Emotional processing in posttraumatic stress disorder

Measuring emotion dysregulation in daily life: an experience sampling study

Background: Literature underscores the importance of emotion dysregulation in clinical research. However, one critical limitation of the existing investigations in this area involves the lack of psychometrically valid measures for assessing emotion dysregulation in individuals' daily lives. This study examined the factor structure and psychometric properties of momentary versions of the Difficulties in Emotion Regulation Scale (mDERS) and the Difficulties in Emotion Regulation Scale-Positive (mDERS-P).Methods: Participants were 145 community women (M age = 40.66, 40.7% white) experiencing intimate partner violence and using substances who participated in a baseline interview and then completed surveys three times a day for 30 days.Results: Analyses supported the reliability of the mDERS and the mDERS-P. The two-state, two-trait model, with separate factors for negative and positive emotion dysregulation at both the within-and between-levels, fit the data best. Momentary negative, but not positive, emotions were positively related to the mDERS; both momentary negative and positive emotions were positively related to the mDERS-P. Baseline trait negative, but not positive, emotion dysregulation, was related to greater variability in momentary negative and positive emotion dysregulation.Conclusion: Findings advance our understanding and measurement of emotion dysregulation using intensive longitudinal approaches.

Patterns of comorbid PTSD, depression, alcohol use disorder, and insomnia symptoms in firefighters: A latent profile analysis

BACKGROUND

Firefighters are an at-risk population for multiple psychiatric conditions, including posttraumatic stress disorder (PTSD), depression, alcohol use disorders (AUDs), and insomnia. These disorders are likely to co-occur; however, patterns of comorbidity have scarcely been investigated in firefighters. We aimed to identify subgroups of comorbidity of PTSD, depression, AUDs, and insomnia in a nationwide population of firefighters in South Korea.

METHODS

A total of 54,054 firefighters responded to an online survey. Latent classes of comorbidity were categorized using latent profile analysis (LPA) based on the symptom scores of PTSD, depression, AUDs, and insomnia. Analysis of variance was performed to compare the characteristics of the identified classes, and multinomial logistic regression was conducted to examine whether anger reactions, resilience, and number of traumatic events predicted class membership.

RESULTS

The LPA identified four subgroups: minimal symptoms (n = 42,948, 79.5 %), predominant PTSD (n = 2858, 5.3 %), subthreshold symptoms and comorbidity (n = 7003, 13.0 %), and high symptoms and comorbidity (n = 1245, 2.3 %). Three comorbidity classes were defined based on severity and one class showed predominant PTSD symptoms. Number of traumatic exposures predicted predominant PTSD, while resilience and anger reactions predicted severity of comorbidities.

LIMITATIONS

The cross-sectional design and usage of self-reported questionnaires are limitations of this study.

CONCLUSIONS

The severity of PTSD, depression, AUDs and insomnia tend to correlate and co-occur in firefighters. Our findings highlight the need to assess comorbid symptoms in firefighters and need to reduce anger reactions and enhance resilience in those with multiple comorbidities.

Maternal deprivation causes CaMKII downregulation and modulates glutamate, norepinephrine and serotonin in limbic brain areas in a rat model of single prolonged stress

BACKGROUND

Early life stress is a major risk factor for later development of psychiatric disorders, including post-traumatic stress disorder (PTSD). An intricate relationship exists between various neurotransmitters (such as glutamate, norepinephrine or serotonin), calcium/calmodulin-dependent protein kinase II (CaMKII), as an important regulator of glutamatergic synaptic function, and PTSD. Here, we developed a double-hit model to investigate the interaction of maternal deprivation (MD) as an early life stress model and single prolonged stress (SPS) as a PTSD model at the behavioral and molecular levels.

METHODS

Male Wistar rats exposed to these stress paradigms were subjected to a comprehensive behavioral analysis. In hippocampal synaptosomes we investigated neurotransmitter release and glutamate concentration. The expression of CaMKII and the content of monoamines were determined in selected brain regions. Brain-derived neurotrophic factor (BDNF) mRNA was quantified by radioactive in situ hybridization.

RESULTS

We report a distinct behavioral phenotype in the double-hit group. Double-hit and SPS groups had decreased hippocampal presynaptic glutamatergic function. In hippocampus, double-hit stress caused a decrease in autophosphorylation of CaMKII. In prefrontal cortex, both SPS and double-hit stress had a similar effect on CaMKII autophosphorylation. Double-hit stress, rather than SPS, affected the norepinephrine and serotonin levels in prefrontal cortex, and suppressed BDNF gene expression in prefrontal cortex and hippocampus.

LIMITATIONS

The study was conducted in male rats only. The affected brain regions cannot be restricted to hippocampus, prefrontal cortex and amygdala.

CONCLUSION

Double-hit stress caused more pronounced and distinct behavioral, molecular and functional changes, compared to MD or SPS alone.

Study protocol and rationale for a pilot randomized clinical trial comparing processing of positive memories technique with supportive counseling for PTSD

BACKGROUND

Research indicates that positive memories have a role in posttraumatic stress disorder's (PTSD) symptomatology and treatment. Following treatment development guidelines, a novel PTSD intervention - Processing of Positive Memories Technique (PPMT) - was developed and subsequently examined for its effects and feasibility in pilot studies. Extending this research, the proposed pilot randomized clinical trial with PPMT and Supportive Counseling (SC) arms will examine PPMT's effects on PTSD severity and biomarkers of stress systems' dysregulation (awakening salivary alpha amylase [sAA] and cortisol concentrations); examine mechanistic targets (affect) underlying PPMT's effects; and refine PPMT. We hypothesize that the PPMT arm will report greater decreases in PTSD severity and greater decreases in awakening sAA/cortisol ratio compared to the SC arm; and that improved affect (more positive affect and less negative affect) will mediate associations between intervention arm and changes in PTSD severity.

METHODS

We will recruit 70 individuals aged 18-65 years with PTSD. They will be randomized to 5 weekly therapy sessions of PPMT or SC, and will be assessed at baseline, weekly during treatment, 1-week post-treatment, and 3-months post-treatment. Primary outcomes are past-week PTSD severity, past-week positive and negative affect levels, and feedback data on PPMT's feasibility, format, and content. The secondary outcome is the awakening sAA/cortisol ratio. Statistical analyses include mixed-effect models and within-subjects cross-lag longitudinal mediation analyses.

CONCLUSION

Study results will advance knowledge of trauma interventions by examining effects and feasibility of a novel PTSD intervention, and by elucidating potential mechanisms underlying PPMT's effects. Clinical Trials #: NCT05523453.

Integration of limbic self-neuromodulation with psychotherapy for complex post-traumatic stress disorder: treatment rationale and case study

Treatment Rationale: Exposure to repeated sexual trauma, particularly during childhood, often leads to protracted mental health problems. Childhood adversity is specifically associated with complex posttraumatic stress disorder (PTSD) presentation, which is particularly tenacious and treatment refractory, and features severe emotion dysregulation. Augmentation approaches have been suggested to enhance treatment efficacy in PTSD thus integrating first-line psychotherapy with mechanistically informed self-neuromodulation procedures (i.e. neurofeedback) may pave the way to enhanced clinical outcomes. A central neural mechanism of PTSD and emotion dysregulation involves amygdala hyperactivity that can be volitionally regulated by neurofeedback. We outline a treatment rationale that includes a detailed justification for the potential of combining psychotherapy and NF and delineate mechanisms of change. We illustrate key processes of reciprocal interactions between neurofeedback engagement and therapeutic goals.Case Study: We describe a clinical case of a woman with complex PTSD due to early and repetitive childhood sexual abuse using adjunctive neurofeedback as an augmentation to an ongoing, stable, traditional treatment plan. The woman participated in (a) ten sessions of neurofeedback by the use of an fMRI-inspired EEG model of limbic related activity (Amygdala Electrical-Finger-Print; AmygEFP-NF), (b) traditional weekly individual psychotherapy, (c) skills group. Before and after NF training period patient was blindly assessed for PTSD symptoms, followed by a 1, 3- and 6-months self-report follow-up. We demonstrate mechanisms of change as well as the clinical effectiveness of adjunctive treatment as indicated by reduced PTSD symptoms and improved daily functioning within this single case.Conclusions: We outline an integrative neuropsychological framework for understanding the unique mechanisms of change conferring value to conjoining NF applications with trauma-focused psychotherapy in complex PTSD.

