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Ascienzo S, Sprang G, Royse D. Are Differences Evident in the Ways Boys and Girls Appraise and Interpret Their Traumatic Experiences? A Qualitative Analysis of Youth Trauma Narratives. VIOLENCE AND VICTIMS 2024; 39:143-167. [PMID: 38955470 DOI: 10.1891/vv-2024-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
The purpose of this study was to explore potential similarities and differences in the ways boys and girls appraise and interpret their traumatic experiences, and better understand how gender roles, performance, and socialization processes may impact trauma experiences, appraisals, and narratives within the context of trauma-focused treatment. We used thematic analysis to analyze the trauma narratives of youth (N = 16) ages 8-16 who had experienced multiple types (M = 5.38) of child maltreatment and who were receiving Trauma-focused Cognitive Behavioral Therapy to address clinically elevated posttraumatic stress symptoms. Four themes emerged: variations in the content of negative cognitions, differences in relational emotion, adoption of socially prescribed gender roles, and symptom differences. Although many similarities existed in youth's trauma narratives, differences emerged that point to the importance of social context and the ways gender role expectations and socialization processes influence youth's appraisal of and responses to traumatic events. Findings indicate the importance of considering distress tolerance, relational emotion, gender identity development, and role socialization within the treatment milieu.
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Affiliation(s)
- Sarah Ascienzo
- School of Social Work, North Carolina State University, Raleigh, NC, USA
| | - Ginny Sprang
- Center on Trauma and Children, Department of Psychiatry, University of Kentucky, Lexington, KY, USA
| | - David Royse
- College of Social Work, University of Kentucky, Lexington, KY, USA
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2
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Rojczyk P, Heller C, Seitz-Holland J, Kaufmann E, Sydnor VJ, Berger L, Pankatz L, Rathi Y, Bouix S, Pasternak O, Salat D, Hinds SR, Esopenko C, Fortier CB, Milberg WP, Shenton ME, Koerte IK. Intimate partner violence perpetration among veterans: associations with neuropsychiatric symptoms and limbic microstructure. Front Neurol 2024; 15:1360424. [PMID: 38882690 PMCID: PMC11178105 DOI: 10.3389/fneur.2024.1360424] [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: 12/23/2023] [Accepted: 05/03/2024] [Indexed: 06/18/2024] Open
Abstract
Background Intimate partner violence (IPV) perpetration is highly prevalent among veterans. Suggested risk factors of IPV perpetration include combat exposure, post-traumatic stress disorder (PTSD), depression, alcohol use, and mild traumatic brain injury (mTBI). While the underlying brain pathophysiological characteristics associated with IPV perpetration remain largely unknown, previous studies have linked aggression and violence to alterations of the limbic system. Here, we investigate whether IPV perpetration is associated with limbic microstructural abnormalities in military veterans. Further, we test the effect of potential risk factors (i.e., PTSD, depression, substance use disorder, mTBI, and war zone-related stress) on the prevalence of IPV perpetration. Methods Structural and diffusion-weighted magnetic resonance imaging (dMRI) data were acquired from 49 male veterans of the Iraq and Afghanistan wars (Operation Enduring Freedom/Operation Iraqi Freedom; OEF/OIF) of the Translational Research Center for TBI and Stress Disorders (TRACTS) study. IPV perpetration was assessed using the psychological aggression and physical assault sub-scales of the Revised Conflict Tactics Scales (CTS2). Odds ratios were calculated to assess the likelihood of IPV perpetration in veterans with either of the following diagnoses: PTSD, depression, substance use disorder, or mTBI. Fractional anisotropy tissue (FA) measures were calculated for limbic gray matter structures (amygdala-hippocampus complex, cingulate, parahippocampal gyrus, entorhinal cortex). Partial correlations were calculated between IPV perpetration, neuropsychiatric symptoms, and FA. Results Veterans with a diagnosis of PTSD, depression, substance use disorder, or mTBI had higher odds of perpetrating IPV. Greater war zone-related stress, and symptom severity of PTSD, depression, and mTBI were significantly associated with IPV perpetration. CTS2 (psychological aggression), a measure of IPV perpetration, was associated with higher FA in the right amygdala-hippocampus complex (r = 0.400, p = 0.005). Conclusion Veterans with psychiatric disorders and/or mTBI exhibit higher odds of engaging in IPV perpetration. Further, the more severe the symptoms of PTSD, depression, or TBI, and the greater the war zone-related stress, the greater the frequency of IPV perpetration. Moreover, we report a significant association between psychological aggression against an intimate partner and microstructural alterations in the right amygdala-hippocampus complex. These findings suggest the possibility of a structural brain correlate underlying IPV perpetration that requires further research.
