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Kivelä LMM, Fiß F, van der Does W, Antypa N. Examination of Acceptability, Feasibility, and Iatrogenic Effects of Ecological Momentary Assessment (EMA) of Suicidal Ideation. Assessment 2024; 31:1292-1308. [PMID: 38098238 PMCID: PMC11292966 DOI: 10.1177/10731911231216053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Ecological momentary assessment (EMA) can be used to examine the dynamics of suicidal ideation in daily life. While the general acceptability and feasibility of EMA in suicide research has been established, further examination of potential iatrogenic effects (i.e., negative reactivity) and identifying those more likely to react negatively is needed. Participants (N = 82) with current suicidal ideation completed 21 days of EMA (4×/day) and filled in M = 78% (Med = 84%) of the EMA. No positive or negative affect reactivity was observed in EMA ratings over the study period. Retrospectively, most participants rated their experience as positive (69%); 22% indicated mood worsening, and 18% suicidal ideation reactivity. Those with more borderline personality traits, posttraumatic stress disorder (PTSD), and higher depressive, anxiety, and suicidal ideation symptoms, were more likely to report iatrogenic effects. In conclusion, while high compliance rates and lack of affect reactivity during EMA indicate that EMA is well tolerated in suicide research, a minority of participants may report subjective mood effects in retrospect.
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Affiliation(s)
| | - F. Fiß
- Leiden University, The Netherlands
| | - W. van der Does
- Leiden University, The Netherlands
- Leiden University Treatment and Expertise Centre (LUBEC), The Netherlands
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2
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Nester MS, Wisco BE. Trauma reminders and disgust: The roles of posttraumatic stress disorder symptom severity, trauma type, and reminder type. J Trauma Stress 2024. [PMID: 39023017 DOI: 10.1002/jts.23076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 05/25/2024] [Accepted: 05/27/2024] [Indexed: 07/20/2024]
Abstract
Disgust is a common emotional response to trauma but is studied less frequently than fear or other negative emotions. In laboratory settings, individuals with a history of sexual assault report more disgust following exposure to trauma reminders than those exposed to other trauma types, and people with more severe posttraumatic stress disorder (PTSD) symptoms typically report more disgust than those with lower symptom levels. It remains unknown whether this association is also present in ecological contexts and if these associations vary by trauma reminder type. The present sample included 80 trauma-exposed community members (PTSD: n = 39, no PTSD: n = 41) who completed up to 17 prompts per day for 3 days (2,158 total completed surveys). Multilevel models indicated that trauma reminders were associated with increased feelings of disgust, B = 0.16, SE = 0.06, p < .001, which was consistent across trauma reminder types, p < .001-p = .001. PTSD symptom severity moderated the association between trauma reminders and disgust such that it was stronger for participants with higher CAPS-5 scores, B = 0.02, SE = 0.01, p = .011. All trauma reminder types demonstrated the same pattern of moderation, ps = .003-.022, except flashbacks, p = .070. Trauma type was not a significant moderator of any trauma reminder type, ps = .193-.929. These findings suggest that trauma reminders encountered in daily life are associated with feelings of disgust. The results underscore the importance of exploring disgust as a trauma-related emotional experience among trauma survivors.
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Affiliation(s)
- M Shae Nester
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Blair E Wisco
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
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Zhu Y, Zhang G, Zhan S, Jiao D, Anme T. Do multigenerational homes moderate the intergenerational transmission of maternal adverse childhood experiences? Eur J Psychotraumatol 2024; 15:2355757. [PMID: 38809612 PMCID: PMC11138223 DOI: 10.1080/20008066.2024.2355757] [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: 09/27/2023] [Accepted: 05/06/2024] [Indexed: 05/31/2024] Open
Abstract
ABSTRACTBackground: Maternal adverse childhood experiences (ACEs) may lead to increased behavioural problems in children. However, the mediating roles of psychological distress and corporal punishment, two common mechanisms underlying the intergenerational transmission of maternal ACEs, in these relations have not been examined in Chinese samples. Multigenerational homes (MGH) are the dominate living arrangement in China; however, limited research focuses on the effects of MGHs on the intergenerational transmission of maternal ACEs.Objective: This study explored the parallel mediating effects of corporal punishment and psychological distress on the association between maternal ACEs and children's behaviour and whether MGHs can strengthen or weaken the relationship between maternal ACEs and corporal punishment or psychological distress.Participants and setting: Participants were 643 three-year-old children and their mothers (mean age of 32.85 years, SD = 3.79) from Wuhu, China.Methods: Mothers completed online questionnaires measuring ACEs, psychological distress, corporal punishment, their family structure, and children's behavioural problems. This study used a moderated mediation model.Results: The findings suggest that psychological distress and corporal punishment mediate the association between maternal ACEs and children's behavioural problems. The mediating role of corporal punishment was found depend on whether mothers and their children reside in MGHs. MGHs were not found to have a moderating role in the indirect relationship between maternal ACEs and children's behaviour problems via psychological distress.Conclusion: Our findings highlight the importance of addressing psychological distress and corporal punishment when designing interventions targeted Chinese mothers exposed to ACEs and their children, especially those living in MGHs.
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Affiliation(s)
- Yantong Zhu
- Faculty of Educational Science, Anhui Normal University, Wuhu, People’s Republic of China
| | - Gengli Zhang
- Faculty of Educational Science, Anhui Normal University, Wuhu, People’s Republic of China
| | - Shuwei Zhan
- School of Education, Central China Normal University, Wuhan, People’s Republic of China
| | - Dandan Jiao
- Department of Nursing, First Affiliated Hospital and College of Clinical Medicine, Henan University of Science and Technology, Luoyang, People’s Republic of China
| | - Tokie Anme
- Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Long Y, Dickey L, Pegg S, Argiros A, Venanzi L, Dao A, Kujawa A. Interpersonal Trauma Effects on Adolescent Depression: The Moderating Role of Neurophysiological Responses to Positive Interpersonal Images. Res Child Adolesc Psychopathol 2024; 52:195-206. [PMID: 37707698 PMCID: PMC10843025 DOI: 10.1007/s10802-023-01118-0] [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] [Accepted: 08/25/2023] [Indexed: 09/15/2023]
Abstract
Trauma exposure is associated with a heightened risk for depression and such risk is thought to vary based on the type of traumatic events (e.g., interpersonal, including abuse and domestic violence, or non-interpersonal, including accidents or natural disasters). Depression is often accompanied by altered emotional reactivity, and the late positive potential (LPP) serves as a reliable neurophysiological measure of sustained attention towards emotional stimuli, raising questions regarding the role of the LPP in moderating trauma effects on depression. We conducted a cross-sectional study of 201 adolescents aged 14-17 years (61.2% female) who were oversampled for current depression and elevated risk of depression based on maternal history. Clinical interviews were conducted to assess diagnoses and lifetime trauma exposure, and participants reported on current depressive symptoms. Electroencephalogram (EEG) was continuously recorded while participants completed a previously validated interpersonal emotional images task. Cumulative trauma (CT) and interpersonal trauma (IPT) were both associated with greater depressive symptoms, but non-interpersonal trauma (NIPT) was not significantly related to depressive symptoms. The association between IPT and depressive symptoms was moderated by the LPP to positive interpersonal images, such that IPT-exposed adolescents with blunted neural responses to such images showed the greatest symptoms. This result was specific to IPT, and the LPP to threatening interpersonal images did not significantly moderate the effects of IPT on depressive symptoms. These findings highlight the unique effects of interpersonal trauma on depressive symptoms and elucidate a potential vulnerability linking trauma exposure to depression risk among adolescents.
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Affiliation(s)
- Yinru Long
- Department of Psychology and Human Development, Vanderbilt University Peabody College, 230 Appleton Place, Nashville, TN, 37203-5721, United States of America.
| | - Lindsay Dickey
- Department of Psychology and Human Development, Vanderbilt University Peabody College, 230 Appleton Place, Nashville, TN, 37203-5721, United States of America
| | - Samantha Pegg
- Department of Psychology and Human Development, Vanderbilt University Peabody College, 230 Appleton Place, Nashville, TN, 37203-5721, United States of America
| | - Alexandra Argiros
- Department of Psychology and Human Development, Vanderbilt University Peabody College, 230 Appleton Place, Nashville, TN, 37203-5721, United States of America
| | - Lisa Venanzi
- Department of Psychology and Human Development, Vanderbilt University Peabody College, 230 Appleton Place, Nashville, TN, 37203-5721, United States of America
| | - Anh Dao
- Department of Psychology and Human Development, Vanderbilt University Peabody College, 230 Appleton Place, Nashville, TN, 37203-5721, United States of America
| | - Autumn Kujawa
- Department of Psychology and Human Development, Vanderbilt University Peabody College, 230 Appleton Place, Nashville, TN, 37203-5721, United States of America
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van der Kolk BA, Wang JB, Yehuda R, Bedrosian L, Coker AR, Harrison C, Mithoefer M, Yazar-Klosinki B, Emerson A, Doblin R. Effects of MDMA-assisted therapy for PTSD on self-experience. PLoS One 2024; 19:e0295926. [PMID: 38198456 PMCID: PMC10781106 DOI: 10.1371/journal.pone.0295926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 11/28/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION There is a resurgence of interest in the therapeutic potential of psychedelic substances such as 3,4-methylenedioxymethamphetamine (MDMA). Primary findings from our randomized, double-blind, placebo-controlled, multi-site Phase 3 clinical trial of participants with severe PTSD (NCT03537014) showed that MDMA-assisted therapy induced significant attenuation in the Clinician-Administered PTSD Scale for DSM-5 compared to Therapy with placebo. Deficits in emotional coping skills and altered self-capacities constitute major obstacles to successful completion of available treatments. The current analysis evaluated the differential effects of MDMA-assisted therapy and Therapy with placebo on 3 transdiagnostic outcome measures and explored the contribution of changes in self-experience to improvement in PTSD scores. METHODS Participants were randomized to receive manualized therapy with either MDMA or placebo during 3 experimental sessions in combination with 3 preparation and 9 integration therapy visits. Symptoms were measured at baseline and 2 months after the last experimental session using the 20-item Toronto Alexithymia Scale (TAS-20), the 26-item Self Compassion Scale (SCS), and the 63-item Inventory of Altered Self-Capacities (IASC). RESULTS 90 participants were randomized and dosed (MDMA-assisted therapy, n = 46; Therapy with placebo, n = 44); 84.4% (76/90) had histories of developmental trauma, and 87.8% (79/90) had suffered multiple traumas. MDMA-assisted therapy facilitated statistically significant greater improvement on the TAS-20, the SCS, and most IASC factors of interpersonal conflicts; idealization disillusionment; abandonment concerns; identity impairment; self-awareness; susceptibility to influence; affect dysregulation; affect instability; affect skill deficit; tension reduction activities; the only exception was identity diffusion. CONCLUSION Compared with Therapy with placebo, MDMA-assisted therapy had significant positive effects on transdiagnostic mental processes of self-experience which are often associated with poor treatment outcome. This provides a possible window into understanding the psychological capacities facilitated by psychedelic agents that may result in significant improvements in PTSD symptomatology.
