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It’s a pretty common experience to have intrusive cognitions (ICs, or thoughts, memories, and images that are distressing, unwanted, and happen seemingly “out of nowhere”). Lots of people feel like they might be going crazy when that happens, even though ICs happen to almost everyone - even well-trained soldiers in the U.S. Army have this experience. Understanding more about these experiences will help lots of different people, but particularly trauma survivors since ICs are common after trauma, and are a hallmark feature of posttraumatic stress disorder (PTSD).

Prior research on post-traumatic intrusive cognition has mostly focused on intrusive memories of trauma. A few studies have identified other kinds of ICs in individuals who have been through potentially traumatic events (e.g., Reynolds & Brewin, 1998; Bernsten & Rubin, 2008), but in general very little work has been done to understand the content of intrusive thoughts that people have after difficult experiences. Treatments tend to focus only on memories (since they have been well studied) but what other types of ICs do people have during posttraumatic adjustment?

The purpose of our study was to explore the content of ICs in recently returned Army soldiers. To our knowledge, no previous studies have attempted to describe intrusive cognition in service members post-deployment. In addition, little is known about how the content of IC relates to posttraumatic distress in service members. To further explore these questions, the research team examined the content of intrusive cognition in soldiers by categorizing ICs by content themes. Then, we explored how the content of the cognition was related to probable diagnostic status, distress and impairment, negative affect, and symptoms of PTSD.

We asked our sample of recently deployed (between 3-12 months post-deployment) U.S. Army soldiers (N = 1521) to write down an IC about their recent deployment that was upsetting to them (e.g., made it hard to concentrate or get things done). The vast majority of soldiers (95%) were able to identify an IC about deployment without any additional prompting from study staff. We then transcribed the cognitions they reported and categorized the content of the cognitions by themes. We found that while trauma-related cognitions (i.e., combat and injury or death) are quite common (and are reported with greater frequency by soldiers with probable PTSD), other ICs that are not directly trauma-related (i.e., ICs of leadership, family, friends) are also common and related to ongoing distress. The presence of specific ICs of injury or death, combat, military sexual trauma, health, leadership and family were all unique predictors of distress after adjusting for combat exposure. So, even thoughts that aren’t memories of trauma per se (e.g., ICs about friends, family, and leadership) can be disruptive post-deployment. This finding is consistent with other studies, which have demonstrated that reports of pre-deployment, deployment, and post-deployment stressors outside of combat exposure are predictive of risk and resilience.

These findings suggest to us that in the first year post-deployment, ICs about deployment are nearly ubiquitous in soldiers. In addition, while ICs related to trauma were common and related to distress, soldiers also reported ICs about a wide range of other topics. Psychoeducation and preventive trainings available to returning soldiers have typically focused on coping with directly combat-related thoughts (e.g., Ruzek et al., 2007). We need to consider these findings when we develop post-deployment interventions; service members may need trainings that normalize and promote adjustment to ICs with a wide range of content.

Reference Article

Shipherd, J. C., Salters-Pedneault, K., & Matza, A. (2016). Intrusive Cognitive Content and Postdeployment Distress. Journal of Traumatic Stress, n/a-n/a. doi: 10.1002/jts.22113

Discussion Questions:

  1. What aspects of our current prevention offerings to post-deployed service members can be updated to reflect the wide range of intrusive cognitive content uncovered in this study?
  2. How can mental health professionals better help service members returning from combat to cope with the seemingly universal process of intrusive cognition?

Author Bios:

Jillian C. Shipherd, Ph.D. is at the National Center for PTSD at the VA Boston Healthcare, System, an Associate Professor at Boston University School of Medicine, and Director of the LGBT Program for Office of Patient Care Services, in Washington DC.

Alexis Matza, Ph.D. is the Field Coordinator for the LGBT Program for Office of Patient Care Services in Washington D.C.

Kristalyn Salters-Pedneault, Ph.D. is an Associate Professor of Clinical Psychology at Eastern Connecticut State University.


Berntsen, D., & Rubin, D. C. (2008). The reappearance hypothesis revisited: Recurrent involuntary memories after traumatic events and in everyday life. Memory and Cognition, 36, 449–460. http://doi.org/10.3758/MC.36.2.449

Clark, D. A. (2005). Intrusive Thoughts in Clinical Disorders: Theory, Research and Treatment. London: Guilford.

Reynolds, M., & Brewin, C. R. (1998). Intrusive cognitions, coping strategies and emotional responses in depression, post-traumatic stress disorder and a non-clinical population. Behaviour Research and Therapy, 36, 135–147. http://doi.org/10.1016/S0005-7967(98)00013-8

Ruzek, J. I., Brymer, M. J., Jacobs, A. K., Layne, C. M., Vernberg, E. M., & Watson, P. J. (2007). Psychological First Aid. Journal of Mental Health Counseling, 29, 17–49. http://doi.org/10.17744/mehc.29.1.5racqxjueafabgwp