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Haim-Nachum S, Kube T, Rozenkrantz L, Lazarov A, Levy-Gigi E, Michael T, Neria Y, Sopp MR. Does disconfirmatory evidence shape safety-and danger-related beliefs of trauma-exposed individuals? Eur J Psychotraumatol 2024; 15:2335788. [PMID: 38626065 PMCID: PMC11022916 DOI: 10.1080/20008066.2024.2335788] [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: 11/24/2023] [Accepted: 03/11/2024] [Indexed: 04/18/2024] Open
Abstract
Recent accounts of predictive processing in posttraumatic stress disorder (PTSD) suggest that trauma-exposed individuals struggle to update trauma-related hypotheses predicting danger, which may be involved in the etiology and maintenance of this disorder. Initial research supports this account, documenting an association between trauma-exposure, impaired expectation updating, and PTSD symptoms. Yet, no study to date has examined biased belief updating in PTSD using a scenario-based approach.Objective: Here, we examined the predictive processing account among trauma-exposed and non-trauma-exposed individuals using a modified Trauma-Related version of the Bias Against Disconfirmatory Evidence task.Method: The task presents both danger-and safety-related scenarios highly relevant for trauma-exposed individuals. For each scenario, participants viewed several explanations and rated their plausibility. Their ability to update their initial interpretation following new-contradictory information was assessed.Results: Preregistered analyses did not reveal any significant findings. Based on indications that our sample may not have been sufficiently powered, we conducted exploratory analyses in an extended sample of participants. These analyses yielded a significant association between reduced belief updating and PTSD symptoms which was evident for disconfirming both safety and danger scenarios. However, the effect sizes we found were in the small-to-medium range.Conclusion: Although preliminary, our current findings support initial evidence that individuals with higher PTSD symptoms show a higher resistance to update their beliefs upon new disconfirmatory evidence. Our results should be interpreted cautiously in light of the extended sample and the limitations of the current study.
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Affiliation(s)
- Shilat Haim-Nachum
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Tobias Kube
- Department of Clinical Psychology and Psychotherapy, RPTU University of Kaiserslautern-Landau, Landau, Germany
| | | | - Amit Lazarov
- School of Psychological Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Einat Levy-Gigi
- Faculty of Education and the Brain Science Center, Bar-Ilan University, Ramat-Gan, Israel
| | - Tanja Michael
- Division of Clinical Psychology and Psychotherapy, Saarland University, Saarbrücken, Germany
| | - Yuval Neria
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
- Department of Epidemiology, Columbia University Irving Medical Center, New York, NY, USA
| | - M. Roxanne Sopp
- Division of Clinical Psychology and Psychotherapy, Saarland University, Saarbrücken, Germany
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The relationship between multiple traumatic events and the severity of posttraumatic stress disorder symptoms – evidence for a cognitive link. Eur J Psychotraumatol 2023; 14:2165025. [PMID: 37052097 PMCID: PMC9879173 DOI: 10.1080/20008066.2023.2165025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background: Previous research has shown that multiple traumatic experiences cumulatively increase the risk for the development of severe symptoms of posttraumatic stress disorder (PTSD). Yet, little is known about the specific psychological mechanism through which this increased risk comes about.Objective: In the present study, we examined a possible cognitive link between multiple traumatic events and PTSD symptom severity through dysfunctional cognitions and expectations.Methods: A sample of patients with a diagnosed PTSD (N = 70; MAge = 42.06; 82% female) and high symptom burden (IES-R M = 79.24) was examined. On average, patients had experienced 5.31 different traumatic events. In a structural equation model, we tested the hypothesis that the relationship between multiple traumatic experiences and PTSD symptom severity is mediated through dysfunctional general cognitions and dysfunctional situation-specific expectations. General trauma-related cognitions were assessed with the Posttraumatic Cognition Inventory (PTCI) and trauma-related situational expectations were assessed with the Posttraumatic Expectations Scale (PTES).Results: The direct effect of the number of traumatic events on PTSD symptom severity was non-significant. Instead, as hypothesised, there was evidence for a significant indirect effect via dysfunctional general cognitions and situation-specific expectations.Conclusions: The current results further specify the cognitive model of PTSD by indicating that the relationship between the number of traumatic events and PTSD symptom severity is mediated through dysfunctional cognitions and expectations. These findings emphasise the importance of focused cognitive treatment approaches that seek to modify dysfunctional cognitions and expectations in people with multiple traumatic experiences.
