Emotion Regulation and Posttraumatic Stress Symptoms: A Meta-Analysis

Existential isolation and well-being in justice-involved populations

Much work in psychology has focused on feelings of social isolation and/or loneliness. Only recently have psychologists begun to explore the concept of existential isolation (EI). EI is the subjective sense that persons are alone in their experience and that others are unable to understand their perspective. EI thus occurs when people feel that they have a unique worldview unshared by others. Measured as either a state or trait, empirical studies have shown EI undermines life meaning and decreases well-being; people scoring high on EI report lower levels of need satisfaction, purpose in life, and meaningfulness and increased death-related concerns. There is also a positive correlation between EI and anxiety, depression, and suicidal ideation. The purpose of this perspective paper is to review literature on EI and discuss its relevance to people who have been involved with the justice system. Given their higher rates of substance use, mental health difficulties, and trauma, this traditionally underserved population is particularly susceptible to compromised well-being. We theorize that EI may impede the impact of therapeutic interventions in justice settings as more isolated individuals may feel disjointed from their counselors and peers, thereby decreasing levels of treatment engagement, participation, satisfaction, and perceived social support. Professionals may be able to mitigate issues related to EI by an enhanced focus on establishing authenticity within the therapist-client relationship (e.g., empathy, perspective taking, compassion), connecting with clients via I-sharing [i.e., matching on a shared experience(s)], and/or encouraging active participation in client's behavioral healthcare needs (e.g., self-reflection).

Reduced heart rate variability and expressive suppression interact to prospectively predict COVID-19 pandemic-related post-traumatic stress symptoms

The COVID-19 pandemic is a unique period of stress that, in some cases, led to post-traumatic stress symptoms (PTSSs). Emotion regulation strategies are known to modulate the emotional response to stressful events. Expressive suppression (ES) is a maladaptive strategy related to the exacerbation of the physiological stress response. Heart rate variability (HRV), an index of cardiac autonomic balance strictly related to ES, was also shown to predict PTSSs. This was the first study to investigate whether the pre-pandemic ES use and resting-state HRV predicted pandemic-related PTSSs. Before the pandemic, 83 (58 females) university students completed the Emotion Regulation Questionnaire (ERQ), self-report measures of anxiety and depressive symptoms, and a three-minute resting-state electrocardiogram recording. After 12 months, 61 (45 females) participants completed a self-report measure of pandemic-related PTSSs and repeated the self-report psychological measures. Pre-pandemic anxiety symptoms prospectively predicted greater PTSSs. Moreover, a significant interaction between HRV and ES in predicting PTSSs emerged, whereby those who had higher levels of ES and reduced HRV showed higher PTSSs. These findings suggest that an integrated assessment of HRV and ES might be useful for identifying individuals who are more vulnerable to the development of PTSSs during crises.

Deployment-related PTSD symptomatology and social functioning: Probing the mediating roles of emotion regulation and mentalization in an outpatient veteran sample

Deployment-related posttraumatic stress disorder (PTSD) impacts social functioning in families. Therefore, it is important to examine the factors that contribute to social functioning in families that are confronted with deployment-related PTSD. The goal of this study was to assess the association between PTSD symptom severity and social functioning using self-report questionnaires in an outpatient veteran sample and to test the mediating roles of emotion regulation (Study 1, N = 100) and mentalization (Study 2, N = 38). Study 1 demonstrated that emotion regulation problems fully mediated PTSD associated family dysfunctioning. Study 2 did not demonstrate a mediation role of mentalization, but also did not demonstrate an association between PTSD and social dysfunctioning. Maladaptive mentalization was associated with poor child adjustment. Critically, a between-study comparison revealed that PTSD symptom severity was significantly higher in Study 1 than in Study 2. Overall, our findings suggest that social dysfunctioning may only appear when a given severity threshold of PTSD is reached, in which emotion regulation might be a key clinical factor. Maladaptive mentalization may be critical for post-deployment child adjustment. Future research should further examine social functioning in samples with different PTSD severity profiles and include the role of mentalization. Longitudinal data are needed to gain further insight into the causal relationships among the factors considered and the etiological pathways that lead to developing social dysfunction over time.

Posttraumatic stress symptoms and interpersonal processes in burn survivors and their partners

Background: A burn event can elicit symptoms of posttraumatic stress disorder (PTSD) in survivors and their partners and may impact the way these couple members interact with each other. They may try to protect each other from further emotional distress by avoiding talking about the burn event, but they may also show concern towards each other.Objective: The aim of this study was to investigate bidirectional relationships between survivor's and partner's PTSD symptoms and two interpersonal processes: partner-oriented 'self-regulation', which is avoidance-oriented, and 'expressed concern', which is approach-oriented.Method: In this longitudinal multi-centre study, 119 burn survivors and their partners participated. Measures of PTSD symptoms, self-regulation, and expressed concern were administered in the acute phase following the burns, and follow-ups took place up to 18 months postburn. Intra- and interpersonal effects were examined in a random intercept cross-lagged panel model. Exploratory effects of burn severity were also investigated.Results: Within individuals, survivor's expressed concern predicted later higher levels of survivor's PTSD symptoms. In their partners, self-regulation and PTSD symptoms reinforced each other in the early phase postburn. Between the two couple members, partner's expressed concern predicted later lower levels of survivor's PTSD symptoms. Exploratory regression analyses showed that burn severity moderated the effect of survivor's self-regulation on survivor's PTSD symptoms, indicating that self-regulation was continuously related to higher levels of PTSD symptoms over time within more severely burned survivors, but not in less severely burned survivors.Conclusion: PTSD symptoms and self-regulation reinforced each other in partners and possibly also in more severely burned survivors. Partner's expressed concern was related to lower levels of survivor's PTSD symptoms, whereas survivor's expressed concern was related to higher levels of survivor's PTSD symptoms. These findings emphasize the importance of screening for and monitoring PTSD symptoms in burn survivors and their partner and of encouraging couple's self-disclosure.

Acute stress and PTSD among trauma-exposed children and adolescents: Computational prediction and interpretation

BACKGROUND

Youth receiving medical care for injury are at risk of PTSD. Therefore, accurate prediction of chronic PTSD at an early stage is needed. Machine learning (ML) offers a promising approach to precise prediction and interpretation.

AIMS

The study proposes a clinically useful predictive model for PTSD 6-12 months after injury, analyzing the relationship among predictors, and between predictors and outcomes.

METHODS

A ML approach was utilized to train models based on 1167 children and adolescents of nine perspective studies. Demographics, trauma characteristics and acute traumatic stress (ASD) symptoms were used as initial predictors. PTSD diagnosis at six months was derived using DSM-IV PTSD diagnostic criteria. Models were validated on external datasets. Shapley value and partial dependency plot (PDP) were applied to interpret the final model.

RESULTS

A random forest model with 13 predictors (age, ethnicity, trauma type, intrusive memories, nightmares, reliving, distress, dissociation, cognitive avoidance, sleep, irritability, hypervigilance and startle) yielded F-scores of.973,0.902 and.961 with training and two external datasets. Shapley values were calculated for individual and grouped predictors. A cumulative effect for intrusion symptoms was observed. PDP showed a non-linear relationship between age and PTSD, and between ASD symptom severity and PTSD. A 43 % difference in the risk between non-minority and minority ethnic groups was detected.

CONCLUSIONS

A ML model demonstrated excellent classification performance and good potential for clinical utility, using a few easily obtainable variables. Model interpretation gave a comprehensive quantitative analysis on the operations among predictors, in particular ASD symptoms.

