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How Posttraumatic Stress Disorder Symptoms Affect Memory for New Events and Their 'Hotspots' over a Long Delay

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Title: How Posttraumatic Stress Disorder Symptoms Affect Memory for New Events and Their 'Hotspots' over a Long Delay
Language: English
Authors: Nielsen, Niels Peter (ORCID 0000-0001-8320-2991), Berntsen, Dorthe (ORCID 0000-0001-5941-314X)
Source: Applied Cognitive Psychology. Jan-Feb 2022 36(1):59-68.
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 10
Publication Date: 2022
Document Type: Journal Articles
Reports - Research
Descriptors: Posttraumatic Stress Disorder, Symptoms (Individual Disorders), Memory, Intervals, Emotional Response
DOI: 10.1002/acp.3898
ISSN: 0888-4080
Abstract: Memory for traumatic events and their most distressing moments (hotspots) are typically examined in patients with posttraumatic stress disorder (PTSD) using retrospective memory reports for the index trauma. Effects of PTSD symptoms on memory for new (post-trauma) events and their hotspots have received less attention. Here we used a prospective, experimental design to address this question. Participants completed measures of PTSD symptoms, were exposed to either an emotional (N = 54) or a neutral (N = 44) simulated event, reported hotspots, and rated them on memory characteristics. After a 1-year delay, participants once again reported hotspots and rated their memory characteristics. PTSD symptoms obtained before the event predicted emotional intensity, bodily reaction, and distress associated with hotspots from the event after a 1-year delay, irrespective of event type. This suggests that memory for events in general and not just memory of the index trauma is affected by PTSD symptoms.
Abstractor: As Provided
Entry Date: 2022
Accession Number: EJ1325293
Database: ERIC
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  Value: <anid>AN0154795782;bu801jan.22;2022Jan24.04:15;v2.2.500</anid> <title id="AN0154795782-1">How posttraumatic stress disorder symptoms affect memory for new events and their "hotspots" over a long delay </title> <p>Memory for traumatic events and their most distressing moments (hotspots) are typically examined in patients with posttraumatic stress disorder (PTSD) using retrospective memory reports for the index trauma. Effects of PTSD symptoms on memory for new (post‐trauma) events and their hotspots have received less attention. Here we used a prospective, experimental design to address this question. Participants completed measures of PTSD symptoms, were exposed to either an emotional (N = 54) or a neutral (N = 44) simulated event, reported hotspots, and rated them on memory characteristics. After a 1‐year delay, participants once again reported hotspots and rated their memory characteristics. PTSD symptoms obtained before the event predicted emotional intensity, bodily reaction, and distress associated with hotspots from the event after a 1‐year delay, irrespective of event type. This suggests that memory for events in general and not just memory of the index trauma is affected by PTSD symptoms.</p> <p>Keywords: memory; posttraumatic stress disorder; trauma; trauma film paradigm; virtual</p> <hd id="AN0154795782-2">INTRODUCTION</hd> <p>The moments associated with strongest emotion during a stressful event are often termed "emotional hotspots." Emotional hotspots have been defined as "moments of peak emotional distress during the event" (Holmes et al., 2005, p. 3), but often, they are simply referred to as "the worst moments" (e.g., Grey et al., 2002; Jelinek et al., 2010). Hotspots are assumed to be especially long lasting and persistent in memory, hence, they are believed to be of special importance in the development and maintenance of PTSD (Holmes et al., 2005). This notion is based on findings demonstrating that the majority of intrusive images in clinical samples with PTSD are designated to hotspots (Holmes et al., 2005), and that hotspots were more frequently addressed in successful treatment of PTSD compared to unsuccessful treatment (Nijdam et al., 2013).</p> <p>With the exception of one study (Nielsen et al., 2020), hotspots have been investigated in clinical settings in patients undergoing psychotherapy for a traumatic experience (e.g., Grey et al., 2001; Grey et al., 2002; Grey & Holmes, 2008; Holmes et al., 2005; Jelinek et al., 2010; Nijdam et al., 2013). Hence, previous research has examined hotspots only in relation to the development and maintenance of PTSD, and for memories of stressful events that took place in the past (i.e., the index trauma). Previous research therefore leaves unclarified whether current level of PTSD symptoms influences what people perceive as hotspots and how they remember those hotspots over time. It also leaves unaddressed whether hotspots are limited to memory for trauma or whether they are present for other types of events, and therefore may be viewed as a more general memory phenomenon. The present approach was developed to address these issues. Instead of examining how individuals with elevated levels of PTSD symptoms retrospectively identify and remember as the worst moments of their traumatic event, we examine how already existing PTSD symptoms proactively affect memory of a new event and its associated hotspots. We include both an emotional and a neutral event to examine whether hotspots are limited to stressful events or may be found for other types of events. Including both types of events also allows us to investigate whether the potential effect of pre‐event PTSD on immediate and delayed reports of hotspots differ as a function of event type.</p> <p>Examining the role of pre‐event PTSD symptoms in relation to hotspots is motivated by findings that PTSD symptoms are associated with increased affect intensity, influencing memory for a range of different autobiographical events, not limited to traumatic or stressful events (Rubin et al., 2008; Rubin et al., 2011). In addition, it has been demonstrated that elevated levels of PTSD symptoms are associated with reduced memory suppression of both aversive (Catarino et al., 2015) and neutral material (Mary et al., 2020). Furthermore, recent work showed that veterans with PTSD displayed increased emotional reactions in response to the retrieval of memories of <emph>novel</emph>, trauma‐related and unrelated scenes compared to veterans without PTSD (Staugaard et al., 2021). Moreover, studies have shown that also future thinking, which is relying on some of the same mechanisms involved in autobiographical memory, is affected by PTSD. For example, Berntsen and Rubin (2015) showed that measures of pre‐traumatic stress reactions (e.g., intrusive images of possible stressful events in the future) obtained before deployment were an important predictor for PTSD symptoms after deployment in Danish veterans. Finally, Brown et al. (2013) found more over‐general events in both memories and future projections of PTSD patients relative to controls, thus providing further evidence that memory broadly, and not only memory of the index event is affected by PTSD.</p> <p>To increase ecological validity and real life relevance, we examine the effect of pre‐event PTSD on memory for hotspots over a 1‐year delay. Because prior research on hotspots has been conducted in clinical settings, reports of hotspots have been taken retrospectively several months or even years after the traumatic event (e.g., Holmes et al., 2005). In such studies, it is not possible to examine the pro‐active effects of pre‐event PTSD on memory for hotspots from new events, as memory characteristics for the hotspots taken as part of trauma therapy might be affected by the high level of PTSD symptoms in trauma patients, and as no measure of PTSD prior to the event of interest is available. To our knowledge, the combination of using emotional and neutral stimuli and deploying a long delay is unique to the present study. The present approach is clinically relevant by potentially shedding light on findings demonstrating that individuals who already have developed PTSD in response to an initial trauma, show greater vulnerability in response to new stressful events (e.g., Schock et al., 2016). It may also help to clarify how negative alterations in cognition affect the processing and remembering of new events (American Psychiatric Association, 2013).