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Affiliation(s)
| | - Julie B. Wang
- MAPS Public Benefit Corporation (MAPS PBC), San Jose, CA, United States of America
| | - Rachel Yehuda
- James J. Peters Veterans Affairs Medical Center, Bronx, NY, United States of America
- Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Leah Bedrosian
- MAPS Public Benefit Corporation (MAPS PBC), San Jose, CA, United States of America
| | - Allison R. Coker
- University of California, San Francisco, San Francisco, CA, United States of America
- Multidisciplinary Association for Psychedelic Studies (MAPS), San Jose, CA, United States of America
| | - Charlotte Harrison
- MAPS Public Benefit Corporation (MAPS PBC), San Jose, CA, United States of America
| | - Michael Mithoefer
- MAPS Public Benefit Corporation (MAPS PBC), San Jose, CA, United States of America
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States of America
| | - Berra Yazar-Klosinki
- MAPS Public Benefit Corporation (MAPS PBC), San Jose, CA, United States of America
| | - Amy Emerson
- MAPS Public Benefit Corporation (MAPS PBC), San Jose, CA, United States of America
| | - Rick Doblin
- Multidisciplinary Association for Psychedelic Studies (MAPS), San Jose, CA, United States of America
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Theodoratou M, Kougioumtzis GA, Yotsidi V, Sofologi M, Katsarou D, Megari K. Neuropsychological Consequences of Massive Trauma: Implications and Clinical Interventions. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2128. [PMID: 38138231 PMCID: PMC10744839 DOI: 10.3390/medicina59122128] [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: 11/01/2023] [Revised: 11/24/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023]
Abstract
Traumatic events, especially massive trauma resulting from catastrophic incidents, wars, or severe abuse can elicit significant neuropsychological alterations, with profound implications for cognitive, emotional, and behavioral functioning. This mini-review delineates the primary neural changes post-trauma and underscores the importance of timely neuropsychological and clinical interventions. Specific brain regions, including the amygdala and prefrontal cortex, undergo physiological changes that can lead to memory impairments, attention deficits, and emotional disturbances. PTSD, a commonly diagnosed condition post-trauma, exemplifies the intricate relationship between trauma and memory processing. Furthermore, the concept of neuroplasticity, the brain's inherent ability to adapt and rewire, offers hope for recovery. Current clinical interventions, such as cognitive behavioral therapy, mindfulness practices, and biofeedback, leverage this neuroplastic potential to foster healing. The review underscores the vital importance of early intervention to mitigate long-term neuropsychological impacts, emphasizing the role of timely and targeted clinical interventions. The synthesis of this knowledge is crucial for clinicians, allowing for informed therapeutic approaches that holistically address both the physiological and psychological dimensions of trauma.
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Affiliation(s)
- Maria Theodoratou
- Department of Psychology, School of Health Sciences, Neapolis University Pafos, Paphos 8042, Cyprus; (G.A.K.); (M.S.); (D.K.)
- Department of Social Sciences, Hellenic Open University, 263 35 Patras, Greece;
| | - Georgios A. Kougioumtzis
- Department of Psychology, School of Health Sciences, Neapolis University Pafos, Paphos 8042, Cyprus; (G.A.K.); (M.S.); (D.K.)
- Department of Social Sciences, Hellenic Open University, 263 35 Patras, Greece;
- Department of Turkish Studies and Modern Asian Studies, Faculty of Economic and Political Sciences, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Vasiliki Yotsidi
- Department of Social Sciences, Hellenic Open University, 263 35 Patras, Greece;
- Department of Psychology, Panteion University of Social and Political Sciences, 157 72 Athens, Greece
| | - Maria Sofologi
- Department of Psychology, School of Health Sciences, Neapolis University Pafos, Paphos 8042, Cyprus; (G.A.K.); (M.S.); (D.K.)
- Laboratory of Psychology, Department of Early Childhood Education, School of Education, University of Ioannina, 451 10 Ioannina, Greece
- Institute of Humanities and Social Sciences, University Research Centre of Ioannina (U.R.C.I.), 451 10 Ioannina, Greece
| | - Dimitra Katsarou
- Department of Psychology, School of Health Sciences, Neapolis University Pafos, Paphos 8042, Cyprus; (G.A.K.); (M.S.); (D.K.)
- Department of Preschool Education Sciences and Educational Design, Faculty of Humanities, University of the Aegean, 811 00 Mytilene, Greece
| | - Kalliopi Megari
- City College, University of York, Europe Campus, 546 26 Thessaloniki, Greece;
- Department of Psychology, School of Social Sciences, UOWM, 531 00 Florina, Greece
- School of Psychology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
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7
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Kuz M, Uçar HN, Çiçek Zekey Ö, Çetin FH, Türkoğlu S. The Effect of Internet Addiction and Emotion Regulation on Trauma Reactions During the COVID-19 Pandemic in Adolescents With Anxiety Disorder. J Nerv Ment Dis 2023; 211:902-909. [PMID: 35944259 DOI: 10.1097/nmd.0000000000001571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT In this study, we examined the relationship among trauma reactions, anxiety severity, Internet addiction (IA), and emotion regulation difficulties during the COVID-19 pandemic in adolescents with anxiety disorders. The sample of study consisted of 63 adolescents aged 12 to 18 years who were diagnosed with AD and their parents. IA scores and emotional regulation difficulties were significantly higher in the group with pathological trauma reactions than the group exhibiting nonpathological trauma reactions. The trauma scores of adolescents with AD were correlated with IA, emotional regulation difficulties, and anxiety scores. The results of mediation analysis found that IA was the full mediating factor in the relationship between anxiety and trauma scores and a partial mediating factor in the relationship between emotional regulation difficulties and trauma scores. As a result, monitoring adolescents' Internet use not exceeding healthy levels and developing and strengthening emotion regulation skills can help protect against trauma during the COVID-19 pandemic.
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Affiliation(s)
- Merve Kuz
- Department of Child and Adolescent Psychiatry, School of Medicine, Selçuk University, Konya, Turkey
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8
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Greń J, Tylš F, Lasocik M, Kiraly C. Back from the rabbit hole. Theoretical considerations and practical guidelines on psychedelic integration for mental health specialists. Front Psychol 2023; 14:1054692. [PMID: 37904908 PMCID: PMC10613493 DOI: 10.3389/fpsyg.2023.1054692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 08/25/2023] [Indexed: 11/01/2023] Open
Abstract
The growing interest in and prevalence of the use of psychedelics, as well as the potential benefits and negative consequences associated with psychedelic experiences, create a need for mental health specialists to be able to provide adequate and effective intervention regarding the content and consequences of these experiences, that is, psychedelic integration. At the same time, current graduate training in psychiatry, psychology, psychotherapy, counseling, etc., fails to adequately prepare professionals for such interventions. In order to fill this gap, an international, bottom-up project was established to attempt developing guidelines. This project was conducted by means of literature reviews as well as roundtable discussions among project participants, leading to a consensus on the guidelines' final scope and content. Drawing from the outcomes of this project, this article presents proposed comprehensive guidelines covering both theoretical and practical aspects of psychedelic integration, that are intended to serve as a resource for various mental health specialists who may encounter individuals in need of support considering their psychedelic experiences. These guidelines encompass clinician-friendly information on the effects of psychedelics, a definition of psychedelic integration, the general theoretical considerations linked to utilization of psychedelic experiences in clinical practice, a simple model organizing the course of psychedelic integration practice, as well as an overview of the current models of psychedelic integration, along with a selective presentation of basic and specific interventions derived from various psychotherapeutic approaches that can be employed in the practice of psychedelic integration.
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Affiliation(s)
- Jakub Greń
- Public Health Department, Institute of Psychiatry and Neurology, Warsaw, Poland
- Polish Psychedelic Society, Warsaw, Poland
| | - Filip Tylš
- Psyon - Psychedelic Clinic, Prague, Czechia
- 3rd Medical Faculty, Charles University in Prague, Prague, Czechia
- National Institute of Mental Health, Klecany, Czechia
- Czech Psychedelic Society, Prague, Czechia
| | - Michał Lasocik
- Polish Psychedelic Society, Warsaw, Poland
- Polish Society of Process Psychology, Warsaw, Poland
| | - Csaba Kiraly
- Multidiszciplináris Társaság a Pszichedelikumok Kutatásáért, Budapest, Hungary
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9
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Russo JE, Dhruve DM, Oliveros AD. Childhood Trauma and PTSD Symptoms: Disentangling the Roles of Emotion Regulation and Distress Tolerance. Res Child Adolesc Psychopathol 2023; 51:1273-1287. [PMID: 37039922 DOI: 10.1007/s10802-023-01048-x] [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] [Accepted: 02/27/2023] [Indexed: 04/12/2023]
Abstract
Research documents that a history of childhood trauma increases risk for post-traumatic stress disorder (PTSD), greater emotion regulation difficulties (ERD), and reduced distress tolerance (DT). Independent lines of research implicate ERD and DT as transdiagnostic risk factors and link them to PTSD. To elucidate how such mechanisms may influence the etiology, maintenance, and treatment of PTSD, the current study investigates the distinct mediating roles of emotion regulation and DT, exploring which explains a larger indirect effect from childhood trauma to PTSD symptom severity. Participants (N = 385, aged 18-48) who endorsed a history of childhood trauma provided retrospective report of cumulative childhood trauma exposure, and of current ERD, DT, and PTSD symptom severity. Single and dual mediation analyses were used to assess indirect effects through ERD and DT in the relation between cumulative childhood trauma exposure and current PTSD symptom severity. ERD and DT were significantly and inversely related. Higher current self-ratings of PTSD symptom severity were explained by cumulative childhood trauma through ERD (B = 0.93, p < 0.001) and DT (B = 0.50, p < 0.05). The full model explained 36% of the variance in PTSD symptom severity. Current findings provide preliminary evidence of DT and emotion regulation (with specific facets identified) as distinct mechanisms in the development of PTSD. Of clinical relevance, current findings support post-trauma processing theories that contend individuals' recovery requires accepting and learning to modulate trauma-related emotional states. Implications for methods of treatment and prevention are discussed.
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Affiliation(s)
- Jenna E Russo
- Department of Psychology, Mississippi State University, 110 Magruder Hall, P.O. Box 6161, Mississippi State, MS, 39762, USA.
| | - Deepali M Dhruve
- Department of Psychology, Mississippi State University, 110 Magruder Hall, P.O. Box 6161, Mississippi State, MS, 39762, USA
| | - Arazais D Oliveros
- Department of Psychology, Mississippi State University, 110 Magruder Hall, P.O. Box 6161, Mississippi State, MS, 39762, USA
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Yang R, Takarae Y, Adney H, Swineford C, Walker JC, Cheng P, Negash S, Wiggins JL. Neural correlates of irritability symptom relief in adolescents pre- and post-trauma-focused cognitive behavioral therapy: A pilot study on reward processing. Psychiatry Res Neuroimaging 2023; 332:111645. [PMID: 37087811 PMCID: PMC10901248 DOI: 10.1016/j.pscychresns.2023.111645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/23/2023] [Accepted: 04/13/2023] [Indexed: 04/25/2023]
Abstract
Despite that Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is a first-line, evidence-based treatment for youths experiencing trauma-related symptoms, treatment responses vary and it remains unclear for whom and how this treatment works. In this context, we examined pre-treatment neural reward processing and pre- vs. post-treatment changes in neural reward processing, in relation to irritability - a transdiagnostic and dimensional feature present in multiple trauma-related syndromes, following TF-CBT. Adolescents (N = 22) with childhood trauma history completed a child-friendly monetary incentive delay task during fMRI acquisition, prior to and after the treatment, and irritability symptoms were assessed at five time points over the course of the treatment. Individual irritability slopes (i.e., irritability change rate) and intercepts (i.e., initial irritability level), generated by linear growth curve modeling, were integrated with fMRI data. Repeated ANCOVAs demonstrated that both pre-treatment neural response to reward and pre- vs. post-treatment changes in neural reward processing correlated with irritability symptom relief, such that opposite baseline neural reward processing profiles and differential changing patterns were observed in individuals showing irritability symptom relief vs. not. Together, our findings provide proof of concept that integrating brain information with clinical information has the potential to identify predictors and mechanisms of symptom relief.