The role of affect in associations between sleep disturbances and posttraumatic stress disorder symptoms: A systematic review

Strong evidence supports a bidirectional association between sleep disturbances and posttraumatic stress disorder (PTSD). Affect - temporary internal states experienced as feeling good or bad, energized or enervated - may play a central role in explaining this link. The current systematic review summarizes the literature on associations between sleep, PTSD, and affect among trauma-exposed adults. We systematically searched five electronic databases (PubMed, PsycInfo, PTSDpubs, Web of Science, CINAHL) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Of 2656 screened articles, 6 studies met inclusion criteria. Four findings emerged: (1) greater insomnia symptom severity predicted greater PTSD symptom severity above the influence of negative affect, (2) negative affect mediated the effect of sleep quality on next-day PTSD symptom severity, (3) positive affect mediated the effect of PTSD symptom severity on insomnia symptom severity and sleep disturbances, and (4) greater negative affect (specifically, greater anger) was associated with greater severity of PTSD and sleep disturbances. Findings highlight areas for future research, such as the need to investigate more dimensions, timescales, and methods of studies simultaneously assessing affect, sleep, and PTSD, as well as the need for more longitudinal and experimental work to determine causality across these constructs.

Do executive functions buffer against COVID-19 stress?: A latent variable approach

Levels of COVID-19 stress have soared worldwide as a result of the pandemic. Given the pernicious psychological and physiological effects of stress, there is an urgent need for us to protect populations against the pandemic's psychological impact. While there exists literature documenting the prevalence of COVID-19 stress among various populations, insufficient research has investigated psychological factors that might mitigate this worrying trend. To address this gap in the literature, the current study seeks to examine executive functions as a potential cognitive buffer against COVID-19 stress. To do so, the study adopted a latent variable approach to examine three latent factors of executive functions and their relation to COVID-19 stress among a sample of 243 young adults. Structural equation models showed differential associations between COVID-19 stress and the latent factors of executive functions. While the latent factor of updating working memory was associated with attenuated COVID-19 stress, task switching and inhibitory control were not significantly associated with COVID-19 stress. These results further our understanding of the critical processes of executive functions and highlight the nuanced link between executive functions and pandemic-related stress.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-023-04652-8.

Role of positive emotion regulation strategies in the association between childhood trauma and posttraumatic stress disorder among trauma-exposed individuals who use substances

BACKGROUND

The co-occurrence of childhood trauma and posttraumatic stress disorder (PTSD) is highly prevalent and clinically significant. Existing research emphasizes the role of emotion regulation in the relation between childhood trauma and PTSD. Yet, research in this area has almost exclusively examined the influence of strategies aimed at regulating negative emotions, such as anger and sadness.

OBJECTIVE

To extend existing research, the current study examined underlying roles of strategies for regulating positive emotions (i.e., self- and emotion-focused positive rumination and positive dampening) in the association between childhood trauma severity and PTSD symptoms.

PARTICIPANTS AND SETTING

Participants were 320 trauma-exposed community individuals who reported past 30-day substance use (Mage = 35.78, 50.3% men, 81.6% white).

METHOD

Analyses examined whether childhood trauma severity was indirectly related to PTSD symptoms through self-focused positive rumination, emotion-focused positive rumination, and positive dampening.

RESULTS

Positive dampening, but not positive self- and emotion-focused positive rumination, indirectly explained associations between childhood trauma severity and PTSD symptoms (B = .17, SE = .03, 95% CI [.12, .24]).

CONCLUSIONS

These findings highlight the potential utility of targeting positive dampening in the treatment of PTSD symptoms among individuals who use substances with a history of childhood trauma.

Associations between positive memory count and hazardous substance use in a trauma-exposed sample: Examining the moderating role of emotion dysregulation

OBJECTIVES

Research has demonstrated links between autobiographical memory retrieval and hazardous substance use. However, limited work has examined relations between positive autobiographical memories and hazardous substance use, as well as moderating factors influencing these relations. Thus, we examined the potential moderating roles of negative and positive emotion dysregulation in the relations between count of retrieved positive memories and hazardous substance use (alcohol and drug use separately).

METHODS

Participants were 333 trauma-exposed students (Mage  = 21.05; 85.9% women) who completed self-report measures assessing positive memory count, hazardous alcohol and drug use, negative emotion dysregulation, and positive emotion dysregulation.

RESULTS

Positive emotion dysregulation significantly moderated the association between positive memory count and hazardous alcohol use (b = 0.04, 95% confidence interval [CI] [0.01, 0.06], p = 0.019), as well as the association between positive memory count and hazardous drug use (b = 0.02, 95% CI [0.01, 0.03], p = 0.002). Individuals with more positive emotion dysregulation had stronger associations between increases in positive memory count and increased hazardous substance use.

CONCLUSION

Findings indicate that trauma-exposed individuals who retrieve more positive memories and experience difficulties regulating positive emotions report greater hazardous substance use. Positive emotion dysregulation may be an important target for memory-based interventions among trauma-exposed individuals who report hazardous substance use.

Heart and brain traumatic stress biomarker analysis with and without machine learning: A scoping review

The enigma of post-traumatic stress disorder (PTSD) is embedded in a complex array of physiological responses to stressful situations that result in disruptions in arousal and cognitions that characterise the psychological disorder. Deciphering these physiological patterns is complex, which has seen the use of machine learning (ML) grow in popularity. However, it is unclear to what extent ML has been used with physiological data, specifically, the electroencephalogram (EEG) and electrocardiogram (ECG) to further understand the physiological responses associated with PTSD. To better understand the use of EEG and ECG biomarkers, with and without ML, a scoping review was undertaken. A total of 124 papers based on adult samples were identified comprising 19 ML studies involving EEG and ECG. A further 21 studies using EEG data, and 84 studies employing ECG meeting all other criteria but not employing ML were included for comparison. Identified studies indicate classical ML methodologies currently dominate EEG and ECG biomarkers research, with derived biomarkers holding clinically relevant diagnostic implications for PTSD. Discussion of the emerging trends, algorithms used and their success is provided, along with areas for future research.

The role of positive affect processes in the association between posttraumatic stress disorder symptoms and sleep: A multi-study design

OBJECTIVES

Posttraumatic stress disorder (PTSD) symptoms have been linked to sleep disturbances. Limited work has explored how positive affect processes may account for this relationship. Advancing research in this area, we utilized a multi-study design to investigate the role of positive affect processes (levels of positive affect, positive emotionality, hedonic deficits, negative affect interference) in the PTSD-sleep association.

METHODS

Data from 149 trauma-exposed firefighters (M_age = 38.93 ± 9.65, 5.40 % women) were collected between September 2021 and November 2021, and data from 119 trauma-exposed community members (M_age = 29.60 ± 8.67, 68.10 % women) were collected between February 2021 and December 2021. Participants completed an online survey on PTSD symptoms, sleep disturbances, and positive affect processes.

RESULTS

Positive affect levels (b = 0.03, 95 % confidence interval [CI] [0.01, 0.06]; firefighter sample), positive emotionality (b = 0.07, CI [0.03, 0.13]; community sample), and negative affect interference (b = 0.06, CI [0.01, 0.14]; community sample) significantly accounted for the associations between PTSD symptom severity and sleep disturbances controlling for the effects of gender and age.