Context, coping, and mental health in refugees living in protracted displacement

There is currently an unprecedented number of forcibly displaced people worldwide. Little is known, however, about how external stressors and internal coping strategies intersect to influence mental health in displaced refugees, particularly whether specific types of coping strategies are more or less effective across different levels of external stress. This study aimed to understand whether positive and negative internal coping strategies were differentially associated with mental health across high and low levels of external stressors in displaced refugees. Participants were 1,216 refugees living in Indonesia who completed an online survey indexing demographic characteristics, exposure to ongoing stressors, positive psychological coping strategies (i.e., cognitive flexibility, self-efficacy, and hope), negative psychological coping strategies (i.e., rumination and intolerance of uncertainty), psychological symptoms (i.e., posttraumatic stress disorder, depression, and anxiety) and mental health-related quality of life. Participants (27.3% female, M_age = 30.52 years) were from Arabic-, Farsi-, Tamil-, Somali-, Dari-, and English-speaking backgrounds. Results of latent moderated structural equation modeling indicated that the association between negative psychological coping strategies and poorer mental health was stronger at higher levels of stress, whereas the association between positive psychological coping strategies and better quality of life was stronger at lower levels of stress. These findings provide evidence in support of tailored approaches that integrate interventions addressing external stressors and internal coping strategies to support positive mental health and enhanced quality of life in displaced refugees.

Does culture moderate the relationships between rumination and symptoms of posttraumatic stress disorder and depression?

Brooding rumination is positively associated with symptoms of both depression and posttraumatic stress disorder (PTSD). However, non-clinical cross-cultural research indicates that culture may influence these associations. This study aimed to examine the moderating effect of cultural group (Australian versus Malaysian) on the associations between brooding rumination and symptoms of depression and PTSD. European Australians (n = 109) and Malaysians of varying Asian heritages (n = 144) completed an online questionnaire containing the Hospital Anxiety and Depression Scale, PTSD checklist for DSM-5 and the Ruminative Response Scale-Short Form. First, Malaysian participants had higher brooding rumination than Australian participants. Second, higher levels of brooding rumination were positively associated with depression and PTSD symptom severity. Third, contrary to our expectations, cultural group did not moderate the relationships between brooding rumination and symptoms of depression and PTSD. If replicable, these results suggest that existing assessment and treatment approaches that target brooding rumination may apply to Malaysian individuals with depression and PTSD.

Investigating the associations between cognitive appraisals, emotion regulation and symptoms of posttraumatic stress disorder among Asian American and European American trauma survivors

This study investigated whether the associations between emotion regulation and cognitive appraisals and symptoms of posttraumatic stress disorder (PTSD) differ between Asian American and European American trauma survivors. Asian American (n = 103) and European American (n = 104) trauma survivors were recruited through mTurk and completed an on-line questionnaire assessing cognitive appraisals, emotion regulation and PTSD symptomatology. The European American group reported greater trauma-specific rumination, psychological inflexibility, seeking out others for comfort, and negative self-appraisals than the Asian American group. The Asian American group reported greater secondary control appraisals and cultural beliefs about adversity than the European American group. Second, cultural group moderated the associations between (a) brooding rumination, (b) fatalism, (c) self-blame, and (d) negative communal self-appraisals and PTSD symptoms. These associations were larger for the European American group than the Asian American group. Third, there was an indirect pathway from self-construal (independent and interdependent) to PTSD symptoms through certain emotion regulation approaches and cognitive appraisals. Additionally, cultural group was found to moderate several of these indirect effects. These findings highlight the importance of considering cultural background and cultural values in understanding the processes involved in PTSD. Further research in this area is needed.

Locating event centrality in associations of emotion regulation with posttraumatic stress disorder symptoms and posttraumatic growth in emerging adults

Previous research suggests that cognitive reappraisal (CR) and expressive suppression (ES) strategies of emotion regulation (ER) are associated with posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG). How the patterns of these associations may vary in the context of event centrality (EC) however requires investigation to help delineate groups for whom the impact of event centrality may be more salient. We examined whether EC would moderate the associations of CR and ES with PTSD symptoms clusters and PTG domains among 388 emerging adults (18-30 year-olds) of Tiv ethnic group who were survivors of armed attack by Fulani herdsmen and were temporarily sheltered in two internally displaced persons' (IDPs') camps in North-central Nigeria. They completed self-report measures of the variables. Results indicated that EC strengthened the negative associations of CR and the positive associations of ES with avoidance, hyper-arousal and total PTSD symptoms, but not intrusion symptoms. For the PTG domains, EC only strengthened the positive association between CR and personal strength and weakened the association of ES with greater appreciation of life. These findings suggest that primary intervention programs that incorporate training of armed attack survivors in cognitive reappraisal strategy centered on the traumatic event could be effective in controlling PTSD but be less critical in engendering PTG. They also show that the psychological processes that underlie PTSD and PTG are related but involve nuances even within PTSD, and do not seamlessly set into the Janoff-Bulman's "strength through suffering" model of PTG. More research is required to test the model.

The role of women’s resources in the prediction of intimate partner violence revictimization by the same or different aggressors

The literature studying the characteristics associated with revictimization in Intimate Partner Violence (IPV) is heterogeneous and inconclusive. The absence of studies on the role of the emotional variables of the victims and the failure to distinguish revictimization by the same or different aggressors are two of the main limitations in this area of research. The aim of this work was to study the relative contribution of the material, social, and emotional resources available to IPV victims in predicting revictimization by the same or different perpetrators. The sample consisted of 290 women registered in the city of Madrid who had filed at least one police report for intimate partner violence. The material resources of the victims were evaluated through their level of monthly income and employability status, the social resources through perceived social support, and the emotional resources through emotional regulation and coping strategies. Hierarchical multinomial logistic regression models were estimated to predict single-offender victimization (SRV), same-offender revictimization (VSRSA), and multiple-offender revictimization (VSRDA). The results revealed that: (1) differentiating between revictimization by the same and different aggressors improved the fit of the model by 50.8% compared to when only differentiating between victimized and revictimized women; (2) material resources had no significant weight in the prediction of any type of revictimization; (3) SRV women had more social support than VSRDA women (ExpB = 1.027; p < 0.011); (4), those victims who had made several reports to the authorities of violence by different aggressors (VSRDA), had worse emotional regulation than those victims who had made a single report to the authorities (VSRs; ExpB = 2.934; p < 0.026); and (5) VSRDA obtained the worst mental health indexes and they used more coping strategies based on positive reappraisal than the VSR women (ExpB = 0.863; p < 0.009) and those victims with several reports by the same aggressor (VSRSA; ExpB = 0.891; p < 0.028). These results show that being a victim of several episodes of intimate partner violence by different aggressors should be understood as a form of revictimization of great severity associated with worse emotional regulation and less social support.

Emotion Regulation and Distress During the COVID-19 Pandemic: The Role of Childhood Abuse

The COVID-19 pandemic may be experienced as traumatogenic and may fuel or exacerbate psychological distress and trauma-related symptoms. Based on trauma research, one might expect that survivors of childhood abuse would be susceptible to these negative outcomes during the pandemic, and that among this population a stronger relation between emotion regulation difficulties and symptomatology would be found. Aiming to explore these suppositions, an online survey was conducted among 710 Israeli adults. Of them, 370 were childhood abuse survivors. A history of childhood abuse, COVID-19-related stressors, overall psychological distress, and peritraumatic stress symptoms during the pandemic were assessed via self-report measures. Participants with a history of childhood abuse had elevated overall psychological distress as well as peritraumatic stress symptoms during the pandemic, compared to nonabused participants, above and beyond demographic characteristics and COVID-19-related stressors. Emotion regulation difficulties were related to elevated psychological distress and peritraumatic stress symptoms among both childhood abuse survivors and nonabused participants. Nonetheless, a history of childhood abuse moderated the relations between the emotion regulation difficulty of being unable to engage in goal-directed behaviors when distressed (on one hand) and mental outcomes (on the other): Although the associations between inability to engage in goal-directed behaviors, overall psychological distress, and peritraumatic stress symptoms were nonsignificant among nonabused participants, they were significant among childhood abuse survivors. The current findings suggest that a history of childhood abuse might be a risk factor for distress in the face of COVID-19, and that childhood abuse survivors would benefit from clinical interventions that promote emotion regulation skills during this ongoing global health crisis.

