallow’) which varied the probability that studied items would be remembered. In both tasks, deeply encoded items were associated with greater activation in the left hippocampus than were items that had received shallow encoding, suggesting that the involvement of the hippocampus in memory retrieval is independent of whether remembering is intentional or incidental. Right prefrontal and bilateral parietal cortex were more activated during the intentional task than during the incidental task, irrespective of encoding condition. Thus, these regions play a more extensive role in memory retrieval when remembering is intentional.

title: Neural mechanisms of voluntary and involuntary recall: A PET study
abstract: Neuropsychological and neuroimaging studies on episodic memory retrieval have primarily focused on volitional memory tasks. However, some conscious memories arise involuntarily, i.e. without a strategic retrieval attempt, yet little is known about the neural network underlying involuntary episodic memory. The aim of this study was to determine whether voluntary and involuntary recall are mediated by separate cortical networks. We used positron emission tomography (PET) to measure changes in regional cerebral blood flow (rCBF) in 12 healthy subjects during voluntary and involuntary cued recall of pictures and a control condition with no episodic memory requirements. Involuntary recall was elicited by using an incidental memory task. Compared to the control condition, voluntary and involuntary recall were both associated with significant regional cerebral blood flow (rCBF) increases in posterior cingulate gyrus (PCG; BA 23), left precuneus (BA 7), and right parahippocampal gyrus (BA 35/36). In addition, rCBF in right dorsolateral prefrontal cortex (PFC; BA 8/9) and left precuneus (BA 7) was significantly larger during voluntary compared to involuntary recall, while rCBF was enhanced in left dorsolateral PFC (BA 9) during involuntary recall. The findings corroborate an association of the right PFC with a strategic component of episodic memory retrieval. Moreover, they show for the first time that it is possible to activate the medial temporal lobe, the PCG, and the precuneus, regions normally associated with retrieval success, without this strategic element. The relatively higher activity in precuneus during voluntary compared to involuntary recall suggests that activity in this region co-varies not only with retrieval success but also with retrieval intentionality.

title: Multimodal Imaging of Incidental Retrieval: The Low Route to Memory
abstract: Memories of past episodes frequently come to mind incidentally, without directed search. It has remained unclear how incidental retrieval processes are initiated in the brain. Here we used fMRI and ERP recordings to find brain activity that specifically correlates with incidental retrieval, as compared to intentional retrieval. Intentional retrieval was associated with increased activation in dorsolateral prefrontal cortex. By contrast, incidental retrieval was associated with a reduced fMRI signal in posterior brain regions, including extrastriate and parahippocampal cortex, and a modulation of a posterior ERP component 170 msec after the onset of visual retrieval cues. Successful retrieval under both intentional and incidental conditions was associated with increased activation in the hippocampus, precuneus, and ventrolateral prefrontal cortex, as well as increased amplitude of the P600 ERP component. These results demonstrate how early bottom–up signals from posterior cortex can lead to reactivation of episodic memories in the absence of strategic retrieval attempts.

title: Voluntary Explicit versus Involuntary Conceptual Memory Are Associated with Dissociable fMRI Responses in Hippocampus, Amygdala, and Parietal Cortex for Emotional and Neutral Word Pairs
abstract: Although functional neuroimaging studies have supported the distinction between explicit and implicit forms of memory, few have matched explicit and implicit tests closely, and most of these tested perceptual rather than conceptual implicit memory. We compared event-related fMRI responses during an intentional test, in which a group of participants used a cue word to recall its associate from a prior study phase, with those in an incidental test, in which a different group of participants used the same cue to produce the first associate that came to mind. Both semantic relative to phonemic processing at study, and emotional relative to neutral word pairs, increased target completions in the intentional test, but not in the incidental test, suggesting that behavioral performance in the incidental test was not contaminated by voluntary explicit retrieval. We isolated the neural correlates of successful retrieval by contrasting fMRI responses to studied versus unstudied cues for which the equivalent “target” associate was produced. By comparing the difference in this repetition-related contrast across the intentional and incidental tests, we could identify the correlates of voluntary explicit retrieval. This contrast revealed increased bilateral hippocampal responses in the intentional test, but decreased hippocampal responses in the incidental test. A similar pattern in the bilateral amygdale was further modulated by the emotionality of the word pairs, although surprisingly only in the incidental test. Parietal regions, however, showed increased repetition-related responses in both tests. These results suggest that the neural correlates of successful voluntary explicit memory differ in directionality, even if not in location, from the neural correlates of successful involuntary implicit (or explicit) memory, even when the incidental test taps conceptual processes.

title: An fMRI investigation of posttraumatic flashbacks
abstract: Highlights ► Flashbacks in PTSD are associated with decreased rather than increased MTL activation. ► Flashbacks in PTSD are associated with activation in the insula and in motor and sensory areas. ► Flashbacks in PTSD may correspond to familiarity rather than recollection responses.