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Lathan EC, Powers A, Kottakis A, Guelfo A, Siegle GJ, Turner JA, Turner MD, Yakkanti V, Jain J, Mekawi Y, Teer AP, Currier JM, Fani N. Civilian moral injury: associations with trauma type and high-frequency heart rate variability in two trauma-exposed community-based samples. Psychol Med 2023; 53:5136-5145. [PMID: 37650341 PMCID: PMC10476056 DOI: 10.1017/s003329172200215x] [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: 03/13/2022] [Revised: 06/13/2022] [Accepted: 06/22/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Moral injury exposure (MIE) and distress (MID) may indirectly affect the relationship between trauma exposure and alterations in autonomic regulation [assessed via high-frequency heart rate variability (hfHRV)] in civilians, but this has not been tested in prior research. We conducted two exploratory studies to examine trauma types' associations with MIE and MID among civilian medical patients (Study 1) and explore how these facets may indirectly affect the relationship between trauma type and hfHRV among civilians seeking mental health services (Study 2). METHODS Participants recruited from a public hospital and/or community advertisements (Study 1, n = 72, 87.5% Black, 83.3% women; Study 2, n = 46, 71.7% Black, 97.8% women) completed measures assessing trauma type, MIE, and MID. In Study 1, trauma types that emerged as significant correlates of MIE and MID were entered into separate linear regression analyses. Trauma types identified were included as predictors in indirect effects models with MIE or MID as the mediator and resting hfHRV (assayed via electrocardiography) as the outcome. RESULTS Childhood sexual abuse emerged as the only significant predictor of MIE, b = 0.38, p < 0.001; childhood sexual abuse, b = 0.26, p < 0.05, and adulthood sexual assault, b = 0.23, p < 0.05 were significant predictors of MID. Participants with greater MIE and MID demonstrated lower hfHRV. Adulthood sexual assault showed an indirect effect on hfHRV through MID, B = -0.10, s.e. = 0.06, 95%CI (-0.232 to -0.005). CONCLUSIONS Moral injury was uniquely associated with sexual violence and lower hfHRV in civilians. Data highlight moral injury as a pathway through which autonomic dysregulation may emerge and its salience for trauma treatment selection.
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Affiliation(s)
- Emma C. Lathan
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Anna Kottakis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Alfonsina Guelfo
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Greg J. Siegle
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jessica A. Turner
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Matthew D. Turner
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Vijwala Yakkanti
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jahnvi Jain
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Yara Mekawi
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Andrew P. Teer
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Joseph M. Currier
- Department of Psychology, University of South Alabama, Mobile, AL, USA
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Herzog P, Kaiser T, Rief W, Brakemeier EL, Kube T. Assessing Dysfunctional Expectations in Posttraumatic Stress Disorder: Development and Validation of the Posttraumatic Expectations Scale (PTES). Assessment 2023; 30:1285-1301. [PMID: 35549727 DOI: 10.1177/10731911221089038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dysfunctional expectations are a particularly important subset of cognitions that influence the development and maintenance of various mental disorders. This study aimed to develop and validate a scale to assess dysfunctional expectations in posttraumatic stress disorder (PTSD), the "Posttraumatic Expectations Scale" (PTES). In a cross-sectional study, 70 PTSD patients completed the PTES, the Posttraumatic Cognitions Inventory (PTCI), as well as measures of the severity of symptoms of PTSD and depression. The results show that the PTES has excellent internal consistency and correlates significantly with the PTCI and PTSD symptom severity. A regression analysis revealed that the PTES explained variance of PTSD symptom severity above the PTCI, supporting the incremental validity of the PTES. While the original version of the PTES comprises 81 items, short scales were constructed using the BISCUIT (best items scales that are cross-validated, unit-weighted, informative and transparent) method. The current findings provide preliminary psychometric evidence suggesting that the PTES is an internally consistent and valid novel self-report measure in patients with PTSD. However, conclusions about the psychometric properties of the PTES are limited because of the absence of criterion-related validity, factor structure evidence, variability over time/response to intervention, and test-retest reliability. Future research should use the PTES in large-scale longitudinal studies to address these aspects to further validate the scale.