</p> <p>In order to address the claim that hotspots are especially long lasting and persistent in memory, we furthermore examine the consistency of hotspot content and hotspot characteristics. Doing so requires a prospective, longitudinal design with reports taken immediately or shortly after the traumatic event and again after a delay, in order to investigate if and how hotspots change over time. So far, only one study has employed such a prospective design (Nielsen et al., 2020). This study did not find the frequency of hotspots, taken after a 1‐week delay, to be lower compared to measures obtained immediately after the event. However, the study demonstrated that the consistency of hotspots was not as high as one might expect based on clinical observations; only about 70%–75% of the hotspots mentioned at Time 1 were repeated after a 1‐week delay. Interestingly, new hotspots also emerged during this interval. Compared with clinical studies, Nielsen et al. (2020) used a relatively short delay, when investigating the effects of time on hotspot characteristics and consistency. Despite the short delay of 1 week, effects of time were found on all memory measures, but not on reports directly related to the experience during the event. In the present study, we extend the delay to 1 year to investigate the effects of such an extended delay on hotspot frequency, consistency, and characteristics. By using a long delay, we aim to detect effects of time that may not be visible at shorter delays. Moreover, we approach the course of a real‐life trauma, where participants often undergo therapy and report worst moments long after the traumatic event.</p> <p>Thus, the aim of the present study is two‐fold. We investigate the effects of pre‐event PTSD symptoms on memory of hotspots from emotional and neutral events. In addition, we investigate the consistency of hotspot content and characteristics. Regarding the first aim, we hypothesize that measures of PTSD symptoms obtained before the virtual events, will affect how hotspots from the virtual events will be experienced and later recalled. Regarding the latter aim, we hypothesize that the effects of time on hotspot content and characteristics will be more pronounced compared to Nielsen et al. (2020), who used a 1‐week delay.</p> <hd id="AN0154795782-3">THE PRESENT STUDY</hd> <p></p> <hd id="AN0154795782-4">Methods</hd> <p></p> <hd id="AN0154795782-5">Participants</hd> <p>A total of 245 participants were recruited through the online subject pool Amazon Mechanical Turk. They were told that the purpose of the study was to understand how people remember a virtual event. Because of ethical considerations, the participants were informed that the video could potentially contain some surprising or unpleasant elements, but not more so than in an everyday movie. Out of the 245 participants, 103 participants completed the follow‐up after the 1‐year delay. In addition to completing the 1‐year follow‐up, 79 of the participants completed a 4‐week follow‐up for a related project. However, the responses from these participants did not differ from the remaining participants.</p> <p>At Time 1, the participants were randomly assigned to either the emotional condition or the neutral condition. Five participants were excluded from the study, because they demonstrated that they did not remember any aspects of the event after the delay. Instead of reporting no hotspots at Time 2, they generated nonsense hotspots based on the presented cue (e.g., "<emph>sky</emph>," "<emph>green</emph>," "<emph>clean air</emph>," and "<emph>lots of space</emph>." Only participants who completed both Session 1 and Session 2 were included in the final sample, and thus, it consisted of 98 participants with 44 participants in the neutral condition and 54 participants in the emotional condition (see Table 1 for demographics). A sample size of 98 was deemed appropriate for conducting regression analyses, given that this sample size exceeded the number of predictors by at least 50 (e.g., Wilson Van Voorhis & Morgan, 2007). In addition, a power analysis conducted in Gpower 3.1 (Faul et al., 2007), indicated that a small to medium effect size for the 2 × 2 interactions would require 96 participants (alpha = .05, power = .80, effect size <emph>f</emph> = .29).The participants in the neutral and emotional condition were matched on all background measures except from age.</p> <p>1 TABLEDemographics and means of the pre‐event measures in the two conditions</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left" /><th align="left">Emotional (<italic>N</italic> = 54)</th><th align="left">Neutral (<italic>N</italic> = 44)</th><th align="left"><italic>t</italic>(96)</th></tr></thead><tbody valign="top"><tr><td>% Female</td><td align="left">63%</td><td align="left">61%</td><td /></tr><tr><td>Age</td><td>35.26 (9.50)</td><td>40.95 (12.69)</td><td>−2.47<xref ref-type="fn" rid="tfn2" /></td></tr><tr><td>Years of education</td><td>15.11 (2.23)</td><td>15.50 (1.97)</td><td>−.90<sup>ns</sup></td></tr><tr><td>CES‐D</td><td>14.93 (10.29)</td><td>14.09 (12.27)</td><td>.37<sup>ns</sup></td></tr><tr><td>PCL‐5 (T1)</td><td>18.37 (17.16)</td><td>17.70 (17.67)</td><td>.19<sup>ns</sup></td></tr><tr><td>BFI‐N</td><td>23.48 (7.84)</td><td>20.82 (7.06)</td><td>.73<sup>ns</sup></td></tr><tr><td>LEC</td><td>11.50 (7.57)</td><td>9.66 (7.35)</td><td>1.21<sup>ns</sup></td></tr><tr><td>STAI (pre‐film)</td><td>37.00 (12.32)</td><td>35.95 (11.57)</td><td>.43<sup>ns</sup></td></tr><tr><td>STAI (post‐film)</td><td>51.72 (16.02)</td><td>37.27 (12.64)</td><td>4.87<xref ref-type="fn" rid="tfn3" /></td></tr></tbody></table> </ephtml> </p> <p>1 Abbreviations: BFI‐N, The Big Five Inventory – neuroticism; CES‐D, Center for Epidemiologic Studies Depression Scale; PCL‐5, PTSD Checklist for DSM‐5; <emph>ns</emph>, not significant; STAI, State–Trait Anxiety Inventory.</p> <ulist> <item>2 * <emph>p</emph> < .05;</item> <item>3 *** <emph>p</emph> < .001.</item> </ulist> <hd id="AN0154795782-6">Design</hd> <p>We employed a 2 × 2 mixed design with event type (emotional vs. neutral) acting as the between‐subjects variable and time (immediate vs. 1‐year delay) acting as the within‐subjects variable. In addition, we employed a correlational design using PTSD symptoms obtained at Time 1 to predict memory qualities immediately after the event, and after a 1‐year delay at Time 2.</p> <hd id="AN0154795782-7">Materials</hd> <p> <emph>Trauma film</emph>. For the purpose of the present study, two novel animated movies, one for each condition, were made, using the in‐game editor of the video game ArmA 3. This is a first‐person shooter war game located in a Mediterranean environment. The movies were animated to take place in a first‐person perspective, that is, a perspective as viewed from within the animated world through the protagonists' own eyes. This is in contrast to most trauma analogue studies using third person perspective films as trauma analogue. This strategy ensured that the viewer would experience the unfolding of the event from the same point of view as they would if they were the protagonist of a real life event. By doing so, a more immersive and realistic experience was generated. The emotional and neutral movies were roughly 2 min each, and importantly, they were identical, with the only exception of the ending of the movie. The movies depicted a first‐person view of a person running along a pathway on a Mediterranean island, encountering different events during the run, such as a quadbike passing by, a helicopter flying over, the sound of a twig snapping, and a person running by. At the end of the movie made for the emotional condition, the viewers ("the protagonist" in the following) see the quadbike parked next to a van parked across the pathway. Suddenly, the protagonist hears gunshots from a machinegun, and hides behind a small bush on the side of the road, still being able to observe what is happening. A crowd of screaming civilians appears on the side of the road running towards the van for cover, but as they get nearer, the van explodes, and the civilians are killed. The protagonist runs towards the bombsite, but all the viewer sees is the corpses of the civilians, and they hear a man coughing and gasping for breath. At the end of the movie made for the neutral condition, they also see the quadbike parked next to the van parked across the pathway. However, this time the civilians are standing and sitting around the van, and as the protagonist gets nearer, it becomes clear, that the van has broken down and instead of gunshots and screaming, they hear the sound of the van backfiring and the civilians talking and laughing (for screenshots, see Figure 1). Because we did not rely on commercially available material, but generated our own films, we were in full control of the material presented during the encoding. Everything, except from the scenery, was programmed by us. This means that we decided exactly what the participants should encounter during the run, in what order, and for how long they should be exposed to every single detail.