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Ellis É, Wieling E, Tate A. Complex Posttraumatic Stress Disorder Links Trauma Exposure and Suicidal Behaviors Among Sexual Minority Populations: A New Target in Suicide Prevention? JOURNAL OF HOMOSEXUALITY 2024; 71:2300-2318. [PMID: 37466931 DOI: 10.1080/00918369.2023.2233654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Exposure to potentially traumatic events and posttraumatic stress are known risk factors for suicidal thoughts and behaviors (STB). Research suggests that sexual minorities are disproportionately exposed to traumatic events and experience greater STB than their heterosexual peers, although few studies have explored connections between these parallel disparities. Further, existing literature may implicate complex posttraumatic stress disorder (CPTSD) as a potential mechanism in the trauma-suicide connection among sexual minorities. This study uses a sample from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III; n = 1351) to test structural equation models for associations between trauma exposure, heterosexist discrimination, and CPTSD with suicide attempt status. We found CPTSD mediated associations between exposure to traumatic events and presence of a lifetime suicide attempt among sexual minority male and female samples. Discrimination demonstrated a synergistic effect on the association between trauma exposure and CPTSD, but, among males, CPTSD did not fully explain associations between discrimination and suicide attempts. Our findings suggest that CPTSD should be considered an important mechanism in the trauma-suicide connection for sexual minorities and may be a potentially important target for suicide prevention and that interventions should address the influence of discrimination on traumatic stress in this high-risk population.
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Affiliation(s)
- Émilie Ellis
- College of Public Health, University of Georgia School of Public Health, Athens, Georgia, USA
| | - Elizabeth Wieling
- Human Development and Family Science, University of Georgia Department of Human Development and Family Science, Athens, Georgia, USA
| | - Allan Tate
- College of Public Health, University of Georgia School of Public Health, Athens, Georgia, USA
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2
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Li Y, Tao VYK, Wu AMS. Exploring implicit theories of shame: developing a new scale assessing shame-related beliefs. MOTIVATION AND EMOTION 2023. [DOI: 10.1007/s11031-023-10008-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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3
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Chou PH, Wang SC, Wu CS, Ito M. Trauma-related guilt as a mediator between post-traumatic stress disorder and suicidal ideation. Front Psychiatry 2023; 14:1131733. [PMID: 37056401 PMCID: PMC10086326 DOI: 10.3389/fpsyt.2023.1131733] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/13/2023] [Indexed: 04/15/2023] Open
Abstract
Background As a mental health issue, suicide is a growing global concern, with patients who have post-traumatic stress disorder (PTSD) being at particularly high risk. This study aimed to investigate whether the link between PTSD and suicidal ideation is mediated by trauma-related guilt. Methods Data were obtained from Wave 1, Time 1 (November 2016), and Time 2 (March 2017) of the National Survey for Stress and Health (NSSH) in Japan. The NSSH is an online longitudinal survey conducted on Japan's national population aged 18 years and older. The cumulative response rate of the survey was 66.7% at Time 2. A total of 1,005 patients with PTSD were included for analyses. The severity of PTSD symptoms was assessed with PTSD DSM-5 Checklist, and the trauma-related guilt were assessed using the two subscales (hindsight-bias/responsibility and global guilt scale) of the trauma-related guilt inventory (TRGI). Suicidal ideation was evaluated using the suicidal ideation attributes scale (SIDAS). Pearson's correlation was used to investigate the associations among PTSD symptoms, TRGI scores, and SIDAS scores. Causal mediation analysis was applied to evaluate the causal relationship between PTSD, trauma-related guilt, and suicidal ideation. Results Pearson's correlation did not show patients' age, gender, and household income significantly associated with SIDAS scores. On the other hand, severities of PTSD symptoms (r = 0.361, p < 0.001) and trauma-related guilt (r = 0.235, p < 0.001) were positively associated with SIDAS scores. After adjusting for age, gender, and household income, the mediation analysis revealed that trauma-related guilt significantly mediates the effects of PTSD symptoms on suicidal ideation. Conclusion Our results implied that trauma-related guilt may represent a critical link between PTSD and suicidal ideation, which may be a noteworthy target for therapeutic intervention.