CONCLUSION

Findings highlight the role of positive affect processes in the link between PTSD and sleep, and support addressing positive affect processes as potential targets in clinical interventions for co-occurring PTSD-sleep problems.

The Role of Anxiety and Depression in the Emotion Regulation Strategies of People Suffering from Post-Traumatic Stress Disorder

Researchers have explored the links between cognitive emotion regulation, impaired cognitive functioning, and anxiety-depression, including the link to anxiety and depression levels. However, very few studies have examined these dimensions in clinical populations with post-traumatic stress disorder (PTSD). A sample of 183 participants was divided into three groups: 59 trauma-exposed with PTSD, 61 trauma-exposed without PTSD, and 63 non-trauma-exposed non-PTSD (controls). All participants were assessed on the following dimensions: PTSD (PCL-5), cognitive emotion regulation (CERQ), anxiety and depression (HADS). Results indicate a specific profile of emotion regulation associated with PTSD. Compared to other groups, participants with PTSD showed more difficulty managing their emotions, with more rumination, self-blame, and catastrophizing. Moreover, these difficulties were also correlated with levels of anxiety and depression, that is, participants with PTSD who had higher anxiety and depression scores used more maladaptive strategies. The PTSD group used significantly more maladaptive cognitive emotion regulation strategies than the other groups, with distinct profiles related to anxiety and depressive symptomatology.

Intimate Partner Violence and Posttraumatic Stress Symptoms: Indirect Effects Through Negative and Positive Emotion Dysregulation

Women who experience intimate partner violence (IPV) are at heightened risk for developing posttraumatic stress (PTS). Emotion dysregulation has been linked to both IPV and PTS, separately, however, unknown is the role of emotion dysregulation in the relation of IPV to PTS among women who experience IPV. Moreover, existing investigations in this area have been limited in their focus on negative emotion dysregulation. Extending prior research, this study investigated whether physical, sexual, and psychological IPV were indirectly associated with PTS symptom severity through negative and positive emotion dysregulation. Participants were 354 women who reported a history of IPV recruited from Amazon's MTurk platform (Mage = 36.52, 79.9% white). Participants completed self-report measures assessing physical (Conflict Tactics Scale), sexual (Sexual Experiences Scale), and psychological (Psychological Maltreatment of Women) IPV; negative (Difficulties in Emotion Regulation Scale) and positive (Difficulties in Emotion Regulation Scale-Positive) emotion dysregulation; and PTS symptom severity (PTSD Checklist for DSM-5) via an online survey. Pearson's correlation coefficients examined intercorrelations among the primary study variables. Indirect effect analyses were conducted to determine if negative and positive emotion dysregulation explained the relations between physical, sexual, and psychological IPV and PTS symptom severity. Physical, sexual, and psychological IPV were significantly positively associated with both negative and positive emotion dysregulation as well as PTS symptom severity, with the exception that psychological IPV was not significantly associated with positive emotion dysregulation. Moreover, negative and positive emotion dysregulation accounted for the relationships between all three IPV types and PTS symptom severity, with the exception of positive emotion dysregulation and psychological IPV. Our findings provide support for the potential underlying role of both negative and positive emotion dysregulation in the associations of IPV types to PTS symptom severity. Negative and positive emotion dysregulation may be important factors to integrate into interventions for PTS among women who experience IPV.

Modeling reciprocal relations between emotion dysregulation and alcohol use using dynamic structural equation modeling: A micro-longitudinal study

BACKGROUND

Research examining emotion dysregulation and alcohol use has increased exponentially over the past decade. However, these studies have been limited by their use of cross-sectional designs and narrow definitions of emotion dysregulation. To address these significant gaps in the extant literature, this study utilized state-of-the-art methodology (i.e., experience sampling) and statistics (i.e., dynamic structural equation modeling) to examine potential reciprocal associations between negative and positive emotion dysregulation and alcohol use at the momentary level.

METHODS

Participants were 145 community women (mean age = 40.56, 40.3% white) experiencing intimate partner violence (IPV) and using substances. Surveys assessing negative and positive emotion dysregulation and alcohol use (i.e., number of standard drinks) were administered three times a day for 30 days using phone-based interactive voice recording.

RESULTS

Significant contemporaneous effects indicated that negative and positive emotion dysregulation both co-occurred with alcohol use. However, levels of negative and positive emotion dysregulation did not predict later alcohol use, nor did alcohol use predict later levels of negative or positive emotion dysregulation. There was significant variability among participants in cross-lagged effects.

CONCLUSIONS

Findings showed that negative and positive emotion dysregulation co-occurred with alcohol use and that there was significant interindividual variability in the cross-lagged associations between negative and positive emotion dysregulation and alcohol use. Research using idiographic approaches may identify women experiencing IPV for whom negative and positive emotion dysregulation drive alcohol use and alcohol use drives negative and positive emotion dysregulation.

Childhood Maltreatment and Anhedonic Symptoms: Test of a Dual-risk Model in Emerging Adults

Anhedonia, defined as deficits in positive affect and approach related behaviors, remains an understudied trauma response. As anhedonic responses to interpersonal violence are associated with a more severe course of psychopathology that is more difficult to treat, an increased focus on risk factors for anhedonia is necessary. The present study sought to address this gap in the literature by testing a theoretical model that highlights two transdiagnostic pathways leading to anhedonic responses in emerging adults attending college. Specifically, our study examined how childhood maltreatment subtypes (a) uniquely associate with depressive and post-traumatic stress (PTS) manifestations of anhedonia and (b) how temperament (i.e., anticipatory positive affect) and distress (i.e., negative mood) explain these relations. At baseline, a racially diverse sample of 462 emerging adults (Age_Mean = 19.45; 75.5% female; 45.5% White) completed self-report forms on childhood abuse and neglect, anticipatory positive affect, negative mood, and anhedonia. Individuals completed measures of temperament and psychological distress again 6-weeks, and 12-weeks later. Latent growth curve models were utilized to test our model. Consistent with hypotheses, deficits in anticipatory positive affect uniquely explained the relation between neglect and depressive/PTS anhedonic symptoms. Meanwhile, negative mood mediated the relation between abuse and both forms of anhedonia. These findings support the theory that two separate risk pathways lead to anhedonia. Support for our model suggests that distinguishing between pathways for anhedonic responses may be the key to a more targeted, transdiagnostic, trauma-informed approach for treating and preventing these deleterious, treatment-resistant, internalizing symptoms.

Deep learning-based classification of posttraumatic stress disorder and depression following trauma utilizing visual and auditory markers of arousal and mood

BACKGROUND

Visual and auditory signs of patient functioning have long been used for clinical diagnosis, treatment selection, and prognosis. Direct measurement and quantification of these signals can aim to improve the consistency, sensitivity, and scalability of clinical assessment. Currently, we investigate if machine learning-based computer vision (CV), semantic, and acoustic analysis can capture clinical features from free speech responses to a brief interview 1 month post-trauma that accurately classify major depressive disorder (MDD) and posttraumatic stress disorder (PTSD).

METHODS

N = 81 patients admitted to an emergency department (ED) of a Level-1 Trauma Unit following a life-threatening traumatic event participated in an open-ended qualitative interview with a para-professional about their experience 1 month following admission. A deep neural network was utilized to extract facial features of emotion and their intensity, movement parameters, speech prosody, and natural language content. These features were utilized as inputs to classify PTSD and MDD cross-sectionally.

