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Tharaud JB, Murphy J, Smith DL, Valdespino-Hayden ZE, Held P. Changes in emotion regulation difficulties and PTSD symptom severity in an intensive treatment program for PTSD. J Affect Disord 2024; 361:620-626. [PMID: 38844167 DOI: 10.1016/j.jad.2024.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Greater difficulties in emotion regulation (ER) and decreased use of adaptive ER strategies have been associated with higher levels of posttraumatic stress disorder (PTSD) symptoms. To date, limited research has explored whether ER improves with PTSD treatment or whether such improvements are linked with improvements in PTSD symptoms. METHODS Veterans and service members with PTSD (N = 223) participated in a 2-week intensive treatment program (ITP) based in Cognitive Processing Therapy (CPT). ER was measured using the Difficulties in Emotion Regulation Short Form (DERS-SF) at baseline and on days 4 and 9 of treatment. PTSD symptoms were reported on the PTSD Symptom Checklist for DSM-5 (PCL-5) at baseline, on days 3, 5, 6, and 8 of treatment, and at post-treatment. RESULTS DERS-SF scores decreased during treatment (Mchange = 5.12, d = 0.38). Baseline DERS-SF did not predict overall PCL-5 scores across timepoints (p = .377). However, scores on the DERS-SF over time were significantly associated with PCL-5 improvement over the course of treatment (p < .001, R2b = 0.07). Finally, improvements in all subscales of the DERS-SF across time except clarity were significantly associated with improvement in PCL-5 over time. LIMITATIONS Additional treatment components in the ITP beyond CPT may have contributed to ER improvements. Conclusions are also limited by the use of self-report data. CONCLUSIONS An intensive CPT-based treatment program for veterans and service members can lead to improved ER in two weeks. ER improvements are associated with PTSD symptom severity during the ITP.
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Affiliation(s)
- Jessica B Tharaud
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, United States of America; Department of Psychological and Brain Sciences, University of Iowa, United States of America
| | - Jonathan Murphy
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, United States of America
| | - Dale L Smith
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, United States of America; Department of Psychiatry, University of Illinois at Chicago, United States of America
| | | | - Philip Held
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, United States of America.
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Austin T, Smith J, Rabin B, Lindamer L, Pittman J, Justice S, Twamley EW, Lantrip C. The Effects of a Single-Session Virtual Rumination Intervention to Enhance Cognitive Functioning in Veterans With Subjective Cognitive Symptoms: Multimethod Pilot Study. JMIR Form Res 2024; 8:e48525. [PMID: 38608264 PMCID: PMC11053393 DOI: 10.2196/48525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Subjective cognitive concerns (SCCs) entail perceived difficulties in thinking or memory, often reported without substantial objective evidence of cognitive impairment. These concerns are prevalent among individuals with a history of brain injuries, neurological conditions, or chronic illnesses, contributing to both psychological distress and functional limitations. They are increasingly considered to be a risk factor for future objective decline. A considerable number of individuals reporting SCCs also exhibit mental health symptoms, such as a history of trauma, depression, or anxiety. Interventions that address modifiable emotional and cognitive factors related to SCC could improve functioning and quality of life. Therefore, the use of emotion regulation strategies, especially those directed at minimizing rumination, could serve as a promising focus for interventions aimed at mitigating subjective cognitive concerns in veteran populations. OBJECTIVE This pilot study explored the feasibility, acceptability, and preliminary efficacy of a brief, 1-session emotion regulation intervention called "Worry Less, Remember More." The Worry Less, Remember More intervention was designed to reduce rumination and improve subjective cognitive functioning in veterans with subjective cognitive changes (N=15). METHODS We randomized 15 veterans to either the active telehealth condition or waitlist control and completed the intervention. Participants were aged between 31 and 67 (mean 49.5, SD 10.1) years, and the sample was primarily male (12/15, 83%) and White (10/15, 67%). The most common diagnoses were posttraumatic stress disorder and depression. Following the intervention, veteran input was sought through semistructured interviews with a subset of 12 participants, examining feasibility, acceptability, and perceived efficacy. Preliminary efficacy was also measured using pre- and postintervention self-report measures. RESULTS Veterans reported that this intervention was acceptable, with 92% (11/12) of the sample reporting that they benefited from the intervention and would recommend the intervention to others with similar difficulties. Semistructured interviews revealed difficulties with feasibility, including problems with the remote consenting process, forgetting appointments, and needing additional strategies to remember to consistently use the interventions. The intervention improved self-reported cognitive symptoms on quantitative measures but did not improve self-reported rumination. CONCLUSIONS This pilot study establishes the preliminary feasibility, acceptability, and efficacy of the Worry Less, Remember More intervention for veterans with subjective cognitive symptoms. Future iterations of the intervention may benefit from simplifying the electronic consent process, providing reminders for appointments, and incorporating compensatory cognitive strategies to assist with using the telehealth system, as well as applying the strategies learned in the intervention. While future research is needed with larger samples, including nonveteran populations, the intervention may also be a useful clinical tool to bridge care between neuropsychology clinics and mental health treatment.