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Affiliation(s)
- Po-Han Chou
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Taichung, Taiwan
- Department of Psychiatry, China Medical University Hospital, China Medical University, Taichung, Taiwan
- *Correspondence: Po-Han Chou, ;
| | - Shao-Cheng Wang
- Department of Psychiatry, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of Medical Laboratory Science and Biotechnology, Chung Hwa University of Medical Technology, Tainan, Taiwan
- Department of Nurse-Midwifery and Women Health, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chi-Shin Wu
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Miaoli, Taiwan
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
- Chi-Shin Wu,
| | - Masaya Ito
- National Center for Cognitive-Behavior Therapy and Research, National Center of Neurology and Psychiatry, Hsinchu, Miaoli, Taiwan
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4
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Mann AJD, Kurtz AJ, Tull MT, Gratz KL. The moderating role of sexual minority status in the associations of the experience and tolerance of shame-related emotions to suicide risk. J Clin Psychol 2022; 78:2579-2594. [PMID: 35509115 PMCID: PMC9790715 DOI: 10.1002/jclp.23367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 03/18/2022] [Accepted: 04/15/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study examined the associations of the experience and tolerance of shame-related emotions to suicide risk, as well as the moderating role of sexual minority status. METHODS Community adults (N = 360) were recruited via MTurk and completed self-report questionnaires. Hierarchical regression analyses examined the main and interactive associations of sexual minority status and shame-related variables to suicide risk. RESULTS Results revealed significant positive associations between self-disgust and suicide risk for sexual minority and heterosexual participants, although the magnitude was greater for sexual minority participants. Additionally, tolerance of shame was significantly negatively related to suicide risk only among sexual minority participants. Finally, exploratory analyses examining the three-way interaction of self-disgust, shame tolerance, and sexual minority status revealed a significant negative association between shame tolerance and suicide risk only among sexual minority participants with high levels of self-disgust. CONCLUSION Results highlight the relevance of shame-related experiences to suicide risk among sexual minorities.
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Affiliation(s)
| | | | | | - Kim L. Gratz
- Department of PsychologyUniversity of ToledoToledoOhioUSA
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5
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Monéger J, Chatard A, Selimbegović L. (Eye-)tracking the escape from the self: guilt proneness moderates the effect of failure on self-avoidance. Cogn Emot 2022; 36:1374-1388. [PMID: 36181473 DOI: 10.1080/02699931.2022.2126441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Failure increases the motivation to escape self-awareness. To date, however, the role of self-conscious emotions (shame and guilt) in triggering escape responses after failure has not been sufficiently addressed. In this pre-registered study (N = 156 undergraduates), we adapted a classic paradigm (avoidance of one's image in a mirror) to a modern eye-tracking technology to test the hypothesis that shame proneness moderates the effect of failure on self-awareness avoidance. Individual differences in guilt and shame proneness were assessed before priming thoughts of failure or success. Then, an eye-tracking paradigm was used to monitor gaze avoidance of one's screen-reflected face during a neutral, unrelated task. Unexpectedly, results showed that guilt but not shame proneness exacerbated self-avoidance after failure. The present findings challenge the dominant view that shame fosters avoidance more so than guilt.