RESULTS

Both video- and audio-based markers contributed to good discriminatory classification accuracy. The algorithm discriminates PTSD status at 1 month after ED admission with an AUC of 0.90 (weighted average precision = 0.83, recall = 0.84, and f1-score = 0.83) as well as depression status at 1 month after ED admission with an AUC of 0.86 (weighted average precision = 0.83, recall = 0.82, and f1-score = 0.82).

CONCLUSIONS

Direct clinical observation during post-trauma free speech using deep learning identifies digital markers that can be utilized to classify MDD and PTSD status.

Exploring the moderating role of gender in the relation between emotional expressivity and posttraumatic stress disorder symptom severity among Black trauma-exposed college students at a historically Black university

OBJECTIVES

Posttraumatic stress disorder (PTSD) is characterized in part by negative alterations of cognition or mood, including alterations in emotional expressivity, or the extent to which one outwardly displays emotions. Yet, research in this area has relied on predominantly white samples and neglected to consider the potential role of gender, despite there being demonstrated gender differences in both PTSD symptom severity and emotional expressivity, separately. The goal of the current study was to fill a critical gap in the literature by examining the moderating role of gender in the relation between PTSD symptom severity and emotional expressivity in a sample of trauma-exposed Black adults.

METHODS

Participants were 207 Black individuals enrolled in a historically Black university in the Southern United States (68.6% female; M_age  = 22.32 years).

RESULTS

Findings provided support for the moderating role of gender in the association between PTSD symptom severity and emotional expressivity. Specifically, greater PTSD symptom severity was inversely related to emotional expressivity among trauma-exposed Black males and positively associated with emotional expressivity among trauma-exposed Black females.

DISCUSSION

These results suggest the potential need for gender-specific assessment and treatment techniques for PTSD symptom severity among trauma-exposed Black college students.

Taking the pulse of a classroom with a gamified audience response system

BACKGROUND AND OBJECTIVE

This paper presents an empirical study of a gamified mobile-based assessment approach that can be used to engage students and improve their educational performance.

METHOD

A gamified audience response system called G-SIDRA was employed. Three gamification elements were used to motivate students in classroom activities: badges for achievements to increase engagement, points to indicate progression and performance in the subject and ranking for promoting competitiveness. A total of 90 medical students in a General and Descriptive Anatomy of the Locomotor System course were taught using G-SIDRA in the academic year 2019/2020. Smart bracelets were configured to collect heart rate measurements from 30 students with the aim of evaluating the impact of the gamification elements. The control group consisted of a sample of 110 students enrolled on the same course in the academic year 2016/2017 using non-gamified SIDRA.

RESULTS

Statistically significant differences were found between multiple choice questions (MCQ) scores obtained by using SIDRA and G-SIDRA in the four experiments (U = 1.621,50, p < 0,01 for Exp1; U = 1.950,00, p < 0,01 for Exp2; U = 955,00, p < 0,01 for Exp3; U = 2.335,00, p < 0,01 for Exp4). In the students' final exam grades, statistically significant differences between students that used G-SIDRA as opposed to SIDRA (T(157) = 3.992; p = 0.044) were obtained. Concerning gamification elements, statistically significantly differences were found in comparing the pulse increases after and before the badge event in the four experiments (U = 2.484,00, p = 0,038 for Exp1; U = 2.109,50, p = 0,046 for Exp2; U = 1.790,50, p = 0,025 for Exp3; U = 1.557,0, p = 0,048 for Exp4). However, there are not statistically significant differences between the pulse increases after and before the ranking event in the four experiments. In a 5-point Likert-type scale, the students expressed satisfaction with G-SIDRA (M = 4.552) and thought the system helped to better understand both theoretical and practical concepts (M = 4.092). Their global assessment of the G-SIDRA platform was 4.471.

CONCLUSIONS

Of the three gamification elements used in the study, only badge has an effect on heart rate. Better student responses and academic performance were achieved when using G-SIDRA. Nevertheless, more research is required to evaluate the impact of the gamification elements on the motivation, engagement and performance of students. Physiological measures are promising approaches for gamification elements evaluation.

Positive Internal Experiences in PTSD Interventions: A Critical Review

Evidence suggests that individuals with post-traumatic stress disorder (PTSD) symptoms exhibit deficits in positive internal experiences. This study critically reviewed empirically validated PTSD interventions to determine (1) whether positive memories, cognitions, and emotions were explicitly addressed and (2) the goals of focusing on these positive internal experiences. We selected 11 empirically validated PTSD interventions listed as "recommended/strongly recommended" in recently published reviews, reviewed existing literature for studies using these interventions (N = 1,070), short-listed randomized controlled trial studies meeting predetermined inclusion criteria for the selected interventions (in English, developed for adults, individual therapy modality, in-person administration, tailored to PTSD; N = 47), and emailed authors (N = 41) to obtain the unique intervention manuals. Hereby, we reviewed 13 unique empirically validated PTSD intervention manuals. Findings indicated 53.85%, 69.23%, and 69.23% of reviewed manuals explicitly discussed positive memories, emotions, and cognitions, respectively. Primarily, positive memories were integral to mechanisms underlying PTSD, a precursor to targeting negative experiences, an indicator of treatment progress, or a way to identify client problems; positive emotions were discussed when providing psychoeducation on PTSD/trauma reactions; and positive cognitions were addressed in reference to coping with negative experiences or as targets to enhance self-concept. This review demonstrates that comparatively, positive memories are infrequently elicited in the reviewed interventions; positive emotions and cognitions are explicitly referenced in two-thirds of the reviewed interventions but are included as a primary focus for therapeutic processing only in a few interventions; and eye movement desensitization and reprocessing has the most comprehensive focus on positive internal experiences.

Emotion regulation and substance use: A meta-analysis

There has been exponential growth in research on emotion regulation and substance use in the past decade. The current meta-analysis evaluated variability in the magnitude of the relation between aspects of emotion regulation and substance use. A search of PsycINFO, Embase, PubMed, CINAHL Plus, and PILOTS in December 2020 resulted in 6642 initial studies, of which 95 met inclusion criteria (association between emotion regulation and substance use was reported, participants were > 18 years old, article was in English). A total of 445 effects were obtained (N = 156,025 participants; weighted M_age = 29.31; 59.5% female; 66.1% White; 76.6% non-clinical). Emotion regulation and substance use were significantly related (r = 0.19; p < 0.001; 95%CI [0.17, 0.20]). Emotion regulation abilities were generally more strongly related to substance use than emotion regulation strategies; this pattern was stronger for behavioral vs. cognitive abilities and extended to both negative and positive emotions. Relations were stronger for older and clinical samples; mixed effects were found for sex and no conclusive effects were found for race. Despite limitations of the existing literature (e.g., cross-sectional, self-reports), results indicated that the magnitude of the relation between emotion regulation and substance use varied considerably as a function of emotion regulation and substance use constructs and sample characteristics.

Sexual victimization and disordered eating among community individuals: The influence of negative and positive emotion dysregulation

OBJECTIVE

Individuals with a history of sexual victimization are at increased odds of developing an eating disorder in their lifetime. Emotion dysregulation has been identified as an outcome of sexual victimization and a vulnerability factor in the emergence and maintenance of disordered eating. However, research in this area has been limited by its narrow focus on dysregulation stemming from negative emotions. The aim of the current study was to explore the potential moderating roles of negative and positive emotion dysregulation in the relations between sexual victimization and disordered eating.

METHOD

Study participants included 473 community individuals who endorsed a history of sexual assault (M_age = 34.66; 44.8% male; 78.4% White). Participants completed measures assessing sexual victimization, negative and positive emotion dysregulation, and disordered eating. Data was collected from January to April of 2020 via Amazon's Mechanical Turk.

RESULTS

Results indicated significant positive relations among sexual victimization, negative and positive emotion dysregulation, and disordered eating. Sexual victimization was found to be more strongly associated with disordered eating at high (vs. low) levels of negative and positive emotion dysregulation.

