Intrusive thoughts are unwanted, distressing thoughts that can be difficult to control. They are common in depression and PTSD, often involving negative self-evaluation, traumatic experiences, or worries.
Studying intrusive thoughts in these disorders is crucial for understanding their role in maintaining distress and informing targeted psychological interventions.
Kralj, A., Payne, A., Holzhauer‐Conti, O., Young, J., & Meiser‐Stedman, R. (2024). Intrusive thoughts and memories in adolescents with major depressive disorder or post‐traumatic stress disorder. British Journal of Clinical Psychology. https://doi.org/10.1111/bjc.12488
Key Points
- Intrusive thoughts and memories are common experiences in adolescents, particularly those with Major Depressive Disorder (MDD) or Post-Traumatic Stress Disorder (PTSD).
- Adolescents with MDD and PTSD are more likely to experience intrusive memories and thoughts associated with greater negative appraisals and emotions compared to non-clinical controls.
- Strong sensory quality distinguishes intrusive memories in adolescent PTSD from those in MDD and non-clinical populations.
- Negative appraisals and emotions associated with intrusive cognitions, rather than the intrusions themselves, differentiate clinical from non-clinical adolescents.
- Assessing and targeting intrusive thoughts and memories in treatment may enhance psychological interventions for adolescents with MDD and PTSD.
Rationale
Intrusive memories and thoughts are well-established features of adult PTSD and depression (Brewin et al., 2010; Payne et al., 2019).
However, little is known about these phenomena in adolescents with MDD and PTSD. Cognitive theories propose that negative appraisals of intrusive experiences maintain distress in these disorders (Ehlers & Clark, 2000; Starr & Moulds, 2006).
Investigating intrusive cognitions in adolescents is crucial, as this developmental stage sees increased stressful life events and the emergence of depressive disorders (Ge et al., 2001).
This study aims to address this gap by examining the frequency, characteristics, and appraisals of intrusive memories and thoughts in adolescents with MDD, PTSD, and non-clinical controls, potentially informing enhancements to psychological treatments for this age group.
Method
The study employed a cross-sectional design comparing three groups: adolescents with MDD (n=11), PTSD (n=13), and non-clinical controls (n=25).
Participants completed diagnostic interviews, self-report measures, and structured interviews assessing intrusive memories and thoughts.
Procedure
Participants first completed an online questionnaire battery assessing trauma history, depression, and anxiety symptoms.
Eligible participants then completed a structured telephone or video call interview involving diagnostic assessment of PTSD and MDD, followed by interview items related to their experience of intrusive memories and thoughts.
Sample
The sample consisted of 49 adolescents aged 11-18 years (M=15.0, SD=1.7), with 79.6% being female.
The MDD group had 11 participants, the PTSD group had 13 participants (6 with PTSD alone, 7 with comorbid MDD), and the control group had 25 participants.
Measures
- Revised Child Anxiety and Depression Scale (RCADS): self-report measure of anxiety and depressive symptoms
- Anxiety Disorders Interview Schedule-Child Version (ADIS-C): structured diagnostic interview for PTSD and MDD
- Intrusive Memory and Intrusive Thought Interview Schedule: assessed frequency, duration, content, emotions, distress, and appraisals related to intrusive cognitions
- Children’s Revised Impact of Event Scale (CRIES-13): measured intrusiveness of intrusive memories
- Trauma Memory Quality Questionnaire (TMQQ): assessed sensory quality of intrusive memories
Statistical Measures
Between-group comparisons were performed using one-way ANOVAs, Welch’s F tests, post-hoc Tukey or Games-Howell tests, and Fisher’s exact tests, with an alpha level of .05. Effect sizes (Cohen’s d) were calculated for all analyses.
Results
Intrusive memories were reported by 92.3% of the PTSD group, 54.5% of the MDD group, and 28.0% of controls.
Intrusive thoughts were experienced by 100% of the MDD group, 76.9% of the PTSD group, and 48.0% of controls.
For intrusive memories, the PTSD group scored higher on intrusiveness (CRIES-13) and sensory quality (TMQQ) compared to controls.
Both clinical groups reported greater emotion severity and more negative appraisals than controls. The PTSD group also reported more distress than controls.
For intrusive thoughts, both clinical groups reported greater emotion severity and more negative appraisals than controls.