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/BU8/01jan22/acp3898-fig-0001.jpg?ephost1=dGJyMMvl7ESepq84yOvsOLCmsE6epq5Srqa4SK6WxWXS" alt="acp3898-fig-0001.jpg" title="1 Screenshots of the simulated events used in the emotional (left) and the neutral (right) condition" /> </p> <p></p> <p>Before viewing the film, the participants completed measures of depression, posttraumatic stress, and neuroticism.</p> <p> <emph>Depression</emph> was measured using the Center for Epidemiologic Studies Depression Scale (CES‐D; Radloff, 1977). This 20‐item scale is a self‐report measure, developed for research in the general population. Respondents indicate, on a 4‐point scale ranging from "<emph>Rarely or none of the time (less than 1 day)</emph>" to "<emph>All of the time (5–7 days)</emph>," how often during the past week they have felt or behaved in different ways (e.g., "<emph>I felt sad</emph>" and "<emph>I talked less than usual</emph>"). Based on the answers, a total score ranging from 0 to 60 is calculated. The scale showed good internal reliability with a Cronbach's alpha of.936 and the scale has demonstrated test–retest correlations between.45 and.70 (Radloff, 1977).</p> <p> <emph>Posttraumatic stress</emph>. The PTSD Checklist for DSM‐5 (PCL‐5; Blevins et al., 2013) was used to measure the level of PTSD symptoms in the sample. PCL‐5 is a self‐report measure, consisting of 20‐items corresponding to the 20 symptoms of PTSD as defined in the DSM‐5 (American Psychiatric Association, 2013). Respondents identified the event that currently bothered them the most, and then indicated on a 5‐point scale ranging from "<emph>Not at all</emph>" to "<emph>Extremely</emph>," how much during the last month, they had been bothered by specific symptoms of PTSD (e.g., "<emph>Repeated</emph>, <emph>disturbing</emph>, <emph>and unwanted memories of the stressful experience</emph>" and "<emph>Avoiding memories</emph>, <emph>thoughts</emph>, <emph>or feelings related to the stressful experience</emph>"). A total score ranging from 0 to 80 was calculated. The scale showed good internal reliability with a Cronbach's alpha of.960.</p> <p> <emph>Neuroticism</emph> was measured using The Big Five Inventory (BFI; John & Srivastava, 1999). For the purpose of the present study, we were only interested in the subscale addressing neuroticism. This scale, consisting of eight items, is a subscale of the 44‐item version of the BFI. It is a self‐report measure, where the respondents indicate, on a 5‐point scale ranging from "<emph>Disagree strongly</emph>" to "<emph>Agree strongly</emph>," to what degree they agree or disagree to statements like "<emph>I am someone who worries a lot</emph>" and "<emph>I am someone who gets nervous easily</emph>." A total score ranging from 8 to 40 is calculated. The scale showed good internal reliability with a Cronbach's alpha of.891.</p> <p> <emph>Current level of anxiety</emph>. The State–Trait Anxiety Inventory for Adults (STAI‐A; Spielberger et al., 1983) was used to measure the current level of anxiety in the participants. STAI‐A is a self‐report measure, in which respondents are asked to indicate, how they feel right now in relation to 20 statements, for example, "<emph>I feel calm</emph>" and "<emph>I am tense</emph>." They are asked to do so on a 4‐point scale ranging from "<emph>Not at all</emph>" to "<emph>Very much so</emph>." We used the measure as a manipulation check, to know if the movies had the intended effect in the two conditions. Because of this, we were only interested in state anxiety, and hence we only asked the participants to complete the 20 items related to this dimension of the STAI‐A. Because of this, a total score ranging from 20 to 80 was calculated. The scale showed good internal reliability with a Cronbach's alpha of.954 (pre‐STAI) and.973 (post‐STAI).</p> <p> <emph>Hotspot characteristics and consistency</emph>. Hotspots were defined as "the moments of highest emotional intensity." Based on clinical findings of hotspot frequency averaging around six hotspots (e.g., Holmes et al., 2005), participants were allowed to report between 0 and 10 hotspots, and they were instructed to describe each hotspot in as few words as possible. Furthermore, they were told that the order of the hotspots was irrelevant (c.f. Nielsen et al., 2020).</p> <p>The participants were asked to rate each hotspot on characteristics related to how they experienced the hotspot during the event (the <emph>during</emph> dimension) and in addition, how they experienced the hotspot when they recalled it (the <emph>memory</emph> dimension). The participants were given the following instructions: "<emph>In the following sections we want you to answer some questions for each of the hotspots</emph>, <emph>you have just generated</emph>. <emph>Please note that in the first section we are asking questions about your experience <bold>while you were watching the movie</bold> and in the second section we are asking questions about your experience <bold>when remembering the movie right now</bold></emph>." This was the case for both the post‐event phase (immediately after watching the event) and for the follow‐up phase, which in this study was conducted after a 1‐year delay.</p> <p>Each hotspot was rated on 5 parameters: valence (−3 = "<emph>Extremely negative</emph>" to 3 = "<emph>Extremely positive</emph>"), emotional intensity (1 = "<emph>Not at all intense</emph>" to 7 = "<emph>Extremely intense</emph>"), to what degree the participant experienced a bodily reaction in relation to the hotspot (1 = "<emph>Not at all</emph>" to 7 = "<emph>Very much</emph>"), the level of distress in relation to the hotspot (1 = "<emph>Very low</emph>" to 7 = "<emph>Very high</emph>"), and finally, how vivid the recollection of the hotspot was (1 = "<emph>Not at all vivid</emph>" to 7 = "<emph>Very vivid</emph>"). With the only exception of vividness, which is by nature a memory characteristic, all characteristics were measured on both the <emph>during</emph> and the <emph>memory</emph> dimension.</p> <p>All hotspots were coded for whether or not they were repeated from Time 1 to Time 2, and if they were novel hotspots reported only at Time 2. A hotspot was considered repeated, if it referred to the same content at both Time 1 and Time 2. On the other hand, a hotspot was considered novel, if it was reported at Time 2 and did not refer to content reported at Time 1. The proportion of "forgotten" hotspots (i.e., hotspots reported at Time 1 but not at Time 2) can be extracted from the proportion of repeated hotspots (=1‐proportion repeated hotspots). The coding was done by a student assistant, blind to the hypothesis, and the first 30% of the data were also coded by the first author. The interrater agreement was high, and the coders agreed in 95% of all cases for the repeated hotspots and in 92% of all cases for the novel hotspots.</p> <p> <emph>Forced choice recall</emph>. To assess memory of the event in general, the participants answered a 20‐item forced choice recall with questions related to semantic and episodic details of the movie (e.g., "<emph>When the gunshots started</emph>, <emph>what did you do</emph>?" and "<emph>What was the color of the van at the end of the movie?</emph>"). The participants were able to choose the answer from three options. Because the ending of the two movies differed depending on condition, the questions in the forced choice test differed slightly between conditions. However, we made sure that the items were matched to address the same details of the movie. An example of this is the item phrased "<emph>Before the van exploded what did you hear?