Emotional dysregulation as trans-nosographic psychopathological dimension in adulthood: A systematic review

Introduction

Emotional dysregulation (ED) is characterized by inappropriate emotional reactions related to environmental or cognitive stimuli. In most recent years, increasing interest has been devoted to its definition and detection across mental disorders for its detrimental role progressively highlighted in both neurodevelopment and adult mental disorders, with implications on the severity of clinical manifestations. The aim of this systematic review was to evaluate and gather the scientific evidence about ED in adult psychiatric population to elucidate the concept of ED as trans-nosographic entity.

Methods

The electronics databases PubMed, Scopus and Web of Science was reviewed to identify studies in accordance with the PRISMA guidelines; at the end of the selection process a total of 29 studies (N = 709; N = 658; N = 1,425) was included. All studies included assessed the presence of ED symptoms, by means of a validate scale in adult (>18 years of age), in clinically diagnosed patients as well as healthy control participants.

Results

Our results suggest ED as a trans-diagnostic factor across multiple mental disorders, such as bipolar disorder, attention deficit hyperactivity disorder, autism spectrum disorder, personality disorders; a better definition of this concept could be helpful to interpret and clarify many clinical cases and improve their diagnostic and therapeutic management.

A Pilot Randomized Clinical Trial of a Novel, Culturally Adapted, Trauma-Focused Cognitive-Behavioral Intervention for War-Related PTSD in Iraqi Women

Trauma-focused cognitive-behavioral therapy (TF-CBT), broadly, is one of the leading evidence-based treatments for youth with posttraumatic stress disorder (PTSD). Generally, few culturally adapted TF-CBT interventions have been examined among war trauma-affected populations in low- and middle-income countries. Using a randomized clinical trial design, a total of 48 war trauma-exposed women in Iraq, M_age (SD) = 32.91 (5.33), with PTSD were randomly assigned to either TF-CBT or wait-list control (WLC) conditions. The intervention group received 12 individual weekly sessions of a culturally adapted TF-CBT intervention. Significant reductions in PTSD symptom severity were reported by women in the TF-CBT condition from pre- to posttreatment. Women in the TF-CBT condition reported significantly greater reductions in PTSD symptoms compared to WLC at 1-month follow-up. Additionally, levels of depression, anxiety, stress, and use of maladaptive emotion regulation strategies were significantly lower in the TF-CBT condition at posttreatment and 1-month follow-up, compared to the WLC condition. Women in the TF-CBT condition also reported significant improvements in various domains of quality of life at posttreatment and 1-month follow-up. This clinical trial provides preliminary cross-cultural support for the feasibility and efficacy of TF-CBT for the treatment of PTSD symptoms among women in non-Western cultures. Future directions and study limitations are discussed.

Prevalence and correlates of anxiety symptoms among Black people in Canada: A significant role for everyday racial discrimination and racial microaggressions

OBJECTIVE

Anxiety disorders are highly prevalent worldwide but vary significantly by country and ethnoracial background. Minimal published data exist on the prevalence of clinically significant anxiety among Black people in Canada and none using validated measures. Therefore, this study sought to establish the frequency of clinically significant anxiety symptoms among a sample of Black people living in Canada as well as examine the association with two forms of racism (racial discrimination and racial microaggressions).

METHODS

Data collected from the Black Community Mental Health project in Canada was analyzed. Participants provided (N= 845) sociodemographic information and completed measures assessing anxiety symptomology (GAD-7), everyday racial discrimination, racial microaggressions, and resilience. Prevalence of anxiety symptomatology was determined across sociodemographic variables as well as categories of everyday racial discrimination and racial microaggressions. Two regression models were conducted to examine the relationship between anxiety symptoms and the two forms of racism controlling for sociodemographic factors.

RESULTS

Overall, nearly a third of participants endorsed clinically significant levels of anxiety symptoms, with higher rates observed among men, unemployed people, those with higher education, people who are separated, and those with no reported family history of mental health problems. Logistic regression models demonstrated that, except for those reporting the greatest frequency of racial discrimination, there is a general linear trend such that those experiencing higher levels of racial discrimination or racial microaggressions are increasingly more likely to present with anxiety symptoms when compared to those reporting low levels of discrimination or microaggressions. Psychological resilience afforded nominal protection but only against exposure to racial microaggressions.

CONCLUSIONS

Rates of clinically significant anxiety are higher among Black people in Canada than reported previously. Both racial discrimination and racial microaggressions predicted higher rates of anxiety symptoms. The results are discussed in relation to previous findings from the US that report similar findings.

Distress Tolerance and Emotion Regulation as Potential Mediators Between Secondary Traumatic Stress and Maladaptive Coping

The extant literature has illustrated that protective service workers experience negative repercussions associated with their job (including the development of secondary traumatic stress; STS) and may utilize maladaptive coping mechanisms. Developing an improved understanding of factors that might explain the relationship between STS and the utilization of maladaptive coping mechanisms is warranted. This study sought to examine emotion regulation and distress tolerance as potential mediators between STS and the utilization of maladaptive coping mechanisms. Participants were 152 elder protective service workers and 105 child protective service workers who completed an online survey of self-report measures of emotion regulation, distress tolerance, STS, and coping behaviors. A parallel multiple mediator model was analyzed using structural equation modeling (SEM) to examine the hypothesis that distress tolerance and emotion regulation would mediate the relationship between STS and the utilization of maladaptive coping. Our hypothesis was partially supported as the effect of STS on maladaptive coping was mediated by emotion regulation but not by distress tolerance. The results from this study have both prevention and intervention implications. From a prevention perspective, efforts could be directed at teaching emotion regulation skills to those at risk for developing STS as a mechanism for decreasing the probability of denial, substance use, behavioral disengagement, and self-blame that may occur as a consequence of STS. From an intervention perspective, some of the negative sequelae of exposure to STS may be averted by teaching EPS and CPS workers who present with STS symptoms, emotion regulation skills.

Using an emotion-focused approach in preventing psychological birth trauma

PURPOSE

This discussion article considers how an emotion-focused approach can be adopted to prevent psychological birth trauma and to optimize perinatal wellbeing for women and their families.

CONCLUSION

Emotion-focused approaches have a different perspective when compared to other classic psychotherapy methods. This approach may help women to resolve the negative impacts of psychological birth trauma; to prevent posttraumatic stress disorder onset; to lead to better results for mother and baby well-being; and may be cost effective.

PRACTICE IMPLICATIONS

Mental health nurses/midwives should receive education about emotion-focused approaches in addition to gaining competence in basic counseling skills so that they can utilize these approaches with women.

Pandemic-activated psychological growth: significance of extraversion, self-consciousness and COVID-19 related anxiety

BACKGROUND

The sense of threat to health and life in the face of a pandemic, accompanied by difficulties imposed by lockdown, may trigger a serious crisis. Among possible consequences of such a crisis may paradoxically be the phenomenon of psychological growth. The aim of this article is to identify predictors of pandemic-activated psychological growth (PPG). The relationships between extraversion, reflective and ruminative self-consciousness and PPG were the subject of our inquiry. Additionally, a question was posed about the indirect effect of self-consciousness on PPG through anxiety.