DISCUSSION

This study provides evidence for the strengthening roles of both high negative and positive emotion dysregulation in the relation between sexual victimization and disordered eating, suggesting the potential utility of targeting both negative and positive emotion dysregulation in disordered eating interventions among individuals with a history of sexual victimization.

The integrated constructionist approach to emotions: A theoretical model for explaining alterations to positive emotional experiences in the aftermath of trauma

Prior research has assumed that individuals with PTSD find positive emotions enjoyable and rewarding. While intuitive, this assumption is problematic for a number of reasons. A growing body of literature suggests that positive emotions can be unwanted and uncomfortable experiences for many people, particularly individuals with PTSD. Yet our empirical and theoretical models of PTSD do not adequately account for this complexity. Throughout the following pages, we argue that the same behavioral processes that have been heavily researched and associated with fear and avoidance of negative emotions and PTSD can be extended to positive emotions as well. We propose the integrated constructionist approach to emotions, which integrates learning theory principles with a constructionist approach and suggest that trauma experiences lead to a shift in the evaluation, interpretation, and labeling of an individual's internal experiences. This evaluative shift results in generalized patterns of emotional responding characterized by efforts to downregulate internal stimuli that were previously defined as positive and may have been appetitive pre-trauma. We subsequently highlight the theoretical, empirical, and clinical importance of taking an idiographic approach to understanding and working with emotions among individuals with PTSD.

The role of emotion dysregulation in the association between posttraumatic stress disorder symptoms and suicidal thoughts and behaviors among veterans

OBJECTIVE

Although research has established a link between posttraumatic stress disorder (PTSD) symptoms and suicidal thoughts and behaviors (STBs), little is known about factors that may accentuate this relation. This study evaluated the influences of negative and positive emotion dysregulation on the association between PTSD symptoms and STBs among veterans.

METHODS

Four-hundred and sixty-five trauma-exposed military veterans in the community (M age  = 38.00, 71.4% male, 69.5% White) completed online questionnaires.

RESULTS

Negative emotion dysregulation did not moderate the relation between PTSD symptoms and STBs. Results showed significant interactive effects of PTSD symptoms and positive emotion dysregulation on STBs, such that PTSD symptoms were more strongly related to STBs at high (vs. low) levels of positive emotion dysregulation. This effect was sustained across domains of positive emotion dysregulation.

CONCLUSIONS

Findings suggest a potential need to consider positive emotion dysregulation in the assessment and treatment of STBs among veterans with PTSD symptoms.

Moderating effects of sleep difficulties on relations between posttraumatic stress disorder symptoms and positive memory count

OBJECTIVES

Posttraumatic stress disorder (PTSD) severity relates to positive memory retrieval difficulties. One variable potentially influencing this relation is sleep difficulties. We examined moderating effects of sleep difficulties (duration and quality) on relations between PTSD severity and count of specific positive memories covarying for age, gender, and depression.

METHODS

Participants were an Amazon Mechanical Turk-recruited trauma-exposed community sample of 205 respondents (M age  = 35.44; 61.40% women).

RESULTS

Moderated regression analyses indicated significant interaction effects between sleep quality (b = 0.03; p = 0.036) and PTSD severity on specific positive memory count. Among individuals reporting better sleep quality, there were negative associations between PTSD severity and specific positive memory count (b = -0.04, SE = 0.02, p = 0.010). Similar results were obtained for PTSD's intrusion and arousal clusters.

CONCLUSION

Results support targeting sleep quality and PTSD severity to improve positive memory retrieval in PTSD and memory interventions, and the importance of considering sleep when examining links between PTSD and positive memory retrieval.

Individual differences in emotion regulation prospectively predict early COVID-19 related acute stress

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.

Positive Emotion Dysregulation Identifies Trauma-Exposed Community Individuals at Risk for Suicide and Nonsuicidal Self-Injury

ABSTRACT

Emotion dysregulation is associated with increased risk for suicidal thoughts and behaviors (STBs) and nonsuicidal self-injury (NSSI). However, research in this area has focused almost exclusively on dysregulation stemming from negative emotions. The present study aimed to address this gap in the literature by examining the associations between the specific domains of positive emotion dysregulation and both STBs and NSSI. Participants included 397 trauma-exposed community adults (Mage = 35.95; 57.7% female; 76.8% White). Results demonstrated significant associations between positive emotion dysregulation and both STBs and NSSI. In particular, higher levels of nonacceptance of positive emotions were found to be significantly related to risk for STBs (versus no risk), higher severity of STBs, and history of NSSI (versus no history). Findings suggest positive emotion dysregulation may play an important role in the etiology and treatment of both STBs and NSSI among trauma-exposed individuals.

Positive emotional intensity and substance use: the underlying role of positive emotional avoidance in a community sample of military veterans

Background: Military veterans are at greater risk for substance misuse. Positive emotional intensity is one well-established antecedent of substance misuse in this population. Positive emotional avoidance, or attempts to alter the form, frequency, or context of positive emotions, may help to explain this association. While clinical practice typically aims to increase positive emotions, such approaches may have iatrogenic effects, as high-intensity positive emotions may be experienced as distressing and prompt avoidance for some populations. This suggests a need to better understand responses to positive emotions to inform clinical practice.Objectives: The goal of the current study was to advance theory, research, and clinical practice by exploring the role of positive emotional avoidance in the associations between positive emotional intensity and both alcohol and drug misuse. We hypothesized that positive emotional intensity would indirectly influence alcohol and drug misuse through positive emotional avoidance.Methods: Participants were a community sample of United States military veterans recruited through Amazon's Mechanical Turk (n = 535, Mage = 37.45, 71.8% male, 69.5% White).Results: Correlations among positive emotional intensity, positive emotional avoidance, and alcohol and drug misuse were significant and positive (rs range from.13 to.41). Further, positive emotional avoidance was found to account for the relations of positive emotional intensity to alcohol (indirect effect: b =.04, 95%CI [.01,.08]) and drug misuse (indirect effect: b =.01, 95%CI [.01,.02]).Conclusions: Results provide preliminary support for the potential clinical utility of targeting avoidance responses to positive emotions in interventions targeting alcohol and drug misuse among military veterans.

Critical considerations for the positive memory-posttraumatic stress disorder model

Posttraumatic stress disorder (PTSD) includes changes in processes such as encoding and retrieval for both traumatic and positive memories. However, most work has predominantly focused on traumatic memories. Thus, Contractor and colleagues proposed a Positive Memory-PTSD model, which highlighted potential benefits associated with and mechanisms underlying positive memory retrieval/processing among individuals reporting PTSD symptoms. To enhance research on and clinical impacts of this model, the current review provides critical considerations for the Positive Memory-PTSD model. Drawing from emerging research and clinical observations, we (i) clarify that the model addresses specific versus overgeneral positive memories; (ii) underscore the importance of considering the heterogeneity in, and transitionary nature of, affect processes following positive memory retrieval; and (iii) highlight the rationale for considering trauma type/count and co-occurring conditions, as potential moderators of relations between positive memory processing and PTSD. Hereby, we provide an updated Positive Memory-PTSD model and implications for positive memory interventions drawing from this model.

Alcohol to down-regulate negative and positive emotions: Extending our understanding of the functional role of alcohol in relation to posttraumatic stress disorder

INTRODUCTION

Functional models of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) underscore the role of internally-driven negative reinforcement. However, with the focus of these models being on negative emotions broadly, there is limited understanding of the effect of alcohol use to down-regulate specific forms of negative emotions or positive emotions generally. Among populations characterized by PTSD, there is growing evidence that positive emotions may elicit aversive reactions and thus be intentionally reduced, including via alcohol use.

