Evaluation of the Psychometric Properties of the 18-Items Dysfunctional Attitudes Scale (Form B) in a Portuguese Sample of People Aged 60 and Over

The aim of the study is to assess the psychometric properties of the Portuguese version of the 18-items Dysfunctional Attitudes Scale (Form B) in a Portuguese sample of people aged 60 and over. Background: The 18-item Dysfunctional Attitudes Scale (Form B) is an instrument for assessing dysfunctional attitudes and can be useful as a predictor of depression for both initial episodes and relapses Methods: This was a one-stage cross-sectional survey of Portuguese-speaking people aged 60 years and over, able to read and write, functionally autonomous, and living in the community in their usual residences. The instrument was evaluated for its psychometric properties. Convergent validity with the Beck Depression Inventory-II was assessed. Results: The Portuguese version of the 18-item Dysfunctional Attitudes Scale (Form B) was structured into three factors, which explained a total of 58.95% of the total variance of the instrument. The exploratory factor analysis resulted in a modified model in which three factors were obtained with an eigenvalue greater than one (Kaiser's criterion). Three factors were obtained instead of two as in the original study. It showed an internal consistency (Cronbach's alpha = 0.770) and an interclass correlation coefficient ranging from 0.166 to 0.449, and the overall convergent validity with the Beck Depression Inventory-II was considered good; Conclusions: The Portuguese version of the Dysfunctional Attitudes Scale (DAS-18B) of people aged 60 and over demonstrated good psychometric properties.

Frontal lobe-related cognition in the context of self-disgust

Self- disgust is an adverse self-conscious emotion that plays an important role in psychopathology and well-being. However, self-disgust has received little attention in the emotion literature, therefore our understanding of the processes underlying the experience of self-disgust is relatively scarce, although neuropsychological and neuroimaging studies support the idea that this emotion may heavily rely on frontal lobe-related cognition. To test this hypothesis, in two studies we investigated the relationship between state and trait levels of self-disgust, cognition and emotion regulation in healthy adults. Specifically, in Study 1 we tested the hypothesis that emotion regulation strategies (avoidance, suppression, and cognitive reappraisal) mediate the relationship between inhibition ability and state and trait levels of self-disgust. In Study 2, we followed a more comprehensive approach to test the hypothesis that frontal lobe-related cognitive processes (updating, Theory of Mind-ToM-, and self-attention) are closely related to the experience of self-disgust in healthy adults. Overall, across these studies, we found evidence to support the idea that inhibition ability and ToM may play a role in the experience of state and trait self-disgust, respectively. However, we did not find consistent evidence across the two studies to support the notion held in the literature that the experience of self- conscious emotions, in this case self-disgust, is heavily dependent on frontal lobe-related cognition.

A Serial Mediation Model of Insecure Attachment and Psychological Distress: The Role of Dispositional Shame and Shame-Coping Styles

Shame is an intense, difficult to regulate, self-conscious emotion that predicts aspects of poor psychological functioning and is also strongly related to early relationships. Attachment insecurities, which constitute non-specific risk factors for psychological maladjustment, have been associated with an individual's tendency to experience shame. In this study, we sought to examine the serial mediating roles of dispositional shame and shame-coping styles (i.e., attack other, attack self, withdrawal and avoidance) in the association between anxious and avoidant attachment, and psychological distress. Using a cross-sectional design, self-reported data were collected. The study sample included 978 respondents (57% female) with a mean age of 32.17 ± 13.48 years. The results of the path analysis indicated that both attachment dimensions were sequentially associated with dispositional shame and then with the attack self shame-coping style, which was, in turn, positively related to psychological distress. Further, attachment insecurities were sequentially associated with dispositional shame and then with the avoidance shame-coping style, which was, in turn, negatively related to psychological distress. The model was gender invariant, suggesting that the serial mediation worked in a similar way for men and women. The practical implications of these findings are discussed.

Understanding loneliness: The roles of self- and interpersonal dysfunction and early parental indifference

Many factors are implicated in developing and maintaining loneliness, including aspects of personality functioning and experience of early adverse childhood events. This study aimed to examine the relationship between domains of personality dysfunction, including self- and interpersonal functioning, and loneliness and determine whether such personality factors mediate the relationship between childhood parental indifference and loneliness. In total, 393 community-dwelling adults, mean age 34.3 (SD = 12.67), were recruited online for cross-sectional assessment of loneliness, personality functioning, big-five personality traits and perceived childhood parental indifference. Linear regression analyses were conducted followed by a parallel mediation model. Self- and interpersonal dysfunction were positively associated with loneliness and remained significant predictors of loneliness after controlling for five-factor personality traits. Impaired personality functioning accounted for 12% of loneliness variance. Finally, self-dysfunction mediated the relationship between childhood parental indifference and loneliness. Findings emphasize the importance of addressing personality functioning when developing psychosocial interventions aimed at tackling loneliness.