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Affiliation(s)
- Philine Rojczyk
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Somerville, MA, United States
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Carina Heller
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Somerville, MA, United States
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
- Department of Clinical Psychology, Friedrich Schiller University Jena, Jena, Germany
- German Center for Mental Health (DZPG), Halle-Jena-Magdeburg, Germany
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits underlying Mental Health (C-I-R-C), Halle-Jena-Magdeburg, Germany
| | - Johanna Seitz-Holland
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Somerville, MA, United States
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Elisabeth Kaufmann
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Somerville, MA, United States
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
| | - Valerie J Sydnor
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Somerville, MA, United States
| | - Luisa Berger
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Somerville, MA, United States
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Lara Pankatz
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Somerville, MA, United States
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Yogesh Rathi
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Somerville, MA, United States
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Sylvain Bouix
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Somerville, MA, United States
- Department of Software Engineering and IT, École de technologie supérieure, Montreal, QC, Canada
| | - Ofer Pasternak
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Somerville, MA, United States
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - David Salat
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, United States
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, MA, United States
- Massachusetts General Hospital Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Boston, MA, United States
| | - Sidney R Hinds
- Department of Radiology and Neurology, Uniformed Services University, Bethesda, MD, United States
| | - Carrie Esopenko
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Catherine B Fortier
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - William P Milberg
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, United States
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Somerville, MA, United States
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Somerville, MA, United States
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Graduate School of Systemic Neuroscience, Ludwig-Maximilians-University, Munich, Germany
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3
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Esopenko C, Jain D, Adhikari SP, Dams-O'Connor K, Ellis M, Haag HL, Hovenden ES, Keleher F, Koerte IK, Lindsey HM, Marshall AD, Mason K, McNally JS, Menefee DS, Merkley TL, Read EN, Rojcyk P, Shultz SR, Sun M, Toccalino D, Valera EM, van Donkelaar P, Wellington C, Wilde EA. Intimate Partner Violence-Related Brain Injury: Unmasking and Addressing the Gaps. J Neurotrauma 2024. [PMID: 38323539 DOI: 10.1089/neu.2023.0543] [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: 02/08/2024] Open
Abstract
Intimate partner violence (IPV) is a significant, global public health concern. Women, individuals with historically underrepresented identities, and disabilities are at high risk for IPV and tend to experience severe injuries. There has been growing concern about the risk of exposure to IPV-related head trauma, resulting in IPV-related brain injury (IPV-BI), and its health consequences. Past work suggests that a significant proportion of women exposed to IPV experience IPV-BI, likely representing a distinct phenotype compared with BI of other etiologies. An IPV-BI often co-occurs with psychological trauma and mental health complaints, leading to unique issues related to identifying, prognosticating, and managing IPV-BI outcomes. The goal of this review is to identify important gaps in research and clinical practice in IPV-BI and suggest potential solutions to address them. We summarize IPV research in five key priority areas: (1) unique considerations for IPV-BI study design; (2) understanding non-fatal strangulation as a form of BI; (3) identifying objective biomarkers of IPV-BI; (4) consideration of the chronicity, cumulative and late effects of IPV-BI; and (5) BI as a risk factor for IPV engagement. Our review concludes with a call to action to help investigators develop ecologically valid research studies addressing the identified clinical-research knowledge gaps and strategies to improve care in individuals exposed to IPV-BI. By reducing the current gaps and answering these calls to action, we will approach IPV-BI in a trauma-informed manner, ultimately improving outcomes and quality of life for those impacted by IPV-BI.
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Affiliation(s)
- Carrie Esopenko
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Divya Jain
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shambhu Prasad Adhikari
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael Ellis
- Department of Surgery, Section of Neurosurgery, University of Manitoba, Pan Am Clinic, Winnipeg, Manitoba, Canada
| | - Halina Lin Haag
- Faculty of Social Work, Wilfrid Laurier University, Ontario, Canada
- Acquired Brain Injury Research Lab, University of Toronto, Toronto, Canada
| | - Elizabeth S Hovenden
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Finian Keleher
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Inga K Koerte
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Mass General Brigham, Harvard Medical School, Somerville, Massachusetts, USA
| | - Hannah M Lindsey
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Amy D Marshall
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Karen Mason
- Supporting Survivors of Abuse and Brain Injury through Research (SOAR), Kelowna, British Columbia, Canada
| | - J Scott McNally
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Deleene S Menefee
- Michael E. DeBakey VA Medical Center, The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Tricia L Merkley
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - Emma N Read
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Philine Rojcyk
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Mass General Brigham, Harvard Medical School, Somerville, Massachusetts, USA
| | - Sandy R Shultz
- Health Sciences, Vancouver Island University, Nanaimo, Canada
- Department of Neuroscience, Monash University, Alfred Centre, Melbourne, Australia
| | - Mujun Sun
- Department of Neuroscience, Monash University, Alfred Centre, Melbourne, Australia
| | - Danielle Toccalino
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Eve M Valera
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Cheryl Wellington
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, Canada
| | - Elisabeth A Wilde
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
- George E. Wahlen ,VA Salt Lake City Heathcare System, Salt Lake City, Utah, USA
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4
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Benight CC, Hurd JA, Morison M, Ricca BP. Big ideas series: self-regulation shift theory: trauma, suicide, and violence. ANXIETY, STRESS, AND COPING 2024; 37:1-15. [PMID: 37555655 DOI: 10.1080/10615806.2023.2242281] [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: 06/16/2022] [Revised: 02/14/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Traumatic stress, suicide, and impulsive violence arguably are three of the most consequential problems facing societies today. Self-regulation shift theory is introduced to capture the underlying coping dynamics involved in these three grave challenges. OBJECTIVES Self-regulation shift theory, based in a nonlinear dynamical systems framework, focuses on critical psychological self-regulation thresholds and the role of cognitive self-appraisals in human adaptation to help understand these three significant societal challenges. METHODS This essay reviews existing evidence within the posttraumatic adaptation process utilizing SRST for understanding dynamic self-regulation. This is followed by integrating SRST within existing current theoretical models for suicidal behaviors and violent outbursts. CONCLUSIONS The essay concludes with methodological suggestions for future research applying SRST and how this research offers important opportunities to develop early warning systems that promote hope when hope seems impossible.