title: The Neural Basis of Involuntary Episodic Memories
abstract: Voluntary episodic memories require an intentional memory search, whereas involuntary episodic memories come to mind spontaneously without conscious effort. Cognitive neuroscience has largely focused on voluntary memory, leaving the neural mechanisms of involuntary memory largely unknown. We hypothesized that, because the main difference between voluntary and involuntary memory is the controlled retrieval processes required by the former, there would be greater frontal activity for voluntary than involuntary memories. Conversely, we predicted that other components of the episodic retrieval network would be similarly engaged in the two types of memory. During encoding, all participants heard sounds, half paired with pictures of complex scenes and half presented alone. During retrieval, paired and unpaired sounds were presented, panned to the left or to the right. Participants in the involuntary group were instructed to indicate the spatial location of the sound, whereas participants in the voluntary group were asked to additionally recall the pictures that had been paired with the sounds. All participants reported the incidence of their memories in a postscan session. Consistent with our predictions, voluntary memories elicited greater activity in dorsal frontal regions than involuntary memories, whereas other components of the retrieval network, including medial-temporal, ventral occipitotemporal, and ventral parietal regions were similarly engaged by both types of memories. These results clarify the distinct role of dorsal frontal and ventral occipitotemporal regions in predicting strategic retrieval and recalled information, respectively, and suggest that, although there are neural differences in retrieval, involuntary memories share neural components with established voluntary memory systems.

title: The reappearance hypothesis revisited: Recurrent involuntary memories after traumatic events and in everyday life
abstract: Recurrent involuntary memories are autobiographical memories that come to mind with no preceding retrieval attempt and that are subjectively experienced as being repetitive. Clinically, they are classified as a symptom of posttraumatic stress disorder. The present work is the first to systematically examine recurrent involuntary memories outside clinical settings. Study 1 examines recurrent involuntary memories among survivors of the tsunami catastrophe in Southeast Asia in 2004. Study 2 examines recurrent involuntary memories in a large general population. Study 3 examines whether the contents of recurrent involuntary memories recorded in a diary study are duplicates of, or differ from, one another. We show that recurrent involuntary memories are not limited to clinical populations or to emotionally negative experiences; that they typically do not come to mind in a fixed and unchangeable form; and that they show the same pattern regarding accessibility as do autobiographical memories in general. We argue that recurrent involuntary memories after traumas and in everyday life can be explained in terms of general and well-established mechanisms of autobiographical memory.

title: Positive involuntary autobiographical memories: You first have to live them
abstract: Highlights ► First study to investigate the formation of positive involuntary autobiographical memories from positively rated films. ► Positive involuntary memories occur frequently and universally. ► Positive mood change at the time of encoding associated with frequency of positive involuntary memories.

title: The emotional brain
abstract: The discipline of affective neuroscience is concerned with the neural bases of emotion and mood. The past 30 years have witnessed an explosion of research in affective neuroscience that has addressed questions such as: which brain systems underlie emotions? How do differences in these systems relate to differences in the emotional experience of individuals? Do different regions underlie different emotions, or are all emotions a function of the same basic brain circuitry? How does emotion processing in the brain relate to bodily changes associated with emotion? And, how does emotion processing in the brain interact with cognition, motor behaviour, language and motivation?

title: Emotion and cognition: insights from studies of the human amygdala.
abstract: Traditional approaches to the study of cognition emphasize an information-processing view that has generally excluded emotion. In contrast, the recent emergence of cognitive neuroscience as an inspiration for understanding human cognition has highlighted its interaction with emotion. This review explores insights into the relations between emotion and cognition that have resulted from studies of the human amygdala. Five topics are explored: emotional learning, emotion and memory, emotion's influence on attention and perception, processing emotion in social stimuli, and changing emotional responses. Investigations into the neural systems underlying human behavior demonstrate that the mechanisms of emotion and cognition are intertwined from early perception to reasoning. These findings suggest that the classic division between the study of emotion and cognition may be unrealistic and that an understanding of human cognition requires the consideration of emotion.

title: Human emotion and memory: interactions of the amygdala and hippocampal complex
abstract: The amygdala and hippocampal complex, two medial temporal lobe structures, are linked to two independent memory systems, each with unique characteristic functions. In emotional situations, these two systems interact in subtle but important ways. Specifically, the amygdala can modulate both the encoding and the storage of hippocampal-dependent memories. The hippocampal complex, by forming episodic representations of the emotional significance and interpretation of events, can influence the amygdala response when emotional stimuli are encountered. Although these are independent memory systems, they act in concert when emotion meets memory.

title: Neural correlates of individual ratings of emotional salience: a trial-related fMRI study
abstract: Accurate appraisal of meaningful environmental signals involves the interpretation of salient information for their intrinsic emotional value and personal relevance. We examined the neural basis for these components of endogenous salience during such appraisals using trial-related functional magnetic resonance imaging (fMRI). Subjects viewed affective pictures and assessed either the emotional intensity or extent of self-relatedness of the content of those pictures. In a parametric factorial design, individualized subjective ratings of these two dimensions were correlated with brain activity. The nucleus accumbens (NAcc) responded to both increasing emotional intensity and self-relatedness. Activity in the amygdala was specifically related to affective judgments and emotional intensity. The volitional act of appraising the extent of personal association specifically engaged the ventral medial prefrontal cortex (MPFC), and additionally recruited dorsal medial frontal regions and insula as the extent of self-relatedness increased. The findings highlight both overlapping and segregated neural representations of intrinsic value and personal relevance during the appraisal of emotional stimuli.