</emph>" in the emotional condition and "<emph>Before passing the van what did you hear?</emph>" in the neutral condition.</p> <hd id="AN0154795782-9">Procedure</hd> <p> <emph>Pre‐event phase</emph>. After accepting the written consent, the participants filled out their age, gender, years of education, and whether or not they were native English speakers. They then completed the CES‐D, PCL‐5, and the BFI. For the purpose of the present study, depression and neuroticism served only as background measures to ensure that the results were not affected by unintended differences on these dimensions between the participants assigned to the neutral and the emotional condition.</p> <p> <emph>Experimental phase</emph>. In the beginning of the experimental phase, the participants completed the STAI‐A for the first time (pre‐event). To ensure that all participants watched the movie with the sound on, they had to listen to an audio file and provide a correct answer to the question "<emph>What animal did you hear in the video</emph>," in order to advance in the survey. They were then given the following instructions: "<emph>You are about to see a video that shows a first‐person perspective view of running along a pathway</emph>. <emph>Imagine that you are the one running along the pathway</emph>." Finally, they were instructed to watch the movie in full screen mode. The two movies that were used in the two conditions are described in detail above.</p> <p>Immediately after having watched the movie, the participants completed the STAI‐A for the second time (post‐event), and indicated how emotionally intense the experience of running along the pathway was on a 7‐point scale ranging from "<emph>Not at all intense</emph>" to "<emph>Extremely intense</emph>."</p> <p> <emph>Post‐event phase</emph>. In the post‐event phase, the participants were instructed to generate up to 10 hotspots from the movie they had just seen. They were allowed to advance in the survey without reporting any hotspots, however, no participants did. After generating the hotspots, the participants were asked to rate each of these hotspots on valence, emotional intensity, bodily reaction, and level of distress in relation to how they experienced it during the event, and on valence, emotional intensity, bodily reaction, level of distress, and vividness in relation to how they experienced the reaction to the memory of the event. Finally, they completed a 20‐item forced choice recall.</p> <p> <emph>Follow‐up phase</emph>. After a 1‐year delay, the participants who had completed part 1 of the study, were invited to take part in the second part of the study by email. At the beginning of this session, the participants were asked to complete the PCL‐5. Afterwards, they were cued with a screenshot of the opening scene of the movie, they saw a year ago. The survey auto‐advanced after 10 s, making it impossible for the participants to look at the screenshot for more or less than 10 s. The participants were then asked to generate hotspots once again, however, this time with these additional instructions: "<emph>It's important to stress</emph>, <emph>that we are not asking you to try to generate the same hotspots as you did a year ago</emph>. <emph>What we are asking you</emph>, <emph>is to think back upon the video and report the moments of highest emotional intensity as you remember them now</emph>." As in Session 1, the participants were allowed to generate between 0 and 10 hotspots, and they were instructed to describe each hotspot in as few words as possible. Furthermore, they were once again told, that the order of the hotspots was irrelevant. After having generated hotspots, the participants were asked to rate each of them on the same characteristics related to the <emph>during</emph> and the <emph>memory</emph> dimension as in Session 1. Finally, they completed the forced choice recall with the same 20 items as in Session 1.</p> <p> <emph>Attention checks</emph>. In order to ensure participants paying attention to the task, we added a total of five attention checks throughout the survey completed in Session 1 and one attention check in the survey completed in Session 2. To pass these checks, participants had to provide a specific response to a question. In order to ensure that participants paid attention to the movie in Session 1, we asked them what flew over them during the run. In case they failed to identify the helicopter, or they failed to provide the correct response to any of the six attention checks, they were sent to the end of the survey, receiving a message telling them that they could not participate in the survey due to inattention.</p> <hd id="AN0154795782-10">RESULTS</hd> <p>We first describe findings showing that participants reacted differently to the emotional versus neutral event, and thus that the experimental manipulation worked. We next describe results from the two factorial analyses, examining hotspots and other memory characteristics immediately versus at a 1‐year delay for the emotional versus neutral event. We then present findings regarding the proactive effects of PTSD symptoms on the memory characteristics measured both immediately and at a 1‐year delay.</p> <p> <emph>Manipulation check</emph>. In order to examine if the movies in the two conditions had the intended impact on the participants' level of anxiety measured by the State–Trait Anxiety Inventory, we performed a 2 × 2 mixed ANOVA with event type (emotional vs. neutral) as the between‐subjects variable and time (pre‐event vs. post‐event) as the within‐subjects variable. We found a significant interaction effect between event type and time on the level of anxiety, <emph>F</emph>(<reflink idref="bib1" id="ref1">1</reflink>, 96) = 28.71, <emph>p</emph> < .001, <emph>η</emph><sups>2</sups><subs>p</subs> = .230. As seen in Table 1, there was no difference in the level of pre‐event anxiety between groups and the interaction was driven by a significant increase in the level of anxiety from pre‐ to post‐event in the emotional condition only. In addition, we performed an independent samples t‐test on the 1‐item measure of emotional intensity answered after the event. As expected, we found that the level of intensity was higher in the emotional condition (<emph>M</emph> = 5.20, <emph>SE</emph> = 0.19) compared to the neutral condition (<emph>M</emph> = 3.11, <emph>SE</emph> = 0.28). This difference, 2.09, BCa 95% CI [1.44, 2.74], was significant, <emph>t</emph>(78.45) = 6.21, <emph>p</emph> < .001, and represented an effect of <emph>d</emph> = 1.30.</p> <p> <emph>Hotspot frequency</emph>. To test for the effects of time and event type on the number of hotspots generated, we conducted a 2 × 2 mixed ANOVA. The test revealed a significant main‐effect of time, a significant main‐effect of event type, and in addition a significant interaction between time and event type (cf. Table 2). The number of reported hotspots dropped over the 1‐year interval, and was higher in the emotional than in the neutral condition. The interaction effect was driven by the fact that the decrease from Time 1 to Time 2 in the number of hotspots reported in the emotional condition (<emph>M</emph><subs>difference</subs> = 1.96) was larger compared to the decrease in the neutral condition (<emph>M</emph><subs>difference</subs> = .86).