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Affiliation(s)
- Tara Austin
- Research Service, VA San Diego Healthcare System, San Diego, United States
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, United States
- The VA Center of Excellence for Research on Returning War Veterans, Waco, TX, United States
| | - Jennifer Smith
- The VA Center of Excellence for Research on Returning War Veterans, Waco, TX, United States
| | - Borsika Rabin
- Research Service, VA San Diego Healthcare System, San Diego, United States
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, United States
- UC San Diego Altman Clinical and Translational Research Center Dissemination and Implementation Science Center, University of California San Diego, San Diego, CA, United States
| | - Laurie Lindamer
- Research Service, VA San Diego Healthcare System, San Diego, United States
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, United States
| | - James Pittman
- Research Service, VA San Diego Healthcare System, San Diego, United States
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, United States
| | - Staley Justice
- The VA Center of Excellence for Research on Returning War Veterans, Waco, TX, United States
| | - Elizabeth W Twamley
- Research Service, VA San Diego Healthcare System, San Diego, United States
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Crystal Lantrip
- The VA Center of Excellence for Research on Returning War Veterans, Waco, TX, United States
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, United States
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Mohammadi Z, Dehghani M, Fathali Lavasani F, Farahani H, Ashouri A. A network analysis of ICD-11 Complex PTSD, emotional processing, and dissociative experiences in the context of psychological trauma at different developmental stages. Front Psychiatry 2024; 15:1372620. [PMID: 38532985 PMCID: PMC10963615 DOI: 10.3389/fpsyt.2024.1372620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/27/2024] [Indexed: 03/28/2024] Open
Abstract
Objective Traumatic experiences are a significant risk factor for psychological disturbances, including disorders such as complex posttraumatic stress disorder, emotion-processing problems, and trauma-related dissociative experiences. The present investigation examined the coexistence of these symptoms using a network analysis model. Method This study included a sample of 406 people referred to comprehensive health centers in Tehran from September to December 2023 with psychopathological syndromes. Variables were assessed using The International Trauma Questionnaire, International Measurement of Exposure to Traumatic Event checklist, Baker Emotional Processing Questionnaire, and Dissociative Experiences. A regularized partial correlation network and Glasso algorithm, in combination with Extended Bayesian information criteria, were applied to estimate the network structure. Results Signs of unprocessed emotions and disturbance in self-organization symptoms were the most important symptoms in the symptom network, forming strong connections with other nodes. Thereby, these two symptoms can be regarded as the most important clinical manifestations in the symptom network following traumatic experiences. Three distinct symptom communities were identified: the community of traumatic experiences (childhood, adolescence, adulthood), the community of dissociative experiences (amnesia, depersonalization/derealization, and absorption), and the community of emotional processing (suppression, unpleasant emotional experience, Signs of unprocessed emotions, avoidance, and emotional control, posttraumatic stress disorder symptoms and disturbance in self-organization symptoms). The strongest edges observed were between childhood trauma-adolescence trauma (0.473) in the community of traumatic experiences, between amnesia and depersonalization/derealization (0.644) in the community of dissociative experiences, and between disturbance in self-organization symptoms and unprocessed emotions (0.324) in the community of emotional processing, indicating the recurrent occurrence of these symptoms. Conclusion In this study, disturbance in self-organization symptoms was identified as the central psychopathologic symptom in individuals experiencing traumas at different developmental stages. It seems that adolescent trauma and not childhood trauma plays a more decisive role in the symptoms that a person manifests after traumatic experiences. Also, posttraumatic stress disorder symptoms and disturbance in self-organization symptoms were recognized in the cluster of emotional processing symptoms and can have substantial roles in prioritizing therapeutic measures.
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Affiliation(s)
- Zahra Mohammadi
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Mahmood Dehghani
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Fathali Lavasani
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | | | - Ahmad Ashouri
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
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Crane MF, Hoare S, Kangas M, Gucciardi DF, Karin E. A coping self-insight scale for adults: development and preliminary psychometric properties. ANXIETY, STRESS, AND COPING 2024; 37:157-179. [PMID: 38053399 DOI: 10.1080/10615806.2023.2290099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/27/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Self-insights focused on the coping process are implicated in the refinement of capacities for resilience. To advance this research, we must identify key coping self-insights and develop a concise measurement tool. OBJECTIVE The purpose of this paper is to develop evidence for the construct dimensionality and validity of a measure of coping self-insight. METHODS Items measuring 13 coping self-insight dimensions were generated via consultation with theoretical work, subject matter experts, and pre-testing items for clarity. Thereafter, the dimensionality of items was assessed with undergraduate students (N = 232) and an online sample (N = 800) via exploratory and confirmatory analyses. Finally, a multi-trait, multi-method approach was used to test discriminant validity in a further sample of students (N = 228). RESULTS The initial item list was reduced to five key dimensions that balanced data-driven and conceptual considerations. Confirmatory Factor Analysis revealed moderate-to-strong correlations (r = .47-.80) among dimensions. We also demonstrated evidence of internal reliability, convergent, criterion, and discriminant validity. Invariance tests for sub-groups of interest (e.g., sex, sample type) frequently demonstrated metric or scalar invariance, except for age sub-groups. CONCLUSIONS Findings offer a starting point regarding the types of coping self-insights important for the emergence of resilience and a validated tool for future research.
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Affiliation(s)
- M F Crane
- School of Psychological Science, Macquarie University, North Ryde, Australia
| | - S Hoare
- School of Psychological Science, Macquarie University, North Ryde, Australia
| | - M Kangas
- School of Psychological Science, Macquarie University, North Ryde, Australia
| | - D F Gucciardi
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - E Karin
- School of Psychological Science, Macquarie University, North Ryde, Australia
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Peyrot C, Provencher J, Duplessis Marcotte F, Cernik R, Marin MF. Using unconditioned responses to predict fear acquisition, fear extinction learning, and extinction retention patterns: Sex hormone status matters. Behav Brain Res 2024; 459:114802. [PMID: 38081517 DOI: 10.1016/j.bbr.2023.114802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
Following a traumatic event, fear dysregulation can increase the likelihood of developing post-traumatic stress disorder (PTSD). This psychopathology is twice as prevalent in women than in men. High physiological reactivity following trauma may be an early risk indicator for the development of PTSD. Elevated physiological reactivity and low estradiol levels have individually been associated with higher fear acquisition and/or lower extinction retention. Thus, sex hormone status may also modulate fear regulation abilities. However, it is unknown whether these two vulnerability factors interact to modulate fear learning and regulation. Using a fear conditioning and extinction protocol, we examined whether physiological reactivity to the aversive stimulus during fear acquisition training predicted fear responses during fear learning, extinction learning, and extinction retention. We verified whether these associations differed according to sex hormone status. Seventy-seven non-clinical participants were recruited including oral contraceptive users (n = 18), early follicular women (n = 20, [low estradiol]), mid-cycle women (n = 20, [high estradiol]), and men (n = 19). Participants underwent a three-day fear conditioning and extinction protocol (day 1: fear acquisition training; day 2: extinction training; day 3: retention test). Skin conductance responses were recorded. In early follicular women, physiological reactivity predicted conditioned and extinguished stimulus fear responses during all phases. For the remaining women, this effect was only present during fear learning and extinction learning. These findings highlight the importance of considering physiological reactivity and sex hormone status following a traumatic event. This knowledge could aid in the early identification of those at higher risk of developing PTSD.
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Affiliation(s)
- Clémence Peyrot
- Research Centre, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, H1N 3J4 Montréal, Québec, Canada; Department of Psychiatry and Addiction, Université de Montréal, 2900 Édouard-Montpetit boulevard, Montréal, Québec H3T 1J4, Canada.
| | - Jessie Provencher
- Research Centre, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, H1N 3J4 Montréal, Québec, Canada; Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke Street W, Montréal, Québec H2X 2P3, Canada.
| | - Félix Duplessis Marcotte
- Research Centre, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, H1N 3J4 Montréal, Québec, Canada; Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke Street W, Montréal, Québec H2X 2P3, Canada.
| | - Rebecca Cernik
- Research Centre, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, H1N 3J4 Montréal, Québec, Canada; Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke Street W, Montréal, Québec H2X 2P3, Canada.
| | - Marie-France Marin
- Research Centre, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, H1N 3J4 Montréal, Québec, Canada; Department of Psychiatry and Addiction, Université de Montréal, 2900 Édouard-Montpetit boulevard, Montréal, Québec H3T 1J4, Canada; Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke Street W, Montréal, Québec H2X 2P3, Canada.
