Thought control strategies as mediators of trauma symptoms in young women with histories of child sexual abuse

Women's strategies for navigating a healthy sex life post-sexual trauma

Sexual trauma is common. Consequences of sexual trauma can include deterioration of mental and physical health and it can also affect future romantic and sexual relationships. Previous studies have identified common healthy and destructive coping mechanisms to recover after experiencing sexual trauma, but few studies have investigated useful strategies to move into a healthy sexual relationship focused on resilience. In-depth semi-structured interviews were conducted with 41 women with a history of sexual trauma who were in a healthy sexual relationship at the time of participation. Participants provided strategies that helped them move beyond the sexually traumatic event(s) toward a healthy sexual relationship. Reflexive thematic analysis identified 5 effective and 6 ineffective strategies reported by the participants. Rich examples of resilience and empowerment were overarching in the effective strategies used for moving toward healthy sexual relationships. Women were also able to reflect on the strategies that were ineffective for them with kindness and understanding for their coping at that time, a normalizing theme for women working through sexual trauma. The results of this study will help therapists and researchers working with women who have experienced sexual trauma learn from their experiences in working beyond trauma toward a healthy sexual relationship.

Beliefs About Traumatic Memories, Thought Control Strategies, and the Impact on PTSD Symptoms After a Natural Disaster

ABSTRACT

This study aimed to investigate the relationships among self-reported meta-memory beliefs, thought control strategies ( i.e. , distraction, reappraisal, worry, social control, and punishment), and posttraumatic stress disorder (PTSD) symptomology, among a sample of earthquake survivors ( N = 412). Correlational analysis and structural equation modeling were used on the responses and showed that stronger positive and negative meta-memory beliefs, and greater worry and punishment, were associated with greater PTSD symptom severity. The results also indicated that meta-memory beliefs had a prominent indirect influence toward PTSD symptomology via their effects toward thought control strategies. Follow-up analysis of variance indicated that those with a history of mental health difficulties reported higher levels of PTSD symptom severity, were more likely to score in the range of clinically relevant PTSD, and had a stronger tendency to negatively appraise unwanted thinking styles. The results of this research provide overall support for the validity of the metacognitive model for PTSD.

The metacognitive model of post-traumatic stress disorder and metacognitive therapy for post-traumatic stress disorder: A systematic review

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.

How Does Childhood Trauma Impact Women's Sexual Desire? Role of Depression, Stress, and Cortisol

The relationship between childhood trauma and adult sexual dysfunction is well documented; however, there is a paucity of research that examines the physiological and psychological mechanisms that may potentiate this relationship. As depression, perceived stress, and hypothalamic pituitary adrenal (HPA) axis dysregulation are correlates of childhood trauma and sexual dysfunction, the current study sought to examine the association of each of these domains with low sexual desire in a sample of (N = 275 [n = 137 women with low sexual desire; n = 138 sexually healthy women]) non-clinically depressed women. First, we assessed the relative contributions of HPA axis dysregulation (as indexed by the diurnal cortisol slope), childhood trauma, depression symptoms and perceived daily stress on low sexual desire. Next, we examined the degree to which HPA axis dysregulation, perceived stress, and depressive symptoms, respectively, mediated the relationship between childhood trauma and sexual desire. Results indicate that diurnal cortisol slope and depression symptoms contribute to low desire over and above perceived stress and childhood trauma and that childhood trauma is associated with low sexual desire predominantly through depressive symptomatology. Theoretical and clinical implications of the findings are discussed.

Sex differences in factors associated with post-traumatic stress disorder in acute type A aortic dissection patients

BACKGROUND

Emergency surgery for acute type A aortic dissection (AAAD) is associated with a high risk for posttraumatic stress disorder (PTSD), and the risk factors for PTSD symptoms development in AAAD patients of different sexes remain unclear.

OBJECTIVE

To identify the risk factors for PTSD symptoms separately in the females and males following AAAD.