</p> <p>2 TABLESummary of means, standard deviations and test results for the phenomenological characteristics, number of hotspots and forced choice recall as a function of event type and time</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left" /><th align="left">Time 1</th><th align="left">Time 2</th><th align="left">Main effects</th><th align="left">Interactions</th></tr><tr><th align="left" /><th align="left">Emotional</th><th align="left">Neutral</th><th align="left">Emotional</th><th align="left">Neutral</th><th align="left">Time</th><th align="left">Event type</th><th align="left">Time × event type</th></tr><tr><th align="left">Variable</th><th align="left"><italic>M</italic> (<italic>SD</italic>)</th><th align="left"><italic>M</italic> (<italic>SD</italic>)</th><th align="left"><italic>M</italic> (<italic>SD</italic>)</th><th align="left"><italic>M</italic> (<italic>SD</italic>)</th><th align="left"><italic>F</italic></th><th align="left"><italic>η</italic><sup>2</sup><sub>p</sub></th><th align="left"><italic>F</italic></th><th align="left"><italic>η</italic><sup>2</sup><sub>p</sub></th><th align="left"><italic>F</italic></th><th align="left"><italic>η</italic><sup>2</sup><sub>p</sub></th></tr></thead><tbody valign="top"><tr><td>Valence (during)</td><td>−1.66 (0.74)</td><td>−0.41 (1.11)</td><td>−1.50 (0.91)</td><td>−0.60 (0.73)</td><td>0.01</td><td>0.000</td><td>64.07<xref ref-type="fn" rid="tfn6" /></td><td>0.400</td><td>2.26</td><td>0.023</td></tr><tr><td>Intensity (during)</td><td>5.04 (1.03)</td><td>3.86 (1.41)</td><td>4.62 (1.17)</td><td>3.41 (1.17)</td><td>8.20<xref ref-type="fn" rid="tfn5" /></td><td>0.079</td><td>39.91<xref ref-type="fn" rid="tfn6" /></td><td>0.294</td><td>0.01</td><td>0.000</td></tr><tr><td>Bodily reaction (during)</td><td>4.28 (1.49)</td><td>3.19 (1.66)</td><td>3.87 (1.37)</td><td>3.38 (1.28)</td><td>6.07<xref ref-type="fn" rid="tfn4" /></td><td>0.059</td><td>20.42<xref ref-type="fn" rid="tfn6" /></td><td>0.175</td><td>0.00</td><td>0.000</td></tr><tr><td>Distress (during)</td><td>4.58 (1.27)</td><td>3.00 (1.42)</td><td>4.01 (1.39)</td><td>2.85 (1.41)</td><td>6.11<xref ref-type="fn" rid="tfn4" /></td><td>0.060</td><td>33.53<xref ref-type="fn" rid="tfn6" /></td><td>0.259</td><td>2.10</td><td>0.021</td></tr><tr><td>Valence (memory)</td><td>−1.50 (0.88)</td><td>−0.25 (1.02)</td><td>−1.25 (0.85)</td><td>−0.38 (0.79)</td><td>0.23</td><td>0.002</td><td>58.89<xref ref-type="fn" rid="tfn6" /></td><td>0.608</td><td>2.81</td><td>0.028</td></tr><tr><td>Intensity (memory)</td><td>4.27 (1.47)</td><td>2.85 (1.49)</td><td>3.39 (1.58)</td><td>2.46 (1.27)</td><td>15.71<xref ref-type="fn" rid="tfn6" /></td><td>0.141</td><td>21.92<xref ref-type="fn" rid="tfn6" /></td><td>0.186</td><td>2.29</td><td>0.023</td></tr><tr><td>Bodily reaction (memory)</td><td>3.37 (1.80)</td><td>2.42 (1.72)</td><td>2.76 (1.65)</td><td>2.13 (1.21)</td><td>7.47<xref ref-type="fn" rid="tfn5" /></td><td>0.072</td><td>7.68<xref ref-type="fn" rid="tfn6" /></td><td>0.074</td><td>0.97</td><td>0.010</td></tr><tr><td>Distress (memory)</td><td>3.75 (1.62)</td><td>2.31 (1.49)</td><td>2.93 (1.74)</td><td>2.17 (1.31)</td><td>9.89<xref ref-type="fn" rid="tfn5" /></td><td>0.093</td><td>15.68<xref ref-type="fn" rid="tfn6" /></td><td>0.140</td><td>4.86<xref ref-type="fn" rid="tfn4" /></td><td>0.048</td></tr><tr><td>Vividness (memory)</td><td>5.61 (1.30)</td><td>5.04 (1.53)</td><td>4.04 (1.50)</td><td>3.43 (1.32)</td><td>116.29<xref ref-type="fn" rid="tfn6" /></td><td>0.548</td><td>5.82<xref ref-type="fn" rid="tfn5" /></td><td>0.057</td><td>0.02</td><td>0.000</td></tr><tr><td>No. of hotspots</td><td>6.19 (2.41)</td><td>4.91 (2.18)</td><td>4.22 (2.04)</td><td>4.05 (1.78)</td><td>29.47<xref ref-type="fn" rid="tfn6" /></td><td>0.235</td><td>4.44<xref ref-type="fn" rid="tfn4" /></td><td>0.038</td><td>4.46<xref ref-type="fn" rid="tfn4" /></td><td>0.044</td></tr><tr><td>Forced choice recall</td><td>12.96 (2.70)</td><td>13.61 (2.19)</td><td>9.83 (2.38)</td><td>9.95 (2.07)</td><td>172.46<xref ref-type="fn" rid="tfn6" /></td><td>0.642</td><td>0.91</td><td>0.009</td><td>1.05</td><td>0.011</td></tr></tbody></table> </ephtml> </p> <ulist> <item>4 * <emph>p</emph> < .05;</item> <item>5 ** <emph>p</emph> < .01;</item> <item>6 *** <emph>p</emph> < .001.</item> </ulist> <p> <emph>Hotspot consistency</emph>. Following the procedure from Nielsen et al. (2020), we calculated two proportions referring to <emph>repeated</emph> and <emph>novel</emph> hotspots in order to investigate if the content of hotspots was the same after the delay. The proportion of repeated hotspots referred to the number of hotspots that were mentioned at Time 1 as well as at Time 2. If this was the case, a hotspot was given a score of 1. This proportion was calculated as the number of repeated hotspots relative to all hotspots generated at Time 1. In addition, to investigate if new hotspots appeared during the delay, all hotspots generated at Time 2 were coded for whether or not they were mentioned at Time 1. If this was not the case, they were considered novel, receiving a score of 1. The proportion of novel hotspots was calculated as the number of novel hotspots relative to all hotspots reported at Time 2. As an example, a participant reported six hotspots at Time 1 and five hotspots at Time 2. Three of the hotspots reported at Time 1 were reported at Time 2, resulting in the participant receiving a <emph>repeated</emph> score of 0.50. On the other hand, two of the hotspots reported at Time 2 were not mentioned at Time 1, resulting in the participant receiving a <emph>novel</emph> score of 0.40. Results based on the raw scoring of novel and repeated hotspots relative to all hotspots reported at Time 1 and Time 2, respectively, as described above, showed that in the emotional condition, 44% of the reported hotspots at Time 1 was repeated at Time 2 and thus 56% were forgotten. In the neutral condition, 48% of the hotspots were repeated and 52% were forgotten. In the emotional condition, 38% of the hotspots reported at Time 2 were novel, which in the neutral condition was the case for 42% of the hotspots reported at Time 2. Independent samples <emph>t</emph>‐tests on the individual proportions revealed that there were no significant differences between the conditions (<emph>p</emph>s > .16).</p> <p>In addition, we wanted to investigate if the level of pre‐event and current PTSD symptoms were associated with the degree of repeated and novel hotspots. Pearson correlation analyses revealed that both pre‐event and current level of PTSD symptoms was positively correlated with the proportion of repeated hotspots, <emph>r</emph> = .391, <emph>p</emph> = .009 and <emph>r</emph> = .506, <emph>p</emph> < .001, respectively. However, these associations were present in the neutral condition only.</p> <p> <emph>Hotspot characteristics</emph>. To investigate the effects of event type and time on the characteristics related to the <emph>during</emph> dimension and the <emph>memory</emph> dimension, we conducted a series of mixed ANOVAs with event type acting as the between‐subjects variable and time acting as the within subjects variable. As expected, we found significant main‐effects of event type on all characteristics, reflecting that the characteristics overall were rated higher (conversely with valence – thus more negative) in the emotional condition compared to the neutral condition (cf. Table 2). Also, as expected, we found a significant main‐effect of time indicating a decrease for all characteristics, except for valence of the hotspots in memory. Interestingly, this was also the case for the characteristics rated for how participants had felt during the events; we found a significant decrease over time on the level of intensity, bodily reaction, and distress as rated retrospectively. The only significant interaction between event type and time was on the level of distress related to the memory dimension. This interaction was driven by a significant decrease during the delay in the emotional condition only (<emph>t</emph>[<reflink idref="bib53" id="ref2">53</reflink>] = 3.51, <emph>p</emph> < .001).</p> <p> <emph>Forced choice recall</emph>. To investigate the effects of event type and time on the number of correct responses on the forced choice recall, we conducted a mixed ANOVA. As seen in Table 2, this revealed a significant main‐effect of time only, representing a decrease in accuracy over the 1‐year delay. Thus, the average number of correct answers was not affected by event type, and the decrease during the delay was identical across the conditions.