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Affiliation(s)
- Charles C Benight
- Lyda Hill Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, USA
- Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, USA
| | - Julie A Hurd
- Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, USA
| | - Margaret Morison
- Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, USA
| | - Bernard P Ricca
- Lyda Hill Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, USA
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Gius BK, Fournier LF, Reljic T, Pogoda TK, Corrigan JD, Garcia A, Troyanskaya M, Hodges CB, Miles SR. Associations Between Sociodemographic, Mental Health, and Mild Traumatic Brain Injury Characteristics With Lifetime History of Criminal Justice Involvement in Combat Veterans and Service Members. Mil Med 2023; 188:e3143-e3151. [PMID: 36029468 DOI: 10.1093/milmed/usac257] [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: 08/15/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Veterans and service members (V/SM) may have more risk factors for arrest and felony incarceration (e.g., posttraumatic stress disorder and at-risk substance use) but also more protective factors (e.g., access to health care) to mitigate behaviors that may lead to arrest. As such, understanding which factors are associated with criminal justice involvement among V/SM could inform prevention and treatment efforts. The current study examined relationships between lifetime history of arrests and felony incarceration and sociodemographic, psychological, and brain injury characteristics factors among combat V/SM. MATERIALS AND METHODS The current study was a secondary data analysis from the Chronic Effects of Neurotrauma Consortium multicenter cohort study, approved by local institutional review boards at each study site. Participants were V/SM (N = 1,540) with combat exposure (19% active duty at time of enrollment) who were recruited from eight Department of Veterans Affairs and DoD medical centers and completed a baseline assessment. Participants were predominantly male (87%) and white (72%), with a mean age of 40 years (SD = 9.7). Most (81%) reported a history of at least one mild traumatic brain injury, with one-third of those experiencing three or more mild traumatic brain injuries (33%). Participants completed a self-report measure of lifetime arrest and felony incarceration history, a structured interview for all potential concussive events, the post-traumatic stress disorder checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and the Alcohol Use Disorders Identification Test-Consumption. Three groups were compared on self-reported level of lifetime history of criminal justice system involvement: (1) no history of arrest or incarceration (65%); (2) history of arrest but no felony incarceration (32%); and (3) history of felony incarceration (3%). RESULTS Ordinal regression analyses revealed that hazardous alcohol consumption (β = .44, P < .001; odds ratio = 1.56) was positively associated with increased criminal justice involvement after adjusting for all other variables. Being married or partnered (β = -.44, P < .001; odds ratio = 0.64) was negatively associated with decreased criminal justice involvement. CONCLUSIONS The rate of lifetime arrest (35%) in this V/SM sample was consistent with rates of arrests in the U.S. general population. One modifiable characteristic associated with lifetime arrest and felony incarceration was hazardous alcohol consumption. Alcohol use should be a top treatment target for V/SM at risk for arrest and those with history of criminal justice involvement.
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Affiliation(s)
- Becky K Gius
- Department of Psychology, University of South Florida, Tampa, FL 33620, USA
- Mental Health and Behavioral Sciences Service, James A Haley Veterans' Hospital, Tampa, FL 33612, USA
| | - Lauren F Fournier
- Department of Psychology, University of South Florida, Tampa, FL 33620, USA
- Mental Health and Behavioral Sciences Service, James A Haley Veterans' Hospital, Tampa, FL 33612, USA
| | - Tea Reljic
- Morsani College of Medicine, University of South Florida, Tampa, FL 33620, USA
| | - Terri K Pogoda
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA 02118, USA
| | - John D Corrigan
- Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH 43210, USA
| | - Amanda Garcia
- Traumatic Brain Injury Center of Excellence, James A Haley Veterans' Hospital, Tampa, FL 33612, USA
- 9Line, LLC, Tampa, FL 33609, USA
| | - Maya Troyanskaya
- Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA
| | - Cooper B Hodges
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Shannon R Miles
- Mental Health and Behavioral Sciences Service, James A Haley Veterans' Hospital, Tampa, FL 33612, USA
- Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
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Fredman SJ, Fischer MS, Baucom DH, Le Y, Taverna EC, Chow SM, Ram N, Marshall AD. PTSD Symptom Cluster Severity Predicts Momentary Emotion Dynamics During Couple Conversations. Behav Ther 2023; 54:330-345. [PMID: 36858763 PMCID: PMC10760910 DOI: 10.1016/j.beth.2022.09.004] [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: 11/16/2021] [Revised: 05/10/2022] [Accepted: 09/18/2022] [Indexed: 11/20/2022]
Abstract
This study investigated the associations between momentary emotion dynamics and posttraumatic stress disorder (PTSD) symptoms. Using a sample of 61 couples (N = 122 individuals) in which all individuals were trauma exposed and at least one partner screened positive for PTSD, we examined the intra- and interpersonal regulation of vocally encoded emotional arousal (fundamental frequency [f0]) and how these momentary emotion regulatory patterns relate to specific PTSD symptoms during two couple conversations: one designed to elicit conflict and one to elicit intimacy. PTSD symptoms were assessed using a gold standard clinical interview. In both conversations, higher reexperiencing symptoms were associated with greater emotional inertia (i.e., more resistance to change in emotional state following deviation from one's emotional equilibrium), and higher avoidance symptoms were associated with less emotional inertia (i.e., quicker return to emotional equilibrium). In the intimacy conversations, individuals also responded to their partners' arousal. Furthermore, individuals whose partners exhibited higher emotional numbing symptoms exhibited more emotional inertia, suggesting that emotion regulation may be a function of both one's own and one's partner's PTSD symptoms. Attending to the interpersonal context of emotion dynamics during PTSD treatment may enhance outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Nilam Ram
- The Pennsylvania State University and Stanford University