A meta-analysis of the association between shame and dissociation

Shame and dissociation have been implicated theoretically and empirically in trauma exposure and its sequelae, with shame understood as an intense negative emotion and dissociation as a reaction to intense negative emotions. Understanding the connection between shame and dissociation is important for theory and practice; however, the strength of this association remains unclear. For example, in therapy, both shame and dissociation serve as a barrier to engaging with emotion. Theoretically, these two states should be distinct, as one (dissociation) confers low affective intensity and the other (shame) high intensity. The present meta-analysis focused on the magnitude of the association between these two phenomena and investigated the extent to which gender, trauma exposure, psychiatric comorbidities, and demographic characteristics influence this association given their independent links to shame and dissociation. An initial search of six databases identified 151,844 articles. Duplicates were removed, and additional articles were excluded based on abstract and title screening. After contacting authors for missing data, a full-text screen yielded 25 articles for the present analysis. The results indicate that shame and dissociation were moderately correlated (k = 33, n = 4,705), r = .42, 95% CI [.35, .48], p < .001, but no clear clinical moderators emerged. Despite this association, very few studies utilized experimental designs to examine the association between these constructs. Future research should focus on experimental study designs to investigate the extent to which shame induces dissociation or vice versa.

Is shame the missing link between traumatic experiences and posttraumatic stress disorder in Burundian children living on the streets?

BACKGROUND

Shame is an emotion reflecting an anticipated social devaluation of the self. It is strongly associated with experiences of humiliation and rejection in early life. Individuals suffering from posttraumatic stress disorder (PTSD) often struggle with shame. However, little is known about how shame contributes to the development and maintenance of PTSD symptoms in children. The present study investigated the ways childhood exposure to human-induced traumatic events promotes a coping mechanism of defeat and withdrawal facilitated by the experience of shame. We tested a dose-response relationship between lifetime experienced traumatic event types and PTSD in children using shame as a mediator.

METHODS

We conducted semi-structured interviews with 33 male children who lived and worked on the streets of Bujumbura, the capital of Burundi at the time of data collection. We assessed self-reported PTSD symptom severity, lifetime traumatic event load, violence experienced on the streets, and shame intensity.

RESULTS

Mediation analyses revealed a significant indirect effect of lifetime traumatic events on PTSD symptom severity through shame intensity and a significant indirect effect of violence experienced on the streets on PTSD symptom severity through shame intensity.

CONCLUSION

Our study suggests the mediating role of shame between traumatic experiences as well as violent experiences and PTSD symptom severity in children living on the streets. Shame in children suffering from PTSD seems to play a crucial role in the development and maintenance of PTSD symptoms.

Early shaming experiences and psychological distress: The role of experiential avoidance and self-compassion

OBJECTIVES

Early shaming experiences have been suggested to be associated with later psychopathological symptoms. Understanding this relationship is complex, due to a number of psychological processes potentially influencing this. Therefore, the aim of the current study was to further explore the nature of the mediating effect of experiential avoidance in the association between early shame experiences and psychological distress, and whether self-compassion moderates this relationship by mitigating the effects of this.

DESIGN

A cross-sectional design was conducted using self-report measures of early shaming experiences, experiential avoidance, self-compassion, and psychological distress.

METHOD

An online study of 556 participants, comprised of participants from the general population and university students participated within this online study.

RESULTS

The moderated mediation model explained 51% of variance within depressive symptoms. Experiential avoidance was found to mediate the association between early shaming experiences and depressive symptoms. This mediating relationship was shown to be moderated by self-compassion, with higher levels of self-compassion being associated with lower levels of depressive symptoms across all levels of experiential avoidance levels (low, medium, and high).

CONCLUSION

These findings suggest that self-compassion may play a significant buffering role within attenuating the effects of experiential avoidance associated with depressive symptoms. Such findings present important clinical and theoretical implications in further understanding the protective role of self-compassion within early shaming experiences and the relationship between depressive symptoms.