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Woodhams J, Duran F. A model for secondary traumatic stress following workplace exposure to traumatic material in analytical staff. COMMUNICATIONS PSYCHOLOGY 2024; 2:13. [PMID: 39242898 PMCID: PMC11332005 DOI: 10.1038/s44271-024-00060-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 01/29/2024] [Indexed: 09/09/2024]
Abstract
Analytical professionals working in criminal justice and in social media companies are exposed to aversive details of traumatic events. Albeit indirect, exposure in these roles is repeated and can be extreme, including exposure to material containing lethal violence, sexual assault, and serious self-harm, leading to post-traumatic stress disorder and Secondary Traumatic Stress reactions. Incorporating relevant empirical research, this article considers the mechanisms that may contribute to post-exposure post-traumatic stress disorder and Secondary Traumatic Stress reactions in these roles. Building on the Ehlers and Clark model, subsequent extensions, and the authors' experience of working as, and conducting research with, law enforcement professionals, a new model is proposed to explain post-exposure post-traumatic stress disorder/Secondary Traumatic Stress reactions.
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Affiliation(s)
- Jessica Woodhams
- School of Psychology, University of Birmingham, Birmingham, United Kingdom.
| | - Fazeelat Duran
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
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Kim JH, Chun J, Kim J, Ju HJ, Kim BJ, Jeong J, Lee DH. Emotion regulation from a virtue perspective. BMC Psychol 2024; 12:11. [PMID: 38173038 PMCID: PMC10765715 DOI: 10.1186/s40359-023-01490-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The ability to regulate one's emotional state is an important predictor of several behaviors such as reframing a challenging situation to reduce anger or anxiety, concealing visible signs of sadness or fear, or focusing on reasons to feel happy or calm. This capacity is referred to as emotion regulation. Deficits in this ability can adversely affect one's adaptive coping, thus are associated with a variety of other psychopathological symptoms, including but not limited to depression, borderline personality disorder, substance use disorders, eating disorders, and somatoform disorders. METHODS The present study examined emotion regulation in relation to the virtue-based psychosocial adaptation model (V-PAM). 595 participants were clustered based on their Difficulties in Emotion Regulation Scale (DERS) score, producing two clusters (i.e., high functioning vs. low functioning). Then, emotion regulation group membership was discriminated by using five V-PAM virtue constructs, including courage, integrity, practical wisdom, committed action, and emotional transcendence. RESULTS Results show that five virtues contribute to differentiating group membership. Practical wisdom was the strongest contributor, followed by integrity, emotional transcendence, committed action, and courage. Predictive discriminant analysis was conducted and 71% of cases were correctly classified. A discussion of the relationship between emotion regulation and virtues was elaborated. CONCLUSION The concept of virtue holds significant importance in the comprehension of an individual's capacity to regulate their emotions, meriting future study.
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Affiliation(s)
- Jeong Han Kim
- School of Rehabilitation Services and Counseling, University of Texas - Rio Grande Valley, 1201 W University Dr, Edinburg, TX, 78539, USA
| | - Jina Chun
- Department of Rehabilitation Psychology and Special Education, University of Wisconsin- Madison, 1000 Bascom Mall, Madison, WI, 53706, USA
| | - Jaeyoung Kim
- Department of Counseling, Educational Psychology, and Special Education, Michigan State University, 620 Farm Lane, Erickson Hall Rm. 459, East Lansing, MI, 48824, USA
| | - Hyun-Ju Ju
- Department of Early Childhood, Special Education, and Counselor Education, University of Kentucky, 597 S Upper St, Lexington, KY, 40508, USA
| | - Byung Jin Kim
- Department of Counselor Education and Rehabilitation, California State University-Fresno, 5241 N Maple Ave, Fresno, CA, 93740, USA
| | - Jeongwoon Jeong
- Department of Individual, Family, and Community Education, The University of New Mexico, Albuquerque, NM, 87131, USA
| | - Dong Hun Lee
- Traumatic Stress Center, Department of Education, Sungkyunkwan University, 51112 Hoam Hall, 25‑2, Sungkyunkwan‑ro, Jongno‑gu, 03063, Seoul, Republic of Korea.
- Traumatic Stress Center, Department of Education, Sungkyunkwan University, 16419, Seoul, South Korea.
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Messman BA, Fentem A, Compton SE, Griffith EL, Blumenthal H, Contractor AA, Slavish DC. The role of affect in associations between sleep disturbances and posttraumatic stress disorder symptoms: A systematic review. Sleep Med 2023; 110:287-296. [PMID: 37689045 DOI: 10.1016/j.sleep.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/14/2023] [Accepted: 08/28/2023] [Indexed: 09/11/2023]
Abstract
Strong evidence supports a bidirectional association between sleep disturbances and posttraumatic stress disorder (PTSD). Affect - temporary internal states experienced as feeling good or bad, energized or enervated - may play a central role in explaining this link. The current systematic review summarizes the literature on associations between sleep, PTSD, and affect among trauma-exposed adults. We systematically searched five electronic databases (PubMed, PsycInfo, PTSDpubs, Web of Science, CINAHL) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Of 2656 screened articles, 6 studies met inclusion criteria. Four findings emerged: (1) greater insomnia symptom severity predicted greater PTSD symptom severity above the influence of negative affect, (2) negative affect mediated the effect of sleep quality on next-day PTSD symptom severity, (3) positive affect mediated the effect of PTSD symptom severity on insomnia symptom severity and sleep disturbances, and (4) greater negative affect (specifically, greater anger) was associated with greater severity of PTSD and sleep disturbances. Findings highlight areas for future research, such as the need to investigate more dimensions, timescales, and methods of studies simultaneously assessing affect, sleep, and PTSD, as well as the need for more longitudinal and experimental work to determine causality across these constructs.