METHODS

A sample population of 214 patients who had AAAD surgery was recruited. Patients' sociodemographic and disease-specific data were collected during hospitalization.

RESULTS

In this study, PTSD symptoms was present in 22.1% of the male patients and 20.0% of the female patients (P = 0.739). For the male patients with AAAD, PTSD symptoms were significantly positively associated with HADS-D score (P = 0.029), while those with university education and above (P = 0.039), stronger subjective support (P = 0.010) and greater optimism (P = 0.001) had significantly lower possibility for the presence of PTSD symptoms. For the female patients with AAAD, support availability (P = 0.031) was significantly negatively associated with PTSD symptoms while HADS-D score (P = 0.033) was significantly positively associated with PTSD symptoms.

CONCLUSION

Risk factors for PTSD symptoms differ in male patients and female patients following AAAD.

Gratitude Moderates the Mediating Effect of Deliberate Rumination on the Relationship Between Intrusive Rumination and Post-traumatic Growth

PURPOSE

This study examines the moderating effect of gratitude on the mediating effect of deliberate rumination on the relationship between intrusive rumination and post-traumatic growth (PTG).

METHODS

We used self-report questionnaires to collect data from 450 18-68-year-old participants (Mage = 39.73, SD = 13.73) residing in major cities and regions across South Korea. Data that were collected from 411 participants were subjected to analysis. Version 25 of SPSS (Statistical Package for Social Science) and PROCESS macro were used to analyze mediation, moderation, and moderated mediation effects.

RESULTS

Deliberate rumination mediated the relationship between intrusive rumination and PTG. Gratitude moderated the effect of deliberate rumination on PTG. Finally, gratitude moderated the mediating effect of deliberate rumination on the relationship between intrusive rumination and PTG.

CONCLUSION

Deliberate rumination and gratitude facilitate PTG for traumatized adults. In particular, gratitude reinforces the effect of deliberate rumination on PTG.

The mediating role of the metacognition, time perspectives and experiential avoidance on the relationship between childhood trauma and post-traumatic stress disorder symptoms

Background: The current study was designed to investigate the direct and indirect effects of the childhood trauma, metacognition, time perspectives and experiential avoidance in prediction of post-traumatic stress disorder (PTSD) symptoms. Methods: Participants included 432 adult patients referred for treatment to psychological, psychiatric disorders clinics and medical clinics of Shiraz, Iran. They were exposed to a traumatic event according to criterion A in the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-V). Childhood Trauma Questionnaire (CTQ), Post-traumatic Checklist for DSM-5 (PCL-5), Zimbardo Time Perspective Inventory (ZTPI), Acceptance and Action Questionnaire - II (AAQ-II) and metacognitions questionnaire-30 (MCQ-30) all were applied for data collection. Results: The results indicated that childhood trauma has a direct correlation with symptoms of PTSD, metacognition, and time perspectives, while it has an indirect correlation with experiential avoidance as well as symptoms of PTSD. Thus, metacognition and time perspectives play a mediating role between childhood trauma and experiential avoidance. In the same way, all three variables (metacognition, time perspectives, and experiential avoidance) play the same role between childhood trauma and symptoms of PTSD. Conclusions: Altogether, results of this study were consistent with the metacognitive model as well as Time Perspective Theory for PTSD and emphasizes that childhood trauma, metacognition, time perspectives and experiential Avoidance are important in explanation of PTSD symptoms.