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Affiliation(s)
- Jean Monéger
- Department of Psychology, University of Poitiers, Poitiers, France.,Research Center on Cognition and Learning, CNRS 7295, Poitiers, France
| | - Armand Chatard
- Department of Psychology, University of Poitiers, Poitiers, France.,Research Center on Cognition and Learning, CNRS 7295, Poitiers, France.,Clinical Research Unit, Centre Hospitalier Laborit, Poitiers, France
| | - Leila Selimbegović
- Department of Psychology, University of Poitiers, Poitiers, France.,Research Center on Cognition and Learning, CNRS 7295, Poitiers, France
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6
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Nikolić M, Hannigan LJ, Krebs G, Sterne A, Gregory AM, Eley TC. Aetiology of shame and its association with adolescent depression and anxiety: results from a prospective twin and sibling study. J Child Psychol Psychiatry 2022; 63:99-108. [PMID: 34132398 PMCID: PMC9292396 DOI: 10.1111/jcpp.13465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Shame is considered a maladaptive self-conscious emotion that commonly co-occurs alongside depression and anxiety. Little is known, however, about the aetiology of shame and its associations with depression and anxiety. We estimated, for the first time, genetic and environmental influences on shame and on its associations with depression and anxiety in adolescence. METHODS The sample was twin and sibling pairs from the Genesis 1219 Study (Time 1, N = 2,685; males 42.8%, Mage = 14.95, SD = 1.67, age range: 12-21; Time 2, N = 1618; males 39.7%, Mage = 16.97, SD = 1.64, age range: 14-23). Participants completed validated questionnaires to measure shame (at Time 1), depression and anxiety (at Times 1 and 2). RESULTS Shame was moderately to strongly associated with concurrent depression and anxiety. Prospectively, shame was significantly associated with an increase in depression, but not anxiety. Genetic analyses revealed that shame was moderately heritable with substantial nonshared environmental influence. The associations between shame and concurrent depression and anxiety were primarily accounted for by overlapping genetic influences. Prospectively, the association between shame and later depression was primarily accounted for by genetic and nonshared environmental influences shared with earlier depression. The unique association between shame and later depression was mostly explained by common nonshared environmental influences. CONCLUSIONS The findings offer novel evidence regarding aetiology of shame-although moderately heritable, shame in adolescents may also result from nonshared environmental factors. Genetic and nonshared environmental influences contribute to the co-occurrence of shame with depression and anxiety.
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Affiliation(s)
| | | | - Georgina Krebs
- King’s College LondonLondonUK,National and Specialist OCD and Related Disorders Clinic for Young PeopleSouth London and Maudsley NHS Foundation TrustLondonUK
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7
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Rugo-Cook KF, Kerig PK, Crowell SE, Bryan CJ. Fluid vulnerability theory as a framework for understanding the association between posttraumatic stress disorder and suicide: A narrative review. J Trauma Stress 2021; 34:1080-1098. [PMID: 34881461 DOI: 10.1002/jts.22782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 12/11/2022]
Abstract
Suicide is a persistent issue in the United States and across the globe. A large body of published research shows that posttraumatic stress disorder (PTSD) increases the risk of suicidal ideation, suicidal behaviors, and death by suicide. However, the existing literature examining why that association might pertain is widely dispersed across disciplines (e.g., psychology, nursing) and lacks an integrative theoretical framework, making it difficult to conceptualize the current state of science in this area. Therefore, the primary aims of this narrative review were to (a) provide a comprehensive and interdisciplinary critique of the current state of knowledge regarding mechanisms that underlie the association between PTSD and suicide and (b) organize that knowledge according to a specified theoretical framework. The framework guiding this review is "fluid vulnerability theory," a diathesis-stress model of suicide that emphasizes the dynamic nature of suicide risk across cognitive, emotional, behavioral, and physiological domains. A summary of the findings, including patterns that emerged, gaps that remain, and recommendations for the advancement of science and practice in this area are addressed in this narrative review.