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Affiliation(s)
- Brett A Messman
- Department of Psychology, University of North Texas, 1155 Union Circle, Denton, TX 76203, USA.
| | - Andrea Fentem
- Department of Psychology, University of North Texas, 1155 Union Circle, Denton, TX 76203, USA
| | - Sidonia E Compton
- Department of Psychology, University of North Texas, 1155 Union Circle, Denton, TX 76203, USA
| | - Elizabeth L Griffith
- Department of Psychology, University of North Texas, 1155 Union Circle, Denton, TX 76203, USA
| | - Heidemarie Blumenthal
- Department of Psychology, University of North Texas, 1155 Union Circle, Denton, TX 76203, USA
| | - Ateka A Contractor
- Department of Psychology, University of North Texas, 1155 Union Circle, Denton, TX 76203, USA
| | - Danica C Slavish
- Department of Psychology, University of North Texas, 1155 Union Circle, Denton, TX 76203, USA
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Hernández-Posadas A, Lommen MJJ, de la Rosa Gómez A, Bouman TK, Mancilla-Díaz JM, del Palacio González A. Transdiagnostic factors in symptoms of depression and post-traumatic stress: a systematic review. CURRENT PSYCHOLOGY 2023:1-16. [PMID: 37359653 PMCID: PMC10226442 DOI: 10.1007/s12144-023-04792-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/28/2023]
Abstract
The current systematic review sought to identify quantitative empirical studies that focused on the transdiagnostic factors of intolerance of uncertainty, emotional dysregulation and rumination, and their relation with depression and post-traumatic stress disorder (PTSD). The overall research aim was to examine the relationship between these transdiagnostic factors and their relation with depression and PTSD symptoms. The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Out of the 768 articles initially identified, 55 met the inclusion criteria for the current review. The results determined that intolerance of uncertainty is indirectly related to depression and PTSD symptoms, mainly through other factors including emotion dysregulation and rumination. Additionally, emotional dysregulation is a significant predictor of both depression and PTSD symptoms. Rumination is a robust factor related to depression and PTSD symptoms, this relationship was significant in cross-sectional and longitudinal studies. This review provides evidence on the transdiagnostic factors of intolerance of uncertainty, emotional dysregulation and rumination in the relationship with depression and PTSD symptoms.
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Affiliation(s)
- Alejandrina Hernández-Posadas
- Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, Netherlands
- Faculty of Higher Studies Iztacala, National Autonomous University of Mexico, Av. De los Barrios Núm. 1, Los Reyes Iztacala, Torre de Tutorías, 2do. Piso, Cubículo 22, Edo. de Mexico 54090 Tlalnepantla, Mexico
| | - Miriam J. J. Lommen
- Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, Netherlands
| | - Anabel de la Rosa Gómez
- Faculty of Higher Studies Iztacala, National Autonomous University of Mexico, Av. De los Barrios Núm. 1, Los Reyes Iztacala, Torre de Tutorías, 2do. Piso, Cubículo 22, Edo. de Mexico 54090 Tlalnepantla, Mexico
| | - Theo K. Bouman
- Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, Netherlands
| | - Juan Manuel Mancilla-Díaz
- Faculty of Higher Studies Iztacala, National Autonomous University of Mexico, Av. De los Barrios Núm. 1, Los Reyes Iztacala, Torre de Tutorías, 2do. Piso, Cubículo 22, Edo. de Mexico 54090 Tlalnepantla, Mexico
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Limowski AR, DeJesus CR, Ward-Ciesielski EF, McDermott MJ. Emotion dysregulation, help-seeking attitudes, and posttraumatic stress disorder symptoms: A structural equation model. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:871-878. [PMID: 34242125 DOI: 10.1080/07448481.2021.1909039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Objective: Most college students have experienced an adverse event in their lifetime, yet help-seeking rates remain low. This study seeks to understand psychological factors that might contribute to delays in treatment initiation among trauma-affected students. Participants: Our sample consisted of 531 undergraduate students of which 27% scored above the clinical cutoff for PTSD using the PTSD Checklist for DSM-5 (PCL-5). Methods: This cross-sectional study explored relationships among help-seeking attitudes, emotion dysregulation, and PTSD symptoms using structural equation modeling. Results: Findings demonstrated that individuals with more severe emotion dysregulation had more severe PTSD symptoms and held more negative attitudes toward seeking help. Conclusions: Individuals who are the most in need of treatment hold attitudes that may impede help-seeking. We discuss clinical implications and ways college counseling centers can maximize outreach and programming efforts to increase treatment initiation and engagement.
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Affiliation(s)
- Anne R Limowski
- Department of Psychology, Hofstra University, Hempstead, NY, USA
| | | | - Erin F Ward-Ciesielski
- Department of Psychology, Hofstra University, Hempstead, NY, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Michael J McDermott
- Department of Psychology, University of Louisiana at Lafayette, Lafayette, LA, USA
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Miethe S, Wigger J, Wartemann A, Fuchs FO, Trautmann S. Posttraumatic Stress Symptoms and its Association with Rumination, Thought Suppression and Experiential Avoidance: a Systematic Review and Meta-Analysis. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2023. [DOI: 10.1007/s10862-023-10022-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
AbstractPosttraumatic stress disorder (PTSD) is a severe mental disorder causing high individual and societal costs. The use of maladaptive emotion regulation (ER) strategies has been identified as a potential contributing factor. This meta-analysis aimed to quantify the associations between PTSD symptoms and rumination, thought suppression and experiential avoidance. The systematic literature search resulted in 5574 studies, 75 of which were included in the analysis. From those eligible studies 189 effect sizes were obtained. For symptoms of posttraumatic stress, large effects were found for associations with rumination (r = .52) and experiential avoidance (r = .48), whereas a medium effect size was found for thought suppression (r = .29). With respect to different PTSD symptom clusters, associations ranged between r = .35 and r = .41 for associations with intrusive re-experiencing, between r = .39 and r = .41 for associations with avoidance, between r = .50 and r = .53 for associations with alterations in cognitions and mood and between r = .41 and r = .45 for associations with alterations in arousal and activity. Few available studies provide some evidence that associations might be somewhat reduced but still substantial in longitudinal compared to cross-sectional studies. These findings provide valuable targets for future investigations with the long-term goal of improving targeted interventions for the prevention and treatment of PTSD symptoms.