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Affiliation(s)
- Ruiyu Yang
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, United States; Department of Psychology, San Diego State University, United States.
| | - Yukari Takarae
- Department of Psychology, San Diego State University, United States
| | - Hailey Adney
- Department of Psychology, San Diego State University, United States
| | - Conner Swineford
- Department of Psychology, San Diego State University, United States
| | - Johanna C Walker
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, United States; Department of Psychology, San Diego State University, United States
| | - Philip Cheng
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Hospital, United States
| | - Sesen Negash
- Department of Counseling & School Psychology, San Diego State University, United States
| | - Jillian Lee Wiggins
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, United States; Department of Psychology, San Diego State University, United States
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11
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Feola B, Flook EA, Gardner H, Phan KL, Gwirtsman H, Olatunji B, Blackford JU. Altered bed nucleus of the stria terminalis and amygdala responses to threat in combat veterans with posttraumatic stress disorder. J Trauma Stress 2023; 36:359-372. [PMID: 36938747 PMCID: PMC10548436 DOI: 10.1002/jts.22918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 03/21/2023]
Abstract
Posttraumatic stress disorder (PTSD) significantly impacts many veterans. Although PTSD has been linked to alterations in the fear brain network, the disorder likely involves alterations in both the fear and anxiety networks. Fear involves responses to imminent, predictable threat and is driven by the amygdala, whereas anxiety involves responses to potential, unpredictable threat and engages the bed nucleus of the stria terminalis (BNST). The BNST has been implicated in PTSD, but the role of the BNST in combat veterans with PTSD has yet to be examined. Identifying alterations in BNST responses to unpredictable threat could provide important new targets for treatment. The current study examined whether veterans with PTSD have altered BNST or amygdala responses (function and connectivity) to unpredictable and predictable threat. The fMRI task involved viewing predictable threat cues followed by threat images, predictable neutral cues followed by neutral images, and unpredictable threat cues followed by either a threat or neutral image. Participants included 32 combat-exposed veterans with PTSD and 13 combat-exposed controls without PTSD. Across all conditions, veterans with PTSD had heightened BNST activation and displayed stronger BNST and amygdala connectivity with multiple fear and anxiety regions (hypothalamus, hippocampus, insula, ventromedial prefrontal cortex) relative to controls. In contrast, combat controls showed a pattern of stronger connectivity during neutral conditions (e.g., BNST-vmPFC), which may suggest a neural signature of resilience to developing PTSD, ηp 2 = .087-.527, ps < .001. These findings have implications for understanding fear and anxiety networks that may contribute to the development and maintenance of PTSD.
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Affiliation(s)
- Brandee Feola
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth A Flook
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hannah Gardner
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - K Luan Phan
- Department of Psychiatry, The Ohio State University, Columbus, Ohio, USA
| | - Harry Gwirtsman
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Tennessee Valley HealthCare System, U.S. Department of Veterans Affairs, Nashville, Tennessee, USA
| | - Bunmi Olatunji
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Jennifer Urbano Blackford
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Tennessee Valley HealthCare System, U.S. Department of Veterans Affairs, Nashville, Tennessee, USA
- Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
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12
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Saunderson JM, Stickley A, Sturidsson K, Koposov R, Sukhodolsky DG, Ruchkin V. Posttraumatic Stress and Perceived Interpersonal Provocation in Adolescents. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:3191-3214. [PMID: 35613735 PMCID: PMC9850389 DOI: 10.1177/08862605221104525] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To examine the impact of posttraumatic stress on the choice of responses to and attribution of intentionality in peer provocation in adolescent boys and girls. Methods: A sample of 2678 adolescents from Northern Russia, aged 13-17 years (59.3% female; 95.7% ethnic Russian) completed self-reports on posttraumatic stress and rated hypothetical peer provocation scenarios that teenagers can encounter in their daily lives. Results: Adolescents with clinically significant levels of posttraumatic stress symptoms (n=184 (6.8%)) reported a different pattern of reactions to peer provocation as compared to all other adolescents. Boys and girls with high levels of posttraumatic symptoms reported that they would be less likely to discuss conflict situations and more likely to react with physical aggression. Compared to their male counterparts, girls with high levels of posttraumatic stress symptoms were more likely to endorse hostile intentions, avoid provocations, and were less likely to endorse verbally aggressive responses. In provocation scenarios that involved physical aggression, girls with high levels of posttraumatic stress symptoms were less likely to endorse verbal aggressive responses and more likely to endorse physically aggressive responses than girls without clinically significant levels of posttraumatic symptoms. Girls with high levels of posttraumatic stress symptoms were also more likely to avoid socially aggressive situations than non-traumatized girls, whereas boys had an opposite pattern. Conclusions: High levels of posttraumatic stress symptoms may play a significant role in the endorsement of aggressive reactions in conflicts with peers and patterns of reactions may be gender-specific. A history of posttraumatic stress should be carefully evaluated in children and adolescents seeking treatment for aggressive behavior.
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Affiliation(s)
| | - Andrew Stickley
- Department of Preventive
Intervention for Psychiatric Disorders, National Institute of Mental
Health, National Center of Neurology
and Psychiatry, Kodaira, Tokyo, Japan
- Stockholm Center for Health and
Social Change (SCOHOST), Södertörn
University, Huddinge, Sweden
| | - Knut Sturidsson
- Department of Clinical
Neuroscience, Division of Psychology, Karolinska Institute,
Stockholm, Sweden
| | - Roman Koposov
- Regional Centre for Child and Youth
Mental Health and Child Welfare, Faculty of Health Sciences,
UiT The Arctic
University of Norway, Tromsø, Norway
- Sechenov First Moscow State Medical
University, Moscow, Russia
| | | | - Vladislav Ruchkin
- Child Study Center,
Yale University
Medical School, New Haven, CT, USA
- Department of Child and Adolescent
Psychiatry, Division of Neuroscience, Uppsala University,
Uppsala, Sweden
- Säter Forensic Psychiatric
Clinic, Säter, Sweden
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13
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Brockdorf AN, Gratz KL, Messman TL, DiLillo D. Trauma Symptoms and Deliberate Self-Harm Among Sexual Violence Survivors: Examining State Emotion Regulation and Reactivity as Dual Mechanisms. PSYCHOLOGY OF VIOLENCE 2023; 13:23-33. [PMID: 37284068 PMCID: PMC10241447 DOI: 10.1037/vio0000432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Objective Posttraumatic stress disorder (PTSD) symptoms have been associated with elevated rates of deliberate self-harm, including among women who have experienced sexual violence (SV); however, processes underlying this association have not been widely examined. Because a common function of deliberate self-harm is to reduce negative internal states, SV survivors may use self-harm to cope with impairments in broader affective processes associated with PTSD symptoms. To test this hypothesis, the present study examined the role of two aspects of emotional responding (i.e., state emotional reactivity and emotion dysregulation) as mechanisms between greater PTSD symptoms and risk for future deliberate self-harm among SV survivors. Method Participants were 140 community women with a history of SV who completed two waves of data collection. At baseline, participants reported on their PTSD symptoms, as well as state emotional reactivity and state emotion dysregulation following a standardized laboratory stressor task (i.e., the Paced Auditory Serial Addition Task [PASAT-C]). Participants then completed a self-report measure of deliberate self-harm 4 months later. Results Results from a parallel mediation analysis indicated that greater state emotion dysregulation, but not state emotional reactivity, mediated prospective associations between more severe PTSD symptoms at baseline and greater risk for deliberate self-harm 4-months later. Conclusions Applied to the context of survivors' daily lives, these findings underscore the importance of deficits in emotion regulation during times of distress in predicting risk for later deliberate self-harm.
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Affiliation(s)
| | | | | | - David DiLillo
- Department of Psychology, University of Nebraska–Lincoln
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14
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Sánchez MAA, González JA, Sánchez Fonseca JD, Calderón NP, Cárdenas-Poveda DC, López JML. Analysis of EEG and ECG in women with intimate partner violence experience during an emotional task. Int J Psychophysiol 2023; 183:148-158. [PMID: 36502937 DOI: 10.1016/j.ijpsycho.2022.12.001] [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: 03/01/2022] [Revised: 11/17/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022]
Abstract
Intimate Partner Violence (IPV) has been associated with cognitive, emotional, physical and physiological alterations, and with the presence of anxiety disorders. There is not enough research on this problem from an interdisciplinary approach despite the above. Therefore, this research compared the emotion perception and electrophysiological responses, elicited by an emotional task, in women who had experienced IPV and women who had not (WIPV). Forty-five participants (22 with and 23 without IPV experience) were presented with nine images from the International Affective Picture System (IAPS) database and performed a self-report using the Self-Assessment Manikin (SAM). In parallel, electrophysiological signals (ECG and EEG) were acquired, for the analysis of emotional response. In the between-group analysis, the IPV group showed lower perceived dominance and greater central asymmetry in the alpha band than the WIPV group; additionally, the IPV group exhibited a significant positive correlation between the valence of the images and the alpha band power in central areas. In the within-group analysis, the WIPV group showed greater activation in the alpha band and alpha/beta ratio in frontal areas during the emotional elicitation, as compared to baseline. Furthermore, the ECG analysis showed that, for the IPV group, there was a decrease in the power of the high-frequency (HF) band and an increase in the power of the very-low-frequency (VLF) band of heart rate variability (HRV) during the elicitation stage. It is hypothesized that the IPV group could present higher stress levels and greater physiological activity during emotional stimuli than the WIPV group. Possible changes in emotional regulation and anxiety levels due to IPV experiences are discussed.
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Affiliation(s)
- Miguel Angel Angulo Sánchez
- Corporación Universitaria Minuto de Dios Uniminuto, Psychology Program, CRA 73 A 81B-70, Bogotá 111021, Bogotá D.C, Colombia.
| | - Juan Andrés González
- Escuela Colombiana de Ingeniería Julio Garavito, Biomedical Engineering Program, Av. CRA 40 205-59, Bogotá 111166, Bogotá D.C, Colombia
| | - Jessica D Sánchez Fonseca
- Escuela Colombiana de Ingeniería Julio Garavito, Biomedical Engineering Program, Av. CRA 40 205-59, Bogotá 111166, Bogotá D.C, Colombia
| | - Natalia Perea Calderón
- Escuela Colombiana de Ingeniería Julio Garavito, Biomedical Engineering Program, Av. CRA 40 205-59, Bogotá 111166, Bogotá D.C, Colombia
| | - D Carolina Cárdenas-Poveda
- Corporación Universitaria Minuto de Dios Uniminuto, Psychology Program, CRA 73 A 81B-70, Bogotá 111021, Bogotá D.C, Colombia
| | - Juan Manuel López López
- Escuela Colombiana de Ingeniería Julio Garavito, Biomedical Engineering Program, Av. CRA 40 205-59, Bogotá 111166, Bogotá D.C, Colombia
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15
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Willis N, Dowling C, O'Reilly G. Stabilisation and Phase-Orientated Psychological Treatment for Posttraumatic Stress Disorder – A Systematic Review and Meta-Analysis. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2022. [DOI: 10.1016/j.ejtd.2022.100311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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16
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Afrin R, Prybutok G. Insights into the antecedents of cyberchondria: a perspective from the USA. Health Promot Int 2022; 37:6680034. [PMID: 36047641 DOI: 10.1093/heapro/daac108] [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: 11/13/2022] Open
Abstract
This study establishes a theoretical framework for assessing antecedents of cyberchondria, which is a process of amplified anxiety about one's health because of excessive online health information seeking. We examined the framework through partial least squares structural equation modeling after collecting data through a cross-sectional online survey. This research contributes to the literature by (i) evaluating the roles of health anxiety (HA) and affective responses (AR) on cyberchondria; (ii) equipping health strategists with understanding about ways to tailor their educational and communication strategies to specific segments by importance-performance map analysis and necessary condition analysis. Finally, by (iii) providing strategic tactics to curb cyberchondria so that it becomes possible to attain a better patient outcome. Findings suggest that the existing association between intolerance of uncertainty and cyberchondria is serially mediated by HA and AR. For healthcare educators and practitioners, the findings of this research deliver a blueprint for effectively controlling cyberchondria.
