Cueing natural event boundaries improves memory in people with post-traumatic stress disorder

Pitts et al. Cognitive Research: Principles and Implications https://doi.org/10.1186/s41235-023-00478-x (2023) 8:26 Cognitive Research: Principles and Implications Open Access ORIGINAL ARTICLE Cueing natural event boundaries improves memory in people with post‑traumatic stress disorder Barbara L. Pitts1, Michelle L. Eisenberg2, Heather R. Bailey1 and Jeffrey M. Zacks2*    Abstract People with post-traumatic stress disorder (PTSD) often report difficulty remembering information in their everyday lives. Recent findings suggest that such difficulties may be due to PTSD-related deficits in parsing ongoing activity into discrete events, a process called event segmentation. Here, we investigated the causal relationship between event segmentation and memory by cueing event boundaries and evaluating its effect on subsequent memory in people with PTSD. People with PTSD (n = 38) and trauma-matched controls (n = 36) watched and remembered videos of everyday activities that were either unedited, contained visual and auditory cues at event boundaries, or contained visual and auditory cues at event middles. PTSD symptom severity varied substantial within both the group with a PTSD diagnosis and the control group. Memory performance did not differ significantly between groups, but people with high symptoms of PTSD remembered fewer details from the videos than those with lower symptoms of PTSD. Both those with PTSD and controls remembered more information from the videos in the event boundary cue condition than the middle cue or unedited conditions. This finding has important implications for translational work focusing on addressing everyday memory complaints in people with PTSD. Keywords PTSD, Symptom severity, Event segmentation, Memory, Cueing Introduction Approximately 5% of US adults experience clinical levels of post-traumatic stress disorder (PTSD) following a life-threatening event (Perrin et al., 2014). Individuals with PTSD experience intrusive reminders of the traumatic event, changes in cognition and mood, general hyperarousal, and they actively avoid anything associated with the event. Many of the symptoms of PTSD involve memory problems for the traumatic event, such as vivid flashbacks, life-like nightmares, intense negative feelings about the event, and detachment from event reminders long after the event has ended (American Psychiatric *Correspondence: Jeffrey M. Zacks 1 Kansas State University, Manhattan, KS 66506, USA 2 Washington University in St. Louis, St. Louis, MO 63130, USA Association, 2013). In fact, many current theories of PTSD propose that memory abnormalities are central to the development and persistence of symptoms (Beierl et al., 2020; Brewin, 2018; Rubin et al., 2008). For example, Brewin (2011, 2014) proposed that PTSD stems from incomplete long-term memory representations that don’t accurately reflect sensory input. Some theories of PTSD further propose an attentional bias toward perceptual details of an event over conceptual information (Ehlers & Clark, 2000). According to this perspective, high basal arousal levels induce data-driven processing of ongoing activity, which results in memory representations of events that have rich perceptual information and poor event structure (i.e., disorganized and incoherent), with minimal contextual information. These characteristics make such memories difficult for people with PTSD to voluntarily search for and retrieve information from episodic memory (Sherrill & Magliano, 2017). This © The Author(s) 2023. 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Cognitive Research: Principles and Implications (2023) 8:26 Page 2 of 10 is consistent with findings from Sherrill and Magliano (2017) that state anxiety increases perceptual processing over conceptual processing. These processing deficits are proposed to not just be a side effect of PTSD symptoms, but Ehlers and Clark (2000) also proposed that they contribute to and maintain the disorder. Therefore, understanding these underlying memory deficits may be crucial for developing treatments and improving functional outcomes (Scott et al., 2015). In addition to trauma-related memory disturbances, people with PTSD often report trouble remembering aspects of everyday life. For example, combat veterans with PTSD report higher frequency of forgetting everyday things, such as names and appointments and decreased use of mnemonics, than combat veterans without PTSD (Carlozzi et al., 2011). These real-world memory failures are consistent with previously reported PTSD-related differences in memory using neuropsychological measures. These studies find that verbal memory, in particular, is significantly worse in patients with PTSD than those without (Johnsen & Asbjornsen, 2008). These PTSD-related memory deficits are associated with poor social and occupational functioning (Geuze et al., 2009) and worse treatment outcomes (Wild & Gur, 2008). Despite subjective memory complaints and objective neuropsychological deficits associated with PTSD, previous experimental studies often fail to find differences in real-world memory (Carlozzi et al., 2011; Roca & Freeman, 2001). This discrepancy between memory findings may be due to the use of simple verbal or visual materials in standardized objective measures, which may not reflect real-world memory difficulties. However, more recently, we have demonstrated objective PTSD-related memory deficits using real-world video stimuli: People with higher PTSD severity recalled fewer fine-grained actions from videos of everyday events than did control subjects who also had a history of trauma (Pitts et al., 2022) and more severe PTSD symptoms were related to worse memory performance (Eisenberg et al., 2016; Pitts et al., 2022). In addition to these objective memory deficits, we also found that participants with higher PTSD symptom severity were less able to effectively encode the to-be-remembered activity, suggesting a potential mechanism to explain memory deficits associated with PTSD. According to Event Segmentation Theory (Zacks et al., 2007), effectively encoding ongoing activity requires the perceptual system to break up or (...truncated)