The PTSD group reported more distress than controls. Intrusive thoughts were more frequent in the MDD group and of longer duration in the PTSD group compared to controls.
Insight
This study highlights the prevalence and clinical significance of intrusive memories and thoughts in adolescents with MDD and PTSD.
The high frequency of these intrusions in clinical groups suggests they may be important targets for psychological interventions.
The strong sensory quality of intrusive memories in PTSD aligns with cognitive theories proposing poorly contextualized sensory-based memory representations in this disorder.
Notably, negative emotions and appraisals, rather than the intrusions themselves, differentiated clinical from non-clinical adolescents, supporting cognitive models emphasizing the role of appraisals in maintaining distress.
Future research should employ larger samples and longitudinal designs to further elucidate the mechanisms underlying intrusive cognitions in adolescent psychopathology.
Implications
The findings underscore the importance of assessing and addressing intrusive memories and thoughts in the clinical care of adolescents with MDD and PTSD.
Incorporating psychoeducation, normalization, and coping strategies targeting these intrusions may enhance psychological treatments.
The strong sensory quality of intrusive memories in PTSD suggests interventions focusing on contextualizing sensory-based representations may be particularly relevant for this group.
In contrast, the role of negative emotions and appraisals across both clinical groups highlights these as potential transdiagnostic treatment targets.
Clinicians should routinely assess intrusive cognitions to inform case formulation and treatment planning for adolescents presenting with depressed mood or post-traumatic stress.
Strengths
The study had several methodological strengths, including:
- Use of well-validated diagnostic interviews and self-report measures
- Inclusion of both PTSD and MDD clinical groups, allowing for comparison
- Structured assessment of intrusive cognitions, ensuring consistency and clarity
- Calculation of effect sizes to inform future research
Limitations
The study’s limitations include:
- Small sample size, limiting statistical power and generalizability
- Cross-sectional design, precluding causal inferences
- Potential bias in intrusive thought content due to the example provided in the interview
- Inability to distinguish the impact of PTSD vs. comorbid depression due to the small number of PTSD-only participants
These limitations highlight the need for replication with larger samples and longitudinal designs to yield more conclusive findings and explore the unique contributions of PTSD and depression to intrusive cognition experiences.
References
Primary reference
Kralj, A., Payne, A., Holzhauer‐Conti, O., Young, J., & Meiser‐Stedman, R. (2024). Intrusive thoughts and memories in adolescents with major depressive disorder or post‐traumatic stress disorder. British Journal of Clinical Psychology. https://doi.org/10.1111/bjc.12488
Other references
Brewin, C. R., Gregory, J. D., Lipton, M., & Burgess, N. (2010). Intrusive images in psychological disorders: Characteristics, neural mechanisms, and treatment implications.Psychological Review, 117(1), 210–232. https://doi.org/10.1037/a0018113
Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319-345. https://doi.org/10.1016/S0005-7967(99)00123-0
Ge, X., Conger, R. D., & Elder, G. H., Jr. (2001). Pubertal transition, stressful life events, and the emergence of gender differences in adolescent depressive symptoms. Developmental Psychology, 37(3), 404–417. https://doi.org/10.1037/0012-1649.37.3.404
Payne, A., Kralj, A., Young, J., & Meiser-Stedman, R. (2019). The prevalence of intrusive memories in adult depression: A meta-analysis. Journal of Affective Disorders, 253, 193-202. https://doi.org/10.1016/j.jad.2019.04.055
Starr, S., & Moulds, M. L. (2006). The role of negative interpretations of intrusive memories in depression. Journal of Affective Disorders, 93(1-3), 125-132. https://doi.org/10.1016/j.jad.2006.03.001
Keep Learning
Socratic questions for a college class to discuss this paper:
- How might the developmental stage of adolescence influence the experience and impact of intrusive memories and thoughts compared to adulthood?
- What are the potential mechanisms through which negative appraisals of intrusive cognitions maintain distress in MDD and PTSD? How might these mechanisms inform treatment approaches?
- Considering the study’s limitations, what would be the ideal design for a future study to further elucidate the role of intrusive cognitions in adolescent psychopathology?
- How might the assessment and treatment of intrusive memories and thoughts differ between adolescents with PTSD versus those with MDD, given the differences in sensory quality observed in this study?
- What are the potential implications of the high prevalence of intrusive cognitions in non-clinical adolescents? How might this inform prevention and early intervention efforts?