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Affiliation(s)
- Kelsi F Rugo-Cook
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Patricia K Kerig
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Sheila E Crowell
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Craig J Bryan
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, New York, USA
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Cunningham KC, Aunon FM, Patel TA, Mann AJ, DeBeer BB, Meyer EC, Morissette SB, Silvia PJ, Gratz KL, Calhoun PS, Beckham JC, Kimbrel NA. Nonsuicidal Self-Injury Disorder, Borderline Personality Disorder, and Lifetime History of Suicide Attempts among Male and Female Veterans with Mental Health Disorders. J Affect Disord 2021; 287:276-281. [PMID: 33799048 PMCID: PMC9004586 DOI: 10.1016/j.jad.2021.03.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Expanding on research that has identified nonsuicidal self-injury (NSSI) as a strong predictor of suicide risk, the present study examined NSSI disorder (NSSID) and borderline personality disorder (BPD) as unique contributors to lifetime suicide attempts. To our knowledge, the present study represents the first exploration of these associations among veterans. METHODS Participants included 124 male (74%) and female (26%) veterans diagnosed with at least one mental health disorder. Posttraumatic stress disorder (93%) and major depression (86%) were the most common mental health diagnoses. Large proportions of the sample met criteria for NSSID (48%) and BPD (40%). Suicide attempts were reported by 28% of the sample. Chi-square tests determined the bivariate associations among NSSID, BPD, history of suicide attempts, and other variables. Significant diagnostic (i.e., MDD, BPD, and NSSID) and demographic (i.e., age) characteristics were included as covariates in a logistic regression model examining the associations of BPD and NSSID with suicide attempts. RESULTS BPD, Χ2=11.1, p<0.001, and NSSID, Χ2=13.9, p<0.001, were uniquely associated with suicide attempts. When all significant predictors were included in the final model, only NSSID emerged as a significant contributor to suicide attempts, OR = 4.9, p < 0.001. LIMITATIONS Causality cannot be determined from cross-sectional analyses. CONCLUSION These findings highlight NSSID as a powerful and unique correlate of suicide attempts among veterans, beyond the associations of established diagnostic risk factors. Improving our understanding of the relationship between NSSID and suicide risk has the potential to inform suicide prevention efforts and improve clinical outcomes among veterans.
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Affiliation(s)
| | | | - Tapan A. Patel
- Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Adam J. Mann
- Durham Veterans Affairs Health Care System, Durham, NC, USA,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Bryann B. DeBeer
- VA Rocky Mountain Mental Illness, Research, Education, and Clinical Center, Aurora, CO,Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, University of Colorado
| | - Eric C. Meyer
- Department of Rehabilitation Science and Technology, University of Pittsburgh
| | - Sandra B. Morissette
- VISN 17 Center of Excellence for Research on Returning War Veterans at Central Texas Veterans Health Care System, Waco, TX, USA,Department of Psychology, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Paul J. Silvia
- Department of Psychology, University of North Carolina at Greensboro, NC, USA
| | - Kim L. Gratz
- Department of Psychology, University of Toledo, OH, USA
| | - Patrick S. Calhoun
- Durham Veterans Affairs Health Care System, Durham, NC, USA,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA,VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Jean C. Beckham
- Durham Veterans Affairs Health Care System, Durham, NC, USA,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA
| | - Nathan A. Kimbrel
- Durham Veterans Affairs Health Care System, Durham, NC, USA,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA,VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA,Corresponding author at: Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham Veterans Affairs Health Care System, 3022 Croasdaile Drive, Durham, NC, 27705. (N.A. Kimbrel)
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Johnson CM, Holmes SC, Suvak MK, Song J, Shields N, Lane JEM, Sijercic I, Cohen ZD, Stirman SW, Monson CM. The Effect of PTSD Symptom Change on Suicidal Ideation in a Combined Military and Civilian Sample Engaged in Cognitive Processing Therapy. Behav Ther 2021; 52:774-784. [PMID: 33990249 DOI: 10.1016/j.beth.2020.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/25/2020] [Accepted: 10/02/2020] [Indexed: 11/30/2022]
Abstract
In light of the well-established relationship between posttraumatic stress disorder (PTSD) and suicidal ideation (SI), there has been a push for treatments that simultaneously improve symptoms of PTSD and decrease SI. Using data from a randomized controlled hybrid implementation-effectiveness trial, the current study investigated the effectiveness of Cognitive Processing Therapy (CPT; Resick, Monson, & Chard, 2016) on PTSD and SI. The patient sample (N = 188) was diverse in military and veteran status, gender, and comorbidity, and 73% of the sample endorsed SI at one or more points during CPT. Participants demonstrated significant improvement in SI over the course of CPT. Multilevel growth curve modeling revealed a significant association between PTSD symptom change and change in SI. Results from cross-lagged multilevel regressions indicated that PTSD symptoms predicted SI in the next session, yet SI in a given session did not predict PTSD symptoms in the next session. Potentially relevant clinical factors (i.e., military status, gender, depression diagnosis, baseline SI, study consultation condition) were not associated with the relationship between PTSD symptoms and SI. These results add to the burgeoning literature suggesting that evidence-based treatments for PTSD, like CPT, reduce suicidality in a range of individuals with PTSD, and that this reduction is predicted by improvements in PTSD symptoms.