OBJECTIVE

The current study examined the associations among PTSD symptom severity, alcohol use to down-regulate both negative (i.e., despondency and anger) and positive emotions, and alcohol misuse.

METHOD

Data were collected from 320 trauma-exposed, substance-using individuals in the community (M age = 35.78, 46.9% women).

RESULTS

Individuals with greater PTSD symptom severity reported significantly higher alcohol use to down-regulate despondency, anger, and positive emotions, which, in turn, were linked to greater alcohol misuse.

CONCLUSIONS

Alcohol use may serve to down-regulate both negative (i.e., despondency and anger) and positive emotions, and these functions may help to explain the association of PTSD symptom severity to alcohol misuse. PTSD-AUD models may benefit from specifying a negatively reinforcing function of alcohol use in the context of positive emotions.

The role of positive emotion dysregulation in the relationship between childhood abuse and PTSD in a community sample of veterans

BACKGROUND

The co-occurrence of childhood abuse and posttraumatic stress disorder (PTSD) among United States military veterans is highly prevalent and clinically significant. Emotion dysregulation is one factor that has been found to underlie the association between childhood abuse and PTSD, yet past research has focused exclusively on dysregulation stemming from negative emotions.

OBJECTIVE

The current study extends existing research by clarifying the role of positive emotion dysregulation in the relation between childhood abuse and PTSD in a community sample of military veterans.

PARTICIPANTS AND SETTING

Participants were 465 trauma-exposed military veterans in the community (Mage = 38.00, 71.6 % women, 69.5 % White).

METHOD

Using structural equation modeling, we tested the indirect association of childhood abuse to PTSD symptom severity through positive emotion dysregulation.

RESULTS

The hypothesized model showed adequate model fit, χ2 (32, n = 465) = 176.22, p < .001, CFI = .97, RMSEA = .10, 90 % CI [.08, .11], SRMR = .04. Results showed that childhood abuse was indirectly associated with PTSD symptom severity through positive emotion dysregulation.

CONCLUSIONS

This finding highlights the potential utility of targeting positive emotion dysregulation in the detection and treatment of PTSD symptoms in veterans who experienced childhood abuse.

Is the Association between Postpartum Depression and Early Maternal-Infant Relationships Contextually Determined by Avoidant Coping in the Mother?

This study analyzes the moderating role of avoidant coping (in early pregnancy) in the relationship between postpartum depressive (PPD) symptoms and maternal perceptions about mother-baby relations and self-confidence. Participants were 116 low-risk obstetric mothers (mean age = 31.2 years, SD = 3.95, range 23-42) who received care and gave birth at a Spanish public hospital. Measurements were made at two points in time: at first trimester of pregnancy (maternal avoidance coping) and four months after childbirth (PPD and maternal perceptions). Avoidant coping was associated with the perception of the baby as irritable and unstable (p = 0.003), including irritability during lactation (p = 0.041). Interaction effects of avoidant coping and postpartum depression were observed on the perception of the baby as irritable (p = 0.031) and with easy temperament (p = 0.002). Regarding the mother's self-confidence, avoidant coping was related to a lack of security in caring for the baby (p < 0.001) and had a moderating effect between PPD and mother's self-confidence (i.e., lack of security in caring for the baby, p =0.027; general security, p = 0.007). Interaction effects showed that the use of avoidant coping in the mother exacerbated the impact of PPD on the early mother-infant relationship.

Association of Positive Emotion Dysregulation to Resting Heart Rate Variability: The Influence of Positive Affect Intensity

Background

A fast-growing body of research provides support for the role of positive emotion dysregulation in the etiology and maintenance of a wide range of psychiatric difficulties and clinically relevant behaviors. However, this work has exclusively relied on the subjective assessment of positive emotion dysregulation. Advancing research, the current study examined associations between physiological and subjective indices of positive emotional responding in the laboratory. Specifically, we explored the relation of the Difficulties in Emotion Regulation Scale - Positive (Weiss, Gratz, & Lavender, 2015) to resting heart rate variability (HRV) at high and low state positive affect intensity.

Methods

Participants were 122 individuals recruited from college and community settings (M _age = 23.39, 84.4% female, 68.0% White).

Results

Findings indicated a positive relation between positive emotion dysregulation and resting HRV at high state positive affect and a negative relation between positive emotion dysregulation and resting HRV at low state positive affect.

Conclusions

Results extend our understanding of the associations among subjective and physiological indices of positive emotional processes. These findings have key implications for the conduct of research on positive emotion dysregulation.

The moderating role of emotion dysregulation in the relation between potentially morally injurious experiences and alcohol misuse among military Veterans

Alcohol misuse is a serious and pervasive problem among US military Veterans. The commission or omission of acts that transgress important moral standards, known as potentially morally injurious events (PMIEs), has been theoretically and empirically linked to alcohol misuse in this population. Emotion dysregulation has been implicated in the pathogenesis of alcohol misuse and may be relevant in the context of PMIEs. The goal of this study was to examine the roles of negative and positive emotion dysregulation in the relation between PMIEs and alcohol misuse. Participants were a community sample of US military Veterans who were predominantly white (69.5%) and male (71.6%), with a mean age of 38.00. The interaction between PMIEs and both negative and positive emotion dysregulation (separately) significantly predicted alcohol misuse. Simple slopes tests revealed that the relation between PMIEs and alcohol misuse was only significant at high levels of negative and positive emotion dysregulation. Findings underscore the potential utility of targeting both negative and positive emotion dysregulation in alcohol misuse interventions for military Veterans experiencing PMIEs.

Network analysis of COVID-19-related PTSD symptoms in China: the similarities and differences between the general population and PTSD sub-population

BACKGROUND AND OBJECTIVES

Prevalent Post-traumatic Stress Disorder (PTSD) negatively affected individuals during the COVID-19 pandemic. Using network analyses, this study explored the construct of PTSD symptoms during the COVID-19 pandemic in China to identify similarities and differences in PTSD symptom network connectivity between the general Chinese population and individuals reporting PTSD.

METHODS

We conducted an online survey recruiting 2858 Chinese adults. PTSD symptoms were measured using the PCL-5 and PTSD was determined according to the DSM-5 criteria.

RESULTS

In the general population, self-destructive/reckless behaviours were on average the most strongly connected to other PTSD symptoms in the network. The five strongest positive connections were found between 1) avoidance of thoughts and avoidance of reminders, 2) concentration difficulties and sleep disturbance, 3) negative beliefs and negative trauma-related emotions, 4) irritability/anger and self-destructive/reckless behaviours, and 5) hypervigilance and exaggerated startle responses. Besides, negative connections were found between intrusive thoughts and trauma-related amnesia and between intrusive thoughts and self-destructive/reckless behaviours. Among individuals reporting PTSD, symptoms such as flashbacks and self-destructive/reckless behaviours were on average most strongly connected to other PTSD symptoms in the network. The five strongest positive connections were found between 1) concentration difficulty and sleep disturbance, 2) intrusive thoughts and emotional cue reactivity, 3) negative beliefs and negative trauma-related emotions, 4) irritability/anger and self-destructive/reckless behaviour, and 5) detachment and restricted affect. In addition, a negative connection was found between intrusive thoughts and self-destructive/reckless behaviours.

CONCLUSION

Our results indicate similarly positive connections between concentration difficulty and sleep disturbance, negative beliefs and negative trauma-related emotions, and irritability/anger and self-destructive/reckless behaviours in the general and PTSD-reported populations. We argue that self-destructive/reckless behaviours are a core symptom of COVID-19 related PTSD, worthy of more attention in future psychiatric programmers.

