Effects of vulnerable personality traits of PTSD, working memory abilities and peritraumatic cognitive processing on analogue traumatic flashbacks

Trauma-related flashback (also called intrusive imagery) is one of the most typical re-experience symptoms of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) and has important impacts on the development of PTSD. The cognitive model of PTSD and the dual representation theory of PTSD both emphasize the effects of abnormal peritraumatic cognitive processing (i.e., data-driven processing or sensational representation being strengthened while conceptual processing or contextual representation being weakened). Some vulnerable personality traits of PTSD and working memory abilities are also focused in studies of analogue and real trauma, and are considered as risk factors and protective factors respectively. This study aimed to examine the effects of vulnerable personality traits of PTSD, working memory abilities and peritraumatic cognitive processing on flashbacks in different periods after analogue trauma. A total of 159 healthy college students (38 males; age = 17~26 ys, M = 20.44 ± 1.80) participated in the study, who were screened by a self-designed health status questionnaire (e.g., “Did you receive psychotherapy or psychopharmaceutical treatment in recent two years?”), Beck Depression Inventory-II (BDI-II), and Self-report Anxiety Scale (SAS). In the laboratory, they were asked to watch a 14’34’’ long Road Traffic Accidents (RTAs) film alone. Trait anxiety, trait dissociation, neuroticism and attentional control were measured before watching the film respectively by State-trait Anxiety Inventory-Trait version (STAI-T), Dissociative Experiences Scale-II (DES-II), the revised Eysenck Personality Questionnaire Short Scale for Chinese (EPQ-RSC), and Attentional Control Scale (ACS), while working memory capacity was tested by a revised Operation Span Task (OSPAN) seven days later. Immediately after the film, data-driven processing and conceptual processing were measured by Thoughts and Feelings Questionnaire-Chinese Revised (TFQ-CR). Five minutes after the film, participants firstly read a standardized description about the film-related flashback until they fully understood it with the help of the experimenter, and then reported immediate flashback (number, vividness and distress level). In the following week after the laboratory portion, participants independently reported flashback at three regular time points every day through WeChat or QQ. Upon coming back to the laboratory, they reported the frequency of posttraumatic symptoms through the Impact of Event Scale-Revised (IES-R) and triggered flashback after finishing a single-blind fake task assessing the degree in which they liked (10 relevant to the film). Structural equation model (SEM) and Bootstrap method were mainly adopted in the statistical analyses. Results showed that data-driven processing positively predicted the number, vividness and distress level of all three kinds of flashbacks (i.e., immediate, one-week and triggered) and one-week frequency of intrusion; higher neuroticism predicted higher distress level of triggered flashback; attentional control and working memory capacity both negatively predicted one-week frequency of intrusion. Conceptual processing played a mediating role between attentional control and distress level of immediate flashback. Furthermore, attentional control was positively associated with conceptual processing, whereas conceptual processing negatively predicted distress level of immediate flashback. These findings suggest that data-driven processing is the main factor influencing flashbacks in different periods after trauma; conceptual processing mainly affects the early acute stress response, while attentional control functions as a protective factor; neuroticism and working memory ability have long-term effects on flashback, and working memory ability serves as a protective factor.