PRACTITIONER POINTS

Early shaming experiences have been linked to later psychological distress. Experiential avoidance identified a core underlying psychological process in the relationship between early shaming experiences and psychological distress. Self-compassion offers a range of protective features that may alleviate the effects of experiential avoidance and depressive symptoms. Self-compassion-based interventions that target experiential avoidance may offer greater reductions within depressive symptoms.

Dissociation and emotion regulation strategies: A meta-analytic review

OBJECTIVE

Clinical and neurobiological models posited that dissociative mechanisms might affect processes involved in emotional generation and regulation. However, there is a lack of a comprehensive theoretical framework that systematically includes dissociation within emotional functioning.

METHODS

The current study aims at conducting a meta-analytic review on the relationship between dissociation and emotion regulation in order to empirically estimate to what extent dissociation is related to emotion regulation processes. The meta-analysis was based on r coefficient as effect size measure, using a random-effect approach.

RESULTS

The meta-analysis included 57 independent studies for a total of 11596 individuals. Findings showed an overall moderate relationship between dissociation and emotion regulation (r_w = .32; p < .05). The association between dissociation and emotion regulation was the same among clinical samples than non-clinical ones. Furthermore, dissociation showed moderate to large relationships with maladaptive domains of emotion regulation, namely disengagement (r_w = 0.34; p < .01) (i.e., behavioral avoidance, experiential avoidance, thought and emotional suppression) and aversive cognitive perseveration (r_w = 0.38; p < .001) (i.e., rumination, worry and nonacceptance). The analysis did not find significant relationship between dissociation and adaptive domain of emotional regulation (i.e., problem solving, mindfulness).

CONCLUSION

Dissociation in the context of emotion regulation might be viewed as a basic neuro-mental mechanism that automatically contribute to the over-modulation of emotional states through avoidance reactions from internal and external reality. Future longitudinal studies are needed to clarify the causal relationships between dissociation and emotion regulation.

Adaptation of the Fears of Compassion Scale into Turkish: a reliability and validity study

BACKGROUND

The concept of fear of compassion draws the interest of researchers in both clinical and scientific fields. The Fears of Compassion Scale (FCS) was developed in order to examine the fear of compassion for others, compassion from others and compassion for one's self. This study aims to adapt the FCS into the Turkish language. The Satisfaction with Life Scale and the Self-Compassion Scale were used to assess the criterion-related validity of the FCS.

PARTICIPANTS AND PROCEDURE

In order to determine the construct validity of the scale, validity and reliability studies and factor analysis were carried out on 681 participants (Mage = 32.00, SD = 10.15; 64% female and 36% male).

RESULTS

The results of the confirmatory factor analysis yielded the expected 3-factor solution (the fear of compassion for others, the fear of compassion from others and the fear of self-compassion), which consists of 35 items. The internal consistency validity coefficient of the whole scale was .92. Moreover, there were significant negative relationships between the Fears of Compassion Scale, the Satisfaction with Life Scale and Self-Compassion Scale, which are similar to those of the original scale.

CONCLUSIONS

These significant findings reveal the Turkish adaptation of the FCS to be a valid and reliable measurement tool.

The Compassionate Kitbag: A creative and integrative approach to compassion-focused therapy

PURPOSE

This paper outlines the concept of the 'Compassionate Kitbag', a novel multi-sensory-based means of helping draw together the various elements of compassionate mind training and processes within compassion-focused therapy (CFT), to help clients cultivate and facilitate their capacities for compassion. Building on the work of Lucre and Corten (2013, Psychology and Psychotherapy: Theory, Research and Practice, 86, 387), this is the first published work exploring this concept and the theoretical underpinnings, with a specific focus on how this can be used to support people with attachment and relational trauma.

METHODS

A narrative review of the literature on multi-sensory stimulation in facilitating people's capacities for compassion was conducted, coupled with a review of the literature of the use of non-human and transitional objects as explained by attachment theory and the broader scientific research underpinning the CFT model.

RESULTS

Clinical examples of how to use the Compassionate Kitbag to help stimulate compassionate therapeutic processes demonstrate the benefits of and how to begin utilizing this approach in compassion-focused work with clients with complex needs.

CONCLUSIONS

The Compassionate Kitbag's potential therapeutic value lies in offering multifarious creative and tangible means of accessing compassion to a wide range of individuals whom are typically fearful of, blocked, and/or resistant to compassion. Further research into the wider application of the concept of the Compassionate Kitbag is needed.