title: Sex-related hemispheric lateralization of amygdala function in emotionally influenced memory: an FMRI investigation.
abstract: The amygdala appears necessary for enhanced long-term memory associated with emotionally arousing events. Recent brain imaging investigations support this view and indicate a sex-related hemispheric lateralization exists in the amygdala relationship to memory for emotional material. This study confirms and further explores this finding. Healthy men and women underwent functional Magnetic Resonance Imaging (fMRI) while viewing a series of standardized slides that were rated by the subjects as ranging from emotionally neutral to highly arousing. Two weeks later, memory for the slides was assessed in an incidental recognition test. The results demonstrate a significantly stronger relationship in men than in women between activity of the right hemisphere amygdala and memory for those slides judged as arousing, and a significantly stronger relationship in women than in men between activity of the left hemisphere amygdala and memory for arousing slides. An ANOVA confirmed a significant interaction between sex and hemisphere regarding amygdala function in memory. These results provide the strongest evidence to date of a sex-related hemispheric lateralization of amygdala function in memory for emotional material. Furthermore, they underscore the view that investigations of neural mechanisms underlying emotionally influenced memory must anticipate, and begin to account for, the apparently substantial influence of sex.

title: The amygdala modulates the consolidation of memories of emotionally arousing experiences.
abstract: Converging findings of animal and human studies provide compelling evidence that the amygdala is critically involved in enabling us to acquire and retain lasting memories of emotional experiences. This review focuses primarily on the findings of research investigating the role of the amygdala in modulating the consolidation of long-term memories. Considerable evidence from animal studies investigating the effects of posttraining systemic or intra-amygdala infusions of hormones and drugs, as well as selective lesions of specific amygdala nuclei, indicates that (a) the amygdala mediates the memory-modulating effects of adrenal stress hormones and several classes of neurotransmitters; (b) the effects are selectively mediated by the basolateral complex of the amygdala (BLA); (c) the influences involve interactions of several neuromodulatory systems within the BLA that converge in influencing noradrenergic and muscarinic cholinergic activation; (d) the BLA modulates memory consolidation via efferents to other brain regions, including the caudate nucleus, nucleus accumbens, and cortex; and (e) the BLA modulates the consolidation of memory of many different kinds of information. The findings of human brain imaging studies are consistent with those of animal studies in suggesting that activation of the amygdala influences the consolidation of long-term memory; the degree of activation of the amygdala by emotional arousal during encoding of emotionally arousing material (either pleasant or unpleasant) correlates highly with subsequent recall. The activation of neuromodulatory systems affecting the BLA and its projections to other brain regions involved in processing different kinds of information plays a key role in enabling emotionally significant experiences to be well remembered.

title: Prefrontal cortical function and anxiety: controlling attention to threat-related stimuli
abstract: Threat-related stimuli are strong competitors for attention, particularly in anxious individuals. We used functional magnetic resonance imaging (fMRI) with healthy human volunteers to study how the processing of threat-related distractors is controlled and whether this alters as anxiety levels increase. Our work builds upon prior analyses of the cognitive control functions of lateral prefrontal cortex (lateral PFC) and anterior cingulate cortex (ACC). We found that rostral ACC was strongly activated by infrequent threat-related distractors, consistent with a role for this area in responding to unexpected processing conflict caused by salient emotional stimuli. Participants with higher anxiety levels showed both less rostral ACC activity overall and reduced recruitment of lateral PFC as expectancy of threat-related distractors was established. This supports the proposal that anxiety is associated with reduced top-down control over threat-related distractors. Our results suggest distinct roles for rostral ACC and lateral PFC in governing the processing of task-irrelevant, threat-related stimuli, and indicate reduced recruitment of this circuitry in anxiety.

title: What attributes guide the deployment of visual attention and how do they do it?
abstract: As you drive into the centre of town, cars and trucks approach from several directions, and pedestrians swarm into the intersection. The wind blows a newspaper into the gutter and a pigeon does something unexpected on your windshield. This would be a demanding and stressful situation, but you would probably make it to the other side of town without mishap. Why is this situation taxing, and how do you cope?

title: Enhanced priming for trauma-related material in posttraumatic stress disorder.
abstract: Intrusive reexperiencing in posttraumatic stress disorder (PTSD) has been linked to perceptual priming for trauma-related material. A prospective longitudinal study (N = 69) investigated perceptual priming for trauma-related, general threat, and neutral words in assault survivors with and without PTSD, using a new version of the word-stem completion task. Survivors with PTSD showed enhanced priming for trauma-related words. Furthermore, priming for trauma-related words measured soon after the trauma was associated with subsequent PTSD severity at 3, 6, and 9 months. The enhanced priming effect was specific to trauma-related words. Enhanced perceptual priming for traumatic material appears to be one of the cognitive processes operating in PTSD.

title: Perceptual processing advantages for trauma-related visual cues in post-traumatic stress disorder
abstract: Intrusive re-experiencing in post-traumatic stress disorder (PTSD) comprises distressing sensory impressions from the trauma that seem to occur ‘out of the blue’. A key question is how intrusions are triggered. One possibility is that PTSD is characterized by a processing advantage for stimuli that resemble those that accompanied the trauma, which would lead to increased detection of such cues in the environment.  We used a blurred picture identification task in a cross-sectional (n=99) and a prospective study (n=221) of trauma survivors.  Participants with acute stress disorder (ASD) or PTSD, but not trauma survivors without these disorders, identified trauma-related pictures, but not general threat pictures, better than neutral pictures. There were no group differences in the rate of trauma-related answers to other picture categories. The relative processing advantage for trauma-related pictures correlated with re-experiencing and dissociation, and predicted PTSD at follow-up.  A perceptual processing bias for trauma-related stimuli may contribute to the involuntary triggering of intrusive trauma memories in PTSD.