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Affiliation(s)
- Rifat Afrin
- Department of Rehabilitation and Health Services, College of Health and Public Service, University of North Texas, Denton, TX, USA
| | - Gayle Prybutok
- Department of Rehabilitation and Health Services, College of Health and Public Service, University of North Texas, Denton, TX, USA
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17
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Mathew AS, Lotfi S, Bennett KP, Larsen SE, Dean C, Larson CL, Lee HJ. Association between spatial working memory and Re-experiencing symptoms in PTSD. J Behav Ther Exp Psychiatry 2022; 75:101714. [PMID: 34906826 PMCID: PMC9173718 DOI: 10.1016/j.jbtep.2021.101714] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/13/2021] [Accepted: 12/04/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Few studies have evaluated the link between working memory (WM) and post-traumatic stress disorder (PTSD). Further, it is unknown whether this relationship is accounted for by other relevant variables including negative affect, emotional dysregulation, or general non-WM-related cognitive control deficits, which are associated with PTSD. The purpose of this study was to determine the extent to which a computerized WM task could predict PTSD symptomology incrementally beyond the contribution of other relevant variables associated with PTSD. METHODS Thirty veterans were eligible to complete emotional symptom questionnaires, a heart-rate variability measure, and computerized tasks (i.e., emotional Stroop and automated complex span tasks). A three-stage hierarchical regression was conducted with the PCL-5 total score and symptom clusters (i.e., re-experiencing, avoidance, hyperarousal, and negative cognition/mood) as the dependent variable. RESULTS Results revealed that only the re-experiencing symptom cluster was significantly predicted by executive, verbal, and visuospatial WM tasks, which explained an additional 29.7% of the variance over and above other relevant variables. Most notably, the visuospatial task was the only WM task that significantly explained PCL-5 re-experiencing symptoms. LIMITATIONS This study was based on a small sample of veterans with PTSD and causality cannot be determined with this cross-sectional study. CONCLUSIONS Overall, the results suggest that deficits in visuospatial WM are significantly associated with PTSD re-experiencing symptoms after controlling for other relevant variables. Further research should evaluate whether an intervention to improve visuospatial WM capacity can be implemented to reduce re-experiencing symptoms.
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Affiliation(s)
- Abel S Mathew
- Department of Psychology, University of Wisconsin-Milwaukee, USA
| | - Salahadin Lotfi
- Department of Psychology, University of Wisconsin-Milwaukee, USA; Rogers Behavioral Health, Research Center and Clinical Effectiveness Department, USA
| | | | - Sadie E Larsen
- Milwaukee VA Medical Center, USA; Medical College of Wisconsin, USA
| | - Caron Dean
- Milwaukee VA Medical Center, USA; Medical College of Wisconsin, USA
| | | | - Han-Joo Lee
- Department of Psychology, University of Wisconsin-Milwaukee, USA.
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18
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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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19
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Lapid Pickman L, Gelkopf M, Greene T. Do positive and negative emotional reactions during war predict subsequent symptomatology? A prospective experience sampling study. J Anxiety Disord 2021; 84:102492. [PMID: 34749217 DOI: 10.1016/j.janxdis.2021.102492] [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: 03/18/2021] [Revised: 10/01/2021] [Accepted: 10/20/2021] [Indexed: 10/20/2022]
Abstract
While peritraumatic negative emotions have been associated with subsequent posttraumatic stress and depression, the predictive role of real-time emotional reactions to specific stressors during prolonged stress exposure is still unclear, particularly that of positive emotions. The current study uses experience sampling methodology to examine individual general levels of negative and positive emotions, and emotional reactivity to specific stressors during war, as prospective predictors of posttraumatic stress and depression. Ninety-six civilians exposed to rocket fire during the 2014 Israel-Gaza war reported exposure to rocket warning sirens and levels of ten negative and six positive emotions twice a day for 30 days. Symptoms of posttraumatic stress and depression were then assessed two months post-war. Participants reported higher negative emotions and lower positive emotions during assessment windows with sirens. Over time, negative emotions decreased and positive emotions increased. Higher levels of overall negative emotions predicted posttraumatic stress symptoms and depression symptoms two months later. Levels of positive emotions, and negative and positive emotional reactivity to sirens, were not associated with subsequent symptomatology. Our results indicate the stronger role of overall negative emotions as predictors of symptomatology compared with momentary emotional reactivity, and the stronger predictive role of negative compared with positive emotions.
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Affiliation(s)
- Liron Lapid Pickman
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; NATAL - Israel Trauma and Resiliency Center, Tel Aviv, Israel.
| | - Marc Gelkopf
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; NATAL - Israel Trauma and Resiliency Center, Tel Aviv, Israel
| | - Talya Greene
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; Division of Psychiatry, University College London, London, UK
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20
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Knight RC, Emery LJ. Immediate & delayed effects of suppression and mindfulness as emotion regulation strategies. ANXIETY STRESS AND COPING 2021; 35:474-487. [PMID: 34550823 DOI: 10.1080/10615806.2021.1978430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND & OBJECTIVES Emotion regulation is an integral component of multiple physical and psychological functions, and problems with emotion regulation are thought to be involved with the development of psychological disorders. Most laboratory research on emotion regulation has been limited to investigating short-term impact during a single session. DESIGN & METHODS In the current study, we investigated the potential delayed consequences of the short-term use of two emotion regulation strategies: mindfulness and suppression. To do so, a two-session design was implemented, with 56 undergraduate participants viewing images under various regulation instructions at Time 1, returning one week later for a recognition memory test for these images at Time 2. Images were rated for valence and arousal at both time points. RESULTS We hypothesized that images encoded mindfully would elicit lower levels of anxiety upon re-exposure, while suppression would increase levels of anxiety. Results did not support original hypotheses: although participants reported being calmer and happier at re-exposure, this effect did not vary by strategy. High-anxiety participants reported higher arousal levels regardless of Instruction condition or Time Point. CONCLUSIONS These findings suggest that short-term use of emotion regulation does not impact feelings of calmness long-term, when exposed to anxiety-provoking stimuli.
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Affiliation(s)
| | - Lisa Jo Emery
- Department of Psychology, Appalachian State University, Raleigh, NC, USA
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21
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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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22
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Maftei A, Holman AC. The prevalence of exposure to potentially morally injurious events among physicians during the COVID-19 pandemic. Eur J Psychotraumatol 2021; 12:1898791. [PMID: 33968327 PMCID: PMC8075083 DOI: 10.1080/20008198.2021.1898791] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background: Given the profound psychological distress caused by the Covid-19 pandemic, healthcare workers are at high risk of being exposed to potentially morally injurious events (PMIEs). Objective: We aimed to explore the prevalence and associated factors with PMIEs in a sample of Romanian physicians, of which almost half worked in Covid-19 treatment medical units. Method: We ran a web-based survey in April 2020, three weeks after the general lockdown to contain the novel coronavirus. Participants (N = 114, aged 23 to 67, M = 38.85, SD = 9.82, 74.6% females) answered the PMIE scale items, in addition to questions related to the physical and emotional self-impact related questions, and demographical and work-related variables (i.e. age, gender, medical experience, and speciality). Results: Results suggested that almost 50% of the participants reported high levels of PMIE exposure. No significant associations were found between PMIE exposure, and the type of medical unit physicians worked in (Covid-19 or non-Covid-19), nor their specialization and medical experience. Demographic variables (i.e. age and gender) and experience did not predict PMIE exposure. However, we found significant associations between PMIE and the physicians' physical and emotional self-reported impact. Conclusions: Healthcare systems, governments, and societies worldwide need to recognize that physicians are prone to PMIE exposure and related adverse psychological outcomes due to their daily activity in containing the pandemic. Public policies need to actively offer and promote psychological support, to protect and help physicians from the adverse mental health outcomes following the pandemic.
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Affiliation(s)
- Alexandra Maftei
- Faculty of Psychology and Educational Sciences, "Alexandru Ioan Cuza" University, Iasi, Romania
| | - Andrei-Corneliu Holman
- Faculty of Psychology and Educational Sciences, "Alexandru Ioan Cuza" University, Iasi, Romania
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23
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Leonard SJ, Vujanovic AA. Thwarted Belongingness and PTSD Symptom Severity among Firefighters: The Role of Emotion Regulation Difficulties. Behav Modif 2021; 46:352-373. [PMID: 33724058 DOI: 10.1177/01454455211002105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present investigation examined the associations among thwarted belongingness (TB), emotion regulation difficulties (ERD), and posttraumatic stress disorder (PTSD) symptom severity among firefighters. First, the associations of TB and ERD with PTSD symptom severity were evaluated. Second, the indirect effect of TB on PTSD symptom severity through ERD was examined. The sample included 246 trauma-exposed firefighters (M age = 40.21, SD = 9.93, 93.1% male) who completed an online questionnaire battery. Results demonstrate significant, positive associations among TB, ERD, and PTSD symptom severity; and an indirect effect of TB on PTSD symptom severity through heightened ERD (β = 0.17; CI [0.08, 0.29]). Alternate indirect effect models were also significant, underscoring the potentially bidirectional associations of these variables. These findings suggest that there is merit in investigating the role of interpersonal factors and ERD among firefighter populations to better understand PTSD symptomatology. Clinical and empirical implications are discussed.
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24
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Lapid Pickman L, Gelkopf M, Greene T. Emotional reactivity to war stressors: An experience sampling study in people with and without different psychiatric diagnoses. Stress Health 2021; 37:127-139. [PMID: 32794338 DOI: 10.1002/smi.2978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 07/07/2020] [Accepted: 08/03/2020] [Indexed: 01/06/2023]
Abstract
There is a lack of knowledge regarding real-time emotional reactivity to high-intensity stressors, particularly in people with mental illness, a potentially vulnerable population. The current study aimed to examine negative emotional reactions to recurring high-intensity stressors within a continuous war situation, in people with different psychiatric diagnosis types. Experience sampling method was used to examine emotional reactions among 143 civilians exposed to rockets during the 2014 Israel-Gaza war, of them 18.2% with psychosis, 14.7% with anxiety or depression and 67.1% without mental illness. Participants reported exposure to rocket warning sirens and the levels of 10 negative emotions twice a day for 30 days. Negative emotional levels were higher on most emotions following high-intensity stressors (sirens), that is, emotional reactivity was demonstrated in real-time during war. Overall, no difference in reactivity was found among the three study groups. Moreover, people with anxiety/depression were less reactive than people without mental illness on sadness and being overwhelmed. The findings indicate similar and sometimes lower emotional reactivity to high-intensity stressors in people with mental illness compared to the general population. Nevertheless, people with mental illness seem to have significant emotional needs during war, to be addressed in prevention and intervention efforts.
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Affiliation(s)
- Liron Lapid Pickman
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.,NATAL-Israel Trauma and Resiliency Center, Tel Aviv, Israel
| | - Marc Gelkopf
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.,NATAL-Israel Trauma and Resiliency Center, Tel Aviv, Israel
| | - Talya Greene
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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25
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Wermuth K, Ülsmann D, Borngräber J, Gallinat J, Schulte-Herbrüggen O, Kühn S. Structural signature of trauma: white matter volume in right inferior frontal gyrus is positively associated with use of expressive suppression in recently traumatized individuals. Eur J Psychotraumatol 2021; 12:1837512. [PMID: 33505636 PMCID: PMC7817216 DOI: 10.1080/20008198.2020.1837512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Background: Differences in grey and white matter structure have been found between trauma-exposed individuals with and without PTSD. Yet, it remains unclear which functional processes are underlying these volumetric changes. Avoidance- and suppression-based emotion regulation strategies are candidates of interest since they play an important role in the development and maintenance of PTSD. Method: We used voxel-based morphometry to examine differences in brain structure in 20 recently trauma-exposed individuals and 20 healthy controls in respect of their relation to emotion regulation. Results: We found a significantly larger white matter volume close to the right inferior frontal gyrus (rIFG) in patients compared to healthy controls. White matter volume close to the rIFG was positively correlated with expressive suppression. Conclusion: The region of volumetric white matter difference in our study overlaps with brain regions previously associated with executive functioning and inhibitory control, functions that are known to be impaired in PTSD. Our findings support the idea that impaired executive functions in PTSD might be compensated by suppression-based emotion regulation strategies.