PRACTITIONER POINTS

Many patients with ruptured and/or traumatized early attachment relationships can find more traditional talking therapies difficult to access. Compassion-focused therapy (CFT) can offer an evolutionary-based understanding of interpersonal difficulties which can be helpful for such patients. Creatively harnessing and utilizing multi-sensory and non-linguistic social signals in CFT is key to exercising the care-giving and care-receiving social mentalities that facilitate compassionate flow. There is considerable evidence to support the use of a multi-sensory component to the therapeutic work to help patients cultivate and facilitate their capacities for compassion. The Compassionate Kitbag can be a way of supporting patients to create concrete representations of compassion in the context of the compassionate mind training component of the therapeutic work. Some of these objects can become transitional objects which can aid the therapeutic work.

Affective and cognitive factors associated with hallucination proneness in the general population: the role of shame and trauma-related intrusions

Introduction: Feelings of shame may be an important factor implicated in the onset and maintenance of hallucination (or hearing voices). Shame has been shown to increase trauma-related intrusions and avoidance and may reinforce negative beliefs about the self, which in turn may contribute to hallucinations in clinical and non-clinical populations. To our knowledge, no study has so far explored the role of shame in hallucination-proneness. Therefore, the main goal of the present study is to explore the mediation role of shame, trauma-related intrusions and avoidance in the association between childhood trauma and hallucination-proneness.Methods: Self-report questionnaires were used to assess past traumatic experiences, trauma-related symptoms, shame, and hallucination proneness in 175 participants from the general population.Results: Mediation analyses (joint-significance test and Monte Carlo test) showed that both shame and intrusions mediated the association between childhood trauma and hallucination-proneness.Conclusions: Our results reinforce the importance of considering previous experiences of trauma and trauma-related symptoms, including feelings of shame in individuals experiencing hallucinations. Moreover, this study reinforces previous studies showing some preliminary evidence that compassion-focused therapy, whose primary goal is to reduce shame by increasing self-compassion, could have a significant effect on voices whose content is hostile.

The Origins of Fears of Compassion: Shame and Lack of Safeness Memories, Fears of Compassion and Psychopathology

Empirical and clinical research suggests that some individuals find self-generating compassion and receiving compassion from others difficult and aversive. However, it is unclear how these fears of compassion are linked to early experiences and to psychopathological symptoms. This study explores the relationship between shame traumatic memories, centrality of shame memories, early memories of warmth and safeness, fears of compassion, and depression, anxiety and paranoid symptoms. Participants were 302 individuals from the general community population, who completed self-report measures of fears of compassion, shame memories, early affiliative memories, and psychopathology. Shame traumatic and central memories were positively associated with fears of compassion for self, for others and from others, whereas early memories of warmth and safeness were negatively related to such fears. Path analyses revealed that fears of compassion for self and of receiving compassion from others mediated the effects of shame traumatic memory, centrality of shame memory and early memories of warmth and safeness on depressive, anxious and paranoid symptoms. These findings have implications for therapeutic interventions as these fears, as well as the negative shame-based emotional memories fuelling them, may need to be addressed in therapy to assist patients in self-generating and receiving compassion.

Development of a measure for the assessment of peer-related positive emotional memories

OBJECTIVES

Previous research has demonstrated a link between early experiences of warmth, safeness, and soothing, and positive feelings, health, and well-being outcomes. Although the impact of positive parent-related early relationships and its posterior recall is well documented, research on the recall of warmth and safeness experiences within early peer relationships remains scarce. In fact, it is considered that the protective role of early positive peer relationships deserves intensive research; however, a specific measure that assesses this construct is still to be created. This study describes the development and validation of a new measure designed to assess the recall of early experiences of warmth, safeness, and affection in relation to peers (EMWSS-peers).

DESIGN AND METHODS

Distinct samples, comprising individuals of both genders aged between 18 and 68 years old, were used to test the EMWSS-peers factorial structure through principal axis factoring (PAF) and confirmatory factor analysis (CFA), and to examine its psychometric properties.

RESULTS

Principal axis factoring's results indicated that the 12-item scale presents a one-factor structure explaining a total of 71.50% of the variance. The CFA confirmed the plausibility of this structure. The EMWSS-peers also presented excellent internal consistency and construct, concurrent, and divergent validities.

CONCLUSIONS

The EMWSS-peers seems to be a new avenue for the study of memories of early experiences with friends and colleagues and may entail a relevant contribution to clinical and research fields, particularly for upcoming investigations on the relationship of peer-related affiliative memories with well-being and mental health.