title: Attentional biases in PTSD: More evidence for interference.
abstract: Attentional biases to trauma-related stimuli have been widely demonstrated in individuals with posttraumatic stress disorder (PTSD). However, the majority of these studies used methods not suited to differentiating difficulty disengaging attention from threatening stimuli (interference) from facilitated detection of threat. In the current study, a visual search task (VST) with a lexical decision component was used to differentiate between attentional interference and facilitation. Forty-six sexual assault survivors with High PTSD or Low PTSD symptoms completed the VST with three types of stimuli (trauma-related, general threat-related, and semantically-related neutral words), to examine the specificity of attentional biases associated with PTSD symptoms. High PTSD participants showed increased interference to trauma-related words relative to Low PTSD participants. Furthermore, the increased attentional interference in High PTSD participants was specific to trauma-related stimuli. No evidence was found for facilitated detection of threatening stimuli in PTSD. These results provide additional support for attentional biases in PTSD relating to attentional interference with trauma-related cues rather than facilitated detection of threat. The implications for this pattern of results are discussed in relation to anxiety disorders that are characterized by rumination and/or intrusions (e.g., PTSD, GAD) rather than those more circumscribed to fight or flight response (e.g., phobias).

title: The role of attentional biases in PTSD: is it interference or facilitation?
abstract: Although attentional biases have been demonstrated in individuals with posttraumatic stress disorder (PTSD), the cognitive methodologies used have not allowed for disambiguation of two types of attentional biases. It remains unclear if PTSD involves difficulty disengaging attention from threatening stimuli (interference) or facilitated detection. To differentiate between attentional interference and facilitation, 57 male Vietnam-era veterans (30 High PTSD and 27 Low PTSD) completed a visual search task with a lexical decision component. High PTSD veterans who engaged in the interference task first showed increased interference to threat-relevant words relative to Low PTSD veterans. However, no evidence was found for facilitated detection of threatening stimuli in PTSD.

title: Orienting Attention to Locations in Internal Representations
abstract: Three experiments investigated whether it is possible to orient selective spatial attention to internal representations held in working memory in a similar fashion to orienting to perceptual stimuli. In the first experiment, subjects were either cued to orient to a spatial location before a stimulus array was presented (pre-cue), cued to orient to a spatial location in working memory after the array was presented (retro-cue), or given no cueing information (neutral cue). The stimulus array consisted of four differently colored crosses, one in each quadrant. At the end of a trial, a colored cross (probe) was presented centrally, and subjects responded according to whether it had occurred in the array. There were equivalent patterns of behavioral costs and benefits of cueing for both pre-cues and retro-cues. A follow-up experiment used a peripheral probe stimulus requiring a decision about whether its color matched that of the item presented at the same location in the array. Replication of the behavioral costs and benefits of pre-cues and retro-cues in this experiment ruled out changes in response criteria as the only explanation for the effects. The third experiment used event-related potentials (ERPs) to compare the neural processes involved in orienting attention to a spatial location in an external versus an internal spatial representation. In this task, subjects responded according to whether a central probe stimulus occurred at the cued location in the array. There were both similarities and differences between ERPs to spatial cues toward a perception versus an internal spatial representation. Lateralized early posterior and later frontal negativities were observed for both preand retro-cues. Retro-cues also showed additional neural processes to be involved in orienting to an internal representation, including early effects over frontal electrodes.

title: Cognitive control of attention in the human brain: Insights from orienting attention to mental representations
abstract: In this review, we summarize a new line of experimentation showing that attentional orienting can bias information processing in the working memory domain as well as in the perceptual domain to optimize goal-directed behavior. A new experimental paradigm was developed, which revealed that spatial orienting cues that appear after perceptual events (retro-cues), when these have been internalized into working memory representations, can retrospectively enhance performance to a similar degree as spatial precues appearing before perceptual events. As part of their facilitatory action, retro-cues diminish the costs of retrieving items from increasing loads within working memory. Hemodynamic and electrophysiological brain imaging experiments show a high degree of overlap between brain areas and dynamics involved in spatial orienting in the working memory domain compared to the perceptual domain. In addition, functional magnetic resonance imaging points to the selective involvement of frontal areas during spatial orienting in the working memory domain. The roles of different frontal areas remain to be clarified but may include both early roles in guiding spatial shifts occurring within a mnemonic context as well as selection of memorized targets amidst distracting stimuli. Experiments have also begun to reveal the ability to orient attention selectively to object-based representations in working memory and suggest that the neural representations of objects in working memory can be directly modulated by this process. The findings bolster contemporary notions of a strong theoretical relationship between attentional orienting and working memory, suggesting that these two cognitive functions interact in more ways and directions than previously considered.