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Affiliation(s)
- Katharina Wermuth
- Max Planck Institute for Human Development, Center for Lifespan Psychology, Berlin, Germany.,St. Hedwig-Krankenhaus, Clinic for Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany
| | - Dominik Ülsmann
- Friedrich Von Bodelschwingh-Klinik Clinic for Psychiatry, Psychotherapy and Psychosomatic Medicine, Berlin, Germany
| | - Janine Borngräber
- St. Hedwig-Krankenhaus, Clinic for Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany
| | - Jürgen Gallinat
- St. Hedwig-Krankenhaus, Clinic for Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany.,University Clinic Hamburg-Eppendorf, Clinic and Policlinic for Psychiatry and Psychotherapy, Hamburg, Germany
| | - Olaf Schulte-Herbrüggen
- St. Hedwig-Krankenhaus, Clinic for Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany.,Friedrich Von Bodelschwingh-Klinik Clinic for Psychiatry, Psychotherapy and Psychosomatic Medicine, Berlin, Germany
| | - Simone Kühn
- Max Planck Institute for Human Development, Center for Lifespan Psychology, Berlin, Germany.,University Clinic Hamburg-Eppendorf, Clinic and Policlinic for Psychiatry and Psychotherapy, Hamburg, Germany
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Khan A, O’Donovan A, Neylan T, Gross J, Cohen B. Suppression, but not reappraisal, is associated with inflammation in trauma-exposed veterans. Psychoneuroendocrinology 2020; 122:104871. [PMID: 33010600 PMCID: PMC8425342 DOI: 10.1016/j.psyneuen.2020.104871] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/10/2020] [Accepted: 09/11/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Emotion dysregulation can elicit inflammatory activity. The current study examined whether specific maladaptive and adaptive emotion regulation strategies were associated with inflammatory markers in trauma-exposed veterans, above and beyond PTSD. METHODS In a cohort study, 606 participants exposed to a Criterion A trauma and recruited from Veteran Health Administration facilities completed fasting blood draws, the Emotion Regulation Questionnaire, and the Clinician Administered PTSD Scale-IV. Inflammation was assessed with high sensitivity C-reactive protein (hsCRP), white blood cell count (WBC), and fibrinogen levels. An inflammation index was created by summing standardized log-transformed levels of the three biomarkers. Our primary linear regression models were adjusted for sex, age, race, education, income, creatinine, and PTSD. RESULTS Suppression, but not cognitive reappraisal, was significantly associated with higher levels of the inflammatory index (β = 0.14, p = 0.001). Parallel analyses for the individual inflammatory markers also showed suppression, but not reappraisal, was significantly associated with higher hsCRP (β = 0.11, p = 0.01), WBC (β = 0.11, p = 0.01), and fibrinogen (β = 0.10, p = 0.02). CONCLUSIONS Emotional suppression is related to elevated systemic inflammation independent of PTSD. Cognitive reappraisal is unrelated to inflammation. Findings suggest over-utilization of maladaptive, rather than under-utilization of adaptive, emotion regulation strategies may be associated with systemic inflammation in trauma-exposed veterans.
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Affiliation(s)
- A.J. Khan
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States,Department of Psychiatry, University of California, San Francisco, CA, United States,Corresponding author at: San Francisco VA Health Care System 4150 Clement Street, San Francisco, CA, 94121, United States. (A.J. Khan)
| | - A. O’Donovan
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States,Department of Psychiatry, University of California, San Francisco, CA, United States
| | - T.C. Neylan
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States,School of Medicine, University of California, San Francisco, CA, United States
| | - J.J. Gross
- Department of Psychology, Stanford University, Stanford, CA, United States
| | - B.E. Cohen
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States,School of Medicine, University of California, San Francisco, CA, United States
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Macia KS, Moschetto JM, Wickham RE, Brown LM, Waelde LC. Cumulative Trauma Exposure and Chronic Homelessness Among Veterans: The Roles of Responses to Intrusions and Emotion Regulation. J Trauma Stress 2020; 33:1017-1028. [PMID: 32662141 DOI: 10.1002/jts.22569] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 04/23/2020] [Accepted: 05/25/2020] [Indexed: 01/01/2023]
Abstract
Veterans with mental health problems and a history of interpersonal and military trauma exposure are at increased risk for chronic homelessness. Although studies have examined posttraumatic stress disorder (PTSD) as a predictor of homelessness, there is limited understanding of specific mechanisms related to cumulative trauma exposure. We sought to elucidate how cumulative interpersonal and military trauma exposure may be linked to homelessness chronicity by examining the role of factors that influence trauma recovery and functional impairment. Specifically, we examined the indirect association of cumulative trauma exposure with homelessness chronicity through distress and responses to trauma-related intrusions and emotion regulation problems in a sample of 239 veterans in community-based homeless programs. Participants completed measures of trauma exposure, responses to intrusions, intrusion distress, difficulties with emotion regulation, and duration and episodes of homelessness. Structural equation modeling was used to test a serial indirect effect model in which cumulative trauma exposure was indirectly associated with homelessness chronicity through distress from and responses to intrusions as well as emotion regulation problems. The results supported the hypothesized sequential indirect effect for episodes of homelessness, indirect effect odds ratio (IE ORs) = 1.12-1.13, but not for current episode duration, IE OR = 1.05. Overall, the present findings elucidate specific trauma-related factors that may be particularly relevant to episodic patterns of homelessness and interfere with efforts to remain housed. These findings represent an important step toward shaping policy and program development to better meet mental health care needs and improve housing outcomes among homeless veterans.
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Affiliation(s)
- Kathryn S Macia
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
| | - Jenna M Moschetto
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
| | - Robert E Wickham
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
| | - Lisa M Brown
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
| | - Lynn C Waelde
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
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Arden MD, Rabinovitz S. Child Sexual Abuse and the Moralization of Purity. JOURNAL OF CHILD SEXUAL ABUSE 2020; 29:697-716. [PMID: 31751186 DOI: 10.1080/10538712.2019.1694118] [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: 02/18/2019] [Revised: 10/15/2019] [Accepted: 11/09/2019] [Indexed: 06/10/2023]
Abstract
Recent studies were able to associate disgust with the moral domain of purity, as well as a heightened sensitivity to disgust with sexual victimization. However, no empirical evidence has yet to document the exact relation between sexual victimization and its impact on the moralization of purity. Therefore, the present study aimed to examine the relationship between child sexual abuse (CSA) and the moral domain of purity, by means of judgments toward three different types of disgust: pathogen, sexual and moral. To test this, The Three Domains of Disgust Scale (TDDS) was given to both CSA participants (n = 29) and to a non-sexually abused population (N-SAP; n = 31). . Results have shown a statistically significant difference between the CSA and N-SAP groups on the combined dependent variables (i.e., pathogen, sexual and moral disgust). However, only the sexual disgust domain, out of the other two domains has been found to hold significance. Furthermore, consistent with previous empirical findings, similar gender patterns of moral judgments have been found between the two groups (i.e., CSA and N-SAP), though with a statistical significance only in the sexual domain. Implications of these findings are discussed.
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Affiliation(s)
- Mattan D Arden
- School of Criminology, University of Haifa , Haifa, Israel
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Raudales AM, Weiss NH, Schmidt NB, Short NA. The role of emotion dysregulation in negative affect reactivity to a trauma cue: Differential associations through elicited posttraumatic stress disorder symptoms. J Affect Disord 2020; 267:203-210. [PMID: 32217220 PMCID: PMC10923236 DOI: 10.1016/j.jad.2020.02.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/16/2019] [Accepted: 02/08/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Recent research has linked emotion dysregulation with increases in subjective ratings of negative affect (NA reactivity) to trauma reminders, a central symptom of posttraumatic stress disorder (PTSD). The current study adds to this burgeoning line of research by exploring elicited PTSD symptoms as a mechanism explicating the relation between emotion dysregulation and NA reactivity following trauma cue exposure. METHODS Participants were 60 treatment-seeking marijuana users with insomnia symptoms who reported exposure to a traumatic event. Participants were administered questionnaires assessing emotion dysregulation, PTSD symptoms, and NA prior to and/or after listening to a personalized trauma script, and subsequently completed a diagnostic interview. RESULTS Results demonstrated that greater emotion dysregulation was associated with heightened NA reactivity through re-experiencing symptoms, but not avoidance or dissociation symptoms, even after accounting for past 30-day PTSD symptom severity and pre-trauma script NA. These effects were driven by the dimensions of emotion dysregulation characterized by nonacceptance of negative emotions and limited access to effective emotion regulation strategies. LIMITATIONS This study requires replication among other clinical samples, and is limited by use of self-report measures. CONCLUSIONS Findings provide novel empirical support for one mechanism through which emotion dysregulation may confer vulnerability to PTSD symptomology, and offer implications for refining PTSD treatments.
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Affiliation(s)
- Alexa M Raudales
- University of Rhode Island, Department of Psychology, 142 Flagg Road, Kingston, RI 02881 USA.
| | - Nicole H Weiss
- University of Rhode Island, Department of Psychology, 142 Flagg Road, Kingston, RI 02881 USA
| | - Norman B Schmidt
- Florida State University, Department of Psychology, 1107W. Call St., Tallahassee, FL 32306-4301 USA.
| | - Nicole A Short
- University of Rhode Island, Department of Psychology, 142 Flagg Road, Kingston, RI 02881 USA
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Winders S, Murphy O, Looney K, O'Reilly G. Self‐compassion, trauma, and posttraumatic stress disorder: A systematic review. Clin Psychol Psychother 2020; 27:300-329. [DOI: 10.1002/cpp.2429] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Sarah‐Jane Winders
- Department of Clinical PsychologyUniversity College Dublin Dublin Ireland
| | - Orlagh Murphy
- Department of Clinical PsychologyUniversity College Dublin Dublin Ireland
| | - Kathy Looney
- Department of Clinical PsychologyUniversity College Dublin Dublin Ireland
| | - Gary O'Reilly
- Department of Clinical PsychologyUniversity College Dublin Dublin Ireland
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Gurtovenko K, Katz LF. Post-Traumatic Stress, Mother's Emotion Regulation, and Parenting in Survivors of Intimate Partner Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:876-898. [PMID: 29294652 DOI: 10.1177/0886260517690874] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Post-traumatic stress symptoms (PTSS) are high among female survivors of intimate partner violence (IPV), and children of parents experiencing PTSS are at heightened risk for a wide range of emotional and behavioral problems. Parenting has significant influence on child adjustment, and although links have been found between parental psychopathology and maladaptive parenting, little is known about the factors that may explain this relation. The current study examines mother's emotion regulation (ER) as a factor influencing the relation between mother PTSS and parenting around children's emotions in a study sample of sixty-four female survivors of IPV and their 6- to 12-year-old children. Mothers reported on their own PTSS and their parenting. Respiratory sinus arrhythmia (RSA) was used as a psychophysiological index of mother's ER. Experiential components of mother's ER was also measured by observer coding of the Meta-Emotion Interview, a structured assessment that asks parents about their attitudes toward and experiences with emotions, including their regulation of emotions. Mother's RSA reactivity moderated the relation between PTSS and negative parenting. There was also a significant indirect relation between mothers' PTSS symptom severity and supportive parenting reactions through mothers' self-report of ER. Results suggest that mother's ER abilities represent factors that significantly affect associations between maternal PTSS and parent's emotion socialization practices. Implications for assessment and intervention with families exposed to the stress of IPV are discussed.