PARTICIPANTS AND PROCEDURE

The study involved 1206 participants aged 18 to 26 years, who declared that the pandemic situation significantly threatened their important life goals. Procedure: cross-sectional design. Four online short questionnaire-measures were used: the Ten-Item Personality Inventory (TIPI), the Rumination-Reflection Questionnaire (RRQ), the Current Self-disposition Scale (CSS), and the Post-traumatic Growth Inventory (PTGI).

RESULTS

Extraversion and reflective self-consciousness were direct predictors of higher PPG, whereas ruminative self-consciousness was directly related to a lower PPG. There was an indirect effect of ruminative self-consciousness on PPG through COVID-19 related anxiety.

CONCLUSIONS

Although the results do not confirm the permanence of a growth effect, finding PPG predictors considered as beneficial resources for coping with difficult pandemic circumstances appears to be valuable in the current state of affairs.

Predictors of posttraumatic stress symptom severity and meaning made in treatment-seeking veterans

OBJECTIVE

Combat-exposed veterans risk encountering events that disrupt beliefs. To facilitate reduced discrepancy between prior beliefs and current trauma appraisals, veterans may engage in a process of meaning-making. Meaning-making can lead to positive outcomes, such as integrating the traumatic event into one's life narrative or adapting global meaning (meaning made) or elicit distress. Given these potentially different outcomes, this study examined potential correlates of posttraumatic stress symptom (PTSS) severity and meaning made, including relationship attachment dimensions of anxiety and avoidance, and difficulties with emotion regulation, while controlling for combat exposure.

METHOD

Veterans receiving mental health services at a Veterans Affairs (VA) Medical Center and a VA community-based outpatient clinic (N = 130) completed measures through a paper-and-pencil survey. Almost all participants (92%) were male, with a mean age of 55.92 years.

RESULTS

In terms of meaning made, lower levels of attachment anxiety and emotional clarity (an aspect of emotion regulation) predicted higher meaning made. In terms of PTSS severity, higher attachment avoidance, attachment anxiety, and difficulties engaging in goal-directed behavior (an aspect of emotion regulation) significantly predicted higher PTSS severity.

CONCLUSION

Aspects of both attachment style and emotion regulation difficulties affect meaning made and PTSS severity. These constructs may be especially relevant for clinicians working with veterans to help PTSS and support meaning made postcombat.

Emotion dysregulation and heart rate variability improve in US veterans undergoing treatment for posttraumatic stress disorder: Secondary exploratory analyses from a randomised controlled trial

BACKGROUND

Emotion regulation (ER) is a key process underlying posttraumatic stress disorder (PTSD), yet, little is known about how ER changes with PTSD treatment. Understanding these effects may shed light on treatment processes.

METHODS

We recently completed a non-inferiority design randomised controlled trial demonstrating that a breathing-based yoga practice (Sudarshan kriya yoga; SKY) was not clinically inferior to cognitive processing therapy (CPT) across symptoms of PTSD, depression, or negative affect. Here, in secondary exploratory analyses (intent-to-treat N = 85; per protocol N = 59), we examined whether self-reported ER (Difficulties in Emotion Regulation Scale; DERS) and physiological ER (heart rate variability; HRV) improved with treatment for clinically significant PTSD symptoms among US Veterans.

RESULTS

DERS-Total and all six subscales improved with small-to-moderate effect sizes (d = .24-.66) following CPT or SKY, with no differences between treatment groups. Following SKY (but not CPT), HR max-min (average difference between maximum and minimum beats per minute), LF/HF (low-to-high frequency) ratio, and normalised HF-HRV (high frequency power) improved (moved towards a healthier profile; d = .42-.55).

CONCLUSIONS

To our knowledge, this is the first study to demonstrate that a breathing-based yoga (SKY) improved both voluntary/intentional and automatic/physiological ER. In contrast, trauma-focused therapy (CPT) only reliably improved self-reported ER. Findings have implications for PTSD treatment and interventions for emotional disorders more broadly.

TRIAL REGISTRATION

Secondary analyses of ClinicalTrials.gov NCT02366403 .

Abstract thinking as a risk factor for the development of posttraumatic stress disorder symptoms in student paramedics

cognitive processing is characterized by "why?" and "what if?" questions and associated with processes such as rumination and worry. The tendency to think abstractly in response to stress has not been examined as a longitudinal risk factor for later stress reactions. The present study evaluated the extent to which an abstract thinking style could represent a risk factor for posttraumatic stress disorder (PTSD) symptoms in student paramedics over a 6-month follow-up period. Student paramedics (N = 89) recruited from universities in the United Kingdom were assessed for baseline symptoms, abstract thinking, and cognitive responses to stressful memories; a follow-up assesment was conducted 6 months later in their training. All participants were exposed to a potentially traumatic event between baseline and follow-up. Baseline symptoms and trauma history accounted for 45% of the variation in follow-up posttraumatic symptoms, with abstract thinking style explaining an additional 2.5% over and above what could be predicted from initial symptom levels. Abstract thinking was moderately related to rumination in response to stressful memories, r = .45, and correlated with follow-up symptoms of PTSD, r = .49; anxiety, r = .40; and depression, r = .27. This study builds on previous work suggesting that abstract processing mode and abstract rumination are risk factors for PTSD. Abstract thinking in response to stress represents a potentially modifiable risk factor that could be targeted by a resilience-focused intervention for individuals likely to encounter traumatic events.

Emotion regulation as mediator between childhood adversity and psychopathology: A meta-analysis

Childhood adversity is a major risk factor for multiple forms of psychopathology, and recent efforts have focused on understanding the underlying psychological mechanisms. One outstanding candidate is emotion regulation, which has been associated with both childhood adversity, and psychopathology. Based on the available evidence, the present meta-analysis set out to investigate the mechanistic involvement of emotion regulation in the relation between childhood adversity and psychopathology. Systematic searches in three databases (PubMed; PsycINFO; Web of Science) identified 215 eligible studies. Using meta-analytic structural equation modeling, we fitted a partial mediation model to the available data across studies, in which childhood adversity was related to psychopathology both directly and through emotion regulation. Multiple emotion regulation dimensions were analyzed, including emotion regulation difficulties and the habitual use of rumination, distraction, reappraisal, and suppression. Measures of psychopathology included a wide range of internalizing and externalizing symptoms in both clinical and non-clinical samples. The results indicated that childhood adversity was positively associated with emotion regulation difficulties, as well as with the habitual use of rumination and suppression. In turn, these measures of emotion regulation were positively associated with psychopathology. Habitual reappraisal use showed negative relations with both childhood adversity and psychopathology. All these emotion regulation measures were supported as mediators in the relation between childhood adversity and psychopathology. In contrast, distraction was not related to childhood adversity or psychopathology, and its mediator role was not supported. These results suggest that altered emotion regulation is a consistent marker of childhood adversity and contributes to risk of psychopathology.