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Affiliation(s)
- Philipp Herzog
- Philipps-University Marburg, Germany
- University of Greifswald, Germany
- University of Koblenz-Landau, Germany
| | | | | | | | - Tobias Kube
- Philipps-University Marburg, Germany
- University of Koblenz-Landau, Germany
- Beth Israel Deaconess Medical Center, Boston, MA, USA
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Jobson L, Willoughby C, Specker P, Wong J, Draganidis A, Lau W, Liddell B. Investigating the associations between cognitive appraisals, emotion regulation and symptoms of posttraumatic stress disorder among Asian American and European American trauma survivors. Sci Rep 2022; 12:18127. [PMID: 36307529 PMCID: PMC9616820 DOI: 10.1038/s41598-022-22995-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/21/2022] [Indexed: 12/30/2022] Open
Abstract
This study investigated whether the associations between emotion regulation and cognitive appraisals and symptoms of posttraumatic stress disorder (PTSD) differ between Asian American and European American trauma survivors. Asian American (n = 103) and European American (n = 104) trauma survivors were recruited through mTurk and completed an on-line questionnaire assessing cognitive appraisals, emotion regulation and PTSD symptomatology. The European American group reported greater trauma-specific rumination, psychological inflexibility, seeking out others for comfort, and negative self-appraisals than the Asian American group. The Asian American group reported greater secondary control appraisals and cultural beliefs about adversity than the European American group. Second, cultural group moderated the associations between (a) brooding rumination, (b) fatalism, (c) self-blame, and (d) negative communal self-appraisals and PTSD symptoms. These associations were larger for the European American group than the Asian American group. Third, there was an indirect pathway from self-construal (independent and interdependent) to PTSD symptoms through certain emotion regulation approaches and cognitive appraisals. Additionally, cultural group was found to moderate several of these indirect effects. These findings highlight the importance of considering cultural background and cultural values in understanding the processes involved in PTSD. Further research in this area is needed.
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Affiliation(s)
- Laura Jobson
- grid.1002.30000 0004 1936 7857Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC 3800 Australia
| | - Casey Willoughby
- grid.1002.30000 0004 1936 7857Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC 3800 Australia ,grid.1005.40000 0004 4902 0432School of Psychology, University of New South Wales, Sydney, NSW 2052 Australia
| | - Philippa Specker
- grid.1005.40000 0004 4902 0432School of Psychology, University of New South Wales, Sydney, NSW 2052 Australia
| | - Joshua Wong
- grid.1002.30000 0004 1936 7857Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC 3800 Australia ,grid.1005.40000 0004 4902 0432School of Psychology, University of New South Wales, Sydney, NSW 2052 Australia
| | - Adriana Draganidis
- grid.1002.30000 0004 1936 7857Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC 3800 Australia
| | - Winnie Lau
- grid.1008.90000 0001 2179 088XPhoenix Australia-Centre for Posttraumatic Mental Health and Department of Psychiatry, University of Melbourne, Carlton, VIC 3053 Australia
| | - Belinda Liddell
- grid.1005.40000 0004 4902 0432School of Psychology, University of New South Wales, Sydney, NSW 2052 Australia
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Blackwell SE, Ehring T, Gladwin TE, Margraf J, Woud ML. The relationship between self-traumatized and self-vulnerable automatic associations and posttraumatic stress symptoms among adults who have experienced a distressing life event. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02441-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AbstractConvergent evidence supports a crucial role for dysfunctional appraisals in the development and maintenance of post-traumatic stress disorder (PTSD). However, most research in this area has used self-report measures, assessing only explicit forms of such negative cognitions; the relevance of their more automatically-activated counterparts, as assumed by cognitive models, remains relatively unexplored. The current study aimed to further our understanding of the potential utility of measuring automatic dysfunctional associations in the context of posttraumatic stress. The relationship between scores on two different implicit association tests (IATs) and posttraumatic stress symptoms was investigated in a sample of adults (N = 279) who reported having experienced a potentially traumatic negative life event. Participants completed the two IATs (one assessing self-traumatized associations, the other self-vulnerable associations), a self-report measure of dysfunctional appraisals, and measures of posttraumatic stress symptoms and other aspects of psychopathology online. Scores indicating higher levels of dysfunctional associations on both IATs were associated with higher levels of posttraumatic stress symptoms. Only scores on the IAT measuring self-vulnerable associations, and not the IAT measuring self-traumatized associations, continued to show an association with posttraumatic stress symptoms after controlling for explicit dysfunctional appraisals. Overall, the results indicate the value of investigating PTSD-relevant automatic associations to further develop our understanding of cognitive processes implicated in posttraumatic stress.
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Mancini AD, Aldrich L, Shevorykin A, Veith S, John G. Threat appraisals, neuroticism, and intrusive memories: a robust mediational approach with replication. ANXIETY STRESS AND COPING 2020; 34:66-82. [PMID: 32972259 DOI: 10.1080/10615806.2020.1825693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: The appraisal of a stressor substantially influences how we adapt to it. We used an experimental paradigm to test and replicate the effects of threat appraisals on subsequent intrusive memories, as well as their moderation by neuroticism. Method: In three studies (total N = 562), participants were randomly assigned to an aversive or control video and then asked to report their threat appraisals of the video. Intrusive memories were assessed at one, three, five, and seven days. We used a robust framework for testing causal mediational effects and their magnitude, including sensitivity analyses and new effect size metrics. Results: We found that threat appraisals mediated the effect of the video on intrusive memories (studies 1-3), and for people higher in neuroticism, the causal mediational pathway was stronger (study 1 and 2). Conclusions: These findings provide methodologically strong evidence that threat appraisals have causal effects on subsequent intrusive memories and that neuroticism enhances this effect, lending empirical support to appraisal theories of posttraumatic stress disorder.