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Affiliation(s)
- Clara M Johnson
- Dissemination and Training Division, National Center for PTSD
| | - Samantha C Holmes
- College of Staten Island, City University of New York; Yale School of Medicine
| | | | - Jiyoung Song
- Dissemination and Training Division, National Center for PTSD
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10
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Puhalla A, Flynn A, Vaught A. Shame as a Moderator between Emotion Dysregulation and Posttraumatic Stress Disorder Severity among Combat Veterans Seeking Residential Treatment. J Affect Disord 2021; 283:236-242. [PMID: 33561805 DOI: 10.1016/j.jad.2021.01.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 01/10/2021] [Accepted: 01/30/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Growing evidence suggests that emotion dysregulation may be predictive of posttraumatic stress disorder (PTSD) severity, with emotional non-acceptance, lack of counter strategies, impulse control deficits, and lack of emotional awareness all being positive predictors. However, findings have been mixed. This may be due to no previous study examining the association between emotion dysregulation and PTSD severity with shame, a maintaining factor of PTSD, as a potential moderator. METHODS The present study examined the relationship between emotion dysregulation, shame, and PTSD severity among 78 male combat veterans (mean age = 42.19) upon their admission to a residential combat PTSD program. RESULTS Results demonstrated that shame and all facets of emotion dysregulation (except lack of emotional awareness & clarity) were positively associated with PTSD severity. Shame moderated the relationship between lack of emotional awareness and strategies. Among those at or below the sample mean on shame, lack of access to strategies was a positive predictor of PTSD severity. Comparatively, among those with high levels of shame, emotional awareness predicted greater PTSD severity, while among those with low levels of shame, emotional awareness predicted lower PTSD severity. LIMITATIONS Limitations included reliance on self-report questionnaires and an all-male sample. CONCLUSIONS Thus, emotion dysregulation may only predict PTSD severity among those reporting lower levels of shame, suggesting the importance of addressing shame as well as emotion dysregulation deficits among those with PTSD. Moreover, emotional awareness may be either a risk or protective factor depending on levels of shame.
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Affiliation(s)
| | - Aidan Flynn
- Coatesville Veterans Affairs Medical Center (CVAMC), Coatesville, PA, USA
| | - Amanda Vaught
- Coatesville Veterans Affairs Medical Center (CVAMC), Coatesville, PA, USA
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11
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Laban G, Ben-Zion Z, Cross ES. Social Robots for Supporting Post-traumatic Stress Disorder Diagnosis and Treatment. Front Psychiatry 2021; 12:752874. [PMID: 35185629 PMCID: PMC8854768 DOI: 10.3389/fpsyt.2021.752874] [Citation(s) in RCA: 3] [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: 08/03/2021] [Accepted: 12/27/2021] [Indexed: 12/13/2022] Open
Abstract
Post-Traumatic Stress Disorder (PTSD) is a severe psychiatric disorder with profound public health impact due to its high prevalence, chronic nature, accompanying functional impairment, and frequently occurring comorbidities. Early PTSD symptoms, often observed shortly after trauma exposure, abate with time in the majority of those who initially express them, yet leave a significant minority with chronic PTSD. While the past several decades of PTSD research have produced substantial knowledge regarding the mechanisms and consequences of this debilitating disorder, the diagnosis of and available treatments for PTSD still face significant challenges. Here, we discuss how novel therapeutic interventions involving social robots can potentially offer meaningful opportunities for overcoming some of the present challenges. As the application of social robotics-based interventions in the treatment of mental disorders is only in its infancy, it is vital that careful, well-controlled research is conducted to evaluate their efficacy, safety, and ethics. Nevertheless, we are hopeful that robotics-based solutions could advance the quality, availability, specificity and scalability of care for PTSD.