Examining the relationship between higher educational attainment, trauma symptoms, and internalizing behaviors in child sexual abuse survivors

The trauma symptoms of child sexual abuse (CSA) survivors don't end with the abuse, or even with the advent of adulthood. Instead, these symptoms can persist into all the realms of a survivor's life, including education, which sets the foundation for career advancement. This retrospective study of adult survivors of childhood sexual abuse (n=260) examined the relationships between trauma symptoms, dissociation, dissociative amnesia, anxiety, depression, sleep problems and higher education attainment. The purpose of this study was to determine if these factors are associated with higher education completion for childhood sexual abuse (CSA) survivors. Linear regressions and ANOVAs suggest that many of these variables are significantly associated with survivors' educational trajectory, and multiple linear regressions show that trauma symptoms (as measured by the Trauma Symptom Checklist-40), caregivers' education levels, and age at onset of abuse are significant predictors of decreased education levels. This information can provide insight into additional risk and protective factors for CSA survivors in order to enhance acute and long-term management of trauma symptoms to increase levels ofattainment of higher education.

Accounting for intrusive thoughts in PTSD: Contributions of cognitive control and deliberate regulation strategies

BACKGROUND

Persistent, trauma-related intrusive thoughts are common in individuals with posttraumatic stress disorder (PTSD). Automatic aspects of cognitive functioning (including executive functioning) and maladaptive deliberate attempts at cognitive regulation have been proposed as individual difference factors that may perpetuate intrusive thoughts. The current study sought to examine the joint contribution of these two factors on intrusive thoughts in PTSD.

METHOD

Forty-two women with PTSD completed an executive functioning assessment followed by a thought suppression task. Intrusive thoughts (frequency and duration), as well as participants' use of specific cognitive regulation strategies (avoidance-based thought regulation strategies; TRS), were measured during the task. Hierarchical linear regression was used to examine the interaction of executive functioning and TRS on intrusive thoughts.

RESULTS

Greater use of TRS was associated with greater intrusive thought persistence for those with low executive functioning, but not those with high executive functioning.

LIMITATIONS

Data was collected cross-sectionally and the laboratory thought suppression task may not correspond to naturalistic thought regulation.

CONCLUSIONS

Results are consistent with prior literature suggesting that certain responses deployed by individuals to control intrusive thoughts may be unhelpful, but that a higher level of cognitive capacity may mitigate this effect. Implications of these findings for recent models of cognition in PTSD are discussed.

Interpersonal difficulties mediate the relationship between child sexual abuse and depression symptoms

This study examined the influence of interpersonal functioning as a mediator in the relationship between child sexual abuse and depression symptoms, after accounting for the influence of child physical abuse. The research questions build on the existing knowledge base by examining mechanisms of adult adjustment among child sexual abuse survivors. In the current study, 2,892 young adult women (18-29 years old; M = 19.06) reported on child sexual and physical abuse, 5 domains of interpersonal functioning, and depression symptoms. The results supported aggression, sensitivity, ambivalence, and lack of sociability as mediators in the relationship between child sexual abuse and depression symptoms. These results suggest that interpersonal difficulties related to hostility, emotional reactivity, inability to collaborate, and isolation may be of particular interest when understanding depression in child sexual abuse survivors. The findings support interpersonal problems as a key mechanism of depression symptoms following child sexual abuse and is even demonstrated when examining long-term outcomes and controlling for child physical abuse. The hypotheses and findings are discussed in the context of interpersonal psychotherapy for depression.

Thought control strategies and rumination in youth with acute stress disorder and posttraumatic stress disorder following single-event trauma

OBJECTIVE

Certain thought control strategies for managing the intrusive symptoms of posttraumatic stress disorder (PTSD) are thought to play a key role in its onset and maintenance. Whereas measures exist for the empirical assessment of such thought control strategies in adults, relatively few studies have explored how children and adolescents manage posttraumatic intrusive phenomena.

METHODS

In a prospective longitudinal study of 10-16-year-olds with PTSD, who were survivors of road traffic collisions and assaults, a variety of thought control strategies were assessed in the acute phase. These included strategies thought to be protective (reappraisal, social support) as well as maladaptive (distraction, punishment, worry). Ruminative responses to the trauma were assessed at the follow-up assessment.