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Wisco BE, Vrshek-Schallhorn S, May CL, Campbell AA, Nomamiukor FO, Pugach CP. Effects of trauma-focused rumination among trauma-exposed individuals with and without posttraumatic stress disorder: An experiment. J Trauma Stress 2023; 36:285-298. [PMID: 36655347 DOI: 10.1002/jts.22905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/19/2022] [Accepted: 11/16/2022] [Indexed: 01/20/2023]
Abstract
Rumination, or thinking repetitively about one's distress, is a risk factor for posttraumatic stress disorder (PTSD). Current theories suggest that rumination contributes to PTSD symptoms directly, by increasing negative reactions to trauma cues (i.e., symptom exacerbation), or represents a form of cognitive avoidance, if verbal ruminations are less distressing than trauma imagery. The goal of this study was to test the symptom exacerbation and cognitive avoidance accounts of trauma-focused rumination. We recruited 135 trauma-exposed participants (n = 60 diagnosed with PTSD) and randomly assigned them to ruminate about their trauma, distract themselves, or engage in trauma imagery. For individuals with and without PTSD, rumination led to larger increases in subjective distress (i.e., negative affect, fear, sadness, subjective arousal, valence) than distraction, ηp 2 s = .04-.13, but there were no differences between rumination and imagery ηp 2 s = .001-.02. We found no evidence that rumination or imagery elicited physiological arousal, ds = 0.01-0.19, but did find that distraction reduced general physiological arousal, as measured by heart rate, relative to baseline, d = 0.84, which may be due to increases in parasympathetic nervous system activity (i.e., respiratory sinus arrhythmia), d = 0.33. These findings offer no support for the avoidant function of rumination in PTSD. Instead, the findings were consistent with symptom exacerbation, indicating that rumination leads directly to emotional reactivity to trauma reminders and may be a fruitful target in PTSD intervention.
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Affiliation(s)
- Blair E Wisco
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Suzanne Vrshek-Schallhorn
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Casey L May
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Allison A Campbell
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Faith O Nomamiukor
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Cameron P Pugach
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
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13
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Reyes AT, Cross CL. Relationships Among Rumination, Resilience, Mindfulness, and Perceived PTSD Symptoms in Military Veterans Returning to College: A Cross-Sectional Study. J Psychosoc Nurs Ment Health Serv 2022:1-8. [DOI: 10.3928/02793695-20221027-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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14
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Zhen B, Yao B, Zhou X. How does parent-child communication affects posttraumatic stress disorder and growth in adolescents during the COVID-19 pandemic? The mediating roles of self-compassion and disclosure. J Affect Disord 2022; 306:1-8. [PMID: 35301037 PMCID: PMC8920085 DOI: 10.1016/j.jad.2022.03.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 01/14/2022] [Accepted: 03/10/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Research suggests that family factors play an important role in adolescent posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG). Parent-child communication has attracted particular attention. However, it remains unclear whether parent-child communication affects PTSD and PTG via unique or shared underlying mechanisms. The study aim was to examine the effect of parent-child communication on PTSD and PTG via self-compassion and self-disclosure. METHODS Self-report questionnaires were administered to 683 adolescents during the COVID-19 pandemic. RESULTS Open parent-child communication was positively associated with PTG and negatively associated with PTSD via two 1-step indirect paths of self-compassion and self-disclosure, and by one 2-step indirect path of self-compassion to self-disclosure. Problematic parent-child communication was negatively associated with PTG and positively associated with PTSD via two 1-step indirect paths of self-compassion and self-disclosure. LIMITATIONS First, pandemics differ from other disasters, generalizing these findings to other traumatized populations must be cautious. Then, this was a cross-sectional study, so longitudinal effects could not be examined and causal relationships cannot be confirmed. CONCLUSIONS Different types of parent-child communication have different influencing mechanisms on PTSD and PTG. Therefore, distinct intervention strategies are needed targeted to these two psychological reactions.
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Affiliation(s)
- Baohua Zhen
- College of Educational Science, Anhui Normal University, Wuhu 241000, China
| | - Benxian Yao
- College of Educational Science, Anhui Normal University, Wuhu 241000, China; Department of Psychology, Hefei Normal University, Hefei 238076, China.
| | - Xiao Zhou
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou 310028, China.
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15
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Owens GP, Hamrick LA, Keller EM, Perkins M, Collins S, Thomas EA, Haag I, Swan S, Pickering N. Predictors of posttraumatic stress symptom severity and meaning made in treatment-seeking veterans. J Clin Psychol 2022; 78:2564-2578. [PMID: 35510293 DOI: 10.1002/jclp.23369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 03/17/2022] [Accepted: 04/15/2022] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- Gina P Owens
- Department of Psychology, University of Tennessee, Knoxville, Tennessee, USA
| | - Lauren A Hamrick
- Department of Psychology, University of Tennessee, Knoxville, Tennessee, USA
| | - Emily M Keller
- Department of Psychology, University of Tennessee, Knoxville, Tennessee, USA
| | - Marjorie Perkins
- Department of Psychology, University of Tennessee, Knoxville, Tennessee, USA
| | - Summer Collins
- Department of Psychology, University of Tennessee, Knoxville, Tennessee, USA
| | - Elizabeth A Thomas
- Department of Psychology, University of Tennessee, Knoxville, Tennessee, USA
| | - Ian Haag
- William C. Tallent VA Outpatient Clinic, Knoxville, Tennessee, USA
| | - Scott Swan
- William C. Tallent VA Outpatient Clinic, Knoxville, Tennessee, USA
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16
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Wang C, Song X, Lee TMC, Zhang R. Psychometric Properties of the Chinese Version of the Brief State Rumination Inventory. Front Public Health 2022; 10:824744. [PMID: 35359769 PMCID: PMC8960134 DOI: 10.3389/fpubh.2022.824744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
State rumination, unlike trait rumination which is described as a persistent and stable response style, is usually triggered by a specific stressful event and causes negative emotions within a short period of time. The measurement methods of trait rumination, such as the ruminative response scale (RRS), are therefore not fully applicable to state rumination. Recently, researchers have developed the brief state rumination inventory (BSRI) to characterize state rumination, addressing the gap in the field of accurate measurement of state rumination. To develop such an effective tool in the Chinese context, we developed a Chinese version of the BSRI and tested its psychometric properties. Two studies were conducted to address the research goal. In Study 1, we recruited 512 subjects, each of whom completed the Chinese version of the BSRI, RRS, emotional regulation questionnaire (ERQ), depression–anxiety–stress scale (DASS), and positive and negative affect scale (PANAS). Results showed that the scores of the BSRI were positively correlated with all other scale scores (ps < 0.001), and the correlation with the RRS was the highest, indicating that the BSRI showed good convergent validity. Additionally, the Cronbach's alpha coefficient for the Chinese version of the BSRI was 0.93. Study 2 aimed to examine the ecological validity of the Chinese version of the BSRI. We recruited another 54 subjects who were randomly divided into two groups, with 27 in the rumination induction group and 27 in the distraction group, and recorded the BSRI scores of the two groups before and after a specific experiment. We found there was a significant increase in BSRI scores after rumination induction (t = 3.91, p < 0.001), while there was no significant difference in the concrete distraction group before and after the experiment (t = 0.70, p = 0.48). In sum, the Chinese version of the BSRI showed good reliability and validity for assessing state rumination in the general Chinese population.