</p> <p> <emph>Effects of pre‐event PTSD on hotspot frequency and characteristics at Time 1</emph>. In order to investigate the effects of pre‐event PTSD symptoms, we examined if the level of PTSD symptoms measured at Time 1 and event type were significant predictors of the number of hotspots and their characteristics as reported at Time 1. In addition, we wanted to investigate, if event type moderated the relationship between level of PTSD and hotspot frequency and hotspot characteristics. To this aim, we conducted a series of moderated multiple regression analyses, one for each dependent variable, with level of PTSD symptoms and event type entered in step 1 and their interaction entered in step 2. As seen in Table 3, all models were significant. However, adding the interaction term at step 2 did not improve model fit in any of the models. The regression analyses revealed that event type was a significant predictor of the number of hotspots reported as well as of the characteristics in Model 1. This was only the case for some characteristics when adding the interaction term to the model. The level of PTSD symptoms was a significant predictor of bodily reaction and the level of distress in relation to how the participants experienced recalling the hotspot immediately after the event. When adding the interaction term to the model, the level of PTSD symptoms was a significant predictor of bodily reaction and vividness in relation to how the participants experienced recalling the event. The fact that the interaction term was non‐significant shows that the association with PTSD‐symptoms was independent of whether the event was neutral or emotional.</p> <p>3 TABLESummary of standardized Beta coefficients, F‐values and R Square change for the moderated regression analyses with time 1 level of PTSD symptoms, event type, and their interaction as predictors for the frequency of hotspots and their characteristics at time 1</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left" /><th align="left">Step 1</th><th align="left">Model 1 summary</th><th align="left">Step 2</th><th align="left">Model 2 summary</th></tr><tr><th align="left">Variable</th><th align="left">PCL‐5</th><th align="left">Event type</th><th align="left"><italic>F</italic></th><th align="left">∆<italic>R</italic><sup>2</sup></th><th align="left">PCL‐5</th><th align="left">Event type</th><th align="left">PCL‐5<xref ref-type="fn" rid="tfn9" /> event type</th><th align="left"><italic>F</italic></th><th align="left">∆<italic>R</italic><sup>2</sup></th></tr></thead><tbody valign="top"><tr><td>Valence (during)</td><td>.093</td><td>.564<xref ref-type="fn" rid="tfn11" /></td><td>22.79<xref ref-type="fn" rid="tfn11" /></td><td>.324<xref ref-type="fn" rid="tfn11" /></td><td>−.023</td><td>.434<xref ref-type="fn" rid="tfn11" /></td><td>.212</td><td>22.79<xref ref-type="fn" rid="tfn11" /></td><td>.015</td></tr><tr><td>Intensity (during)</td><td>.166</td><td>−.434<xref ref-type="fn" rid="tfn11" /></td><td>13.32<xref ref-type="fn" rid="tfn11" /></td><td>.203<xref ref-type="fn" rid="tfn11" /></td><td>.149</td><td>−.454<xref ref-type="fn" rid="tfn11" /></td><td>.031</td><td>8.801<xref ref-type="fn" rid="tfn11" /></td><td>.000</td></tr><tr><td>Bodily reaction (during)</td><td>.193</td><td>−.328<xref ref-type="fn" rid="tfn11" /></td><td>8.20<xref ref-type="fn" rid="tfn11" /></td><td>.147<xref ref-type="fn" rid="tfn11" /></td><td>.217</td><td>−.301<xref ref-type="fn" rid="tfn9" /></td><td>−.044</td><td>5.44<xref ref-type="fn" rid="tfn10" /></td><td>.001</td></tr><tr><td>Distress (during)</td><td>.042</td><td>−.510<xref ref-type="fn" rid="tfn11" /></td><td>16.94<xref ref-type="fn" rid="tfn11" /></td><td>.263<xref ref-type="fn" rid="tfn11" /></td><td>.141</td><td>−.399<xref ref-type="fn" rid="tfn10" /></td><td>−.181</td><td>11.84<xref ref-type="fn" rid="tfn11" /></td><td>.011</td></tr><tr><td>Valence (memory)</td><td>.092</td><td>.558<xref ref-type="fn" rid="tfn11" /></td><td>22.11<xref ref-type="fn" rid="tfn11" /></td><td>.318<xref ref-type="fn" rid="tfn11" /></td><td>−.030</td><td>.421<xref ref-type="fn" rid="tfn11" /></td><td>.224</td><td>15.78<xref ref-type="fn" rid="tfn11" /></td><td>.017</td></tr><tr><td>Intensity (memory)</td><td>.160</td><td>−.430<xref ref-type="fn" rid="tfn11" /></td><td>12.85<xref ref-type="fn" rid="tfn11" /></td><td>.213<xref ref-type="fn" rid="tfn11" /></td><td>.164</td><td>−.426<xref ref-type="fn" rid="tfn10" /></td><td>−.006</td><td>8.47<xref ref-type="fn" rid="tfn11" /></td><td>.002</td></tr><tr><td>Bodily reaction (memory)</td><td>.301<xref ref-type="fn" rid="tfn10" /></td><td>−.257<xref ref-type="fn" rid="tfn10" /></td><td>8.99<xref ref-type="fn" rid="tfn11" /></td><td>.159<xref ref-type="fn" rid="tfn11" /></td><td>.309<xref ref-type="fn" rid="tfn10" /></td><td>−.247</td><td>−.015</td><td>5.94<xref ref-type="fn" rid="tfn11" /></td><td>.009</td></tr><tr><td>Distress (memory)</td><td>.223<xref ref-type="fn" rid="tfn9" /></td><td>−.415<xref ref-type="fn" rid="tfn11" /></td><td>13.82<xref ref-type="fn" rid="tfn11" /></td><td>.225<xref ref-type="fn" rid="tfn11" /></td><td>.237</td><td>−.399<xref ref-type="fn" rid="tfn10" /></td><td>−.026</td><td>9.13<xref ref-type="fn" rid="tfn11" /></td><td>.029</td></tr><tr><td>Vividness (memory)</td><td>.190</td><td>−.196<xref ref-type="fn" rid="tfn9" /></td><td>3.893<xref ref-type="fn" rid="tfn9" /></td><td>.056<xref ref-type="fn" rid="tfn9" /></td><td>.282<xref ref-type="fn" rid="tfn9" /></td><td>−.092</td><td>−.169</td><td>2.93<xref ref-type="fn" rid="tfn9" /></td><td>.010</td></tr><tr><td>No. of hotspots T1)</td><td>−.078</td><td>−.269<xref ref-type="fn" rid="tfn10" /></td><td>4.01<xref ref-type="fn" rid="tfn9" /></td><td>.078<xref ref-type="fn" rid="tfn9" /></td><td>.004</td><td>−.177</td><td>−.151</td><td>2.93<xref ref-type="fn" rid="tfn9" /></td><td>.008</td></tr><tr><td>Forced choice recall (T1)</td><td>−.079</td><td>.129</td><td>.32</td><td>.023</td><td>−.219</td><td>−.028</td><td>.257</td><td>1.51</td><td>.023</td></tr></tbody></table> </ephtml> </p> <ulist> <item>7 <emph>Note</emph>: Event type was coded 0 for emotional and 1 for neutral.</item> <item>8 Abbreviation: PCL‐5, PTSD Checklist for DSM‐5.</item> <item>9 * <emph>p</emph> < .05;</item> <item>10 ** <emph>p</emph> < .01;</item> <item>11 *** <emph>p</emph> < .001.</item> </ulist> <p> <emph>Effects of pre‐event PTSD on hotspot frequency and characteristics at Time 2</emph>. In addition, we were interested in examining if event type and the level of PTSD symptoms at Time 1 were significant predictors of the number of hotspots and their characteristics reported at Time 2. Applying the same statistical method as described above, we found that all models with the exception of the model for vividness and number of hotspots were significant (cf. Table 4). Again, adding the interaction term did not improve model fit in any of the models. Event type was a significant predictor of all characteristics in Model 1. However, adding the interaction term as a predictor in Model 2, made event type insignificant as a predictor of all characteristics related to the memory dimension except from valence. The level of PTSD symptoms was a significant predictor of bodily reaction and distress related to the memory dimension in Model 1, and in addition emotional intensity related to the memory dimension in Model 2. Again, the fact that the interaction term was non‐significant shows that the association with PTSD‐symptoms was independent of whether the event was neutral or emotional.</p> <p>4 TABLESummary of standardized beta coefficients, F‐values and R Square change for the moderated regression analyses with time 1 level of PTSD symptoms, event type, and their interaction as predictors for the frequency of hotspots and their characteristics at time 2</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left" /><th align="left">Step 1</th><th align="left">Model 1 summary</th><th align="left">Step 2</th><th align="left">Model 2 summary</th></tr><tr><th align="left">Variable</th><th align="left">PCL‐5</th><th align="left">Event type</th><th align="left"><italic>F</italic></th><th align="left">∆<italic>R</italic><sup>2</sup></th><th align="left">PCL‐5</th><th align="left">Event type</th><th align="left">PCL‐5<xref ref-type="fn" rid="tfn14" /> event type</th><th align="left"><italic>F</italic></th><th align="left">∆<italic>R</italic><sup>2</sup></th></tr></thead><tbody valign="top"><tr><td>Valence (during)</td><td>−.032</td><td>.472<xref ref-type="fn" rid="tfn16" /></td><td>13.74<xref ref-type="fn" rid="tfn16" /></td><td>.224<xref ref-type="fn" rid="tfn16" /></td><td>.013</td><td>.523<xref ref-type="fn" rid="tfn16" /></td><td>−.083</td><td>9.19<xref ref-type="fn" rid="tfn16" /></td><td>.002</td></tr><tr><td>Intensity (during)</td><td>.048</td><td>−.458<xref ref-type="fn" rid="tfn16" /></td><td>12.83<xref ref-type="fn" rid="tfn16" /></td><td>.213<xref