title: Posterior parietal cortex and the filtering of distractors
abstract: Neural systems for visual processing can focus attention on behaviorally relevant objects, filtering out competing distractors. Neurophysiological studies in animals and brain imaging studies in humans suggest that such filtering depends on top-down inputs to extrastriate visual areas, originating in structures important for attentional control. To test whether the posterior parietal cortex may be a necessary source of signals that filter distractors, we measured the ability of a patient with bilateral parietal lesions to discriminate the features of a target surrounded by distractors of variable contrast. In the presence of distractors, the patient was impaired at discriminating both grating orientation and faces, and the magnitude of the impairment increased with distractor salience. These attentional deficits are remarkably similar to those caused by damage to monkey extrastriate regions V4 and/or TEO, which are thought to be recipients of top-down attentional feedback. In contrast to the effects of V4 and TEO lesions, however, the parietal lesions impaired performance even with widely spaced targets and distractors, a finding consistent with the projections of parietal cortex to visual processing areas covering a wide range of receptive field sizes and eccentricities.

title: The Generality of Parietal Involvement in Visual Attention
abstract: Functional magnetic resonance imaging (fMRI) was used to determine whether different kinds of visual attention rely on a common neural substrate. Within one session, subjects performed three different attention experiments (each comparing an attentionally demanding task with an easier task using identical stimuli): (1) peripheral shifting, (2) object matching, and (3) a nonspatial conjunction task. Two areas were activated in all three experiments: one at the junction of intraparietal and transverse occipital sulci (IPTO), and another in the anterior intraparietal sulcus (AIPS). These regions are not simply involved in any effortful task, because they were not activated in a fourth experiment comparing a difficult language task with an easier control task. Thus, activity in IPTO and AIPS generalizes across a wide variety of attention-requiring tasks, supporting the existence of a common neural substrate underlying multiple modes of visual selection.

title: Distraction and target selection in the brain: An fMRI study
abstract: To attend successfully, a specification of what is currently relevant is necessary, but not sufficient. Irrelevant stimuli that are also present in the environment must be recognized as such and filtered out at the same time. Using functional magnetic resonance imaging, we showed that posterior brain regions in parietal, occipital and temporal cortex are recruited in order to ignore distracting visual stimuli, while the specification and selection of relevant stimuli is associated with differential activity in frontal cortex and hippocampal areas instead. The results thus suggest that the selection of relevant objects can be anatomically dissociated from the handling of competing irrelevant objects. The dissociation between the increased involvement of parietal and occipital cortex in handling distraction on one hand, and that of frontal cortex in target specification on the other provides neurophysiological support for models of attention that make this functional distinction.

title: Orienting Attention to Locations in Perceptual Versus Mental Representations
abstract: Extensive clinical and imaging research has characterized the neural networks mediating the adaptive distribution of spatial attention. In everyday behavior, the distribution of attention is guided not only by extrapersonal targets but also by mental representations of their spatial layout. We used eventrelated functional magnetic resonance imaging to identify the neural system involved in directing attention to locations in arrays held as mental representations, and to compare it with the system for directing spatial attention to locations in the external world. We found that these two crucial aspects of spatial cognition are subserved by extensively overlapping networks. However, we also found that a region of right parietal cortex selectively participated in orienting attention to the extrapersonal space, whereas several frontal lobe regions selectively participated in orienting attention within on-line mental representations.

title: Meta-analytic evidence for a superordinate cognitive control network subserving diverse executive functions
abstract: Classic cognitive theory conceptualizes executive functions as involving multiple specific domains, including initiation, inhibition, working memory, flexibility, planning, and vigilance. Lesion and neuroimaging experiments over the past two decades have suggested that both common and unique processes contribute to executive functions during higher cognition. It has been suggested that a superordinate fronto–cingulo–parietal network supporting cognitive control may also underlie a range of distinct executive functions. To test this hypothesis in the largest sample to date, we used quantitative meta-analytic methods to analyze 193 functional neuroimaging studies of 2,832 healthy individuals, ages 18–60, in which performance on executive function measures was contrasted with an active control condition. A common pattern of activation was observed in the prefrontal, dorsal anterior cingulate, and parietal cortices across executive function domains, supporting the idea that executive functions are supported by a superordinate cognitive control network. However, domain-specific analyses showed some variation in the recruitment of anterior prefrontal cortex, anterior and midcingulate regions, and unique subcortical regions such as the basal ganglia and cerebellum. These results are consistent with the existence of a superordinate cognitive control network in the brain, involving dorsolateral prefrontal, anterior cingulate, and parietal cortices, that supports a broad range of executive functions.

title: Alterations in the neural circuitry for emotion and attention associated with posttraumatic stress symptomatology
abstract: Information processing models of posttraumatic stress disorder (PTSD) suggest that PTSD is characterized by preferential allocation of attentional resources to potentially threatening stimuli. However, few studies have examined the neural pattern underlying attention and emotion in association with PTSD symptomatology. In the present study, combat veterans with PTSD symptomatology engaged in an emotional oddball task while undergoing functional magnetic resonance imaging (fMRI). Veterans were classified into a high or low symptomatology group based on their scores on the Davidson Trauma Scale (DTS). Participants discriminated infrequent target stimuli (circles) from frequent standards (squares) while emotional and neutral distractors were presented infrequently and irregularly. Results revealed that participants with greater PTSD symptomatology showed enhanced neural activity in ventral-limbic and dorsal regions for emotional stimuli and attenuated activity in dorsolateral prefrontal and parietal regions for attention targets. In the anterior cingulate gyrus, participants with fewer PTSD symptoms showed equivalent responses to attentional and emotional stimuli while the high symptom group showed greater activation for negative emotional stimuli. Taken together, the results suggest that hyperresponsive ventral-limbic activity coupled with altered dorsal-attention and anterior cingulate function may be a neural marker of attention bias in PTSD.