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7
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Mavragani A, Lecomte T, Potvin S, Riopel G, Vézina C, Villeneuve M, Abdel-Baki A, Khazaal Y. A Mobile Health App (ChillTime) Promoting Emotion Regulation in Dual Disorders: Acceptability and Feasibility Pilot Study. JMIR Form Res 2023; 7:e37293. [PMID: 36705963 PMCID: PMC9919461 DOI: 10.2196/37293] [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: 03/09/2022] [Revised: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND A growing number of studies highlight the importance of emotion regulation in the treatment and recovery of individuals with psychosis and concomitant disorders such as substance use disorder (SUD), for whom access to integrated dual-disorder treatments is particularly difficult. In this context, dedicated smartphone apps may be useful tools to provide immediate support to individuals in need. However, few studies to date have focused on the development and assessment of apps aimed at promoting emotional regulation for people with psychosis. OBJECTIVE The aim of this study was to evaluate the feasibility, acceptability, and potential clinical impact of a dedicated app (ChillTime) for individuals with psychotic disorders and concurrent SUD. The app design process followed recommendations for reducing cognitive effort on a mobile app. A total of 20 coping strategies regrouped in four categories (behavioral, emotional, cognitive, spiritual) were included in the app. METHODS This open pilot study followed a pre-post design. After the initial assessment, researchers asked participants to use the app as part of their treatment over a 30-day period. Feasibility was determined by the frequency of use of the app and measured using the number of completed strategies. Acceptability was determined by measuring ease of use, ease of learning, satisfaction, and perceived utility at the end of the 30-day study period based on responses to satisfaction questionnaires. Clinical scales measuring emotion regulation, substance use (ie, type of substance, amount taken, and frequency of use), and various psychiatric symptoms were administered at the beginning and end of the 30-day period. RESULTS A total of 13 participants were recruited from two first-episode psychosis clinics in Montreal, Quebec, Canada. All participants were symptomatically stable, were between 18 and 35 years of age (mostly men; 70% of the sample), and had a schizophrenia spectrum disorder with a comorbid substance use diagnosis. A total of 11 participants completed the study (attrition<20%). Approximately half of the participants used the tool at least 33% of the days (11-21 days). Cognitive and emotion-focused techniques were rated the highest in terms of usefulness and were the most frequently used. The majority of participants gave positive answers about the ease of use and the ease of learning the tool. A nonsignificant association of ChillTime use with negative symptoms and drug use was observed. No other statistically significant changes were observed. CONCLUSIONS The ChillTime app showed good feasibility (approximately half of the participants used the tool at least 33% of the days) and acceptability among people with schizophrenia spectrum disorder and SUD. Trends suggesting a potential impact on certain clinical outcomes will need to be replicated in larger-sample studies before any conclusion can be drawn.
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Affiliation(s)
| | - Tania Lecomte
- Département de Psychologie, Université de Montréal, Montreal, QC, Canada.,Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
| | - Stéphane Potvin
- Département de Psychologie, Université de Montréal, Montreal, QC, Canada.,Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
| | - Gabrielle Riopel
- Département de Psychologie, Université de Montréal, Montreal, QC, Canada
| | - Camille Vézina
- Département de Psychologie, Université de Montréal, Montreal, QC, Canada
| | - Marie Villeneuve
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
| | - Amal Abdel-Baki
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.,Département de Psychiatrie, Université de Montréal, Montreal, QC, Canada
| | - Yasser Khazaal
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada.,Département de Psychiatrie, Université de Montréal, Montreal, QC, Canada
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8
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Pebole MM, Greco CE, Gobin RL, Phillips BN, Strauser DR. Impact of childhood maltreatment on psychosomatic outcomes among men and women with disabilities. Disabil Rehabil 2022; 44:7491-7499. [PMID: 34762011 DOI: 10.1080/09638288.2021.1998666] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE This project examined the impact of childhood maltreatment types on psychosomatic outcomes among adults with a range of self-reported disabilities. MATERIALS AND METHODS Participants (n = 643) were recruited using Amazon Mechanical Turk and Cloud Research. Single-item questions assessed sociodemographic information. The Childhood Trauma Questionnaire measured childhood maltreatment types (emotional, physical, and sexual abuse, and emotional and physical neglect) and the RAND-36 Item Health Survey evaluated physical functioning, pain, and energy/fatigue. Logistic regressions determined associations between childhood trauma and psychosomatic outcomes; stratified models compared men and women. RESULTS Multivariate-adjusted models indicated physical abuse was positively associated with poor physical functioning (OR: 2.03; 95%CI: 1.35-3.06) with this relationship being stronger for men (OR: 3.25; 95%CI: 1.42-7.43) than women (OR: 1.91; 95%CI: 1.17-3.13). Adjusted models showed that physical neglect was protective against fatigue (OR: 0.58; 95% CI: 0.36-0.94), while emotional neglect increased the risk of fatigue (OR: 1.74; 95%CI: 1.02-2.95). Lastly, physical abuse was positively associated with pain (OR: 1.53; 95%CI: 1.01-2.33). This relationship was stronger in men (OR: 4.99; 95%CI: 1.91-12.99). CONCLUSIONS Results improve our understanding of risk factors for poor physical health outcomes and can guide the development of trauma-sensitive rehabilitation services.Implications for RehabilitationIndividuals with disabilities who report childhood maltreatment may experience poor psychosomatic outcomes in adulthood.Consequences of experiencing childhood maltreatment may manifest differently between men and women over the course of the lifespan.It is essential to integrate trauma-informed principles into treatment plans for individuals with poor psychosomatic health.Rehabilitation professionals should screen for abuse and refer individuals to the appropriate mental and physical health services.