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Abstract
PURPOSE OF REVIEW Childhood maltreatment is associated with all types of eating disorders. We provide a systematic review of the recent literature on comorbid posttraumatic stress disorder (PTSD) in patients with eating disorders, and focus on prevalence, relationship with symptom severity, operating mechanisms and treatment. RECENT FINDINGS The prevalence of comorbid PTSD in patients with eating disorders ranges from 9 to 24%, with research suggesting that comorbid PTSD is associated with more severe eating disorder symptoms. Maladaptive emotional regulation strategies may mediate the relationship between PTSD and eating disorders. Two pilot studies provide preliminary evidence that concurrent cognitive behavior therapy (CBT) for PTSD and eating disorders may be beneficial and that repetitive transcranial magnetic stimulation (rTMS) could be helpful in the treatment of PTSD in some eating disorder patients. SUMMARY PTSD is a common comorbidity in patients with eating disorders and impacts the severity of their eating disorder symptoms. However, there is little research into concurrent treatments for PTSD and eating disorders. Difficulties in emotional regulation may be a common mechanism in both disorders.
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A pilot randomized trial of a dual n-back emotional working memory training program for veterans with elevated PTSD symptoms. Psychiatry Res 2019; 275:261-268. [PMID: 30939398 PMCID: PMC6508098 DOI: 10.1016/j.psychres.2019.02.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/06/2019] [Accepted: 02/06/2019] [Indexed: 11/20/2022]
Abstract
Anxiety is characterized by excessive attention to threatening information, leading to impaired working memory (WM) performance and elevated anxious thoughts. Preliminary research indicates that individuals with PTSD show particular difficulty with WM in emotional contexts (Schweizer et al., 2011). Although several studies show that computerized training can improve WM capacity for anxious individuals (Owens et al., 2013; Schweizer et al., 2011; 2013), there has been very little research on WM training for PTSD or with Veterans (Saunders et al., 2015). In a pilot randomized trial, we assigned Veterans with elevated PTSD symptoms to an online emotional WM training, either adaptive (n-back; n = 11) or a less potent training (1-back; n = 10). Overall, both groups showed significant decreases in PTSD symptoms. The n-back group showed a trend of outperforming the 1-back group in improving reexperiencing symptoms (which are likely to be associated with impaired WM functioning). This population anecdotally found the intervention quite challenging, which may be why even the less potent 1-back was still helpful. These preliminary findings justify the effort for developing new WM-focused PTSD intervention for complex, vulnerable populations, particularly as online training can improve accessibility.
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Military Veteran Status and Posttraumatic Stress Disorder Symptomatology Among Urban Firefighters: The Moderating Role of Emotion Regulation Difficulties. J Nerv Ment Dis 2019; 207:224-231. [PMID: 30865077 DOI: 10.1097/nmd.0000000000000958] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A significant portion of firefighters are military veterans, and both populations experience high rates of trauma and posttraumatic stress disorder (PTSD) symptomatology. We investigated main and interactive effects of military veteran status (MVS) and emotion regulation difficulties (ERD) with regard to PTSD symptom severity in firefighters. Covariates included trauma load, number of years in the fire department, and depressive symptom severity. The sample was composed of 839 (93.9% men; mean age = 38.4, SD = 8.5) trauma-exposed firefighters who completed a web-based questionnaire battery. Structural equation modeling was used. ERD were significantly, positively associated with PTSD symptom severity (β = 0.30, confidence interval [CI] = 0.20-0.41, p < 0.001). A significant interactive effect was noted (β = 0.07, CI = 0.01-0.14, p = 0.020); firefighters who endorsed MVS and greater ERD had the highest levels of PTSD symptom severity. It is vital that future work examine associations between MVS and relevant cognitive mechanisms for the purposes of informing effective screening, intervention, and prevention programs.
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35
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Lahti K, Vänskä M, Qouta SR, Diab SY, Perko K, Punamäki RL. Maternal experience of their infants' crying in the context of war trauma: Determinants and consequences. Infant Ment Health J 2019; 40:186-203. [PMID: 30715730 DOI: 10.1002/imhj.21768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We examined, first, how prenatal maternal mental health and war trauma predicted mothers' experience of their infant crying, indicated by emotions, cognitions, and behavior; and second, how these experiences influenced the mother-infant interaction and infant development. Participants were 511 Palestinian mothers from the Gaza Strip, reporting their war trauma, symptoms of posttraumatic stress disorder (PTSD), depression, and perceived stress during pregnancy (Time 1). They reported experiences of infant crying at 4 months (Time 2), and the mother-infant interaction and infant sensorimotor and language development at 12 months of infants' age (Time 3). Results revealed that maternal mental health problems, but not war trauma, were important to experiences of infant crying. A high level of PTSD symptoms predicted negative emotions evoked by infant crying, and high depressive symptoms predicted low active and positive responses to crying. Unexpectedly, high prenatal perceived stress predicted high active and positive responsiveness. Concerning the consequences, mothers' sensitive interpretation of infant crying predicted optimal infant sensorimotor development, and mothers' active and positive responses predicted high emotional availability in mother-infant interaction. Crying is the first communication tool for infants, and mothers' sensitive responses to crying contribute to infant well-being. Therefore, reinforcing mother's optimal responses is important when helping war-affected dyads.
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Affiliation(s)
- Katri Lahti
- Department of Psychology, University of Tampere, Tampere, Finland
| | - Mervi Vänskä
- Department of Psychology, University of Tampere, Tampere, Finland
| | - Samir R Qouta
- Department of Education and Psychology, Islamic University Gaza, Gaza City, Palestine
| | - Safwat Y Diab
- Department of Educational Psychology, Al Quds Open University, Gaza Strip, Palestine
| | - Kaisa Perko
- Department of Psychology, University of Tampere, Tampere, Finland
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36
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Spiller TR, Liddell BJ, Schick M, Morina N, Schnyder U, Pfaltz M, Bryant RA, Nickerson A. Emotional Reactivity, Emotion Regulation Capacity, and Posttraumatic Stress Disorder in Traumatized Refugees: An Experimental Investigation. J Trauma Stress 2019; 32:32-41. [PMID: 30729584 DOI: 10.1002/jts.22371] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 10/02/2018] [Accepted: 10/06/2018] [Indexed: 11/08/2022]
Abstract
Refugees who suffer from posttraumatic stress disorder (PTSD) often react with strong emotions when confronted with trauma reminders. In this study, we aimed to investigate the associations between low emotion regulation capacity (as indexed by low heart rate variability [HRV]), probable PTSD diagnosis, and fear and anger reaction and recovery to trauma-related stimuli. Participants were 81 trauma-exposed refugees (probable PTSD, n = 23; trauma-exposed controls, n = 58). The experiment comprised three 5-min phases: a resting phase (baseline); an exposition phase, during which participants were exposed to trauma-related images (stimulus); and another resting phase (recovery). We assessed HRV at baseline, and fear and anger were rated at the end of each phase. Linear mixed model analyses were used to investigate the associations between baseline HRV and probable DSM-5 PTSD diagnosis in influencing anger and fear responses both immediately after viewing trauma-related stimuli and at the end of the recovery phase. Compared to controls, participants with probable PTSD showed a greater increase in fear from baseline to stimulus presentation, d = 0.606. Compared to participants with low emotion regulation capacity, participants with high emotion regulation capacity showed a smaller reduction in anger from stimulus presentation to recovery, d = 0.548. Our findings indicated that following exposure to trauma-related stimuli, probable PTSD diagnosis predicted increased fear reactivity, and low emotion regulation capacity predicted decreased anger recovery. Impaired anger recovery following trauma reminders in the context of low emotion regulation capacity might contribute to the increased levels of anger found in postconflict samples.
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Affiliation(s)
- Tobias R Spiller
- University of Zurich, University Hospital Zurich, Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, Switzerland
| | - Belinda J Liddell
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Matthis Schick
- University of Zurich, University Hospital Zurich, Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, Switzerland
| | - Naser Morina
- University of Zurich, University Hospital Zurich, Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, Switzerland
| | - Ulrich Schnyder
- University of Zurich, University Hospital Zurich, Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, Switzerland
| | - Monique Pfaltz
- University of Zurich, University Hospital Zurich, Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, Switzerland
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, Australia
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Zielinski MJ, Privratsky AA, Smitherman S, Kilts CD, Herringa RJ, Cisler JM. Does development moderate the effect of early life assaultive violence on resting-state networks? An exploratory study. Psychiatry Res Neuroimaging 2018; 281:69-77. [PMID: 30266022 PMCID: PMC6373177 DOI: 10.1016/j.pscychresns.2018.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 07/31/2018] [Accepted: 08/27/2018] [Indexed: 12/15/2022]
Abstract
Current neurocircuitry models of PTSD do not account for developmental effects, despite that early life assaultive violence is a potent risk factor for PTSD. Here, we preliminarily evaluated developmental stage as a moderator of the effect of early life assaultive violence on resting-state connectivity amongst regions associated with emotion generation and regulation using fMRI. Participants were adult women (n = 25) and adolescent girls (n = 36) who had or had not experienced early life assaultive violence. We found significant interactions between developmental stage and trauma exposure on resting-state functional connectivity (FC). Left amygdala connectivity with the left ventral anterior cingulate gyrus (BA 32) was reduced among trauma-exposed compared to control adolescents, but increased among trauma-exposed compared to control adults. A corresponding pattern of results was identified for FC between rostral anterior cingulate gyrus seed region and a similar right ventral anterior superior frontal gyrus cluster. Increased FC in both regions for assaulted adult women scaled positively with self-reported emotion regulation difficulties. Our results should be viewed tentatively due to sample limitations, but provide impetus to examine whether neurocircuitry models of PTSD may be strengthened by accounting for developmental stage.
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Affiliation(s)
- Melissa J Zielinski
- Brain Imaging Research Center, Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 72205, USA.
| | - Anthony A Privratsky
- Brain Imaging Research Center, Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 72205, USA
| | - Sonet Smitherman
- Brain Imaging Research Center, Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 72205, USA
| | - Clinton D Kilts
- Brain Imaging Research Center, Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 72205, USA
| | - Ryan J Herringa
- Department of Psychiatry, University of Wisconsin School of Medicine & Public Health, Madison, WI 53726, USA
| | - Josh M Cisler
- Brain Imaging Research Center, Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 72205, USA; Department of Psychiatry, University of Wisconsin School of Medicine & Public Health, Madison, WI 53726, USA
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Schweizer T, Renner F, Sun D, Kleim B, Holmes EA, Tuschen-Caffier B. Psychophysiological reactivity, coping behaviour and intrusive memories upon multisensory Virtual Reality and Script-Driven Imagery analogue trauma: A randomised controlled crossover study. J Anxiety Disord 2018; 59:42-52. [PMID: 30269002 PMCID: PMC6249992 DOI: 10.1016/j.janxdis.2018.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 08/11/2018] [Accepted: 08/14/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Peri- and post-traumatic factors predict the differential development of stress-associated mental disorders. Prospective designs assessing these risk factors in real-time under controlled experimental conditions can overcome limitations of retrospective designs. Therefore, we aimed to investigate multi-sensory, experimental analogues of a traumatic experience delivered in Virtual Reality (VR) or Script-Driven Imagery (SDI). METHODS In a randomised controlled crossover design, differences in the induced analogue trauma symptoms between multi-sensory analogue trauma by either VR or SDI versus a neutral condition were assessed in 127 non-clinical participants. RESULTS Analogue symptoms (psychophysiological responses, coping behaviour and intrusive memories of the experimental trauma) increased following analogue trauma in both VR and SDI, with more analogue symptoms for VR. Psychophysiological arousal was in general higher in VR. LIMITATIONS The analogue trauma situation of a car park fire that was used may be infrequent in real life. CONCLUSIONS Multisensory (vision, olfaction, hearing) analogue trauma in VR and SDI offers a useful tool for the induction and real-time assessment of peri- and post-traumatic risk factors for analogue stress-associated psychopathology. VR was more effective in inducing analogue symptoms than SDI, even though the latter might be more personalised. New experimental models for studying trauma exposure and responses may contribute to a better understanding of risk factors and help to identify and protect individuals at risk.
