Background
Prior to the development of DRT, existing theories of PTSD fell into two camps: social-cognitive theories and information-processing theories. Social-cognitive theories (e.g. Horowitz's stress-response theory, Janoff-Bulman'sClinical implications
According to DRT, the symptoms of PTSD arise when memory processes interact with other pre-trauma, peri-trauma, and post-trauma factors. Some of these factors may include severity and duration of the trauma, existing schemas about the self and the world, social support, and the presence of guilt or shame. Based on these interactions, Brewin and colleagues proposed that there are three possible outcomes of post-traumatic emotional processing: completion/integration, chronic emotional processing, and premature inhibition of processing.Completion/integration
Completion/integration occurs when traumatic memories have been consciously processed and integrated with the individual’s existing memories and cognitive schemas. This outcome represents recovery from the effects of trauma exposure and minimal post-traumatic symptoms. For completion/integration to occur, there must be repeated exposure to the traumatic memory and associated stimuli to allow habituation to occur. ThroughChronic emotional processing
Chronic emotional processing may occur as a result of severe or ongoing trauma, lack of social support, or inability to incorporate the traumatic experience into existing schemas. Chronic emotional processing occurs when conscious and unconscious memory processes related to the trauma are not successfully integrated. VAMs and SAMs of the trauma may be chronically processed, meaning that the individual is unable to inhibit the intrusion of SAMs into consciousness and there is little or no shift in existing schemas about the self and the world. This results in intrusive symptoms stemming from SAMs and maladaptive preoccupation with the trauma. Attention and memory biases toward trauma-related stimuli are likely to be present. Furthermore, DRT proposes that mood symptoms such as depression and anxiety may develop as a byproduct of chronic emotional processing.Premature inhibition of processing
Failure to integrate the trauma with existing memories and schemas may occur due to inhibited emotional processing of traumatic memory. This occurs when an individual avoids internal (e.g. thoughts, emotions, sensations) and external (e.g. people, places, situations) stimuli that activate trauma-related SAMs and VAMs. In premature inhibition, avoidance allows the individual to inhibit the intrusion of SAMs into consciousness; this hinders the integration of SAMs into the VAM system. The individual remains vulnerable to emotional distress when trauma-related stimuli are encountered. Attentional bias toward trauma-related stimuli is likely present and may be coupled with impaired memory of the trauma.Empirical evidence
Support
Studies have examined the effect of performing visuospatial tasks during memory consolidation of distressing stimuli. These studies have found that playing the game TETRIS after exposure to distressing stimuli reduces the number of intrusive thoughts. This may mean visuospatial tasks compete with sensory processing of distressing stimuli, therefore impairing this type of processing results in fewer intrusive experiences. Research into the human experience of natural disaster and crisis recognises that there is a large emotional component that requires addressing in order to prevent post traumatic mental health difficulties. In order to process this, an individual needs to make space to reflect on the experience and engage with the emotions connected with this experience. Through this process, growth in resilience and psychological flexibility occurs. In addition, when this process is supported collectively, increases in solidarity and community engagement are found. Conversely, when individuals do not process their emotional experiences, they are less engaged with their community, more emotionally reactive, and more likely to experience depressive symptoms.Criticism
Some studies have found that providing contextual information before exposure to distressing stimuli actually increases the frequency of intrusive thoughts. This appears to contradict DRT which posits that when contextual information (in VAM) and sensory information (in SAM) integrate, this results in decreased intrusive symptoms. DRT has also been criticized for a lack of explanation about how the VAM and SAM systems communicate with each other.References
{{reflist Post-traumatic stress disorder Memory disorders Cognitive modeling