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Affiliation(s)
- Chanyu Wang
- Laboratory of Cognitive Control and Brain Healthy, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Xiaoqi Song
- Laboratory of Cognitive Control and Brain Healthy, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Tatia M. C. Lee
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
- Laboratory of Neuropsychology and Human Neuroscience, The University of Hong Kong, Hong Kong, China
| | - Ruibin Zhang
- Laboratory of Cognitive Control and Brain Healthy, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
- Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- *Correspondence: Ruibin Zhang
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17
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Wolkenstein L, Sommerhoff A, Voss M. Positive Emotion Dysregulation in Posttraumatic Stress Disorder. J Anxiety Disord 2022; 86:102534. [PMID: 35114432 DOI: 10.1016/j.janxdis.2022.102534] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/24/2021] [Accepted: 01/12/2022] [Indexed: 01/24/2023]
Abstract
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.
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Affiliation(s)
- Larissa Wolkenstein
- Department of Psychology, Clinical Psychology and Psychotherapy, Ludwig-Maximilians-Universität München, Leopoldstr. 13, 80802 München, Germany.
| | - Amanda Sommerhoff
- Department of Psychology, Clinical Psychology and Psychotherapy, Ludwig-Maximilians-Universität München, Leopoldstr. 13, 80802 München, Germany.
| | - Maria Voss
- Department of Psychology, Clinical Psychology and Psychotherapy, Ludwig-Maximilians-Universität München, Leopoldstr. 13, 80802 München, Germany.
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Seinsche RJ, Walter B, Fricke S, Neudert MK, Zehtner RI, Stark R, Hermann A. Social phobic beliefs mediate the relationship between post-event processing regarding the worst socially aversive experience and fear of negative evaluation. CURRENT PSYCHOLOGY 2022; 42:1-10. [PMID: 35153460 PMCID: PMC8818836 DOI: 10.1007/s12144-022-02805-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 11/30/2022]
Abstract
The experience of socially aversive events is proposed to be a critical etiological factor in the development of social anxiety symptoms even though the experience itself is also common among healthy individuals. Rather than the event itself, accompanying factors such as maladaptive processing might be associated with higher levels of social anxiety symptoms. One-hundred-seventy-four individuals participated in this online-survey comprising questionnaires regarding social anxiety symptoms and retrospective reports concerning maladaptive processing of the worst socially aversive event. Structural equation modelling was used to analyze the hypothesized mediation of maladaptive processing and fear of negative evaluation by intrusive re-experiencing and social phobic beliefs. The positive association between retrospectively evaluated maladaptive processing after the worst socially aversive event and fear of negative evaluation was mediated by social phobic beliefs but not by intrusive re-experiencing. These results point towards the relevance of further investigating processing strategies after socially aversive events as a potential influencing factor for SAD development. Trial registration. The trial was registered at the German Clinical Trial Register (DRKS00021502) on June 3rd, 2020. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s12144-022-02805-9.
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Affiliation(s)
- Rosa J. Seinsche
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Otto-Behaghel-Str. 10H, Giessen, 35394 Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
| | - Bertram Walter
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
- Center for Mind, Brain and Behavior, Philipps University Marburg and Justus Liebig University Giessen, Giessen, Germany
| | - Susanne Fricke
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Otto-Behaghel-Str. 10H, Giessen, 35394 Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
| | - Marie K. Neudert
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Otto-Behaghel-Str. 10H, Giessen, 35394 Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
| | - Raphaela I. Zehtner
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Otto-Behaghel-Str. 10H, Giessen, 35394 Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
| | - Rudolf Stark
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Otto-Behaghel-Str. 10H, Giessen, 35394 Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
- Center for Mind, Brain and Behavior, Philipps University Marburg and Justus Liebig University Giessen, Giessen, Germany
| | - Andrea Hermann
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Otto-Behaghel-Str. 10H, Giessen, 35394 Germany
- Bender Institute of Neuroimaging, Justus Liebig University Giessen, Giessen, Germany
- Center for Mind, Brain and Behavior, Philipps University Marburg and Justus Liebig University Giessen, Giessen, Germany
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19
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Guzey M, Funk J, Kustermann J, Ehring T. The effect of concreteness training on peri-traumatic processing and intrusive memories following an analogue trauma. Behav Res Ther 2021; 147:103970. [PMID: 34592609 DOI: 10.1016/j.brat.2021.103970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/23/2021] [Accepted: 09/20/2021] [Indexed: 11/25/2022]
Abstract
High levels of rumination are a risk factor for developing posttraumatic stress disorder (PTSD). Theoretical models of rumination as well as earlier empirical findings suggest that the dysfunctional effects of rumination are due to an abstract processing style, and that a more concrete style of thinking has beneficial effects on mental well-being. The present study therefore examined whether concreteness training prior to watching a trauma film prevents analogue PTSD symptoms in the form of intrusive memories. Healthy participants either received concreteness training or were allocated to a no-intervention control condition, and watched a distressing film three days later. We examined differences in intrusive memories related to the film scenes between conditions, and tested whether concreteness training reduces the link between trait rumination and analogue PTSD symptoms. Furthermore, the interacting effect of concreteness training and trait rumination on peri-traumatic processing was investigated. In line with the hypotheses, concreteness training was associated with less frequent intrusive memories and moderated the association between trait rumination and intrusive memories as well as trait rumination and dissociation during the film. These findings lend support to the hypothesis that processing style contributes to the negative impact of rumination on posttraumatic stress symptoms. In addition, they provide preliminary evidence that concreteness training may be a promising intervention for the prevention of PTSD following trauma.
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Affiliation(s)
- Melike Guzey
- Ankara University, Department of Psychology, Turkey.
| | - Julia Funk
- LMU Munich, Department of Psychology, Germany.
