Summary with the article: Retrieving and Modifying Traumatic Memories: Recent Research Relevant to Three Controversies - Engelhard, McNally & van Schie - 2019.

What is this article about?

In this article, the author reviews recent research which is relevant to three controversies in memory for trauma. The author presents an interpretation of recovered memories, which do not rely on the concepts of repression, or false memory. Second, the author talks about the idea that trauma memories often lack narrative structure, and that this can lead to the development of posttraumatic stress disorder (PTSD). Lastly, the authors discuss research of eye-movement desensitization and reprocessing (EMDR) therapy, which aims to improve PTSD.

What are the controversies concerning memories of trauma?

A nonrepression account of recovered memories

The repression perspective states that people, as they become older, are unable to recall memories of childhood sexual abuse, because this memory is too emotional. However, the author states that studies within this perspective, unjustly, mix memory phenomena with one another. For instance, they interpreted normal forgetfulness as ‘an inability to recall trauma’. They also unjustly mixed organic amnesia with psychic repression. Thus, their claims with regard to repression are often false, and not scientifically underpinned. Following the false-memory perspective, people who report memories of childhood sexual abuse are reporting false memories, especially when these memories are reported during recovered-memory therapy. Of course, not all memories are false, even though there are a lot of instances of false memories of trauma. It could be the case that adults experienced childhood sexual abuse, but that they did not experience terror that is associated with trauma. Thus, for a long time, they did not understand that their experience was actually wrong. Later, they understood what happened to them, and some of them develop PTSD after this understanding.

Are traumatic memories fragmented and incoherent?

According to some researchers, memories of trauma are often fragmented, incomplete, and lack narrative coherence. This is often the case for individuals with PTSD. Researchers state that patients have to emotionally process their traumas, and then be able to create a coherent narrative, before they can recover. In one study, Rubin and colleagues (2016) examined 60 trauma-exposed adults, of whom half had PTSD. They matched these adults based on their trauma type (combat, childhood sexual abuse, accidents). The participants were instructed to recount three traumatic, very positive, and three very important memories. They recorded the narratives, and transcribed these. They then looked at how coherent these narratives were. They found that most trauma memories were coherent, and that participants with PTSD did not have less coherent memories compared to participants who had experienced trauma but did not meet the criteria for PTSD. Thus, these findings indicate that the idea that trauma memories are characterized by a lack of narrative coherence, is not true.

Bedard-Gilligan and colleagues also tested whether traumatic memories have to be integrated and coherent, before people can recover from the traumas. They used a sample of PTSD patients who had received exposure therapy or sertraline. From each of these patients, they obtained a trauma narrative, a positive narrative, and a negative, nontrauma related narrative. Then, they evaluated the fragmentation of these memories before and after treatment. The results showed that memory fragmentation was not related to change in therapy. Thus, even if people recovered, this fragmentation did not change. Instead, it shows a person’s style of recounting autobiographical memories. Thus, trauma-related memories are not fragmented compared to non-trauma related memories, but they do cause patients to suffer. Erasing memories is not the ideal, because remembering danger can be important. Instead, it would be best if someone remembered the memories, but did not feel the negative emotions associated with it.

Are eye movements in EMDR therapy effective?

In EMDR, patients recall a traumatic memory, while visually tracking the fingers of the therapist as they move back and forth in front of the patient’s eyes. A long ongoing debate about EMDR is how eye movements help to decrease traumatic memories’ effect. A recent meta-analysis has shown that lateral eye movements enhance the effectiveness of exposure therapy. But, how does this work? There does not seem to be a placebo effect. It is suggested that lateral eye movements limit working memory resources which are essential for memory retrieval. When people recall a memory, distraction can interfere with retrieval. This helps to reduce imagination inflation. Studies have tested the working memory theory. They showed that other dual tasks that compete with memory retrieval, such as vertical eye movements, counting backward, attentional breathing, and playing the computer game Tetris are also effective. However, passive dual tasks such as listening to beeps or finger tapping, are not effective. Eye movements also do not seem to work when they are slow, and when they are combined with a different memory than the one in the pre- or post-tests. Also, the eye-movement therapy is more effective for visual memories than for auditory memories. Lastly, the eye-movement therapy does not only work against distressing memories, but also for imagined future threats, positive memories, and substance-related imagery. All with all, the exact underlying mechanism of this treatment remains unknown.