RESULTS

Posttraumatic stress symptoms (PTSS) at each assessment were associated with the use of punishment and reappraisal, whereas social support and rumination were associated with PTSS symptoms at follow-up. Distraction was unrelated to PTSS at any time point. Rumination accounted for variance in PTSS symptoms at follow-up, even when accounting for baseline PTSS, and was found to mediate the relationships between reappraisal and punishment at baseline and PTSS at the follow-up assessment.

CONCLUSIONS

The present study found no evidence to support advocating any particular thought control strategy for managing the intrusive symptoms of PTSD in youth in the acute posttrauma phase, and raised concerns over the use of reappraisal coping strategies. The study underscores the importance of ruminative responses in the onset and maintenance of PTSD in trauma-exposed youth.

Attentional interference by threat and post-traumatic stress disorder: the role of thought control strategies

Attentional interference by threat is associated with PTSD, but the mechanisms of this relationship remain unclear. Attentional interference might be related to increased use of maladaptive thought control strategies, such as suppressing unwanted thoughts (thought suppression) or replacing threatening thoughts with everyday concerns (worry), which increase PTSD risk. Conversely, attentional interference might be associated with reduced use of adaptive strategies, such as talking about threatening thoughts (social control), which decrease PTSD risk. This study tested if thought control strategies mediate the relationship between attentional interference and PTSD. Sixty-one male Vietnam-era veterans completed measures of PTSD symptoms and thought control strategies. Participants also completed a Visual Search Task measuring attentional interference, which required participants to identify a target letter string among a group of threat or neutral words. Attentional interference by threat was related to PTSD symptoms, and mediation analyses revealed significant indirect effects of attentional interference through thought suppression and worry. Attentional interference was related to re-experiencing and avoidance, but not hyperarousal, symptom clusters. Thought suppression was a unique mediator for re-experiencing, whereas thought suppression and worry both mediated the relationship with avoidance. These results offer evidence for maladaptive thought control strategies as a mechanism linking attentional biases for threat to PTSD.

The mediating effect of daily stress on the sexual arousal function of women with a history of childhood sexual abuse

Psychopathologies such as posttraumatic stress disorder are often proposed as mediators of the sexual arousal dysfunction experienced by women with a history of childhood maltreatment. However, posttraumatic stress disorder symptoms are only part of the difficulties experienced by these women. Other factors to consider include negative affectivity and perceived daily stress. To assess the mediating role of posttraumatic stress disorder symptoms, negative affectivity, and perceived daily stress, we collected data from 62 women with and without a history of childhood maltreatment (sexual, physical and emotional abuse). A comprehensive assessment of sexual arousal functioning and sexual responses was obtained using self-reported measures and psychophysiological measures of vaginal engorgement and subjective sexual arousal during exposure to sexual visual stimuli. The model assessed the simultaneous mediating effect of posttraumatic stress disorder symptoms, negative affectivity and perceived daily stress on the relation between childhood maltreatment and sexual variables. Daily stress, showed a significant and stronger mediation effect on sexual arousal functioning as compared to posttraumatic stress disorder and negative affectivity. These findings suggest that daily stress may be an important mechanism to consider when treating sexual arousal functioning in women who have a history of childhood maltreatment.

Cognitive-behavioral coping strategies associated with combat-related PTSD in treatment-seeking OEF-OIF Veterans