PRACTITIONER POINTS

The EMWSS-peers is a specific measure to assess the recall of warmth and safeness in early peer relationships. The EMWSS-peers is a brief, robust, and reliable self-report instrument. The EMWSS-peers presented excellent internal consistency and construct, concurrent, and divergent validities. The EMWSS-peers may open a new avenue for the study of memories of early peer-related experiences, with potential clinical and research implications.

Group cognitive behavioural therapy with compassion training for depression in a Japanese community: a single-group feasibility study

OBJECTIVE

Depression is a representative mental problem, and more than 350 million people are suffering in the world. Cognitive behavioural therapy (CBT) in individual or group formats is mainly recommended in major guidelines. However, patients with high self-criticism have a poor response to CBT. To treat such patients, psychotherapies focusing on compassion are gaining attention. Although trials have begun to be reported, there are relatively few studies examining the effectiveness of group CBT with compassion work for managing depression. The purpose of this study was to evaluate the feasibility and acceptability and the estimate effect size of group CBT with compassion training for future controlled studies.

RESULTS

Fourteen participants were enrolled in the trial, of which 13 completed the intervention, and 12 completed a 6-month follow-up assessment. Participants received a 1 h group-based CBT with compassion training session every week for 10 weeks. The effect of the intervention on participants' Beck Depression Inventory score was examined using a general linear mixed model. This analysis showed an effect size of d = 1.12 at post intervention and d = 0.92 at 6-month follow-up. Group cognitive behavioural therapy with compassion training for depression shows feasibility and acceptability in a Japanese community. Trial Registration UMIN000015007.

Is Shame Hallucinogenic?

Research into the causes of "hearing voices," formally termed auditory verbal hallucinations (AVH), has primarily focused on cognitive mechanisms. A potentially causative role for emotion has been relatively neglected. This paper uses historical and contemporary case studies of AVH to tentatively generate the hypothesis that shame can be a causal factor in the onset of AVH. Other sources of support for the generation of this hypothesis are then sought. First, evidence is examined for a role of shame in the etiology of post-traumatic stress disorder, a condition that is characterized by phenomena related to AVH (intrusions and dissociation) and in which a substantial minority of sufferers report AVH. Second, the effect on AVH of a psychological therapy specifically designed to counteract shame (Compassion Focused Therapy) is noted. The hypothesis generation process is then expanded to propose mechanisms that could mediate a relation between shame and AVH. It is proposed that employing absorbed or avoidant strategies to deal with shame may lead to AVH through mediating mechanisms such as rumination, suppression, and dissociation. Evolutionary reasons for a relation between shame and AVH are also proposed, including that AVH may be an evolved mechanism to encourage self-protective behaviors in the wake of trauma. It is concluded that existing research supports the generation of this paper's hypothesis, which is now worthy of dedicated empirical testing.

Body image as a target of victimization by peers/parents: Development and validation of the Body Image Victimization Experiences Scale

This study developed and established the psychometric properties of the Body Image Victimization Experiences Scale (BIVES). The BIVES retrospectively assesses the frequency (Part A-frequency) and effect (Part B-impact) of victimization experiences pertaining to body image, perpetrated by peers and parents/caregivers in childhood and adolescence. Distinct samples of Portuguese women were recruited in 2013-2014: two nonclinical samples of the general population (n = 1,177), aged 18-60 years, and a clinical sample of patients with Binge Eating Disorder (BED; n = 73), aged 19-59 years. An exploratory factor analysis was conducted in 632 participants. A confirmatory factor analysis (CFA) and the scale's psychometric properties were tested in 545 participants. The ability of the BIVES to discriminate the clinical from a nonclinical sample was examined. The scale presented two factors indicating the sources of the victimization-peers and parents. CFA results confirmed the scale's structure. The BIVES presented very good internal consistency, construct and discriminant validity, good test-retest reliability, and was associated with related constructs, body image shame, and eating psychopathology. The scale adequately discriminated between the clinical sample and a nonclinical sample. The BIVES is a valid and reliable measure that allows for a comprehensive assessment of body image-related victimization experiences.