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Affiliation(s)
- Guy Laban
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
| | - Ziv Ben-Zion
- Tel-Aviv Sourasky Medical Center, Sagol Brain Institute Tel-Aviv, Wohl Institute for Advanced Imaging, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel.,Departments of Comparative Medicine and Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, United States.,The Clinical Neurosciences Division, VA Connecticut Healthcare System, United States Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, West Haven, CT, United States
| | - Emily S Cross
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom.,Department of Cognitive Science, Macquarie University, Sydney, NSW, Australia
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12
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Fergé JL, Banydeen R, Le Terrier C, Fize H, Miguel M, Kentish-Barnes N, Jehel L, Moroy A, Valentino R, Mehdaoui H. Mental Health of Adolescent Relatives of Intensive Care Patients: Benefits of an Open Visitation Policy. Am J Crit Care 2021; 30:72-76. [PMID: 33385205 DOI: 10.4037/ajcc2021799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Symptoms of anxiety and depression are common in adolescents with a loved one in an intensive care unit (ICU) and are known precursors of posttraumatic stress disorder (PTSD). OBJECTIVES To assess the prevalence of PTSD and associated factors in adolescent (age 12-17 years) relatives of patients in an ICU with an open visitation policy. METHODS One year after the patient was discharged from the ICU, eligible adolescent relatives completed a satisfaction survey, anxiety history questionnaire, and psychometric evaluations (Hospital Anxiety and Depression Scale and 8-item Children's Revised Impact of Event Scale). RESULTS Thirty-two patients intubated for >2 days and with a Simplified Acute Physiology Score II >30 were included. Forty-six adolescents with first- to third-degree relationships to the patient, and in regular contact (≥monthly) with the patient before hospitalization, were enrolled. The prevalence of PTSD among the adolescents was 33%. Adolescents who visited the ICU were less likely to report feelings of regret than those who did not visit the ICU (2% vs 9%, P = .01). A past sense of threat (odds ratio [95% CI], 19.4 [1.9-201.2]; P = .01) and anxiety and depression symptoms (odds ratio [95% CI], 9.6 [1.4-63.7]; P = .02) were independent factors associated with probable PTSD. CONCLUSIONS A cautiously prepared open visiting policy should be maintained for adolescents with a relative in the ICU, because it could prevent feelings of regret and subsequent PTSD. Adolescents with risk factors should be screened and followed up.
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Affiliation(s)
- Jean-Louis Fergé
- Jean-Louis Fergé is an anesthesiologist-intensivist, Intensive Care Unit, CHU Martinique (Centre Hospitalier Universitaire de Martinique), Fort-de-France, France
| | - Rishika Banydeen
- Rishika Banydeen is an epidemiologist-research methodologist, Clinical Research Department, CHU Martinique
| | - Christophe Le Terrier
- Christophe Le Terrier is an intensivist, Intensive Care Unit, CHU Martinique (Centre Hospitalier Universitaire de Martinique), Fort-de-France, France
| | - Hélène Fize
- Helene Fize is a general practitioner, Regional Union of Liberal Doctors of Martinique, Fort-de-France, France
| | - Mathurina Miguel
- Mathurina Miguel is a general practitioner, Regional Union of Liberal Doctors of Martinique, Fort-de-France, France
| | - Nancy Kentish-Barnes
- Nancy Kentish-Barnes is a sociologist, Famiréa Research Group, Saint-Louis University Hospital, Paris, France
| | - Louis Jehel
- Louis Jehel is a psychiatrist, Psychiatric Unit, CHU Martinique
| | - Anne Moroy
- Anne Moroy is a psychiatrist, Psychiatric Unit, National Resource and Resilience Center, Lille, France
| | - Ruddy Valentino
- Ruddy Valentino is an intensivist, Intensive Care Unit, CHU Martinique (Centre Hospitalier Universitaire de Martinique), Fort-de-France, France
| | - Hossein Mehdaoui
- Hossein Mehdaoui is an intensivist, Intensive Care Unit, CHU Martinique (Centre Hospitalier Universitaire de Martinique), Fort-de-France, France
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13
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Krishnamoorthy G, Davis P, O'Donovan A, McDermott B, Mullens A. Through Benevolent Eyes: the Differential Efficacy of Perspective Taking and Cognitive Reappraisal on the Regulation of Shame. Int J Cogn Ther 2020; 14:263-288. [PMID: 32904830 PMCID: PMC7462113 DOI: 10.1007/s41811-020-00085-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Difficulties in regulating feelings of shame is a risk factor for the onset and recurrence of mental health disorders. The present research investigated the impact of the individual differences in propensity to experience shame (or shame-proneness) on two emotion regulation strategies-perspective taking and positive reappraisal. A total of 228 participants, undergraduate students, were allocated randomly to one of the eight experimental conditions. The results revealed that for high shame-prone participants, the use of perspective taking, without positive reappraisal, led to a heightened experience of shame. In contrast, the combination of perspective taking and positive reappraisal led to reductions in shame among high shame-prone participants. The findings highlight the relationship between individual differences, and the separate and combined effects of affect regulation strategies on the experience of shame.