Posttraumatic stress disorder (PTSD) is associated with intrusive trauma-related thoughts and avoidance behaviors that contribute to its severity and chronicity. This study examined thought control and avoidance coping strategies associated with both a probable diagnosis and symptom severity of combat-related PTSD in a sample of 167 treatment-seeking Operations Enduring Freedom and Iraqi Freedom (OEF-OIF) Veterans. Within one year of returning from deployment, Veterans completed a survey containing measures of combat exposure, coping strategies, psychopathology, and postdeployment social support. Veterans with a positive screen for PTSD scored higher than Veterans without a positive screen for PTSD on measures of worry, self-punishment, social control, behavioral distraction, and avoidance coping strategies. Worry and social avoidance coping were positively related to PTSD symptoms, and greater perceptions of understanding from others were negatively related to these symptoms. A structural equation model revealed that scores on a measure of postdeployment social support were negatively associated with scores on measures of maladaptive cognitive coping (i.e., worry, self-punishment) and avoidance coping (social and non-social avoidance coping) strategies, which were positively associated with combat-related PTSD symptoms. These results suggest that maladaptive thought control and avoidance coping may partially mediate the relation between postdeployment social support and combat-related PTSD symptoms in treatment-seeking OEF-OIF Veterans. Consistent with cognitive therapy models, these findings suggest that interventions that target maladaptive coping strategies such as worry, self-punishment, and social avoidance, and that bolster social support, most notably understanding from others, may help reduce combat-related PTSD symptoms in this population.

Examining the role of emotional avoidance in the relationship between posttraumatic stress disorder symptom severity and worry

A growing body of literature suggests that worry is a cognitive activity functioning to avoid unpleasant internal experiences such as negative thoughts, emotions, and somatic responses. Given the highly aversive internal events associated with posttraumatic stress disorder (PTSD), individuals experiencing PTSD symptoms following exposure to a traumatic event may be particularly motivated to engage in avoidant regulation strategies such as worry. Surprisingly, however, few studies to date have examined the relationship between PTSD and worry as well as potential factors that might explain this association. Therefore, the goal of this study was to examine the association between PTSD symptom severity and worry and the extent to which emotional avoidance explains this relationship. To this end, 207 college students with a history of traumatic exposure (meeting Criterion A for a PTSD diagnosis) completed a series of questionnaires assessing history of exposure to potentially traumatic events, PTSD symptom severity, emotional avoidance tendencies, and worry. Results demonstrated that PTSD symptom severity was positively associated with worry and emotional avoidance. Further, emotional avoidance was found to fully account for this relationship, providing support for the proposed emotionally avoidant function of worry. The implications of these findings for future research and the treatment of worry among individuals with a history of traumatic exposure are discussed.

Sleep quality in treatment-seeking veterans of Operations Enduring Freedom and Iraqi Freedom: the role of cognitive coping strategies and unit cohesion

OBJECTIVE

Sleep difficulties are common in individuals exposed to stress or trauma, and maladaptive cognitive coping strategies, such as worry and fear of losing vigilance, as well as low social support, may further impair sleep quality. This study examined the severity and correlates of sleep difficulties in a sample of treatment-seeking veterans of Operations Enduring Freedom and Iraqi Freedom (OEF-OIF).

METHOD

A total of 167 OEF-OIF veterans seeking behavioral or primary care services completed a questionnaire containing measures of sleep quality, combat exposure, psychopathology, fear of loss of vigilance, cognitive coping strategies, and unit and postdeployment social support within 1 year of returning from deployment.

RESULTS

Mean Pittsburgh Sleep Quality Inventory scores in the full sample were indicative of severely impaired sleep. Posttraumatic stress disorder (PTSD) was associated with increased sleep difficulties, most notably sleep disturbances, daytime dysfunction, and sleep quality. Hierarchical regression analysis in the full sample revealed that PTSD symptoms and scores on measures of worry and fear of loss of vigilance were positively associated with sleep difficulties and that scores on a measure of unit member support were negatively associated with sleep difficulties. Among veterans with PTSD, fear of loss of vigilance was positively associated with sleep difficulties and cognitive distraction and unit member support were negatively associated with sleep difficulties.

CONCLUSIONS

Treatment-seeking OEF-OIF veterans report severe sleep difficulties, with more pronounced impairment in veterans with PTSD. The results of this study suggest that interventions to mitigate worry and fear of loss of vigilance and to enhance perceived unit member support may be helpful in reducing sleep difficulties following return from deployment in this population.