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20
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Akbari M, Hosseini ZS, Seydavi M, Zegel M, Zvolensky MJ, Vujanovic AA. Distress tolerance and posttraumatic stress disorder: a systematic review and meta-analysis. Cogn Behav Ther 2021; 51:42-71. [PMID: 34279189 DOI: 10.1080/16506073.2021.1942541] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The association between distress tolerance (DT) and posttraumatic stress disorder (PTSD) is well established. This study aimed to provide an account of the magnitude of this effect across available studies. From the 2,212 records yielded by the initial search, 56 studies comprised 12,672 participants (Mage = 29.96, SD = 12.05; 44.94% women) were included in the investigation upon a priori criteria. Results demonstrated consistent negative associations between DT and PTSD symptoms, such that lower DT was associated with higher PTSD symptom severity and vice versa; the effect size (ES) was relatively small in magnitude (r = -0.335, 95% CI [-0.379, -0.289]). Moreover, ESs for the DT-PTSD association were significantly greater for studies which examined self-reported DT compared to those that examined behavioral DT. The number of traumatic event types experienced (trauma load) was the most consistent moderator of the DT and PTSD association. The clinical implications of the role of DT in PTSD are discussed.
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Affiliation(s)
- Mehdi Akbari
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | | | - Mohammad Seydavi
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Maya Zegel
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, Texas, USA.,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Texas, USA
| | - Anka A Vujanovic
- Department of Psychology, University of Houston, Houston, Texas, USA
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21
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Brown RL, Wood A, Carter JD, Kannis-Dymand L. The metacognitive model of post-traumatic stress disorder and metacognitive therapy for post-traumatic stress disorder: A systematic review. Clin Psychol Psychother 2021; 29:131-146. [PMID: 34155731 DOI: 10.1002/cpp.2633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 11/11/2022]
Abstract
The metacognitive model of post-traumatic stress disorder (PTSD) implicates metacognitive beliefs, meta-memory beliefs and metacognitive control strategies in perpetuating and maintaining symptoms of PTSD. Despite this expanding area of research, the evidence for the metacognitive model of PTSD has not been reviewed. A systematic review according to the PRISMA statement was conducted. Searches across MEDLINE, PubMed and PsycNET, as well as reference lists of the included studies (2004 to March 2020), yielded 221 records. Two independent reviewers screened articles, which were included where the impact of the constructs of interest on PTSD symptoms was investigated within the framework of the metacognitive model for PTSD. Eighteen articles were included in the review. Eleven studies were determined to have good methodological robustness. Metacognitive therapy for PTSD demonstrated reductions in symptoms from pretreatment to post-treatment, which were maintained at follow-up. Predictors of greater PTSD symptom severity included metacognitive beliefs, meta-memory beliefs, and worry, punishment, thought suppression, experiential avoidance, and rumination. Overall, support was found for the validity of the metacognitive model of PTSD.
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Affiliation(s)
- Renee L Brown
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Andrew Wood
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Janet D Carter
- Department of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Lee Kannis-Dymand
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
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22
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Tyra AT, Griffin SM, Fergus TA, Ginty AT. Individual differences in emotion regulation prospectively predict early COVID-19 related acute stress. J Anxiety Disord 2021; 81:102411. [PMID: 33962141 PMCID: PMC9759661 DOI: 10.1016/j.janxdis.2021.102411] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/17/2021] [Accepted: 04/27/2021] [Indexed: 12/18/2022]
Abstract
Preliminary prospective research suggests emotion dysregulation may confer vulnerability to poor stress responses. The present prospective study extends this research by examining both specific emotion regulation strategies and global emotion regulation difficulties in the context of acute stress following onset of the COVID-19 global pandemic in 119 young adults. As part of a larger study, emotion regulation was assessed prior to pandemic onset (January 2019 - February 2020) using two standard measures (Emotion Regulation Questionnaire, ERQ, Gross & John, 2003; Difficulties in Emotion Regulation Scale, DERS, Gratz & Roemer, 2004). A self-report assessment of acute stress was conducted 2-3½ weeks after the COVID-19 pandemic declaration. Results demonstrated cognitive reappraisal and expressive suppression (i.e., ERQ) were not individually predictive of acute stress; however, there was a significant interaction of suppression by reappraisal. Simple effects indicated suppression was negatively associated with acute stress only when reappraisal levels were high. Greater global emotion regulation difficulties (i.e., DERS), particularly nonacceptance of emotions and limited access to emotion regulation strategies, significantly predicted greater acute stress. These results provide further evidence of the temporal relationship between emotion dysregulation and stress reactions, and also suggest the expected effects of emotion regulation strategies may differ across contexts.
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Affiliation(s)
- Alexandra T. Tyra
- Department of Psychology and Neuroscience, Baylor University, One Bear Place 97334, Waco, TX, 76798, USA,Corresponding author
| | - Siobhán M. Griffin
- SASHLab, Centre for Social Issues in Research, Department of Psychology, University of Limerick, V94T9PX, Ireland,Health Research Institute, University of Limerick, V94T9PX, Ireland
| | - Thomas A. Fergus
- Department of Psychology and Neuroscience, Baylor University, One Bear Place 97334, Waco, TX, 76798, USA
| | - Annie T. Ginty
- Department of Psychology and Neuroscience, Baylor University, One Bear Place 97334, Waco, TX, 76798, USA
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23
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Distinguishing between rumination and intrusive memories in PTSD using a wearable self-tracking instrument: a proof-of-concept case study. COGNITIVE BEHAVIOUR THERAPIST 2021. [DOI: 10.1017/s1754470x2100012x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Rumination has been shown to play a part in post-traumatic stress disorder (PTSD), but its relation to the intrusions characteristic of PTSD has mainly been investigated experimentally. This proof-of-concept case study explored the occurrence, personal experiences, and possible relation between rumination and intrusions in two PTSD patients in their daily living using a mixed method approach. A novel wearable self-tracking instrument was employed which provided fine-grained temporal resolution of observation data and could eliminate recall bias. Furthermore, quantitative and qualitative data were collected on participants’ symptoms, rumination and experiences of using the self-tracking instrument. First, without distinguishing between the two phenomena, the participants tracked both for a week. After receiving psychoeducational training for distinguishing between rumination and intrusions, the differentiated phenomena were tracked for a week. Both participants reported being subjectively able to distinguish between rumination and intrusions and made observations with high adherence during the project. Data hinted at a possible temporal relation between the phenomena in line with theories posing rumination as a maladaptive coping strategy as well as an exacerbator of PTSD symptoms. However, relations to mood were inconclusive. Furthermore, by using the self-tracking instrument, participants gained a heightened awareness of the characteristics of rumination and intrusions and contextual cues for occurrence, as well as a greater sense of momentary agency. Results reveal promising prospects in using the wearable self-tracking instrument for further investigation of the relation between rumination and intrusions in the lived lives of PTSD patients, as well as potential for incorporating this method in clinical treatment.
Key learning aims
(1)
Self-tracking with the One Button Tracker is a novel symptom registration method, particularly suited for use in psychotherapeutic treatment and research.