ref-type="fn" rid="tfn16" /></td><td>.032</td><td>−.475<xref ref-type="fn" rid="tfn16" /></td><td>.032</td><td>8.48<xref ref-type="fn" rid="tfn16" /></td><td>.000</td></tr><tr><td>Bodily reaction (during)</td><td>.094</td><td>−.380<xref ref-type="fn" rid="tfn16" /></td><td>8.70<xref ref-type="fn" rid="tfn16" /></td><td>.155<xref ref-type="fn" rid="tfn16" /></td><td>.170</td><td>−.295<xref ref-type="fn" rid="tfn14" /></td><td>−.864</td><td>6.03<xref ref-type="fn" rid="tfn16" /></td><td>.007</td></tr><tr><td>Distress (during)</td><td>.115</td><td>−.381<xref ref-type="fn" rid="tfn16" /></td><td>9.03<xref ref-type="fn" rid="tfn16" /></td><td>.160<xref ref-type="fn" rid="tfn16" /></td><td>.155</td><td>−.336<xref ref-type="fn" rid="tfn14" /></td><td>−.073</td><td>6.04<xref ref-type="fn" rid="tfn16" /></td><td>.002</td></tr><tr><td>Valence (memory)</td><td>−.167</td><td>.468<xref ref-type="fn" rid="tfn16" /></td><td>15.79<xref ref-type="fn" rid="tfn16" /></td><td>.250<xref ref-type="fn" rid="tfn16" /></td><td>−.058</td><td>.590<xref ref-type="fn" rid="tfn16" /></td><td>−.200</td><td>11.19<xref ref-type="fn" rid="tfn16" /></td><td>.014</td></tr><tr><td>Intensity (memory)</td><td>.175</td><td>−.303<xref ref-type="fn" rid="tfn15" /></td><td>6.77<xref ref-type="fn" rid="tfn15" /></td><td>.125<xref ref-type="fn" rid="tfn15" /></td><td>.309<xref ref-type="fn" rid="tfn14" /></td><td>−.152</td><td>−.247</td><td>5.34<xref ref-type="fn" rid="tfn15" /></td><td>.021</td></tr><tr><td>Bodily reaction (memory)</td><td>.241<xref ref-type="fn" rid="tfn14" /></td><td>−.205<xref ref-type="fn" rid="tfn14" /></td><td>5.379<xref ref-type="fn" rid="tfn15" /></td><td>.102<xref ref-type="fn" rid="tfn15" /></td><td>.408<xref ref-type="fn" rid="tfn15" /></td><td>−.016</td><td>−.309</td><td>4.87<xref ref-type="fn" rid="tfn15" /></td><td>.033</td></tr><tr><td>Distress (memory)</td><td>.275<xref ref-type="fn" rid="tfn15" /></td><td>−.233<xref ref-type="fn" rid="tfn14" /></td><td>7.25<xref ref-type="fn" rid="tfn15" /></td><td>.132<xref ref-type="fn" rid="tfn15" /></td><td>.416<xref ref-type="fn" rid="tfn15" /></td><td>−.075</td><td>−.258</td><td>5.76<xref ref-type="fn" rid="tfn15" /></td><td>.023</td></tr><tr><td>Vividness (memory)</td><td>.120</td><td>−.212<xref ref-type="fn" rid="tfn14" /></td><td>3.04</td><td>.060</td><td>.230</td><td>−.088</td><td>−.202</td><td>2.51</td><td>.014</td></tr><tr><td>No. of hotspots Time 2</td><td>.038</td><td>−.045</td><td>.17</td><td>.004</td><td>.026</td><td>−.059</td><td>.023</td><td>.12</td><td>.000</td></tr><tr><td>Forced choice recall (T2)</td><td>−.095</td><td>.025</td><td>.47</td><td>.010</td><td>−.056</td><td>.069</td><td>−.072</td><td>.367</td><td>.002</td></tr></tbody></table> </ephtml> </p> <ulist> <item>12 <emph>Note</emph>: Event type was coded 0 for emotional and 1 for neutral.</item> <item>13 Abbreviation: PCL‐5, PTSD Checklist for DSM‐5.</item> <item>14 * <emph>p</emph> < .05;</item> <item>15 ** <emph>p</emph> < .01;</item> <item>16 *** <emph>p</emph> < .001.</item> </ulist> <hd id="AN0154795782-11">DISCUSSION</hd> <p>In the present study, we investigated how PTSD symptoms affect memory for new emotional and neutral events and their hotspots over a 1‐year delay. We used a prospective, experimental design with animated material as the trauma analogue. This approach has yielded novel insights into the proactive effects of PTSD symptoms on the experience and memory for hotspots from a new event – an area largely overlooked in the literature. Furthermore, we have replicated and extended findings regarding the frequency, consistency, and characteristics of hotspots and how these are influenced by time.</p> <p>The results showed that the level of pre‐event PTSD symptoms significantly predicted the intensity, bodily reaction, and the level of distress associated with remembering the event after 1 year. None of these effects was moderated by whether the event was emotional or neutral.</p> <p>Although the present study specifically addressed hotspots and their characteristics, the finding that the effects of PTSD symptoms on hotspot characteristics were not moderated by event type supports theories suggesting that PTSD symptoms are associated with a general increase in affect intensity affecting the processing and remembering of events (Rubin et al., 2008; Rubin et al., 2011) and/or reduced inhibitory control (Catarino et al., 2015). The fact that elevated levels of pre‐event PTSD symptoms are associated with increased levels of affectivity when recalling hotspots from new events, even after a long delay suggests that changes in autobiographical memory in general may contribute to increased levels of affectivity associated with PTSD, or vice versa. These findings are consistent with prior research (Catarino et al., 2015; Mary et al., 2020; Staugaard et al., 2021) and with recent theories of PTSD (e.g., Marks et al., 2018), stating that factors operating at the time of retrieval may be even more central than factors operating at the time of encoding in understanding the intrusive and unpleasant aspects of the trauma memory in individuals with PTSD.</p> <p>The effect of pre‐existing PTSD symptoms on post‐trauma events has been little studied (see Staugaard et al., 2021, for a review). One important strength of the present approach is that it allowed such investigation through a novel prospective design, which enabled us to include a neutral comparison event. Such comparisons are non‐existent in clinical studies of emotional hotspots. By including a neutral control condition, we demonstrated that the effects of PTSD symptoms on episodic memory for hotspots are not limited to the index trauma itself – nor are they limited to emotional events. These findings may have importance for research on investigative interviewing, as it has been argued that the retrieval experience (e.g., the intensity), affects how confident people are in their memories (Roediger III et al., 2012). Future research should investigate, if the effects of pre‐event PTSD on later recall result in inflated memory confidence due to a more intense and distressing experience at the time of retrieval.</p> <p>In addition to the novel findings of the effects of pre‐event PTSD, we replicated and extended previous work on hotspots frequency, consistency, and characteristics (Nielsen et al., 2020). With regard to the frequency, we replicated findings from the clinical literature showing that often more than one hotspot are reported from an emotional event (Grey & Holmes, 2008; Harris & Ayers, 2012; Holmes et al., 2005; Nijdam et al., 2013). We extended this finding by showing that this is also the case for a neutral event and that the number of reported hotspots decreases over a 1‐year delay for both emotional and neutral events.</p> <p>To our knowledge, the present study is the first to investigate the consistency of hotspots over a longer delay. The present findings suggest that a prospective study is needed to clarify the role of emotional hotspots in the development of PTSD since reports taken retrospectively may differ substantially from the initial experience as well as from memory reports obtained shortly after the event. While clinical psychologists addressing hotspots as part of trauma treatment naturally will have to identify hotspots retrospectively, it would be important to take into account that hotspots reported early in the therapeutic process may no longer be considered hotspots at later stages, whereas other moments might be, as evidenced by the present findings. Therefore, it could be meaningful to evaluate the intensity of the identified hotspots throughout the process of therapy.</p> <p>With regard to the characteristics of hotspots, ratings of intensity, bodily reaction, and level of distress experienced as a reaction to the memory of the event were affected by time. This finding is consistent with previous work using shorter delays (Nielsen et al., 2020). Unlike Nielsen et al. (2020) using a 1‐week delay, we found that this was also the case for intensity, bodily reaction, and level of distress experienced during the event. Not surprisingly, with longer delays, retrospectively reporting how the participant felt during the event becomes the more demanding. This effect of time did not interact with event type, indicating that this is the case for both emotional and neutral events.