520 TREATMENT OF SPECIFIC ANXIETY DISORDERS
emotional Stroop task in order to determine the robustness of the attentional bias. Like
other anxiety disorders, however, the attentional bias in PTSD more likely reflects dif-
ficulty disengaging from threat rather than the facilitation of threat cues.
Clinician Guideline 12.16
Avoidance of trauma- relevant situations may be a coping strategy used to curb an attentional
bias for threat in PTSD. Graded in vivo exposure that is often used in cognitive therapy to
decrease avoidance may also address faulty attentional processing bias of trauma- related
stimuli.Hypothesis 4
PTSD is characterized by a selective and distorted recall of trauma- related threat and danger
information.
Given the prominence of trauma- related intrusions and other reexperiencing symp-
toms in PTSD, the cognitive model predicts that selective recall of traumatic events is
an important contributor to the persistence of PTSD. In fact most cognitive theories
of PTSD consider fragmented representation of trauma in memory a central cognitive
process in the disorder (e.g., Brewin et al., 1996; Ehlers & Clark, 2000; Horowitz,
2001). If trauma representation in PTSD is problematic, we might expect enhanced
recall of trauma cues and more disorganized, unelaborated autobiographical memory
for trauma.
In their review Buckley et al. (2000) concluded there is evidence that PTSD is char-
acterized by an implicit and explicit memory recall bias for trauma stimuli. The most
consistent finding is that individuals with PTSD show enhanced recall of trauma or
emotion words generally compared to non-PTSD trauma individuals or healthy con-
trols (e.g., Kaspi, McNally, & Amir, 1995; Paunovic et al., 2002; Vrana et al., 1995).
However, support for an implicit memory bias has been more inconsistent, with Amir,
McNally, and Wiegartz (1996) finding an implicit memory bias for trauma- specific sen-
tences in a high but not medium or low noise condition, whereas others have failed to
find disorder- specific effects (e.g., McNally & Amir, 1996; Paunovic et al., 2002). These
findings, then, indicate that individuals with PTSD have enhanced explicit recall of
trauma information that could contribute to the persistence of intrusive reexperiencing
symptoms. However, there is less evidence that this memory bias is evident at a more
automatic, preconscious level of processing.
More studies have investigated the organization of traumatic memory, especially
whether trauma memories in PTSD involve more data- driven (i.e., greater processing of
sensory impressions and perceptual characteristics of the trauma) than conceptual- driven
(i.e., processing that focuses on the meaning of a trauma) processing. In a questionnaire
study Halligan, Michael, Clark, and Ehlers (2003) found that compared to assault vic-
tims without PTSD, those with PTSD had more disorganized trauma memories, more
dissociation, and more data- driven encoding of the trauma. These findings have been
replicated in children with ASD following assaults or motor vehicle accidents (Meiser-
Stedman et al., 2007). Furthermore, McKinnon, Nixon, and Brewer (2008) found that