A Pilot Randomized Controlled Trial of Goal Management Training in Canadian Military Members, Veterans, and Public Safety Personnel Experiencing Post-Traumatic Stress Symptoms

Post-traumatic stress disorder (PTSD) is a severe psychiatric illness that disproportionately affects military personnel, veterans, and public safety personnel (PSP). Evidence demonstrates that PTSD is significantly associated with difficulties with emotion regulation (ER) and difficulties with cognitive functioning, including difficulties with attention, working memory, and executive functioning. A wide body of evidence suggests a dynamic interplay among cognitive dysfunction, difficulties with ER, and symptoms of PTSD, where numerous studies have identified overlapping patterns of alterations in activation among neuroanatomical regions and neural circuitry. Little work has examined interventions that may target these symptoms collectively. The primary objective of this pilot randomized controlled trial (RCT) with a parallel experimental design was to assess the effectiveness of goal management training (GMT), a cognitive remediation intervention, in reducing difficulties with cognitive functioning, and to determine its effects on PTSD symptoms and symptoms associated with PTSD, including difficulties with ER, dissociation, and functioning among military personnel, veterans, and PSP. Forty-two military personnel, veterans, and PSP between the ages of 18 and 70 with symptoms of PTSD were recruited across Ontario, Canada between October 2017 and August 2019. Participants were randomized to either the waitlist (WL) (n = 18) or the GMT (n = 22) condition. Participants in both conditions received self-report measures and a comprehensive neuropsychological assessment at baseline, post-intervention, and 3-month follow-up. Following their completion of the 3-month follow-up, participants in the WL condition were given the opportunity to participate in GMT. Assessors and participants were blind to intervention allocation during the initial assessment. A series of 2 (time) × 2 (group) ANOVAs were conducted to assess the differences between the WL and GMT conditions from pre- to post-intervention for the self-report and neuropsychological measures. The results demonstrated significant improvements in measures of executive functioning (e.g., verbal fluency, planning, impulsivity, cognitive shifting, and discrimination of targets) and trending improvements in short-term declarative memory for participants in the GMT condition. Participants in the GMT condition also demonstrated significant improvements from pre- to post-testing in measures of subjective cognition, functioning, PTSD symptom severity, difficulties with ER, dissociative symptom severity, and depression and anxiety symptoms. No adverse effects were reported as a result of participating in GMT. The results of this pilot RCT show promise that GMT may be a useful intervention to improve symptoms of cognitive dysfunction, symptoms of PTSD, and symptoms associated with PTSD within military personnel, veterans, and PSP. Future work is needed to address the small sample size and the durability of these findings.

Trauma Coping Self-Efficacy Mediates Associations Between Adult Attachment and Posttraumatic Stress Symptoms

Attachment orientations reflect individuals' expectations for interpersonal relationships and influence emotion regulation strategies and coping. Previous research has documented that anxious and avoidant attachment orientations have deleterious effects on the trauma recovery process leaving these survivors vulnerable to posttraumatic stress disorder (PTSD) symptoms. However, avoidant attachment may be more complicated. Prior work has also found those high in avoidant attachment but also low in anxious attachment (i.e., dismissing) may not experience such vulnerabilities. Further, avoidant attachment individuals often report higher self-efficacy than their anxiously attached counterparts. The present study examined trauma coping self-efficacy (CSE-T) as a previously unexamined mechanism of action between adult attachment and PTSD symptoms. Structural equation modeling results showed that anxious attachment was associated with lower CSE-T and greater PTSD symptoms six weeks later. Further, a significant indirect effect of anxious attachment on PTSD symptoms through CSE-T was found. Contrary to hypotheses, avoidant attachment also exhibited an indirect effect on PTSD symptoms through CSE-T, such that avoidant attachment was associated with lower CSE-T, which in turn, was associated with greater PTSD symptoms. Also contrary to hypotheses, the interaction between anxious and avoidant attachment was not significantly associated with either CSE-T or PTSD symptoms. Results suggest that both anxious and avoidant attachment orientations contribute to poor self-regulation following trauma, as they undermine perceptions of trauma coping self-efficacy.

"Post-traumatic Stress Disorder and Difficulties in Emotion Regulation Among University Students under the COVID-19 Condition"

"The new global situation of COVID-19 affects the whole world in all aspects of life including mental health. The study’s goal is to detect the relationship between post-traumatic stress disorder (PTSD) and Emotion Regulation (ER) difficulties under the COVID-19 condition. Methods: University students were asked to complete: 1) Emotion Regulation Difficulties Questionnaire (DERS) 2) PTSD Checklist (PCL- 5). 3) Life Events Checklist for DSM-5 (LEC-5). Results: There were 441 students with suspected COVID-19 symptoms out of 1195 students. When compared to students who did not have suspected COVID-19 symptoms, those who did had a greater prevalence of PTSD symptoms (18.2% vs. 4.7%) and DERS (34.5% vs. 23.3%). Additionally, correlation studies demonstrated a significant positive link (Ps< .01) between the PCL, the overall DERS, and all six categories of emotion regulation difficulties. Conclusion: Students with suspected COVID-19 symptoms have more difficulty with emotion regulation and post-traumatic stress disorder than students without such symptoms. This research recommends that during the pandemic, health professionals should implement a suitable psychological intervention for students who exhibit COVID-19 symptoms."

Examining the associations between PTSD symptoms and aspects of emotion dysregulation through network analysis

Despite the clearly established link between posttraumatic stress disorder (PTSD) and emotion dysregulation, little is known about how individual symptoms of PTSD and aspects of emotion dysregulation interrelate. The network approach to mental health disorders provides a novel framework for conceptualizing the association between PTSD and emotion dysregulation as a system of interacting nodes. In this study, we estimated the structural relations among PTSD symptoms and aspects of emotion dysregulation within a large sample of women who participated in a multi-site study of sexual revictimization (N = 463). We estimated expected influence to reveal differential associations among PTSD symptoms and aspects of emotion dysregulation. Further, we estimated bridge expected influence to identify influential nodes connecting PTSD symptoms and aspects of emotion dysregulation. Results highlighted the key role of concentration difficulties in expected influence and bridge expected influence. Findings highlight several PTSD symptoms and aspects of emotion dysregulation that may be targets for future intervention.

Positive Emotion Dysregulation in Posttraumatic Stress Disorder

Although PTSD is associated with both emotion regulation (ER) difficulties and persistent difficulties experiencing positive emotions, research concerning positive ER in PTSD is still scarce. We aimed to clarify whether PTSD patients show dysfunctional responses to positive emotions and whether positive ER is associated with PTSD symptom severity. PTSD patients (N = 59) were compared to healthy controls (HC, N = 58) with respect to their self-reported regulation of positive and negative emotions. We used the Responses to Positive Affect Questionnaire to assess positive ER and the Difficulties in Emotion Regulation Scale and Response Styles Questionnaire to assess negative ER. PTSD patients showed deficient negative as well as deficient positive ER as compared to HC. Both dampening of positive emotions as well as positive rumination were associated with self-reported symptom severity. Furthermore, dampening contributed to the prediction of PTSD symptom severity beyond depressive symptoms and negative rumination. This study supports and expands previous findings of dysfunctional positive ER in PTSD. Further research is needed to clarify whether deficits in positive ER contribute to the onset and maintenance of PTSD. If so, therapeutic approaches should aim to help PTSD patients build up adequate skills to handle positive emotions in PTSD.

Associations between executive functioning, personality, and posttraumatic stress symptoms in adolescent solid organ transplant recipients

BACKGROUND

Pediatric solid organ transplant recipients are susceptible to posttraumatic stress symptoms (PTSS), given the presence of a life-threatening chronic medical condition and potential for complications. However, little is known about what individual characteristics are associated with an increased risk for PTSS among youth who received an organ transplant. The aim of the current study was to evaluate PTSS and its associations with executive functioning (EF) and personality (i.e., neuroticism and conscientiousness) among adolescents with solid organ transplants.

METHODS

Fifty-three adolescents (M_age  = 16.40, SD = 1.60) with a kidney, heart, or liver transplant completed self-report measures of PTSS and personality, whereas caregivers completed a caregiver-proxy report of adolescent EF.