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Affiliation(s)
- Tina Schweizer
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Freiburg, 79085 Freiburg, Germany.
| | - Fritz Renner
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Freiburg, 79085 Freiburg, Germany; MRC Cognition and Brain Sciences Unit, University of Cambridge, CB2 7EF Cambridge, United Kingdom
| | - Dali Sun
- Department of Computer Science, University of Freiburg, 79110 Freiburg, Germany
| | - Birgit Kleim
- Department of Experimental Psychopathology and Psychotherapy, University of Zurich, 8050 Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8032 Zurich, Switzerland
| | - Emily A Holmes
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 65 Solna, Sweden
| | - Brunna Tuschen-Caffier
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Freiburg, 79085 Freiburg, Germany
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Warnke AS, Nagy SM, Pickett SM, Jarrett NL, Hunsanger JA. The examination of behavior inhibition system sensitivity, experiential avoidance, and sex in relation to post-traumatic stress symptom severity: Comparison of a moderated versus mediated model. PERSONALITY AND INDIVIDUAL DIFFERENCES 2018. [DOI: 10.1016/j.paid.2018.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Scoglio AAJ, Rudat DA, Garvert D, Jarmolowski M, Jackson C, Herman JL. Self-Compassion and Responses to Trauma: The Role of Emotion Regulation. JOURNAL OF INTERPERSONAL VIOLENCE 2018; 33:2016-2036. [PMID: 26681787 DOI: 10.1177/0886260515622296] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Emerging literature suggests that self-compassion may be an important concept for understanding recovery from the impact of trauma and posttraumatic stress disorder (PTSD). The present study explored the interconnection among self-compassion, resilience, emotion dysregulation, and PTSD symptom severity in a sample of treatment-seeking women with PTSD. We predicted that self-compassion would be negatively related to PTSD symptom severity and to emotion dysregulation, and positively related to resilience. The results supported our main hypotheses. In addition, emotion dysregulation mediated the relationship between PTSD symptom severity and self-compassion and affected the relationship between self-compassion and resilience. These findings corroborate previous research that points to the important role of self-compassion in mental health and in the aftermath of stressful life events. The present study expands this research by demonstrating that PTSD symptom severity is negatively related to self-compassion in a clinical population of women with experiences of severe and repeated interpersonal trauma.
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Affiliation(s)
| | | | - Donn Garvert
- 3 National Center for PTSD, VA Palo Alto Health Systems, Menlo Park, CA, USA
| | - Maggie Jarmolowski
- 1 Harvard Medical School, Cambridge Health Alliance, Somerville, MA, USA
| | - Christie Jackson
- 4 Manhattan VA Medical Center, NY, USA
- 5 NYU School of Medicine, NY, USA
| | - Judith L Herman
- 1 Harvard Medical School, Cambridge Health Alliance, Somerville, MA, USA
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Sheerin CM, Konig A, Eonta AM, Vrana SR. Effect of expressive and neutral writing on respiratory sinus arrhythmia response over time. J Behav Ther Exp Psychiatry 2018; 59:129-133. [PMID: 29408050 PMCID: PMC5866212 DOI: 10.1016/j.jbtep.2018.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 11/20/2017] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Parasympathetic activity, as indexed by respiratory sinus arrhythmia (RSA), underlies key aspects of emotional and cognitive self-regulation. Examining time-varying RSA response during expressive writing about trauma may help inform theory about mechanisms of this intervention. The present study investigated changes in RSA during expressive writing. METHODS Participants (N = 246, Mage = 21.5 years, 72% female) were randomly assigned to expressive or neutral writing conditions and wrote for three 20-min sessions. RSA was measured continuously during the first and third writing session. RESULTS Linear mixed model analyses of RSA changes within and across sessions by writing groups found that neutral writers, but not expressive writers, exhibited change in RSA. The overall RSA changes during expressive and neutral writing are consistent with theory about the relationship between cognitive and emotional processing mechanisms and vagal activation. LIMITATIONS As the present study was not a clinical sample selected on trauma exposure, findings should be considered preliminary. Additionally, engagement of affective and cognitive processes was only hypothesized, as manipulation checks were not performed. CONCLUSIONS The present study illustrates the benefits of examining changes in RSA over time. Future work with clinical samples should include additional measures and tasks to better define these mechanisms and rule out alternative hypotheses.
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Affiliation(s)
- Christina M Sheerin
- Virginia Institute for Psychiatric and Behavioral Genetics, 800 E Leigh Street, Richmond, VA, USA; Virginia Commonwealth University, 821 West Franklin St., Richmond, VA, USA.
| | - Andrea Konig
- St. Mary’s of Bon Secours Virginia Health System; 5801 Bremo Rd. Richmond, VA
| | - Alison M. Eonta
- Virginia Commonwealth University; 821 West Franklin St., Richmond VA
| | - Scott R. Vrana
- Virginia Commonwealth University; 821 West Franklin St., Richmond VA
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42
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Villalta L, Smith P, Hickin N, Stringaris A. Emotion regulation difficulties in traumatized youth: a meta-analysis and conceptual review. Eur Child Adolesc Psychiatry 2018; 27:527-544. [PMID: 29380069 DOI: 10.1007/s00787-018-1105-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 01/03/2018] [Indexed: 11/27/2022]
Abstract
This article provides a quantitative and conceptual review of emotion regulation difficulties in trauma-exposed young people, and informs future directions in the field. Despite long-standing interest in the influence of emotion regulation difficulties on different internalizing and externalizing psychiatric disorders in childhood, several questions remain unresolved with respect to children and adolescents with PTSD (post-traumatic stress disorder). Meta-analytic data from adult victims suggest that emotion regulation problems are associated with PTSD, but this has never been studied in children and young people. We therefore provide a conceptual review of features related to the phenomenology, assessment, severity and treatment of emotion regulation difficulties in trauma-exposed children and young people. We combine this with a meta-analysis of published literature. We searched studies in Medline, PsychINFO, and Embase databases based on pre-selected criteria. Eight hundred and eighty-six papers were identified and 41 were included. We found that children and adolescents with a diagnosis of PTSD reported more emotion regulation difficulties than those who did not develop PTSD, and that the overall association between the two symptom dimensions was moderately strong. We identify a number of research priorities: the development of instruments to assess emotion regulation difficulties in children, the design of studies that describe its prevalence in young epidemiological traumatized samples, its predictive role in the onset, severity and persistence of post-traumatic symptoms, and its relevance as a moderator, outcome or treatment target for young survivors.
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Affiliation(s)
- L Villalta
- Child and Adolescent Psychiatry Department, Hospital Sant Joan de Deu, Passeig de Sant Joan de Déu, 2, Esplugues de Llobrega, 08950, Barcelona, Spain.
| | - P Smith
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - N Hickin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - A Stringaris
- Mood Brain & Development Unit, Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
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43
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Jones AC, Badour CL, Alex Brake C, Hood CO, Feldner MT. Facets of Emotion Regulation and Posttraumatic Stress: An Indirect Effect via Peritraumatic Dissociation. COGNITIVE THERAPY AND RESEARCH 2018; 42:497-509. [PMID: 32952232 DOI: 10.1007/s10608-018-9899-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Research suggests important associations between emotion regulation difficulties and posttraumatic stress disorder (PTSD) symptomology, with prospective studies indicating that emotion regulation difficulties may lead to increased PTSD symptoms. Peritraumatic dissociation is considered an important and consistent predictor of PTSD symptoms. The present study examines whether peritraumatic dissociation accounts for associations between facets of emotion regulation difficulties and PTSD symptoms. Adult women with a history of sexual victimization participated in an interview to assess past-month PTSD symptoms and self-report questionnaires to assess peritraumatic dissociation and emotion regulation difficulties. Results showed a partial indirect effect of three facets of emotion regulation difficulties (i.e., nonacceptance of negative emotional responses, limited access to emotion regulation strategies perceived as effective in the context of distress, and impulse control difficulties when experiencing negative emotions) on PTSD symptoms through peritraumatic dissociation. Reverse indirect effects models were also explored. The present study offers preliminary evidence that peritraumatic dissociation by traumatized individuals may signal the presence of specific emotion regulation deficits, which may indicate increased risk of heightened PTSD severity.
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44
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Schoenleber M, Berghoff CR, Gratz KL, Tull MT. Emotional lability and affective synchrony in posttraumatic stress disorder pathology. J Anxiety Disord 2018; 53:68-75. [PMID: 29197703 PMCID: PMC5748357 DOI: 10.1016/j.janxdis.2017.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/26/2017] [Accepted: 11/27/2017] [Indexed: 11/17/2022]
Abstract
This study examined the relations of PTSD pathology to both the lability of three specific emotions (anxiety, anger, self-conscious emotions [SCE]) and the extent to which changes in one emotional state co-occur with changes in another emotional state (i.e. affective synchrony). Moreover, given evidence that emotional responding in PTSD may be heightened in response to trauma-related cues, these relations were explored in the context of a trauma cue versus neutral cue. Trauma-exposed patients in residential substance use disorder treatment (N=157) completed a diagnostic interview and two laboratory sessions involving presentation of neutral and individualized trauma scripts. State anxiety, anger, and SCE were assessed at five points throughout each laboratory session. Hierarchical linear modeling indicated that participants (regardless of PTSD status) exhibited greater lability of all emotions following the trauma script versus neutral script. Only anger lability was elevated among those with (versus without) a current PTSD diagnosis following the neutral script. Results also revealed synchrony (i.e., positive covariation) between each possible pair of emotions, regardless of PTSD status. Findings suggest that concurrent changes in anxiety and anger may be especially relevant to PTSD symptom severity.
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Affiliation(s)
- Michelle Schoenleber
- Department of Psychology, St. Norbert College, 100 Grant St., De Pere, WI 54115, United States.
| | - Christopher R Berghoff
- Department of Psychology, University of South Dakota, 414 E. Clark St., Vermillion, SD 57069, United States.
| | - Kim L Gratz
- Department of Psychology, University of Toledo, 2801 W. Bancroft St., Toledo, OH 43606-3390, United States.
| | - Matthew T Tull
- Department of Psychology, University of Toledo, 2801 W. Bancroft St., Toledo, OH 43606-3390, United States.
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45
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Schweizer T, Schmitz J, Plempe L, Sun D, Becker-Asano C, Leonhart R, Tuschen-Caffier B. The impact of pre-existing anxiety on affective and cognitive processing of a Virtual Reality analogue trauma. PLoS One 2017; 12:e0190360. [PMID: 29287111 PMCID: PMC5747458 DOI: 10.1371/journal.pone.0190360] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 12/13/2017] [Indexed: 01/26/2023] Open
Abstract
Dysfunctional processing of traumatic events may be in particular related to high trait anxiety as a pre-traumatic risk factor for the development of post-traumatic stress disorder (PTSD). However, as this has rarely been investigated in prospective, experimental studies, we aimed to analyse the association between high trait anxiety and affective as well as cognitive processing of stress using a new prospective Virtual Reality analogue trauma paradigm to overcome limitations of retrospective or current analogue designs. Individuals with high and low trait anxiety (N = 80) were exposed to a multi-sensory Virtual Reality emergency scenario while psychophysiological stress response, emotion regulation and intrusive memories were assessed. Our results showed that high trait anxiety individuals display increased (i) subjective stress responses, (ii) emotion dysregulation and (iii) intrusive memories upon VR analogue trauma exposure. In particular, our sample of high trait anxiety individuals displayed limited access to different emotion regulation strategies as well as increased worry and rumination regarding perceived intrusive memories. Considering the complex interplay of multiple risk factors, our findings suggests that peri-traumatic affective processing seems to mediate high trait anxiety and post-traumatic intrusive memories thereby pointing out the central role of peri-traumatic processes for intrusion development. In addition, HA as a modulating pre-traumatic risk factor might further increase the risk of later dysfunctional processing of an analogue trauma by interacting with factors of affective processing during analogue trauma exposure. Implications of these findings which may contribute to a higher risk to develop PTSD are discussed.