title: Altered emotional interference processing in the amygdala and insula in women with Post-Traumatic Stress Disorder☆☆☆
abstract: Post-Traumatic Stress Disorder (PTSD) is characterized by distinct behavioral and physiological changes. Given the significant impairments related to PTSD, examination of the biological underpinnings is crucial to the development of theoretical models and improved treatments of PTSD.  We used an attentional interference task using emotional distracters to test for top-down versus bottom-up dysfunction in the interaction of cognitive-control circuitry and emotion-processing circuitry. A total of 32 women with PTSD (based on an interpersonal trauma) and 21 matched controls were tested. Event-related functional magnetic resonance imaging was carried out as participants directly attended to, or attempted to ignore, fear-related stimuli.  Compared to controls, patients with PTSD showed hyperactivity in several brain regions, including the amygdala, insula, as well as dorsal lateral and ventral PFC regions.  These results are consistent with previous studies that have higher amygdala and insular activation in PTSD subjects. However, inhibition of suppression of PFC regions is inconsistent with the fear circuitry model hypothesized by prior research. We suggest that the specific emotional conflict task used appears to target implicit or automatic emotional regulation instead of explicit or effortful emotional regulation. This is particularly relevant as it posited that emotional regulatory difficulties in anxiety disorders such as PTSD appear to occur in implicit forms of emotion regulation.

title: Neural Networks of Information Processing in Posttraumatic Stress Disorder: A Functional Magnetic Resonance Imaging Study
abstract: Neuroimaging studies report reduced medial prefrontal cortical (particularly anterior cingulate) but enhanced amygdala response to fear signals in posttraumatic Stress Disorder (PTSD). We investigated whether anterior cingulate-amygdala dysregulation in PTSD would generalize to salient, but nonthreat related signals.



Individuals with PTSD (n = 14) and age and sex-matched nontraumatized controls (n = 14) completed an auditory oddball paradigm adapted to functional magnetic resonance imaging at a 1.5-T field strength.



Controls displayed bilateral activation in ventral anterior cingulate and amygdala networks, and PTSD subjects showed bilateral dorsal anterior cingulate and amygdala activation to targets relative to nontargets. Compared to controls, PTSD subjects showed enhanced responses to targets in the dorsal and rostral anterior cingulate, and left amygdala. Whole-brain analyses confirmed the expected pattern of distributed prefrontal-parietal responses to targets in the oddball task. Greater activity in posterior parietal somatosensory regions was observed in PTSD.



Our findings of enhanced anterior cingulate responses in PTSD contrast with reports of reduced activity for threat stimuli, suggesting that the latter may be specific to processing of threat-related content. Activation in rostral and dorsal anterior cingulate, left amygdala and posterior parietal networks in response to salient, nonthreatening stimuli may reflect generalized hypervigilance.

title: Mental Imagery, Philosophical Issues about
abstract: Mental imagery, often informally described as ‘seeing in the mind's eye’, ‘visualization’, etc., is quasi-perceptual experience: it significantly resembles perceptual experience, but occurs in the absence of the appropriate perceptual stimuli. 
 
 
 
 
intentionality; 
consciousness; 
representation; 
perception; 
memory

title: Neural foundations of imagery
abstract: Mental imagery has, until recently, fallen within the purview of philosophy and cognitive psychology. Both enterprises have raised important questions about imagery, but have not made substantial progress in answering them. With the advent of cognitive neuroscience, these questions have become empirically tractable. Neuroimaging studies, combined with other methods (such as studies of brain-damaged patients and of the effects of transcranial magnetic stimulation), are revealing the ways in which imagery draws on mechanisms used in other activities, such as perception and motor control. Because of its close relation to these basic processes, imagery is now becoming one of the best understood 'higher' cognitive functions.

title: The nature of intrusive memories after trauma: the warning signal hypothesis.
abstract: Individuals who had experienced a range of different traumas were asked to describe the quality and content of their intrusive memories. Visual intrusions were the most common, and thoughts were uncommon. Intrusion quality varied little with type of trauma. Intrusive memories commonly consisted of stimuli that were present immediately before the traumatic event happened or shortly before the moments that had the largest emotional impact (i.e., when the meaning of the event became more traumatic). It is suggested that intrusive memories are about stimuli that through temporal association with the trauma acquired the status of warning signals, i.e., stimuli that if encountered again would indicate impending danger. This explains why intrusive memories are accompanied by a sense of serious current threat. The warning signal hypothesis may be useful in guiding therapists in identifying the moments with the largest emotional impact that will need reprocessing in treatment, and in educating patients about the nature of reexperiencing symptoms.

title: Maintenance of Intrusive Memories in Posttraumatic Stress Disorder: A Cognitive Approach
abstract: Intrusive recollections are very common immediately after traumatic events and are considered necessary aspects of emotional processing. However, if these intrusive recollections persist over a long time, they are linked to long-term psychiatric disorder, especially Posttraumatic Stress Disorder (PTSD). This paper discusses the need to investigate factors involved in the maintenance of intrusive traumatic recollections. It is suggested that the idiosyncratic meaning of the intrusive recollections predicts the distress caused by them, and the degree to which the individual engages in strategies to control the intrusions. These control strategies maintain the intrusive recollections by preventing a change in the meaning of the trauma and of the traumatic memories. It is further suggested that what is needed is a comprehensive assessment of the processes that prevent change in meaning, going beyond the assessment of avoidance. In particular, safety behaviours, dissociation and numbing, suppression of memories and thoughts about trauma, rumination, activation of other emotions such as anger and guilt and corresponding cognitions, and selective information processing (attentional and memory biases) may be involved in the maintenance of intrusive recollections. Preliminary data supporting these suggestions from studies of individuals involved in road traffic accidents and survivors of child sexual abuse are described.