RESULTS

Twenty-two percent of adolescent transplant recipients reported clinically significant levels of PTSS. Higher EF difficulties and neuroticism levels, and lower conscientiousness levels were significantly associated with higher PTSS (rs -.34 to .64). Simple slope analyses revealed that adolescents with both high EF impairment and high levels of neuroticism demonstrated the highest PTSS (t = 3.47; p < .001).

CONCLUSIONS

Most adolescent transplant recipients in the present study did not report clinically significant levels of PTSS; however, those with high neuroticism and greater EF difficulties may be particularly vulnerable to PTSS following organ transplantation. Following transplantation, medical providers should assess for PTSS and risk factors for developing PTSS. Identification of those at risk for PTSS is critical, given the strong associations between PTSS and certain medical outcomes (e.g., medication nonadherence) among these youth.

Traumatic stress, depression, and non-bereavement grief following non-fatal traffic accidents: Symptom patterns and correlates

Non-fatal traffic accidents may give rise to mental health problems, including posttraumatic stress (PTS) and depression. Clinical evidence suggests that victims may also experience grief reactions associated with the sudden changes and losses caused by such accidents. The aim of this study was to examine whether there are unique patterns of symptoms of PTS, depression, and grief among victims of non-fatal traffic accidents. We also investigated associations of emerging symptom patterns with sociodemographic variables and characteristics of the accident, and with transdiagnostic variables, including self-efficacy, difficulties in emotion regulation, and trauma rumination. Participants (N = 328, Mage = 32.6, SDage = 17.5 years, 66% female) completed self-report measures tapping the study variables. Using latent class analysis (including symptoms of PTS, depression, and grief), three classes were identified: a no symptoms class (Class 1; 59.1%), a moderate PTS and grief class (Class 2; 23.1%), and a severe symptoms class (Class 3; 17.7%). Summed symptom scores and functional impairment were lowest in Class 1, higher in Class 2, and highest in Class 3. Psychological variables were similarly ordered with the healthiest scores in Class 1, poorer scores in Class 2, and the worst scores in Class 3. Different sociodemographic and accident related variables differentiated between classes, including age, education, and time since the accident. In a regression including all significant univariate predictors, trauma rumination differentiated Class 2 from Class 1, all three psychological variables differentiated Class 3 from Class 1, and difficulties with emotion regulation and trauma rumination differentiated Class 3 from Class 2. This study demonstrates that most people respond resiliently to non-fatal traffic accident. Yet, approximately one in three victims experiences moderate to severe mental health symptoms. Increasing PTS coincided with similarly increasing grief, indicating that grief may be considered in interventions for victims of traffic accidents. Trauma rumination strongly predicted class membership and appears a critical treatment target to alleviate distress.

Posttraumatic Stress Disorder and Relationship Satisfaction among Firefighters: The Role of Emotion Regulation Difficulties

Firefighters are exposed to potentially traumatic events throughout their careers, placing them at heightened risk for the development of posttraumatic stress disorder (PTSD). Individuals experiencing PTSD symptoms often experience interpersonal problems and relationship stress, and this may be due to emotion regulation difficulties. The current study examined the association between PTSD symptoms, couple relationship satisfaction, and emotion regulation difficulties among firefighters. Participants were comprised of 188 firefighters (M _age = 41.32, SD = 9.25, 97.3% male) who completed an online questionnaire. Results indicated that PTSD symptom severity was negatively associated with relationship satisfaction and positively associated with emotion regulation difficulties. Additionally, there was a significant negative indirect effect of PTSD symptom severity on relationship satisfaction through heightened emotion regulation difficulties. Negative alterations in cognition and mood were especially relevant to emotion regulation difficulties and relationship satisfaction. Findings highlight the importance of understanding associations between PTSD and interpersonal functioning among firefighters. Emotion regulation difficulties may offer a clinically relevant transdiagnostic factor for targeting PTSD symptoms and relationship functioning among firefighters.

Parents' resolution of their child's diagnosis: A scoping review

This scoping review focused on parents' resolution of their reactions to receiving a diagnosis for their child, based on Marvin and Pianta's model and Reaction to Diagnosis Interview (RDI). We aimed to map the populations examined, the prevalence of parents' narrated resolution, and what is known about its outcomes and determinants. A structured search identified 47 peer-reviewed papers published between 1992-2021. All employed the RDI and most had a cross-sectional design. Studies focused on a wide range of children's health and mental health diagnoses. Days to years after receiving the diagnosis, RDI narratives of 18.43% to 72.49% of the parents (44% on average) indicated lack of resolution. Studies reported associations between unresolved narratives and children's insecure attachment, higher parenting stress, and poorer parental health. However, findings on the associations of narrated resolution with parents' representations of their child, sensitivity, and psychological symptoms were equivocal, and findings on factors that may shape narrated resolution were limited. To advance the understanding of parents' narrated resolution and its effects, we recommend researchers employ prospective and longitudinal designs, evaluate narrated resolution as a continuous phenomenon, focus on outcomes derived from attachment theory, and systematically sample families from heterogenous cultures.

Examining Cultural Differences in the Associations between Appraisals and Emotion Regulation and PostTraumatic Stress Disorder in Malaysian and Australian Trauma Survivors

Appraisals and emotional regulation play a central role in posttraumatic stress disorder (PTSD). Despite research demonstrating cultural differences in everyday appraisals and emotion regulation, little research has investigated the influence of culture on these processes in PTSD. This study examined cultural differences in the associations between appraisals, emotion regulation and PTSD symptoms using trauma survivors from an individualistic Western culture (Australia) and a collectivistic Asian culture (Malaysia). Trauma survivors (N = 228; 107 Australian with European cultural heritage, 121 Malaysian with Malay, Indian or Chinese cultural heritage) completed an on-line survey assessing PTSD (PTSD Checklist for the DSM-5 with Life Events Checklist), appraisals (trauma-related, fatalism, cultural beliefs about adversity) and emotion regulation (suppression, reappraisal, interpersonal). The Malaysian group reported significantly greater fatalism, cultural beliefs about adversity, suppression and interpersonal emotion regulation than the Australian group. Greater trauma-specific appraisals, greater suppression, fewer cultural beliefs about adversity, and less use of social skills to enhance positivity were generally associated with greater PTSD symptom severity, with little evidence of cultural group moderating these associations. Interdependent self-construal mediated the relationships between cultural adversity beliefs, enhanced positivity, reappraisal, perspective taking and PTSD symptoms. Independent self-construal mediated the relationships between fatalism and perspective taking and PTSD symptoms. Cultural group did not moderate these indirect effects. Interdependent self-construal mediated the associations between interpersonal regulation strategies of soothing and social modelling with PTSD symptoms for the Malaysian but not the Australian group. These findings demonstrate the importance of considering self-construal and culture in understanding factors associated with PTSD.

Psychophysiological predictors of change in emotion dysregulation 6 months after traumatic injury

Emotion dysregulation that occurs after trauma conveys risk for multiple disorders, including posttraumatic stress disorder, depression, and anxiety. Psychophysiological data (e.g., skin conductance level [SCL]) may be a useful biomarker for quantifying emotion dysregulation given that autonomic nervous system (ANS)-mediated arousal may underlie this feature. In this longitudinal study, we tested whether SCL collected following a single-incident traumatic injury could predict changes in emotion dysregulation over 6 months. Sixty-six adults were recruited from the emergency department; SCL was quantified during an active trauma narrative, in which participants re-told their traumatic event to a research staff member, as well as a neutral narrative for a control condition. Change in SCL (ΔSCL) was calculated using a maximum activation - minimum activation difference score. Multilevel linear modeling was used to test ΔSCL as a predictor of emotion dysregulation using the Emotion Dysregulation Scale (EDS) over time (3 timepoints over 6 months). Results showed that greater ΔSCL - indicative of increasing arousal- during both the trauma (p = 0.037) and neutral (p = 0.013) narratives was a significant predictor of greater emotion dysregulation at each subsequent timepoint. Further, we found a ΔSCL by time interaction, such that less ΔSCL during the neutral narrative predicted decreased emotion dysregulation over time (b = -1.26, SE = 0.43, t = -2.91, p = 0.004). Results validate the use of lab-based assessments of arousal to study emotion dysregulation in trauma survivors. That recovery from emotion dysregulation was predicted by less arousal during a neutral event underscores the importance of clinically targeting response to safety in trauma survivors.