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Affiliation(s)
- Michelle M Pebole
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Chelsea E Greco
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Robyn L Gobin
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Brian N Phillips
- Department of Special Education and Rehabilitation Counseling, Utah State University, Logan, UT, USA
| | - David R Strauser
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
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9
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Ardestani ZF, Saber M, Dehghan M, Iranpour A, Baniasadi H. Teacher violence from the perspectives of teachers and students and related factors: A survey in Southern Iran. Front Psychol 2022; 13:942284. [PMID: 36478932 PMCID: PMC9720053 DOI: 10.3389/fpsyg.2022.942284] [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: 05/12/2022] [Accepted: 10/31/2022] [Indexed: 09/07/2023] Open
Abstract
INTRODUCTION Teacher violence is defined as the intentional use of power by teachers against students in a variety of ways, including physical, verbal, psychological, and sexual assault. Victims of school violence are more anxious and insecure than other students. An in-depth and comprehensive study on the prevention of violence in schools is urgent and necessary. We conducted this study to determine teacher violence from the perspectives of schoolteachers and students and related factors. METHODS We conducted this descriptive-analytical study on 313 teachers and 400 students in Ardestan, southern Iran, in 2019. We selected teachers and students using a census method and stratified random sampling, respectively. The research instrument was the school violence questionnaire. RESULTS From the perspective of teachers, the mean score of teacher violence (5.7) was significantly lower than that of students (18.3). Male, young, single teachers with diploma and less work experience had significantly higher violence scores than other teachers (P < 0.001). We witnessed this trend in public boys' schools as well (p < 0.001). The total mean score for teacher violence was not significantly different between male and female students. From the perspective of students, the mean score of teacher violence was significantly different (P < 0.001). CONCLUSION Our results suggest that education authorities and school principals should supervise public school teachers with less education, younger students, and boys' schools and provide practical training to improve the communication and emotional skills among these teachers.
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Affiliation(s)
- Zahra Foghara Ardestani
- Department of Health Education and Promotion, School of Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Saber
- Department of Health Education and Promotion, School of Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahlagha Dehghan
- Department of Critical Care Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Abedin Iranpour
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamideh Baniasadi
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
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10
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Lantrip C, Szabo YZ, Kozel FA, Holtzheimer P. Neuromodulation as an Augmenting Strategy for Behavioral Therapies for Anxiety and PTSD: a Narrative Review. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2022; 9:406-418. [PMID: 36714210 PMCID: PMC9881183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE OF REVIEW Post-traumatic stress disorder (PTSD) is a prevalent problem. Despite current treatments, symptoms may persist, and neuromodulation therapies show great potential. A growing body of research suggests that transcranial magnetic stimulation (TMS) is effective as a standalone treatment for PTSD, with recent research demonstrating promising use when combined synergistically with behavioral treatments. In this review, we survey this literature including data suggesting mechanisms involved in anxiety and PTSD that may be targeted by neurostimulation. RECENT FINDINGS Evidence suggests the mechanism of action for TMS that contributes to behavioral change may be enhanced neural plasticity via increased functionality of prefrontal and subcortical/limbic structures and associated networks. Some research has demonstrated a behavioral change in PTSD and anxiety due to enhanced extinction learning or improved ability to think flexibly and reduce ruminative tendencies. Growing evidence suggests TMS may be best used as a therapeutic adjunct, at least acutely, for extinction-based exposure therapies in patients by accelerating therapy response. SUMMARY While TMS has shown promise as a standalone intervention, augmentation with psychotherapy is one avenue of interest. Non-responders to current EBPs might particularly benefit from this sort of targeted approach, and it may shorten treatment length, which would help the successful completion of a course of therapy.
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Affiliation(s)
- Crystal Lantrip
- Department of Veterans Affairs, VISN 17 Center of Excellence for Research On Returning War Veterans, Waco, TX 76711, USA
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Yvette Z. Szabo
- Department of Veterans Affairs, VISN 17 Center of Excellence for Research On Returning War Veterans, Waco, TX 76711, USA
- Department of Health, Human Performance and Recreation, Baylor University, Waco, TX, USA
| | - F. Andrew Kozel
- Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, FL, USA
| | - Paul Holtzheimer
- Department of Veterans Affairs, National Center for PTSD, White River Junction, VT, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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11
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Wei Z, Hu Y, Xiao J, Wang R, Huang Q, Peng Z, Hou G, Chen Q. Impacts of the psychological stress response on aggression in adolescents during the COVID-19 epidemic in China. JOURNAL OF PACIFIC RIM PSYCHOLOGY 2022. [DOI: 10.1177/18344909221102579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The sudden outbreak of COVID-19 has exerted a tremendous impact on the psyche of people around the world, especially adolescents. In order to provide a valuable theoretical basis for effective measures to prevent psychological problems in adolescents during public health emergencies in the future, this study examined the mediating effect of coping style (CS, including positive coping style (PCS) and negative coping style (NCS)) and the moderating effect of emotional management ability (EMA) on the relationship between the psychological stress response (PSR) and aggression (AGG) in adolescents during the COVID-19 epidemic in China. The Buss–Warren Aggression Questionnaire, Simplified Coping Style Questionnaire, and Emotion Management Questionnaire were employed to investigate the mental health of Chinese adolescents from April 10–20 (Time point 1, T1) and May 20–30 (Time point 2, T2), 2020. A total of 1,931 adolescents (aged 10–25 years, M = 19.18 years, 51.4% male) were examined at T1 and 334 adolescents (aged 11–25 years, M = 19.97 years, 48.7% male) were reinvestigated at T2. Overall, 17.6% of the participants at T1 and 16.8% at T2 reported obvious PSR activation. NCS partly mediated the relationship between the PSR and AGG, and the indirect effect was moderated by EMA reported at T2. There were regional differences in the moderated mediation model in low-risk areas at T1. The moderated effects of EMA at T1 and T2 were opposite. Specifically, high EMA resulted in a stronger relationship between NCS and AGG at T1, whereas high EMA resulted in a weaker relationship between NCS and AGG at T2. Psychological reactions resulting from sudden public health events may trigger AGG in younger individuals. However, EMA may have a buffering effect on the onset of AGG. This research expands our understanding of the development of AGG in adolescents during the pandemic.