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Affiliation(s)
- Govind Krishnamoorthy
- University of Southern Queensland, 11 Salisbury Road, Ipswich, Queensland 4305 Australia
| | - Penelope Davis
- Griffith University, 176 Messines Ridge Road, Mount Gravatt, Queensland 4122 Australia
| | - Analise O'Donovan
- Griffith University, 176 Messines Ridge Road, Mount Gravatt, Queensland 4122 Australia
| | - Brett McDermott
- James Cook University, James Cook Drive, Douglas, Queensland 4814 Australia
| | - Amy Mullens
- University of Southern Queensland, 11 Salisbury Road, Ipswich, Queensland 4305 Australia
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Goffnett J, Liechty JM, Kidder E. Interventions to reduce shame: A systematic review. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.jbct.2020.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Zanette LY, Hobbs EC, Witterick LE, MacDougall-Shackleton SA, Clinchy M. Predator-induced fear causes PTSD-like changes in the brains and behaviour of wild animals. Sci Rep 2019; 9:11474. [PMID: 31391473 PMCID: PMC6685979 DOI: 10.1038/s41598-019-47684-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/26/2019] [Indexed: 11/16/2022] Open
Abstract
Predator-induced fear is both, one of the most common stressors employed in animal model studies of post-traumatic stress disorder (PTSD), and a major focus of research in ecology. There has been a growing discourse between these disciplines but no direct empirical linkage. We endeavoured to provide this empirical linkage by conducting experiments drawing upon the strengths of both disciplines. Exposure to a natural cue of predator danger (predator vocalizations), had enduring effects of at least 7 days duration involving both, a heightened sensitivity to predator danger (indicative of an enduring memory of fear), and elevated neuronal activation in both the amygdala and hippocampus – in wild birds (black-capped chickadees, Poecile atricapillus), exposed to natural environmental and social experiences in the 7 days following predator exposure. Our results demonstrate enduring effects on the brain and behaviour, meeting the criteria to be considered an animal model of PTSD – in a wild animal, which are of a nature and degree which can be anticipated could affect fecundity and survival in free-living wildlife. We suggest our findings support both the proposition that PTSD is not unnatural, and that long-lasting effects of predator-induced fear, with likely effects on fecundity and survival, are the norm in nature.
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Affiliation(s)
- Liana Y Zanette
- Department of Biology, Western University, London, Ontario, N6A 5B7, Canada.
| | - Emma C Hobbs
- Department of Biology, Western University, London, Ontario, N6A 5B7, Canada
| | - Lauren E Witterick
- Department of Biology, Western University, London, Ontario, N6A 5B7, Canada
| | - Scott A MacDougall-Shackleton
- Department of Biology, Western University, London, Ontario, N6A 5B7, Canada.,Department of Psychology, Western University, London, Ontario, N6A 5B7, Canada.,The Advanced Facility for Avian Research, Western University, London, Ontario, N6A 5B7, Canada
| | - Michael Clinchy
- Department of Biology, Western University, London, Ontario, N6A 5B7, Canada
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