Adult Attachment and Dyadic Adjustment: The Mediating Role of Shame

Although it is widely recognized that adult attachment is associated with romantic relationship quality, the mechanisms involved remain poorly understood. This study aimed to investigate the mediating role of external and internal shame on the association between attachment and dyadic adjustment. A battery of self-report measures was completed by 228 Portuguese participants and a serial multiple mediation model was tested. Data showed that, in the population under study, attachment dimensions were associated with worse dyadic adjustment through high external and internal shame. Internal shame alone also mediated the association between attachment avoidance and dyadic adjustment. This study identifies a new putative mechanism linking adult attachment and intimate relationship functioning that may be targeted in couples therapy to promote a better dyadic adjustment and relationship functioning.

Shame Experiences Underlying Depression of Adult Turkish Women

Shame is a major component of many mental health problems and affects symptoms, coping styles, remission, and therapeutic ruptures. There are few qualitative studies aimed at understanding shame and its role for patients diagnosed with depression. In this research, we explored the origins of shame, and the coping strategies that patients diagnosed with depression employ to cope with shame. This qualitative research aimed at an in-depth analysis of shame experiences of adult women who had been diagnosed with depression and treated with cognitive behavioral psychotherapy in a Women Health Center in Turkey. Purposive sampling yielded nine high shame prone adult women who were married and had children. Four semi-structured interviews were conducted with each of the nine participants, and 36 semi-structured interviews were analyzed by Interpretative Phenomenological Analysis. According to the results of the analysis, four themes emerged. These were "substitution of rage for the feeling of shame and unworthiness," "perfection struggle to overcompensate the belief of being inadequate," "feeling shame for their own body and sexual acts," and "need for individuation." The results were interpreted by considering the social context and culture of Turkey, and the clinical implications were discussed.

Eating disorders: when social rank perceptions are shaped by early shame experiences

OBJECTIVES

Recent research has shown that early adverse experiences can be an important risk factor for eating disorders. However, the role of early shame memories and how they are structured as traumatic and central memories to self-identity in eating disorders has never been investigated. This study explores the phenomenology of shame memories involving attachment figures and other agents from the wider social domain in patients with eating disorders, and examines the relationship between their traumatic and centrality features, social comparison based on physical appearance, and the severity of eating psychopathology.

DESIGN

The study has a cross-sectional design using a structured interview to assess retrospective data.

METHODS

Participants in this study were 36 patients with an eating disorder diagnosis, who were assessed using Eating Disorder Examination (EDE 16.0D), the Shame Experiences Interview (SEI), and self-report instruments measuring the traumatic features and centrality to identity of shame memories and social comparison.

RESULTS

Results indicated that the traumatic and centrality qualities of shame memories involving social agents other than attachment figures (e.g., peers) are significantly correlated with unfavourable social rank perceptions and with increased eating psychopathology severity. Furthermore, the impact of such shame memories on eating psychopathology is fully mediated by social comparisons based on physical appearance.

CONCLUSIONS

These findings highlight the importance of early shame experiences involving peers and other social agents that become traumatic memories, central to self-identity, to eating disorder patients' perceptions of inferiority and their core psychopathology features.

PRACTITIONER POINTS

Early shame experiences of patients with eating disorders should be carefully assessed. Shame traumatic memories involving social agents outside the family circle (e.g., peers) seem to be especially damaging for patients with eating disorders, and influence how physical appearance is used as a central dimension to establish their social rank. Practitioners should directly work with these shame memories, focusing on diminishing their traumatic nature and reconstruct their central meaning to self-identity.

Perceived causal relations between anxiety, posttraumatic stress and depression: extension to moderation, mediation, and network analysis

BACKGROUND

Previous research demonstrates that posttraumatic memory reexperiencing, depression, anxiety, and guilt-shame are frequently co-occurring problems that may be causally related.

OBJECTIVES

The present study utilized Perceived Causal Relations (PCR) scaling in order to assess participants' own attributions concerning whether and to what degree these co-occurring problems may be causally interrelated.

METHODS

288 young adults rated the frequency and respective PCR scores associating their symptoms of posttraumatic reexperiencing, depression, anxiety, and guilt-shame.

RESULTS

PCR scores were found to moderate associations between the frequency of posttraumatic memory reexperiencing, depression, anxiety, and guilt-shame. Network analyses showed that the number of feedback loops between PCR scores was positively associated with symptom frequencies.

CONCLUSION

Results tentatively support the interpretation of PCR scores as moderators of the association between different psychological problems, and lend support to the hypothesis that increased symptom frequencies are observed in the presence of an increased number of causal feedback loops between symptoms. Additionally, a perceived causal role for the reexperiencing of traumatic memories in exacerbating emotional disturbance was identified.