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Affiliation(s)
- Zhen Wei
- Department of Child Psychiatry and Rehabilitation, Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Yan Hu
- Center for the Study of Applied Psychology, Guangdong Key Laboratory of Mental Health and Cognitive Science and School of Psychology, South China Normal University, Guangzhou, China
| | - Jiayi Xiao
- Center for the Study of Applied Psychology, Guangdong Key Laboratory of Mental Health and Cognitive Science and School of Psychology, South China Normal University, Guangzhou, China
| | - Ruotong Wang
- Center for the Study of Applied Psychology, Guangdong Key Laboratory of Mental Health and Cognitive Science and School of Psychology, South China Normal University, Guangzhou, China
| | - Qianchu Huang
- Internatioanl Department, High School of South China Normal University, China
| | - Ziwen Peng
- Center for the Study of Applied Psychology, Guangdong Key Laboratory of Mental Health and Cognitive Science and School of Psychology, South China Normal University, Guangzhou, China
| | - Gangqiang Hou
- Department of Radiology, Shenzhen Kangning Hospital, Shenzhen, China
| | - Qi Chen
- Center for the Study of Applied Psychology, Guangdong Key Laboratory of Mental Health and Cognitive Science and School of Psychology, South China Normal University, Guangzhou, China
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12
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Zhen B, Yao B, Zhou X. Pandemic Exposure, Post-traumatic Stress Disorder, Conflict Behaviors, and Online Aggressive Behaviors Among College Students During the COVID-19 Pandemic: Examining the Moderating Role of Gender. Front Psychiatry 2022; 13:809173. [PMID: 35370842 PMCID: PMC8967964 DOI: 10.3389/fpsyt.2022.809173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/17/2022] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic impacts people's mental health and behaviors, but the influence mechanism between pandemic exposure, conflict behaviors, and online aggressive behaviors during the COVID-19 outbreak remains unclear. This study will address this gap. Data were collected from 1,153 college students in an online survey that included an pandemic experiences scale, a post-traumatic stress disorder (PTSD) scale, a conflict behaviors scale, and an online aggressive behaviors scale. Structural equation modeling and multi-group comparisons were used to analyze the data. Pandemic exposure positively predicted conflict and online aggressive behaviors through hyperarousal symptoms, and negatively predicted these behaviors through intrusive symptoms. The mediating roles of avoidance and negative alterations in cognition and mood symptoms in the relations between pandemic exposure and conflict behaviors and online aggressive behaviors were non-significant. Among male students, pandemic exposure directly predicted conflict and online aggressive behaviors, but for female students, pandemic exposure indirectly influenced these behaviors through intrusive and hyperarousal symptoms. The intrusive and hyperarousal symptoms play mediating roles in the relations between pandemic exposure and conflict behaviors and online aggressive behaviors. Gender plays a moderating role in the above mediating mechanism.
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Affiliation(s)
- Baohua Zhen
- College of Educational Science, Anhui Normal University, Wuhu, China
| | - Benxian Yao
- College of Educational Science, Anhui Normal University, Wuhu, China
| | - Xiao Zhou
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, China
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13
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Puhalla A, Flynn A, Vaught A. Shame as a Mediator in the Association Between Emotion Dysregulation and Posttraumatic Stress Disorder Symptom Reductions Among Combat Veterans in a Residential Treatment Program. J Trauma Stress 2022; 35:302-307. [PMID: 34291838 DOI: 10.1002/jts.22721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/14/2021] [Accepted: 05/27/2021] [Indexed: 11/06/2022]
Abstract
Emotion dysregulation (ED) can be defined as one's inability to effectively respond to and manage internal experiences and the expression of emotion. ED has been linked to the development and maintenance of posttraumatic stress disorder (PTSD), with recent research suggesting that reductions in ED may predict improved treatment outcomes among both civilian and veteran populations. However, few studies have examined how changes in ED may predict treatment outcomes among veterans with PTSD and whether certain core features of PTSD, such as shame, may act as potential mediators in the association between ED and PTSD symptom reductions. The present study sought to explore facets of ED, feelings of shame, and PTSD symptoms among 43 combat veterans upon their admission and discharge to a residential PTSD program. The results demonstrated that all variables of interest significantly decreased from admission to discharge, ds = 0.75-1.84. Correlations indicated that reductions in ED, R2 = .184, and shame, R2 = .228, were associated with reductions in PTSD symptoms. However, the association between reductions in ED and PTSD was significantly mediated by reductions in shame. Overall, these results suggest that higher levels of emotion regulation may partially affect PTSD symptoms through reductions in shame. This may explain the efficacy of frontline PTSD treatments, as they explicitly focus on the processing of one's traumatic experience by reducing PTSD symptoms through regulation techniques that target emotional-behavioral cycles, which may include the shame-withdraw cycle.