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Affiliation(s)
| | - Laura Aldrich
- Department of Psychology, New York University, NY, USA
| | - Alina Shevorykin
- Department of Psychology, Pace University, Pleasantville, NY, USA
| | - Serena Veith
- Department of Psychology, Pace University, Pleasantville, NY, USA
| | - Grace John
- Department of Psychology, Pace University, Pleasantville, NY, USA
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Kube T, Rozenkrantz L. When Beliefs Face Reality: An Integrative Review of Belief Updating in Mental Health and Illness. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2020; 16:247-274. [DOI: 10.1177/1745691620931496] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Belief updating is a relatively nascent field of research that examines how people adjust their beliefs in light of new evidence. So far, belief updating has been investigated in partly unrelated lines of research from different psychological disciplines. In this article, we aim to integrate these disparate lines of research. After presenting some prominent theoretical frameworks and experimental designs that have been used for the study of belief updating, we review how healthy people and people with mental disorders update their beliefs after receiving new information that supports or challenges their views. Available evidence suggests that both healthy people and people with particular mental disorders are prone to certain biases when updating their beliefs, although the nature of the respective biases varies considerably and depends on several factors. Anomalies in belief updating are discussed in terms of both new insights into the psychopathology of various mental disorders and societal implications, such as irreconcilable political and societal controversies due to the failure to take information into account that disconfirms one’s own view. We conclude by proposing a novel integrative model of belief updating and derive directions for future research.
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Affiliation(s)
- Tobias Kube
- Program in Placebo Studies, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Koblenz-Landau
| | - Liron Rozenkrantz
- Program in Placebo Studies, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology
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Kube T, Berg M, Kleim B, Herzog P. Rethinking post-traumatic stress disorder - A predictive processing perspective. Neurosci Biobehav Rev 2020; 113:448-460. [PMID: 32315695 DOI: 10.1016/j.neubiorev.2020.04.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 12/15/2022]
Abstract
Predictive processing has become a popular framework in neuroscience and computational psychiatry, where it has provided a new understanding of various mental disorders. Here, we apply the predictive processing account to post-traumatic stress disorder (PTSD). We argue that the experience of a traumatic event in Bayesian terms can be understood as a perceptual hypothesis that is subsequently given a very high a-priori likelihood due to its (life-) threatening significance; thus, this hypothesis is re-selected although it does not fit the actual sensory input. Based on this account, we re-conceptualise the symptom clusters of PTSD through the lens of a predictive processing model. We particularly focus on re-experiencing symptoms as the hallmark symptoms of PTSD, and discuss the occurrence of flashbacks in terms of perceptual and interoceptive inference. This account provides not only a new understanding of the clinical profile of PTSD, but also a unifying framework for the corresponding pathologies at the neurobiological level. Finally, we derive directions for future research and discuss implications for psychological and pharmacological interventions.
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Affiliation(s)
- Tobias Kube
- Harvard Medical School, Program in Placebo Studies, Beth Israel Deaconess Medical Center, Brookline Avenue 330, Boston, MA, 02115, USA; University of Koblenz-Landau, Pain and Psychotherapy Research Lab, Ostbahnstr. 10, 76829 Landau, Germany.
| | - Max Berg
- Philipps-University of Marburg, Department of Psychology, Division of Clinical Psychology and Psychological Treatment Gutenbergstraße 18, D-35032, Marburg, Germany
| | - Birgit Kleim
- University of Zurich, Department of Psychology, Binzmühlestrasse 14, Box 8, CH-8050, Zurich, Switzerland; Psychiatric University Hospital (PUK), Lenggstrasse 31, CH-8032, Zurich, Switzerland
| | - Philipp Herzog
- Philipps-University of Marburg, Department of Psychology, Division of Clinical Psychology and Psychological Treatment Gutenbergstraße 18, D-35032, Marburg, Germany; University of Greifswald, Department of Psychology, Clinical Psychology and Psychotherapy, Franz-Mehring-Straße 47, D-17489, Greifswald, Germany; Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, D-23562, Lübeck, Germany
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