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Affiliation(s)
- Tina Schweizer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Julian Schmitz
- Department of Clinical Child and Adolescent Psychology, Institute of Psychology, University of Leipzig, Leipzig, Germany
- Leipzig Research Centre for Early Child Development, University of Leipzig, Leipzig, Germany
| | - Laura Plempe
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Dali Sun
- Department of Artificial Intelligence, Institute of Computer Science, University of Freiburg, Freiburg, Germany
| | - Christian Becker-Asano
- Department of Artificial Intelligence, Institute of Computer Science, University of Freiburg, Freiburg, Germany
| | - Rainer Leonhart
- Department of Social Psychology and Methodology, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Brunna Tuschen-Caffier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
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46
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Joe S, Lee JS, Kim SY, Won SH, Lim JS, Ha KS. Posttraumatic Embitterment Disorder and Hwa-byung in the General Korean Population. Psychiatry Investig 2017; 14:392-399. [PMID: 28845164 PMCID: PMC5561395 DOI: 10.4306/pi.2017.14.4.392] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 05/08/2016] [Accepted: 07/13/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Posttraumatic embitterment disorder (PTED) is characterized by states of "embitterment", characteristically similar to "Hwa-byung", which is a Korean culture-bound syndrome. The present study aimed to assess diagnostic relationships between PTED and Hwa-byung. METHODS A total of 290 participants completed our survey. PTED and Hwa-byung were diagnosed using a diagnostic interview and scale. Scales for depression, suicide ideation, and anger were used for evaluation. Fisher's exact tests and Mann-Whitney U tests were performed to evaluate diagnostic overlap between PTED and Hwa-byung, and associations of scale scores for depression, suicide ideation, and anger between the PTED, Hwa-byung, and non-diagnosed groups. Associations of these scales between the depressive and non-depressive groups, and suicidal and non-suicidal groups were also evaluated. RESULTS Among the participants, 1.7% of the sample fit the diagnostic criteria for PTED and 2.1% fit the criteria for Hwa-byung. No individual fit the criteria for both. Anger scores were significantly higher in the Hwa-byung group than in the non-diagnostic group. There were not any significant differences in anger scores between the PTED and non-diagnostic groups. Depression scores were significantly higher in the PTED than in the non-diagnostic groups. In contrast, no significant differences were observed between depression scores in the Hwa-byung and non-diagnostic groups. CONCLUSION These results suggest that PTED may be a disorder category that is distinct from Hwa-byung.
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Affiliation(s)
- Soohyun Joe
- Department of Psychiatric Rehabilitation, Bugok National Hospital, Changnyung, Republic of Korea
| | - Jung Sun Lee
- Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, USA
| | - Seong Yoon Kim
- Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seung-hee Won
- Department of Psychiatry, Kyungpook National University School of Medicine, Deagu, Republic of Korea
| | - Jong Seok Lim
- Department of Psychiatric Rehabilitation, Bugok National Hospital, Changnyung, Republic of Korea
| | - Kyoo Seob Ha
- Department of Psychiatry, Seoul National Hospital, Seoul, Republic of Korea
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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47
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Pineles SL, Arditte Hall KA, Rasmusson AM. Gender and PTSD: different pathways to a similar phenotype. Curr Opin Psychol 2017; 14:44-48. [DOI: 10.1016/j.copsyc.2016.11.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 11/03/2016] [Accepted: 11/08/2016] [Indexed: 01/13/2023]
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48
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Barlow MR, Goldsmith Turow RE, Gerhart J. Trauma appraisals, emotion regulation difficulties, and self-compassion predict posttraumatic stress symptoms following childhood abuse. CHILD ABUSE & NEGLECT 2017; 65:37-47. [PMID: 28110110 DOI: 10.1016/j.chiabu.2017.01.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/04/2017] [Accepted: 01/05/2017] [Indexed: 06/06/2023]
Abstract
Experiencing traumatic events and abuse is unfortunately common in general, non-clinical samples. Recent research indicates that the ways in which individuals interpret traumatic experiences, as well as the ways that they manage challenging emotions in general, may statistically predict post-traumatic stress disorder (PTSD) symptoms to a greater extent than does trauma itself. Negative trauma appraisals, generalized emotion regulation (ER) difficulties, and low levels of self-compassion have each been shown to influence the connection between trauma exposure and subsequent PTSD symptoms. However, little is known regarding how these processes interact, or their relative contributions to mental health after trauma. The current study analyzed data from 466 university students who completed self-report measures of childhood abuse, PTSD symptoms, trauma appraisals, ER difficulties, and self-compassion. Childhood abuse exposure and PTSD symptoms were positively associated with negative trauma appraisals and ER difficulties, and negatively associated with self-compassion. Self-compassion was inversely associated with negative trauma appraisals and ER difficulties. Multiple mediation analyses demonstrated that negative trauma appraisals, ER difficulties, and levels of self-compassion fully explained the link between abuse exposure and PTSD symptoms via several specific pathways. These findings suggest that researchers, clinicians, and abuse survivors can benefit from addressing these interconnected domains during treatment and recovery processes.
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Affiliation(s)
- M Rose Barlow
- i4Health at Palo Alto University, 1791 Arastradero Rd., Palo Alto, CA 94304, USA.
| | - Rachel E Goldsmith Turow
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA; Seattle University, 901 12th Ave., Seattle, WA 98122, USA.
| | - James Gerhart
- Rush University Medical Center, 1653 W. Congress Pkwy, Chicago, IL 60612, USA.
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49
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Cacciaglia R, Nees F, Grimm O, Ridder S, Pohlack ST, Diener SJ, Liebscher C, Flor H. Trauma exposure relates to heightened stress, altered amygdala morphology and deficient extinction learning: Implications for psychopathology. Psychoneuroendocrinology 2017; 76:19-28. [PMID: 27871027 DOI: 10.1016/j.psyneuen.2016.11.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 11/06/2016] [Accepted: 11/10/2016] [Indexed: 12/13/2022]
Abstract
Stress exposure causes a structural reorganization in neurons of the amygdala. In particular, animal models have repeatedly shown that both acute and chronic stress induce neuronal hypertrophy and volumetric increase in the lateral and basolateral nuclei of amygdala. These effects are visible on the behavioral level, where stress enhances anxiety behaviors and provokes greater fear learning. We assessed stress and anxiety levels in a group of 18 healthy human trauma-exposed individuals (TR group) compared to 18 non-exposed matched controls (HC group), and related these measurements to amygdala volume. Traumas included unexpected adverse experiences such as vehicle accidents or sudden loss of a loved one. As a measure of aversive learning, we implemented a cued fear conditioning paradigm. Additionally, to provide a biological marker of chronic stress, we measured the sensitivity of the hypothalamus-pituitary-adrenal (HPA) axis using a dexamethasone suppression test. Compared to the HC, the TR group showed significantly higher levels of chronic stress, current stress and trait anxiety, as well as increased volume of the left amygdala. Specifically, we observed a focal enlargement in its lateral portion, in line with previous animal data. Compared to HC, the TR group also showed enhanced late acquisition of conditioned fear and deficient extinction learning, as well as salivary cortisol hypo-suppression to dexamethasone. Left amygdala volumes positively correlated with suppressed morning salivary cortisol. Our results indicate differences in trauma-exposed individuals which resemble those previously reported in animals exposed to stress and in patients with post-traumatic stress disorder and depression. These data provide new insights into the mechanisms through which traumatic stress might prompt vulnerability for psychopathology.
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Affiliation(s)
- Raffaele Cacciaglia
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, 68159 Mannheim, Germany; Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Passeig de la vall d'Hebron 171, Barcelona, Catalonia, Spain.
| | - Frauke Nees
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, 68159 Mannheim, Germany
| | - Oliver Grimm
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital of Frankfurt, Frankfurt, Germany
| | - Stephanie Ridder
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, 68159 Mannheim, Germany
| | - Sebastian T Pohlack
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, 68159 Mannheim, Germany
| | - Slawomira J Diener
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, 68159 Mannheim, Germany
| | - Claudia Liebscher
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, 68159 Mannheim, Germany
| | - Herta Flor
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, 68159 Mannheim, Germany.
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50
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Perlick DA, Sautter FJ, Becker-Cretu JJ, Schultz D, Grier SC, Libin AV, Schladen MM, Glynn SM. The incorporation of emotion-regulation skills into couple- and family-based treatments for post-traumatic stress disorder. Mil Med Res 2017; 4:21. [PMID: 28680693 PMCID: PMC5492909 DOI: 10.1186/s40779-017-0130-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 06/06/2017] [Indexed: 01/25/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) is a disabling, potentially chronic disorder that is characterized by re-experience and hyperarousal symptoms as well as the avoidance of trauma-related stimuli. The distress experienced by many veterans of the Vietnam War and their partners prompted a strong interest in developing conjoint interventions that could both alleviate the core symptoms of PTSD and strengthen family bonds. We review the evolution of and evidence base for conjoint PTSD treatments from the Vietnam era through the post-911 era. Our review is particularly focused on the use of treatment strategies that are designed to address the emotions that are generated by the core symptoms of the disorder to reduce their adverse impact on veterans, their partners and the relationship. We present a rationale and evidence to support the direct incorporation of emotion-regulation skills training into conjoint interventions for PTSD. We begin by reviewing emerging evidence suggesting that high levels of emotion dysregulation are characteristic of and predict the severity of both PTSD symptoms and the level of interpersonal/marital difficulties reported by veterans with PTSD and their family members. In doing so, we present a compelling rationale for the inclusion of formal skills training in emotional regulation in couple-/family-based PTSD treatments. We further argue that increased exposure to trauma-related memories and emotions in treatments based on learning theory requires veterans and their partners to learn to manage the uncomfortable emotions that they previously avoided. Conjoint treatments that were developed in the last 30 years all acknowledge the importance of emotions in PTSD but vary widely in their relative emphasis on helping participants to acquire strategies to modulate them compared to other therapeutic tasks such as learning about the disorder or disclosing the trauma to a loved one. We conclude our review by describing two recent innovative treatments for PTSD that incorporate a special emphasis on emotion-regulation skills training in the dyadic context: structured approach therapy (SAT) and multi-family group for military couples (MFG-MC). Although the incorporation of emotion-regulation skills into conjoint PTSD therapies appears promising, replication and comparison to cognitive-behavioral approaches is needed to refine our understanding of which symptoms and veterans might be more responsive to one approach versus others.
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Affiliation(s)
- Deborah A Perlick
- JJPeters Department of Veterans Affairs Medical Center and VISN2 South Mental Illness Research, Education and Clinical Center, 130 West Kingsbridge Rd, Bronx, NY 10468 USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 USA
| | - Frederic J Sautter
- Southeast Louisiana Veterans Health Care System, 1601 Perdido St, New Orleans, LA 70112 USA.,Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112 USA
| | - Julia J Becker-Cretu
- Southeast Louisiana Veterans Health Care System, 1601 Perdido St, New Orleans, LA 70112 USA.,Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112 USA
| | - Danielle Schultz
- JJPeters Department of Veterans Affairs Medical Center and VISN2 South Mental Illness Research, Education and Clinical Center, 130 West Kingsbridge Rd, Bronx, NY 10468 USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 USA
| | - Savannah C Grier
- JJPeters Department of Veterans Affairs Medical Center and VISN2 South Mental Illness Research, Education and Clinical Center, 130 West Kingsbridge Rd, Bronx, NY 10468 USA
| | - Alexander V Libin
- Research and Development, Washington DC VA Medical Center, 50 Irving St NW, Washington, DC 20422 USA.,Georgetown University Medical Center, 3800 Reservoir Rd NW, Washington, DC 20007 USA
| | - Manon Maitland Schladen
- Research and Development, Washington DC VA Medical Center, 50 Irving St NW, Washington, DC 20422 USA.,Georgetown University Medical Center, 3800 Reservoir Rd NW, Washington, DC 20007 USA
| | - Shirley M Glynn
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073 USA.,David Geffen School of Medicine, UCLA, 10833 LeConte Ave #12138, Los Angeles, CA 90095 USA
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