Electromyographic evidence of reduced emotion mimicry in individuals with a history of non-suicidal self-injury

Engaging in facial emotion mimicry during social interactions encourages empathy and functions as a catalyst for interpersonal bonding. Decreased reflexive mirroring of facial expressions has been observed in individuals with different non-psychotic disorders, relative to healthy controls. Given reports of interpersonal relationship difficulties experienced by those who engage in non-suicidal self-injury (NSSI), it is of interest to explore facial emotion mimicry in individuals with a history of this behaviour (HNSSI). Among other things, this will enable us to better understand their emotion regulation and social interaction challenges. Surface facial electromyography (fEMG) was used to record the reflexive facial mimicry of 30 HNSSI and 30 controls while they passively observed a series of dynamic facial stimuli showing various facial expressions of emotion. Beginning with a neutral expression, the stimuli quickly morphed to one of 6 prototypic emotional expressions (anger, fear, surprise, disgust, happiness, or sadness). Mimicry was assessed by affixing surface electrodes to facial muscles known to exhibit a high degree of electrical activity in response to positive and negative emotions: the corrugator supercilii and the zygomaticus major. HNSSI participants, relative to controls, exhibited significantly less electrical activity in the corrugator muscle in response to viewing angry stimuli, and significantly less of an expected relaxation in muscle activity in response to viewing happy stimuli. Mirroring these results, greater endorsement of social influence as a motivator for engaging in NSSI was associated with less mimicry, and greater endorsement of emotion regulation as a motivator was associated with greater incongruent muscle response when viewing happy faces. These findings lend support to the theory that social interaction difficulties in HNSSI might be related to implicit violations of expected social rules exhibited through facial mimicry nonconformity.

Trauma, posttraumatic stress disorder severity, and positive memories

Positive memories play an important role in the aetiology and maintenance of posttraumatic stress disorder (PTSD). However, most trauma research/clinical work has focused solely on the role of traumatic memories. Thus, we examined the relationship between count of retrieved positive memories and PTSD severity, factors associated with count of retrieved positive memories (i.e., rumination, negative/positive emotion dysregulation, fear of positive emotions), and the relationship between positive memory phenomenological domains and PTSD severity. The sample included 185 trauma-exposed participants recruited through Amazon's Mechanical Turk (Mage = 35.69 years; 63.80% female). Results of linear/hierarchical regressions showed that (1) PTSD severity did not predict count of (specific) positive memories; (2) greater positive emotion dysregulation predicted fewer retrieved positive memories controlling for PTSD severity; and (3) greater PTSD severity predicted more negative valence, less vividness, less coherence, less accessibility, less clear time perspective, fewer sensory details, and greater distancing ratings of the retrieved positive memory, controlling for sleep quantity/quality. Findings add to the literature by informing PTSD theoretical perspectives; enhancing an understanding of positive memories in PTSD/trauma treatments; and highlighting potential clinical targets (e.g., positive emotion regulation), when integrating a focus on positive memories into PTSD intervention.

Relations between Emotional Expressivity Dimensions and DSM-5 PTSD Symptom Clusters in a Trauma-Exposed Community Sample

Background and Objective. A growing body of literature indicates a significant contribution and role of positive and negative emotions (specifically expressivity) in post-traumatic stress disorder's (PTSD) symptomatology. The current study examined the facet-level relationships between emotional expressivity and PTSD. Specifically, we investigated which emotional expressivity dimension (impulse strength, negative emotional expressivity, and positive emotional expressivity) most strongly related to DSM-5 PTSD symptom clusters severity (intrusions, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity). Methods. The sample of 123 trauma-exposed participants seeking mental health treatment completed the PTSD Checklist for DSM-5 (PCL-5) and the Berkeley Expressivity Questionnaire (BEQ). Results. Results of multivariate multiple regression analysis indicated that only intensity of emotion and difficulty in controlling such emotions (i.e., impulse strength) was strongly related to all four PTSD symptom clusters. The valence of emotional expressivity (positive or negative) was not related to any of the PTSD symptom clusters. Conclusions. Study findings highlight the role of emotional expressivity, specifically impulse strength, in PTSD's symptomatology and may inform guidelines for emotion-focused clinical work for trauma-exposed individuals with PTSD symptoms.

The hijacked self: Disrupted functional connectivity between the periaqueductal gray and the default mode network in posttraumatic stress disorder using dynamic causal modeling

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Posttraumatic stress disorder (PTSD) shows altered effective connectivity dynamics.

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Modeling between the periaqueductal gray (PAG) and the default mode network (DMN).

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In PTSD, stronger excitatory effective connectivity from the PAG towards the DMN.

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Trauma-related/neutral stimulus modulations to effective connectivity are compared.

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In PTSD, trauma-related stimulus modulations differ significantly to the controls.

Self-related processes define assorted self-relevant or social-cognitive functions that allow us to gather insight and to draw inferences related to our own mental conditions. Self-related processes are mediated by the default mode network (DMN), which, critically, shows altered functionality in individuals with posttraumatic stress disorder (PTSD). In PTSD, the midbrain periaqueductal gray (PAG) demonstrates stronger functional connectivity with the DMN [i.e., precuneus (PCN), medial prefrontal cortex (mPFC)] as compared to healthy individuals during subliminal, trauma-related stimulus processing. Here, we analyzed the directed functional connectivity between the PAG and the PCN, as well as between the PAG and the mPFC to more explicitly characterize the functional connectivity we have observed previously on the corresponding sample and paradigm. We evaluated three models varying with regard to context-dependent modulatory directions (i.e., bi-directional, bottom-up, top-down) among individuals with PTSD (n = 26) and healthy participants (n = 20), where Bayesian model selection was used to identify the most optimal model for each group. We then compared the effective connectivity strength for each parameter across the models and between our groups using Bayesian model averaging. Bi-directional models were found to be favoured across both groups. In PTSD, we revealed the PAG to show stronger excitatory effective connectivity to the PCN, as well as to the mPFC as compared to controls. In PTSD, we further demonstrated that PAG-mediated effective connectivity to the PCN, as well as to the mPFC were modulated more strongly during subliminal, trauma-related stimulus conditions as compared to controls. Clinical disturbances towards self-related processes are reported widely by participants with PTSD during trauma-related stimulus processing, where altered functional connectivity directed by the PAG to the DMN may elucidate experiential links between self- and trauma-related processing in traumatized individuals.

Alcohol misuse to down-regulate positive emotions: A cross-sectional multiple mediator analysis among US military veterans

INTRODUCTION

The co-occurrence of posttraumatic stress disorder (PTSD) and alcohol misuse presents a pervasive and clinically relevant concern among US military veterans.

OBJECTIVE

The current investigation sought to examine the role of positive emotion dysfunction in the relation between PTSD symptomatology and alcohol misuse. To do so, we examined the separate and sequential roles of positive emotional intensity and positive emotional avoidance in the relation between PTSD symptoms and alcohol misuse among US military veterans.

METHOD

Cross-sectional data were collected from 468 US military veterans (M age = 37.74, 70.5% male, 69.0% White) who responded to an online survey.

RESULTS

Findings suggest that positive emotional avoidance, separately, and positive emotional intensity and positive emotional avoidance, sequentially, mediated the relation between PTSD symptoms and alcohol misuse.

CONCLUSIONS

Findings advance theory on the role of positive emotions and related processes in the co-occurrence of PTSD and alcohol misuse, and highlight important avenues for future research and treatment focused on the PTSD-alcohol misuse co-occurrence.

The role of emotion dysregulation in negative affect reactivity to a trauma cue: Differential associations through elicited posttraumatic stress disorder symptoms

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.