An examination of the relations between emotion dysregulation, dissociation, and self-injury among dissociative disorder patients

BACKGROUND

Dissociative disorder (DD) patients report high rates of self-injury. Previous studies have found dissociation and self-injury to be related to emotional distress. To the best of our knowledge, however, the link between emotion dysregulation and self-injury has not yet been examined within a DD population.

OBJECTIVE

The present study investigated relations between emotion dysregulation, dissociation, and self-injury in DD patients, and explored patterns of emotion dysregulation difficulties among DD patients with and without recent histories of self-injury.

METHOD

We utilized linear and logistic regressions and t-test statistical methods to examine data from 235 patient-clinician dyads enrolled in the TOP DD Network Study.

RESULTS

Analyses revealed emotion dysregulation was associated with heightened dissociative symptoms and greater endorsement of self-injury in the past six months. Further, patients with a history of self-injury in the past six months reported more severe emotion dysregulation and dissociation than those without recent self-injury. As a group, DD patients reported the greatest difficulty engaging in goal-directed activities when distressed, followed by lack of emotional awareness and nonacceptance of emotional experiences. DD patients demonstrated similar patterns of emotion dysregulation difficulties irrespective of recent self-injury status.

CONCLUSIONS

Results support recommendations to strengthen emotion regulation skills as a means to decrease symptoms of dissociation and self-injury in DD patients.

The Effect of Cognitive-Affective Factors on PTSD and Alcohol Use Symptoms: An Investigation on Rumination, Suppression, and Reappraisal

Background: Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) are mental health conditions that often co-occur. The complexity of this comorbidity is well-documented, though the role of malleable cognitive-affective factors in PTSD/AUD warrants further study. Specifically, attaining a more comprehensive understanding of the role of malleable cognitive-affective factors in individuals with symptoms of PTSD/AUD may have important implications for future research, such as in treatment-seeking individuals. Extant examinations of cognitive-affective factors have demonstrated unique associations of cognitive reappraisal, expressive suppression, and rumination in PTSD symptom severity, though these effects had yet to be explored in subgroups of comorbid PTSD/AUD.Methods: In a sample of trauma-exposed individuals (n = 334) recruited to participate through an internet labor market, we first empirically examined latent subgroups of PTSD/AUD symptoms using latent profile analysis, then included expressive suppression, cognitive reappraisal, and four dimensions in the model to elucidate their role in specific profile patterns of PTSD/AUD symptom typologies.Results: Our results support a four-class model of PTSD/AUD symptoms, with unique predictive effects of expressive suppression, problem-focused thoughts, repetitive thoughts, and anticipatory thoughts on latent profile status.Conclusions: These findings may have important implications for future research focused on examining cognitive-affective patterns as they apply to intervention techniques in treatment-seeking individuals with symptoms of PTSD/AUD.

Psilocybin for Trauma-Related Disorders

Posttraumatic stress disorder (PTSD) is a debilitating, chronic disorder and efficacy rates of current PTSD treatments are underwhelming. There is a critical need for innovative approaches. We provide an overview of trauma and PTSD and cite literature providing converging evidence of the therapeutic potential of psilocybin for PTSD. No study to date has investigated psilocybin or psilocybin-assisted psychotherapy (PAP) as treatments for PTSD. An open-label study in traumatized AIDS survivors found that PAP reduced PTSD symptoms, attachment anxiety, and demoralization. Several PAP trials show preliminary efficacy in facilitating confronting traumatic memories, decreasing emotional avoidance, depression, anxiety, pessimism, and disconnection from others, and increasing acceptance, self-compassion, and forgiveness of abusers, all of which are relevant to PTSD recovery. There is also early evidence that other classic psychedelics may produce large reductions in PTSD symptoms in combat veterans. However, this body of literature is small, mechanisms are not yet well understood, and the risks of using psychedelic compounds for trauma-related disorders need further study. In sum, evidence supports further investigation of PAP as a radically new approach for treating PTSD.

The Process of Learning Mindfulness and Acceptance through the Use of a Mobile App Based on Acceptance and Commitment Therapy: A Grounded Theory Analysis

This study aimed to explore the process of how college student military veterans with posttraumatic stress disorder (PTSD) symptoms learn mindfulness and acceptance through the use of a mobile app based on acceptance and commitment therapy (ACT). Twenty-three college student veterans with PTSD symptoms participated in the 4-week ACT mobile app-based intervention and took part in three weekly semi-structured interviews. Results of the grounded theory data analysis reveal the core category of Mindful Scaffolding, a process indicating how student veterans cope with the interruptions and intrusions associated with learning mindfulness and acceptance through the use of the ACT-based app. The grounded theory provides a foundational theoretical framework for increasing adherence with using mindfulness- and acceptance-based mobile app interventions for PTSD.

A Preliminary Evaluation of the Unified Protocol among Trauma-Exposed Adults with and without PTSD

The purpose of this study was to evaluate whether the Unified Protocol (UP)-a mechanistically transdiagnostic psychological treatment-provides benefit to individuals with a range of trauma histories, psychological difficulties, and diagnostic comorbidity. Using data from a sequential multiple-assignment randomized trial (SMART), this exploratory analysis included a sample of 69 community-recruited adults seeking outpatient mental health treatment. We examined reductions in anxiety and depressive symptoms and changes in aversive and avoidant reactions to intense emotions-the UP's putative mechanism-first by comparing individuals with and without trauma histories and then specifically among participants with PTSD. Findings suggest that the UP may lead to similar improvements in clinical diagnostic severity, anxiety, and depression among patients with trauma exposure as those without trauma exposure. Roughly half of participants with PTSD demonstrated reductions in PTSD clinical severity, anxiety, depression, and distress aversion, suggesting the UP may be an efficacious treatment for people with PTSD and comorbid conditions.

Link between History of Childhood Maltreatment and Emotion Dysregulation in Adults Suffering from Attention Deficit/Hyperactivity Disorder or Borderline Personality Disorder

Childhood maltreatment (CM) may have a long-term effect on emotion regulation. This study aimed to explore the relationship between CM and emotion dysregulation (ED) in a heterogeneous population. Four hundred seventy French-speaking outpatients (N = 279 ADHD, N = 70 BPD, N = 60 ADHD + BPD, N = 61 clinical controls) completed the Emotion Reactivity Scale (ERS), the Cognitive Emotional Regulation Questionnaire (CERQ), the Childhood Trauma Questionnaire (CTQ), and the Relationship Scales Questionnaire (RSQ). Reports of childhood maltreatment experiences were significantly associated with increased levels of emotion reactivity in all our groups and in the whole population, with a greater use of non-adaptive cognitive emotion regulation strategies and insecure attachment patterns. Emotional abuse showed the strongest effect. Further analysis indicated that an anxious attachment style significantly mediated the relationship between CM and the use of non-adaptive cognitive emotion regulation strategies and emotion reactivity. The results of our study suggest an impact of CM on ED and a potentially marked effect of emotional abuse. They also indicate a potentially mediating role of insecure attachment in the relationship between a history of childhood abuse and emotion reactivity and a higher use of non-adaptive cognitive emotion regulation strategies in adulthood.