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Affiliation(s)
- Alexander Puhalla
- Cincinnati Education and Research for Veterans (CERV) Foundation, Cincinnati, Ohio, USA
| | - Aidan Flynn
- Coatesville Veterans Affairs Medical Center, Coatesville, Pennsylvania, USA
| | - Amanda Vaught
- Coatesville Veterans Affairs Medical Center, Coatesville, Pennsylvania, USA
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14
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Fischer A, Rosner R, Renneberg B, Steil R. Suicidal ideation, self-injury, aggressive behavior and substance use during intensive trauma-focused treatment with exposure-based components in adolescent and young adult PTSD patients. Borderline Personal Disord Emot Dysregul 2022; 9:1. [PMID: 34974844 PMCID: PMC8722304 DOI: 10.1186/s40479-021-00172-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple traumata such as child sexual and/or physical abuse often result in complex psychopathologies and a range of associated dysfunctional behaviors. Although evidence-based interventions exist, some therapists are concerned that trauma-focused psychotherapy with exposure-based elements may lead to the deterioration of associated dysfunctional behaviors in adolescents and young adults. Therefore, we examined the course of suicidal ideation, self-injury, aggressive behavior and substance use in a group of abuse-related posttraumatic stress disorder (PTSD) patients during phase-based, trauma-focused PTSD treatment. METHODS Daily assessments from a randomized controlled trial (RCT) of Developmentally adapted Cognitive Processing Therapy (D-CPT) were analyzed to test for differences in the stated dysfunctional behaviors between the four treatment phases. We conducted multilevel modeling and repeated measure ANOVAs. RESULTS We did not find any significant differences between the treatment phases concerning the stated dysfunctional behaviors, either at the level of urge or at the level of actual actions. On the contrary, in some primary outcomes (self-injury, aggressive behavior), as well as secondary outcomes (distress caused by trauma, joy), we observed significant improvements. DISCUSSION Overall, during D-CPT, adolescents and young adults showed no deterioration in dysfunctional behaviors, while even showing improvements in some, suggesting that trauma-focused treatment preceded by skills building was not deleterious to this population. Hence, the dissemination of effective interventions such as D-CPT should be fostered, whilst the concerns of the therapists regarding exposure-based components need to be addressed during appropriate training. Nevertheless, further studies with momentary assessment, extended measurement methods, a control group and larger sample sizes are needed to confirm our preliminary findings. TRIAL REGISTRATION The trial was registered at the German Clinical Trial Registry (GCTR), DRKS00004787, 18 March 2013, https://www.drks.de/DRKS00004787 .
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Affiliation(s)
- Anne Fischer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt am Main, Germany.
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstr. 25, 85072, Eichstätt, Germany
| | - Babette Renneberg
- Clinical Psychology and Psychotherapy, Freie Universität Berlin, Habelschwerdter Allee 45, 14195, Berlin, Germany
| | - Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt am Main, Germany
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15
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Hosie J, Dunne AL, Meyer D, Daffern M. Aggressive script rehearsal in adult offenders: Relationships with emotion regulation difficulties and aggressive behavior. Aggress Behav 2022; 48:5-16. [PMID: 34664291 DOI: 10.1002/ab.22000] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/30/2021] [Accepted: 10/10/2021] [Indexed: 01/26/2023]
Abstract
This study explored relationships between self-reported emotion regulation difficulties, frequency of aggressive script rehearsal and aggressive behavior in 129 adult male inmates. Significant moderate positive correlations were found between the frequency of aggressive script rehearsal and (1) emotion regulation difficulties overall, as well as the following dimensions, (2) difficulties controlling impulses when experiencing negative emotions, and (3) confidence in the effectiveness of emotion regulation strategies. Significant weak positive correlations were found between the frequency of aggressive script rehearsal and two emotion regulation difficulty dimensions, (1) a lack of understanding of emotional responses, and (2) difficulties in dealing with goal directed behavior when experiencing uncomfortable emotions. No significant correlations were found between aggressive behavior and emotion regulation difficulties, except for a weak positive correlation between aggressive behavior and difficulties controlling impulses when experiencing negative emotions. Multivariate analyses were used to assess whether the frequency of aggressive script rehearsal moderated the effect of emotion regulation difficulties on aggressive behaviour. Significant improvement in the prediction of aggression resulted from consideration of the interaction between (1) aggressive script rehearsal and difficulties in emotional clarity, and (2) aggressive script rehearsal and awareness of emotional experience, even after accounting for the influence of age and attitudes toward violence. In conclusion, the results suggest that the rehearsal of aggressive scripts may function to regulate emotion, particularly amongst people who are inattentive to their emotions or who have difficulty understanding their emotional experiences.
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Affiliation(s)
- Julia Hosie
- Centre for Forensic Behavioural Science Swinburne University of Technology Alphington Victoria Australia
| | - Ashley Lauren Dunne
- Centre for Forensic Behavioural Science Swinburne University of Technology Alphington Victoria Australia
| | - Denny Meyer
- Centre for Forensic Behavioural Science Swinburne University of Technology Alphington Victoria Australia
| | - Michael Daffern
- Centre for Forensic Behavioural Science Swinburne University of Technology Alphington Victoria Australia
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16
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Fabbri C, Rodrigues K, Leurent B, Allen E, Qiu M, Zuakulu M, Nombo D, Kaemingk M, De Filippo A, Torrats-Espinosa G, Shayo E, Barongo V, Greco G, Tol W, Devries KM. The EmpaTeach intervention for reducing physical violence from teachers to students in Nyarugusu Refugee Camp: A cluster-randomised controlled trial. PLoS Med 2021; 18:e1003808. [PMID: 34606500 PMCID: PMC8489723 DOI: 10.1371/journal.pmed.1003808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 09/10/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND School-based violence prevention interventions offer enormous potential to reduce children's experience of violence perpetrated by teachers, but few have been rigorously evaluated globally and, to the best of our knowledge, none in humanitarian settings. We tested whether the EmpaTeach intervention could reduce physical violence from teachers to students in Nyarugusu Refugee Camp, Tanzania. METHODS AND FINDINGS We conducted a 2-arm cluster-randomised controlled trial with parallel assignment. A complete sample of all 27 primary and secondary schools in Nyarugusu Refugee Camp were approached and agreed to participate in the study. Eligible students and teachers participated in cross-sectional baseline, midline, and endline surveys in November/December 2018, May/June 2019, and January/February 2020, respectively. Fourteen schools were randomly assigned to receive a violence prevention intervention targeted at teachers implemented in January-March 2019; 13 formed a wait-list control group. The EmpaTeach intervention used empathy-building exercises and group work to equip teachers with self-regulation, alternative discipline techniques, and classroom management strategies. Allocation was not concealed due to the nature of the intervention. The primary outcome was students' self-reported experience of physical violence from teachers, assessed at midline using a modified version of the ISPCAN Child Abuse Screening Tool-Child Institutional. Secondary outcomes included student reports of emotional violence, depressive symptoms, and school attendance. Analyses were by intention to treat, using generalised estimating equations adjusted for stratification factors. No schools left the study. In total, 1,493 of the 1,866 (80%) randomly sampled students approached for participation took part in the baseline survey; at baseline 54.1% of students reported past-week physical violence from school staff. In total, 1,619 of 1,978 students (81.9%) took part in the midline survey, and 1,617 of 2,032 students (79.6%) participated at endline. Prevalence of past-week violence at midline was not statistically different in intervention (408 of 839 students, 48.6%) and control schools (412 of 777 students, 53.0%; risk ratio = 0.91, 95% CI 0.80 to 1.02, p = 0.106). No effect was detected on secondary outcomes. A camp-wide educational policy change during intervention implementation resulted in 14.7% of teachers in the intervention arm receiving a compressed version of the intervention, but exploratory analyses showed no difference in our primary outcome by school-level adherence to the intervention. Main study limitations included the small number of schools in the camp, which limited statistical power to detect small differences between intervention and control groups. We also did not assess the test-retest reliability of our outcome measures, and interviewers were unmasked to intervention allocation. CONCLUSIONS There was no evidence that the EmpaTeach intervention effectively reduced physical violence from teachers towards primary or secondary school students in Nyarugusu Refugee Camp. Further research is needed to develop and test interventions to prevent teacher violence in humanitarian settings. TRIAL REGISTRATION clinicaltrials.gov (NCT03745573).