Post-traumatic stress disorder's relation with positive and negative emotional avoidance: The moderating role of gender

Post-traumatic stress disorder (PTSD) is characterized by avoidance of trauma-related emotions. Research indicates that this avoidance may extend to any emotional experience that elicits distress, including those that are unrelated to the trauma. Literature in this area has been limited in its exclusive focus on negative emotions. Despite evidence of gender differences in PTSD and emotional avoidance separately, no studies to date have examined gender as a moderator of their association. The goal of the current study was to extend research by exploring the moderating role of gender in the relation between PTSD symptom severity and positive and negative emotional avoidance. Participants were 276 trauma-exposed individuals (65.9% female, 65.6% White, M_age = 19.24) from a university in the north-eastern United States. Moderation results indicated a main effect for PTSD symptom severity on both positive (b = 0.07, p < .001) and negative (b = 0.04, p = .03) emotional avoidance. The interaction of gender and PTSD symptom severity was significant for positive emotion avoidance (b = 0.97, p = .01). Analysis of simple slopes revealed that PTSD symptom severity was significantly associated with positive emotional avoidance for males (b = 0.13, p < .001) but not females (b = 0.03, p = .08). Results suggest the importance of gender-sensitive recommendations for assessment and treatment of emotional avoidance in PTSD.

Extending our understanding of the association between posttraumatic stress disorder and positive emotion dysregulation: A network analysis approach

Posttraumatic stress disorder (PTSD) has empirically-established associations with positive emotion dysregulation. Extending existing research, we utilized a network approach to examine relations between PTSD symptom clusters (intrusions, avoidance, negative alterations in cognitions and mood [NACM], alterations in arousal and reactivity [AAR]) and positive emotion dysregulation dimensions (nonacceptance, impulse control, goal-directed behavior). We identified (1) differential relations of PTSD symptom clusters with positive emotion dysregulation, and (2) central symptoms accounting for the PTSD and positive emotion dysregulation inter-group interconnections. Participants were 371 trauma-exposed community individuals (M_age = 43.68; 70.9 % females; 34.5 % white). We estimated a regularized Gaussian Graphic Model comprising four nodes representing the PTSD symptom clusters and three nodes representing positive emotion dysregulation dimensions. Study results indicated the key role of AAR and intrusions clusters in the PTSD group and impulse control difficulties in the positive emotion dysregulation group. Regarding cross-group connectivity patterns, findings indicate the pivotal role of (1) AAR in its link with positive emotion dysregulation dimensions, and (2) nonacceptance of positive emotions and impairment in goal-directed behavior in the context of positive emotions in their link to PTSD symptom clusters. Thus, the current study indicates the potentially central role of particular PTSD symptom clusters and positive emotion dysregulation dimensions, informing assessment and treatment targets.

Comparison of latent typologies of posttraumatic stress disorder and depression symptoms across military personnel from India and the US

Research has identified heterogeneous subgroups of individuals based on posttraumatic stress disorder (PTSD) and depression symptoms. Using data collected from military personnel in India (N = 146) and U.S. (N = 194), we examined (1) the best-fitting latent class solution; (2) multi-group invariance of the class solution; and (3) construct validity of optimal class solution. Results indicated that the optimal 4-class solution differed in severity and severity/type in the India and U.S. samples respectively. With similarity in the optimal number of classes across cultural samples, the meaning/nature of classes differed. In the India sample, anxiety severity predicted the Low Severity Class vs. all other classes, and the Moderately High Severity/High Severity Classes vs. the Moderately Low Severity Class; number of traumas predicted the High Severity Class vs. other classes; and resilience predicted the Moderately Low Severity Class vs. the Moderately High Severity Class. In the U.S. sample, alcohol use predicted the High Severity Class vs. all other classes, and the High Depression-Low PTSD Class vs. the Low Severity Class; rumination significantly predicted the High Severity and High Depression-Low PTSD Classes vs. each of the High PTSD-Low Depression and Low Severity Classes. Thus, meaning and nature of PTSD-depression subgroups may vary culturally; hence, culturally-sensitive interventions need to account for this heterogeneity.

Relation between PTSD symptom clusters and positive memory characteristics: A network perspective

Positive memory characteristics relate to posttraumatic stress disorder (PTSD) severity. We utilized a network approach to examine relations between PTSD clusters (intrusions, avoidance, negative alterations in cognitions and mood [NACM], alterations in arousal and reactivity [AAR]) and positive memory characteristics (count, accessibility, valence, vividness, coherence, time perspective, sensory details). We identified differential relations between PTSD clusters and positive memory characteristics, and central/bridging symptoms. Participants were an Amazon Mechanical Turk-recruited sample of 206 individuals (M_age = 35.36; 61.20% females). We estimated a regularized Gaussian Graphic Model comprising four nodes representing the PTSD clusters and six nodes representing positive memory characteristics. Regarding cross-community relations, AAR (highest node strength) was negatively associated with positive memory count, valence, coherence, and accessibility; avoidance was positively and negatively associated with positive memory vividness and count respectively. The NACM-AAR and intrusion-avoidance edges were significantly stronger than most edges. From the PTSD community, AAR and avoidance had the highest bridge strength and bridge expected influence respectively; from the positive memory community, coherence and vividness had the highest bridge strength and bridge expected influence respectively. Results indicate the potential pivotal role of AAR, avoidance, coherence, and vividness in the PTSD-positive memory relation, which renders them assessment/treatment targets pending further investigation.

A Network Analysis of Post-traumatic Stress Disorder Symptoms and Correlates During the COVID-19 Pandemic

Background and Objective: The coronavirus disease 2019 (COVID-19) outbreak has been suggested as a collective trauma, which presents a continuing crisis. However, the specific post-traumatic implication of this crisis has not been adequately studied yet. The current study was aimed to ascertain the most central symptom and the strong connections between symptoms of post-traumatic stress disorder (PTSD). At the same time, exploring the relationship between covariates and the network of PTSD symptoms, by taking sex, anxiety, depression, suicidal ideation, quality of life, and social support as covariates, may help us to know the arise and maintenance of PTSD symptoms and give specified suggestions to people under the shadow of COVID-19. Method: The Post-traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), was used to assess the PTSD symptoms extent of 338 healthy participants over the past month. Networks were analyzed using state-of-the-art regularized partial correlation models. In addition, the centrality of the symptoms and the robustness of the results were analyzed. Results: The network analysis revealed that the especially strong connections emerged between avoidance of thoughts and avoidance of reminders, hypervigilance and exaggerated startle response, intrusive thoughts and nightmares, flashbacks and emotional cue reactivity, and detachment and restricted affect. The most central symptoms were self-destructive/reckless behavior. Incorporation of covariates into the network revealed the strong connections path between self-destructive/reckless behavior and loss of interest and depression. Conclusion: Self-destructive/reckless behavior was the most central symptom in the network of PTSD symptoms related to the COVID-19 pandemic, which as an important target of interfere may have great benefits.

The role of gender in the associations among posttraumatic stress disorder symptom, severity, difficulties regulating emotions, and alcohol misuse

INTRODUCTION

The co-occurrence of posttraumatic stress disorder (PTSD) and alcohol misuse is highly prevalent and clinically significant. Delineating mediators (i.e., emotion regulation) and moderators (i.e., gender) of this co-occurrence is critical to understanding underlying mechanisms of such comorbidity and intervention development/refinement.

METHOD

The present study examined the potential mediating role of difficulties regulating negative and positive emotions in this association as well as the moderating role of gender using a moderated mediation analysis. Participants were 475 trauma-exposed community adults recruited from Amazon's Mechanical Turk (MTurk) platform (M_age = 35.62, 55.4% women, 77.0% White).

RESULTS

Difficulties regulating positive (but not negative) emotions significantly mediated the relation between PTSD symptom severity and alcohol misuse. Further, gender was found to significantly moderate each of the paths in this mediation model.

CONCLUSIONS

Results highlight gender-specific intervention targets for reducing alcohol misuse among trauma-exposed individuals who experience PTSD symptoms.