The mediating role of emotion dysregulation in the association between trait mindfulness and PTSD symptoms among trauma-exposed adults

Objectives

Growing evidence of the effectiveness of mindfulness-based interventions for posttraumatic stress disorder (PTSD) warrants greater understanding of factors relevant to the relation between trait mindfulness and PTSD, such as emotion dysregulation (ED). The goal of this study was to examine associations between trait mindfulness, ED, and PTSD symptoms across two samples of trauma-exposed adults.

Methods

Participants for Sample 1 (n = 39, 90% women, 100% Black) and Sample 2 (n = 60, 100% women, 87% Black) were recruited from an urban hospital in the South. Trait mindfulness, ED, and PTSD were assessed.

Results

Across both samples, mindfulness and ED were significantly associated with overall PTSD severity (r = -.49 and r = -.42, ps = .001; r = .53 and r = .51, ps < .001, respectively) in the expected direction. In Sample 1, mindful nonjudgment and difficulty with emotion regulation strategies showed the strongest associations with overall PTSD severity as well as symptom clusters. In Sample 2, mindful acceptance and all ED dimensions (except non-awareness) showed strong associations with overall PTSD severity and particularly with negative cognitions and mood symptoms. In both samples, ED mediated the association between mindfulness and overall PTSD severity (Sample 1: ab = -.15, 95%CI [-.35, -.02]; Sample 2: ab = -.11, 95%CI [-.22, -.04]).

Conclusions

These findings demonstrate the important role of ED in the relation between trait mindfulness and PTSD symptoms among trauma-exposed adults. They highlight the value of examining ED as a mechanism of change in mindfulness-based interventions for PTSD.

Clinical Trials Registration Information

Sample 1: NCT03922581, April 22, 2019; NCT03938350, May 6, 2019; Sample 2: NCT02754557, April 28, 2016.

Reappraisal-related neural predictors of treatment response to cognitive behavior therapy for post-traumatic stress disorder

BACKGROUND

Although trauma-focused cognitive behavior therapy (TF-CBT) is the frontline treatment for post-traumatic stress disorder (PTSD), one-third of patients are treatment non-responders. To identify neural markers of treatment response to TF-CBT when participants are reappraising aversive material.

METHODS

This study assessed PTSD patients (n = 37) prior to TF-CBT during functional magnetic brain resonance imaging (fMRI) when they reappraised or watched traumatic images. Patients then underwent nine sessions of TF-CBT, and were then assessed for symptom severity on the Clinician-Administered PTSD Scale. FMRI responses for cognitive reappraisal and emotional reactivity contrasts of traumatic images were correlated with the reduction of PTSD severity from pretreatment to post-treatment.

RESULTS

Symptom improvement was associated with decreased activation of the left amygdala during reappraisal, but increased activation of bilateral amygdala and hippocampus during emotional reactivity prior to treatment. Lower connectivity of the left amygdala to the subgenual anterior cingulate cortex, pregenual anterior cingulate cortex, and right insula, and that between the left hippocampus and right amygdala were also associated with symptom improvement.

CONCLUSIONS

These findings provide evidence that optimal treatment response to TF-CBT involves the capacity to engage emotional networks during emotional processing, and also to reduce the engagement of these networks when down-regulating emotions.

Go Greener, Less Risk: Access to Nature Is Associated with Lower Risk Taking in Different Domains during the COVID-19 Lockdown

Specific risk attitude and risky behavior had an important boost during the coronavirus disease 2019 (COVID-19) pandemic. In this contribution, we hypothesize that access to nature during home confinement will decrease both the tendency to passive risk taking and alcohol intake. To do so, we interviewed through an online survey two samples of Italian residents during the strict lockdown due to the first wave of the COVID-19 pandemic. Specifically, in Study 1, participants were 1519 Italian residents coming from different Italian regions, whilst in Study 2, participants were 182 students at a university of southern Italy who were monitored for one week. In Study 1, the hierarchical regression analysis attested that access to nature during the lockdown mitigated the tendency to passive risk taking, over and beyond the effect of socio-demographic variables and the psychological construct of impulsiveness, an important personality correlate of risk taking. In Study 2, the hierarchical regression showed that access to green was associated with fewer glasses of alcohol drunk in a week of lockdown. This effect held over and above the effect of socio-demographic variables and the drinking behavior before the outbreak of the COVID-19 pandemic. In both studies, findings confirmed the beneficial effect of access to nature in specific risk-taking domains. Theoretical future directions, as well as practical implications for the management of the COVID-19 emergency by policymakers, are discussed.

Venezuelan Forced Migration to Peru During Sociopolitical Crisis: an Analysis of Perceived Social Support and Emotion Regulation Strategies

While many studies have examined the impact of forced migration on Venezuelan migrants in Latin America, to date scholars have not examined the effect of certain coping mechanisms, namely social support and emotion regulation. Using data from 386 Venezuelan migrants living in Peru (M = 20.22 years, SD = 1.33, 46.4% women), we investigated whether perceived social support from three different sources (family, friends, and significant other) correlated with emotion regulation strategies (cognitive reappraisal and suppression) while controlling for the type of cohabitation and time of residence. The results (1) confirmed the originally proposed internal structure of the Multidimensional Perceived Social Support Scale and Emotion Regulation Questionnaire, showing reliability and validity even in a sample of migrants. Findings demonstrated that (2) perceived social support from family positively predicted cognitive reappraisal strategy when including friends and significant other as covariates; (3) Venezuelans who have resided longer in Peru compared to more recent migrants used cognitive reappraisal strategy at a higher rate despite perceiving low family social support; (4) Venezuelans who resided in Peru for a longer period of time reported higher suppression strategy use when having low significant other support; and (5) there were gender differences regarding cognitive reappraisal as a dependent variable. More specifically, in men, family was a better predictor than friend or significant other support, while among women, family and significant other had the biggest impact. These results demonstrate the importance of social support elements and time of residence on the healthy management of emotions under difficult circumstances, such as forced migration.

Neural correlates of emotional reactivity and regulation in traumatized North Korean refugees

Refugees often report heightened emotional reactivity and emotion regulation difficulties and are at high risk for mental health problems. Given that refugees are repeatedly exposed to traumatic events that may cause changes in the brain, the present study examined neural correlates of emotional reactivity and regulation and their associations with refugee features (e.g., cumulative trauma) and the severity of psychiatric symptoms (e.g., post-traumatic stress disorder [PTSD]) in North Korean (NK) refugees. Forty NK refugees with trauma exposure and varying levels of psychopathology and 41 healthy South Korean (SK) controls without trauma exposure participated in this study. They performed an emotion regulation task during a functional magnetic resonance imaging (fMRI) assessment. Region of interest (ROI), whole brain, and generalized psychophysiological interaction (gPPI) analyses were conducted. NK refugees with trauma exposure and varying levels of psychopathology showed increased activation in response to negative socio-affective pictures in regions involved in affective processing, including the amygdala and hippocampus, relative to healthy SK controls without trauma exposure. They also exhibited greater prefrontal cortex (PFC) activation, amygdala-PFC functional connectivity (FC), and hippocampal-PFC FC during emotion regulation. More severe PTSD symptoms were associated with greater hippocampal response to negative pictures (vs. neutral pictures) in NK refugees. This study provides neuroscientific evidence for neural alterations in association with emotional reactivity and regulation in traumatized refugees. These findings may contribute to a better mechanistic understanding of emotional reactivity and regulation in refugees and suggest potential ways to address the emotional and mental problems of traumatized refugees.