</p> <p>Taken together, the present findings suggest that retrospective reports of emotional hotspots should not be considered accurate records of these moments. Rather, they should be considered as memories of highly emotional moments subject to the same principles of change and reconstruction as all other episodic memories. Consistent with the literature on memory consistency for traumatic events (Engelhard et al., 2008; Southwick et al., 1997; van Giezen et al., 2005), we find that emotional hotspots too are prone to distortions.</p> <p>The present study has some limitations. First, the material used as analogue events bear only some resemblance to a real‐life trauma. Nonetheless, a clearly detectable increase in state anxiety from pre‐ to post film exposure supports the validity of the manipulation. Second, our sample was drawn from Amazon's Mechanical Turk, leaving less experimental control compared to traditional laboratory studies. However, overall, the use of Amazon's Mechanical Turk has been evaluated as a reliable method for conducting online studies, and it has been shown that data compare well to laboratory studies (Buhrmester et al., 2018; Crump et al., 2013). To secure data quality, we embedded several attention checks in the present study. Due to the long delay between Session 1 and Session 2, we were surprised to see how well the participants recalled the event after 1 year. We interpret this a confirmation of the participants' attentiveness to the encoding. Third, it should be noted that the measures of hotspot characteristics related to how the participants experienced the hotspots <emph>during</emph> the event also were taken retrospectively. All self‐report measures of this kind will inevitably rely on memory, however, we reduced retrospection by having the participants complete these measures as closely as possible to experiencing the event.</p> <p>In conclusion, we have demonstrated that level of PTSD symptoms prior to experiencing a new event predicted the reaction to recalling hotspots from this event, even after a 1‐year delay, and independent of whether the event was neutral or emotional. This shows that PTSD symptoms have important proactive memory effects by influencing how new (post‐trauma) events are remembered, irrespective of whether these events are emotional or mundane. The findings challenge a tendency in PTSD research to focus only on retroactive memory effects pertaining to the index trauma, and adds to the literature suggesting that episodic memory more broadly is affected by elevated levels of PTSD symptoms.</p> <hd id="AN0154795782-12">ACKNOWLEDGMENTS</hd> <p>This work was supported by a grant from the Danish National Research Foundation (DNRF89). We wish to thank Marie Rude Olesen for help with coding the data.</p> <hd id="AN0154795782-13">CONFLICT OF INTEREST</hd> <p>The authors declare no conflict of interest.</p> <hd id="AN0154795782-14">INFORMED CONSENT STATEMENT</hd> <p>All participants gave informed consent before participating.</p> <hd id="AN0154795782-15">DATA AVAILABILITY STATEMENT</hd> <p>The data that support the findings of this study are available from the corresponding author upon reasonable request.</p> <ref id="AN0154795782-16"> <title> Footnotes </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Funding information Danmarks Grundforskningsfond, Grant/Award Number: DNRF89</bibtext> </blist> </ref> <ref id="AN0154795782-17"> <title> REFERENCES </title> <blist> <bibtext> American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). 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Understanding power and rules of thumb for determining sample sizes. Tutorials in Quantitative Methods for Psychology, 3 (2), 43 – 50. https://doi.org/10.20982/tqmp.03.2.p043</bibtext> </blist> </ref> <aug> <p>By Niels Peter Nielsen and Dorthe Berntsen</p> <p>Reported by Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib53" firstref="ref2"></nolink>
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Items – Name: Title
  Label: Title
  Group: Ti
  Data: How Posttraumatic Stress Disorder Symptoms Affect Memory for New Events and Their 'Hotspots' over a Long Delay
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Nielsen%2C+Niels+Peter%22">Nielsen, Niels Peter</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-8320-2991">0000-0001-8320-2991</externalLink>)<br /><searchLink fieldCode="AR" term="%22Berntsen%2C+Dorthe%22">Berntsen, Dorthe</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-5941-314X">0000-0001-5941-314X</externalLink>)
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  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Applied+Cognitive+Psychology%22"><i>Applied Cognitive Psychology</i></searchLink>. Jan-Feb 2022 36(1):59-68.
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  Label: Availability
  Group: Avail
  Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 10
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2022
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Posttraumatic+Stress+Disorder%22">Posttraumatic Stress Disorder</searchLink><br /><searchLink fieldCode="DE" term="%22Symptoms+%28Individual+Disorders%29%22">Symptoms (Individual Disorders)</searchLink><br /><searchLink fieldCode="DE" term="%22Memory%22">Memory</searchLink><br /><searchLink fieldCode="DE" term="%22Intervals%22">Intervals</searchLink><br /><searchLink fieldCode="DE" term="%22Emotional+Response%22">Emotional Response</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1002/acp.3898
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0888-4080
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Memory for traumatic events and their most distressing moments (hotspots) are typically examined in patients with posttraumatic stress disorder (PTSD) using retrospective memory reports for the index trauma. Effects of PTSD symptoms on memory for new (post-trauma) events and their hotspots have received less attention. Here we used a prospective, experimental design to address this question. Participants completed measures of PTSD symptoms, were exposed to either an emotional (N = 54) or a neutral (N = 44) simulated event, reported hotspots, and rated them on memory characteristics. After a 1-year delay, participants once again reported hotspots and rated their memory characteristics. PTSD symptoms obtained before the event predicted emotional intensity, bodily reaction, and distress associated with hotspots from the event after a 1-year delay, irrespective of event type. This suggests that memory for events in general and not just memory of the index trauma is affected by PTSD symptoms.
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  Label: Abstractor
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  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2022
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1325293
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1325293
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      – Type: doi
        Value: 10.1002/acp.3898
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 10
        StartPage: 59
    Subjects:
      – SubjectFull: Posttraumatic Stress Disorder
        Type: general
      – SubjectFull: Symptoms (Individual Disorders)
        Type: general
      – SubjectFull: Memory
        Type: general
      – SubjectFull: Intervals
        Type: general
      – SubjectFull: Emotional Response
        Type: general
    Titles:
      – TitleFull: How Posttraumatic Stress Disorder Symptoms Affect Memory for New Events and Their 'Hotspots' over a Long Delay
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      – PersonEntity:
          Name:
            NameFull: Nielsen, Niels Peter
      – PersonEntity:
          Name:
            NameFull: Berntsen, Dorthe
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          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2022
          Identifiers:
            – Type: issn-print
              Value: 0888-4080
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              Value: 36
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              Value: 1
          Titles:
            – TitleFull: Applied Cognitive Psychology
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