title: Mental imagery in emotion and emotional disorders.
abstract: Mental imagery has been considered relevant to psychopathology due to its supposed special relationship with emotion, although evidence for this assumption has been conspicuously lacking. The present review is divided into four main sections: (1) First, we review evidence that imagery can evoke emotion in at least three ways: a direct influence on emotional systems in the brain that are responsive to sensory signals; overlap between processes involved in mental imagery and perception which can lead to responding "as if" to real emotion-arousing events; and the capacity of images to make contact with memories for emotional episodes in the past. (2) Second, we describe new evidence confirming that imagery does indeed evoke greater emotional responses than verbal representation, although the extent of emotional response depends on the image perspective adopted. (3) Third, a heuristic model is presented that contrasts the generation of language-based representations with imagery and offers an account of their differing effects on emotion, beliefs and behavior. (4) Finally, based on the foregoing review, we discuss the role of imagery in maintaining emotional disorders, and its uses in psychological treatment.

title: Looking at pictures: affective, facial, visceral, and behavioral reactions.
abstract: Colored photographic pictures that varied widely across the affective dimensions of valence (pleasant-unpleasant) and arousal (excited-calm) were each viewed for a 6-s period while facial electromyographic (zygomatic and corrugator muscle activity) and visceral (heart rate and skin conductance) reactions were measured. Judgments relating to pleasure, arousal, interest, and emotional state were measured, as was choice viewing time. Significant covariation was obtained between (a) facial expression and affective valence judgments and (b) skin conductance magnitude and arousal ratings. Interest ratings and viewing time were also associated with arousal. Although differences due to the subject's gender and cognitive style were obtained, affective responses were largely independent of the personality factors investigated. Response specificity, particularly facial expressiveness, supported the view that specific affects have unique patterns of reactivity. The consistency of the dimensional relationships between evaluative judgments (i.e., pleasure and arousal) and physiological response, however, emphasizes that emotion is fundamentally organized by these motivational parameters.

title: Emotional memory is perceptual.
abstract: In two experiments it was investigated which aspects of memory are influenced by emotion. Using a framework proposed by Roediger (American Psychologist 45 (1990) 1043-1056), two dimensions relevant for memory were distinguished the implicit-explicit distinction, and the perceptual versus conceptual distinction. In week 1, subjects viewed a series of slides accompanied with a spoken story in either of the two versions, a neutral version, or a version with an emotional mid-phase. In week 2, memory performance for the slides and story was assessed unexpectedly. A free recall test revealed superior memory in the emotional condition for the story's mid-phase stimuli as compared to the neutral condition, replicating earlier findings. Furthermore, memory performance was assessed using tests that systematically assessed all combinations of implicit versus explicit and perceptual versus conceptual memory. Subjects who had listened to the emotional story had superior perceptual memory, on both implicit and explicit level, compared to those who had listened to the neutral story. Conceptual memory was not superior in the emotional condition. The results suggest that emotion specifically promotes perceptual memory, probably by better encoding of perceptual aspects of emotional experiences. This might be related to the prominent position of perceptual memories in traumatic memory, manifest in intrusions, nightmares and reliving experiences.

title: Imagery neurons in the human brain
abstract: Vivid visual images can be voluntarily generated in our minds in the absence of simultaneous visual input. While trying to count the number of flowers in Van Gogh's Sunflowers, understanding a description or recalling a path, subjects report forming an image in their “mind's eye”. Whether this process is accomplished by the same neuronal mechanisms as visual perception has long been a matter of debate. Evidence from functional imaging, psychophysics, neurological studies and monkey electrophysiology suggests a common process, yet there are patients with deficits in one but not the other. Here we directly investigated the neuronal substrates of visual recall by recording from single neurons in the human medial temporal lobe while the subjects were asked to imagine previously viewed images. We found single neurons in the hippocampus, amygdala, entorhinal cortex and parahippocampal gyrus that selectively altered their firing rates depending on the stimulus the subjects were imagining. Of the neurons that fired selectively during both vision and imagery, the majority (88%) had identical selectivity. Our study reveals single neuron correlates of volitional visual imagery in humans and suggests a common substrate for the processing of incoming visual information and visual recall.

title: Neural effects of visualizing and perceiving aversive stimuli: a PET investigation.
abstract: Cerebral blood flow was recorded (using positron emission tomography) while middle-aged subjects viewed or visualized pictures of neutral or aversive stimuli, and then determined whether auditorily presented statements correctly described the stimuli. Visualizing aversive stimuli enhanced cerebral blood flow, relative to visualizing neutral stimuli, in areas 17 (right) and 18 (bilateral), as well as the anterior insula (bilateral) and middle frontal cortex (left). Areas 17 and 18 have been identified as supporting the representations that underlie the experience of imagery, and the anterior insula is a major cortical recipient of input from the autonomic nervous system. Perceiving aversive stimuli enhanced cerebral blood flow, relative to neutral stimuli, in area 46, the angular gyrus and area 19, area 47, and the middle temporal gyrus (all in the left hemisphere). All of these areas have previously been implicated in visual object identification. It is striking that negative emotion did not modulate activation in any areas in the same way during imagery and perception.