(2)
Rumination and intrusions appear to the participants as distinct cognitive phenomena and treatment targets in PTSD.
(3)
Registering rumination and intrusions in real-time could reveal important temporal relations between them and the contexts in which they occur.
(4)
The data obtained with this self-tracking method can potentially be used as a tool in, and for the further development of psychotherapy for PTSD.
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24
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Zhu Y, Zhang L, Zhou X, Li C, Yang D. The impact of social distancing during COVID-19: A conditional process model of negative emotions, alienation, affective disorders, and post-traumatic stress disorder. J Affect Disord 2021; 281:131-137. [PMID: 33316718 PMCID: PMC7723399 DOI: 10.1016/j.jad.2020.12.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/29/2020] [Accepted: 12/03/2020] [Indexed: 01/16/2023]
Abstract
Background The social distancing during COVID-19 is likely to cause a feeling of alienation, which may pose a threat to the public's mental health. Our research aims to examine the relationship between negative emotions and Post-Traumatic Stress Disorder (PTSD), considering the mediation effect of alienation and how it is moderated by anxiety and depression. Methods For this, the current study conducted a cross-sectional survey on 7145 participants during the outbreak of COVID-19, via online questionnaires comprised of a self-designed Negative emotions questionnaire, Symptom Check List 90 (SCL-90), PTSD Checklist-civilian version (PCL-C), and Adolescent Students Alienation Scale (ASAS). Results A total of 6666 pieces of data from the general population were included in the statistical analysis. The descriptive statistics showed a relatively mild level of mental disorders. Besides, results of Conditional Process Model analysis supported our hypotheses that negative emotions and alienation were both predictors for PTSD symptoms, and their direct and indirect effects were all moderated by the level of anxiety. Limitations This study was limited by the generality and causality of the conclusion. The moderating effect of depression was left for further study due to the collinearity problem of variables. Conclusions Social distancing may have an impact on individuals' mental health by the feeling of alienation, which was moderated by affective disorders. Clinical psychologists should identify individuals' particular cognition and mental disorders to provide a more accurate and adequate intervention for them.
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Affiliation(s)
- Yue Zhu
- Faculty of Psychology, Southwest University, Chongqing 400715, China; Key Lab of Cognition and Personality (Ministry of Education), Southwest University, Chongqing 400715, China
| | - Lihua Zhang
- Chongqing Nankai Secondary School, Chongqing 400030, China
| | - Xia Zhou
- Faculty of Psychology, Southwest University, Chongqing 400715, China; Key Lab of Cognition and Personality (Ministry of Education), Southwest University, Chongqing 400715, China
| | - Chenxiang Li
- Faculty of Psychology, Southwest University, Chongqing 400715, China; Key Lab of Cognition and Personality (Ministry of Education), Southwest University, Chongqing 400715, China
| | - Dong Yang
- Faculty of Psychology, Southwest University, Chongqing 400715, China; Key Lab of Cognition and Personality (Ministry of Education), Southwest University, Chongqing 400715, China.
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Arble EP, Shankar S, Steinert SW, Daugherty AM. Mental Health in Residential Healthcare Workers During the COVID-19 Pandemic: The Moderating Role of Selfobject Needs. Front Psychiatry 2021; 12:596618. [PMID: 34777029 PMCID: PMC8578853 DOI: 10.3389/fpsyt.2021.596618] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/29/2021] [Indexed: 11/30/2022] Open
Abstract
The COVID-19 outbreak has affected healthcare across all levels. Older adults and those with chronic illness are at greatest risk for infection complications and mortality, which presents significant psychological distress for residential healthcare workers. The concept of selfobject needs, consisting of Mirroring, Idealizing, and Twinship, may be relevant in explaining psychological distress. This study seeks to enhance our understanding of the needs of healthcare workers responsible for elderly patients and evaluate the role of psychosocial support through selfobject needs to mitigate the effects of trauma during the pandemic. Participants (N = 103) employed in residential healthcare facilities in the metropolitan Detroit, MI (USA) region completed an online survey during the peak initial infection. Assessments included standardized measures of trauma-related symptoms, depression, anxiety, and general distress symptoms, as well as a validated measure of selfobject needs. Residential healthcare workers reported mental health symptoms across domains, including clinical elevations in symptoms of trauma, depression, and anxiety. Selfobject needs and mental health outcomes were positively correlated, indicating that greater unmet relational need was associated with greater severity of symptoms. Greater trauma symptom severity as a proxy index of current experience during the pandemic predicted high depressive symptoms, and greater Mirroring need worsened the effect. These results suggest that interventions targeting selfobject needs, specifically Mirroring, may be effective at mitigating acute mental health symptoms among healthcare workers during a distressing event.
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Affiliation(s)
- Eamonn P Arble
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, United States
| | - Sneha Shankar
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, United States
| | - Steven W Steinert
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, United States
| | - Ana M Daugherty
- Department of Psychology, Department of Psychiatry and Behavioral Neurosciences, and Institute of Gerontology, Wayne State University, Detroit, MI, United States
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Moulds ML, Bisby MA, Wild J, Bryant RA. Rumination in posttraumatic stress disorder: A systematic review. Clin Psychol Rev 2020; 82:101910. [PMID: 32971312 DOI: 10.1016/j.cpr.2020.101910] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 08/17/2020] [Accepted: 08/31/2020] [Indexed: 12/26/2022]
Abstract
Initial models and empirical investigations of rumination in the clinical literature were predominantly in the domain of depression. However, rumination is now well-established as a transdiagnostic cognitive process, including in the context of posttraumatic stress. To clarify the current understanding of rumination in posttraumatic stress, we conducted a systematic review of the empirical literature on rumination in posttraumatic stress disorder (PTSD). Six sub-groups of studies on this topic were identified; these addressed: (i) the frequency and nature of rumination, (ii) cross-sectional relationships between rumination and PTSD symptoms, (iii) the capacity of rumination to predict PTSD longitudinally, (iv) other processes associated with rumination, (v) neurobiological correlates of rumination, and (vi) whether treating PTSD reduces rumination. This review synthesizes these domains of research and identifies key methodological limitations which limit causal inferences, and points to important areas of future research to advance knowledge on rumination in PTSD.
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Affiliation(s)
- Michelle L Moulds
- School of Psychology, The University of New South Wales, UNSW, Sydney, Australia.
| | - Madelyne A Bisby
- School of Psychology, The University of New South Wales, UNSW, Sydney, Australia
| | - Jennifer Wild
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Richard A Bryant
- School of Psychology, The University of New South Wales, UNSW, Sydney, Australia
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