title: Considering PTSD for DSM‐5
abstract: This is a review of the relevant empirical literature concerning the DSM‐IV‐TR diagnostic criteria for PTSD. Most of this work has focused on Criteria A1 and A2, the two components of the A (Stressor) Criterion. With regard to A1, the review considers: (a) whether A1 is etiologically or temporally related to the PTSD symptoms; (b) whether it is possible to distinguish “traumatic” from “non‐traumatic” stressors; and (c) whether A1 should be eliminated from DSM‐5. Empirical literature regarding the utility of the A2 criterion indicates that there is little support for keeping the A2 criterion in DSM‐5. The B (reexperiencing), C (avoidance/numbing) and D (hyperarousal) criteria are also reviewed. Confirmatory factor analyses suggest that the latent structure of PTSD appears to consist of four distinct symptom clusters rather than the three‐cluster structure found in DSM‐IV. It has also been shown that in addition to the fear‐based symptoms emphasized in DSM‐IV, traumatic exposure is also followed by dysphoric, anhedonic symptoms, aggressive/externalizing symptoms, guilt/shame symptoms, dissociative symptoms, and negative appraisals about oneself and the world. A new set of diagnostic criteria is proposed for DSM‐5 that: (a) attempts to sharpen the A1 criterion; (b) eliminates the A2 criterion; (c) proposes four rather than three symptom clusters; and (d) expands the scope of the B–E criteria beyond a fear‐based context. The final sections of this review consider: (a) partial/subsyndromal PTSD; (b) disorders of extreme stress not otherwise specified (DESNOS)/complex PTSD; (c) cross‐ cultural factors; (d) developmental factors; and (e) subtypes of PTSD. Depression and Anxiety, 2011.

title: Key Steps in Developing a Cognitive Vaccine against Traumatic Flashbacks: Visuospatial Tetris versus Verbal Pub Quiz
abstract: Flashbacks (intrusive memories of a traumatic event) are the hallmark feature of Post Traumatic Stress Disorder, however preventative interventions are lacking. Tetris may offer a ‘cognitive vaccine’  against flashback development after trauma exposure. We previously reported that playing the computer game Tetris soon after viewing traumatic material reduced flashbacks compared to no-task . However, two criticisms need to be addressed for clinical translation: (1) Would all games have this effect via distraction/enjoyment, or might some games even be harmful? (2) Would effects be found if administered several hours post-trauma? Accordingly, we tested Tetris versus an alternative computer game – Pub Quiz – which we hypothesized not to be helpful (Experiments 1 and 2), and extended the intervention interval to 4 hours (Experiment 2).  The trauma film paradigm was used as an experimental analog for flashback development in healthy volunteers. In both experiments, participants viewed traumatic film footage of death and injury before completing one of the following: (1) no-task control condition (2) Tetris or (3) Pub Quiz. Flashbacks were monitored for 1 week.  30 min after the traumatic film, playing Tetris led to a significant reduction in flashbacks compared to no-task control, whereas Pub Quiz led to a significant increase in flashbacks. Experiment 2: 4 hours post-film, playing Tetris led to a significant reduction in flashbacks compared to no-task control, whereas Pub Quiz did not.  First, computer games can have differential effects post-trauma, as predicted by a cognitive science formulation of trauma memory. In both Experiments, playing Tetris post-trauma film reduced flashbacks. Pub Quiz did not have this effect, even increasing flashbacks in Experiment 1. Thus not all computer games are beneficial or merely distracting post-trauma - some may be harmful. Second, the beneficial effects of Tetris are retained at 4 hours post-trauma. Clinically, this delivers a feasible time-window to administer a post-trauma “cognitive vaccine”.

title: Erasing trauma memories
abstract: Recent elegant research has raised the salient issue of altering traumatic memories and its treatment implications. Kindt et al [1][1] suggest that ‘if emotional memory could be weakened or even erased, then we might be able to eliminate the root of many psychiatric disorders, such as post-

title: Psychological treatments: A call for mental-health science
abstract: than polio. But immunization services for major childhood diseases such as diphtheria, tetanus and measles remain plagued with inefficiencies, poor oversight and a shortage of resources. Full immunization rates for children in the country were last year estimated at 54% with wide variations across the country, compared to more than 95% in nearby Bangladesh. The figures for Pakistan may even be an overestimate: the survey excluded the FATA and vulnerable populations in mega-cities. In a household survey conducted this year, my colleagues and I found that 25% of children under five years in the urban slums of Karachi were not vaccinated for any childhood disease; the same was true for 64% of children in a relatively peaceful district of the FATA. The time to act is now. The military offensive in North Waziristan has, paradoxically, opened up opportunities to provide health services to children from the FATA through care for displaced families. This could contribute to building community support and to re-establish the rule of law in conflict-ridden areas once people return. Ongoing support will be necessary to eradicate polio: children require multiple doses of vaccine to build immunity. I fervently hope that the government and concerned agencies will devote their energies to scaling up full immunization efforts in these displaced and marginal populations, rather than diverting resources to international travellers. This is a chance to eradicate polio from the planet.