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Affiliation(s)
- Camilla Fabbri
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Katherine Rodrigues
- International Rescue Committee, New York, New York, United States of America
| | - Baptiste Leurent
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Elizabeth Allen
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mary Qiu
- Innovations for Poverty Action, Dar es Salaam, Tanzania
| | | | - Dennis Nombo
- International Rescue Committee, New York, New York, United States of America
| | - Michael Kaemingk
- Behavioral Insights Team, New York, New York, United States of America
| | | | | | - Elizabeth Shayo
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Vivien Barongo
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Giulia Greco
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Wietse Tol
- University of Copenhagen, Copenhagen, Denmark
| | - Karen M. Devries
- London School of Hygiene & Tropical Medicine, London, United Kingdom
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17
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Van Voorhees EE, Dillon KH, Wilson SM, Dennis PA, Neal LC, Medenblik AM, Calhoun PS, Dedert EA, Caron K, Chaudhry N, White JD, Elbogen E, Beckham JC. A Comparison of Group Anger Management Treatments for Combat Veterans With PTSD: Results From a Quasi-Experimental Trial. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP10276-NP10300. [PMID: 34523367 PMCID: PMC8443849 DOI: 10.1177/0886260519873335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Difficulty controlling anger is a significant concern among combat veterans with posttraumatic stress disorder (PTSD), yet few controlled studies have examined the efficacy of anger treatments for this population. This study examined the effects of a group cognitive behavioral therapy (CBT) intervention compared with a group present-centered therapy (PCT) control condition in male and female combat veterans with PTSD. Thirty-six combat veterans with PTSD and anger difficulties began group treatment (CBT, n = 19; PCT, n = 17). Separate multilevel models of self-rated anger, PTSD symptoms, and disability were conducted using data from baseline, each of 12 treatment sessions, posttreatment, and 3- and 6-month follow-up time points. Significant decreases in anger and PTSD symptoms were observed over time, but no significant differences between CBT and PCT were observed on these outcomes. A significant interaction of therapy by time favoring the PCT condition was observed on disability scores. Gender differences were observed in dropout rates (i.e., 100% of female participants dropped out of CBT). Findings suggest that both CBT and PCT group therapy may be effective in reducing anger in combat veterans with PTSD. Results also highlight potential gender differences in response to group anger treatment.
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Affiliation(s)
- Elizabeth E Van Voorhees
- Durham Veterans Affairs Medical Center, NC, USA
- VISN 6 Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
| | - Kirsten H Dillon
- Durham Veterans Affairs Medical Center, NC, USA
- VISN 6 Mental Illness Research, Education and Clinical Center, Durham, NC, USA
| | - Sarah M Wilson
- Durham Veterans Affairs Medical Center, NC, USA
- VISN 6 Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Paul A Dennis
- Durham Veterans Affairs Medical Center, NC, USA
- VISN 6 Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
| | | | | | - Patrick S Calhoun
- Durham Veterans Affairs Medical Center, NC, USA
- VISN 6 Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Eric A Dedert
- Durham Veterans Affairs Medical Center, NC, USA
- VISN 6 Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
| | - Kelly Caron
- Durham Veterans Affairs Medical Center, NC, USA
| | | | | | - Eric Elbogen
- Durham Veterans Affairs Medical Center, NC, USA
- VISN 6 Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
| | - Jean C Beckham
- Durham Veterans Affairs Medical Center, NC, USA
- VISN 6 Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
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18
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Felippe RM, Oliveira GM, Barbosa RS, Esteves BD, Gonzaga BMS, Horita SIM, Garzoni LR, Beghini DG, Araújo-Jorge TC, Fragoso VMS. Experimental Social Stress: Dopaminergic Receptors, Oxidative Stress, and c-Fos Protein Are Involved in Highly Aggressive Behavior. Front Cell Neurosci 2021; 15:696834. [PMID: 34489642 PMCID: PMC8418094 DOI: 10.3389/fncel.2021.696834] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 07/27/2021] [Indexed: 11/18/2022] Open
Abstract
Aggression is defined as hostile behavior that results in psychological damage, injury and even death among individuals. When aggression presents itself in an exacerbated and constant way, it can be considered escalating or pathological. The association between social stress and the emergence of exacerbated aggressiveness is common and is suggested to be interconnected through very complex neurobiological factors. For example, alterations in the expression of the dopaminergic receptors D1 and D2, reactive oxygen species (ROS) and the c-Fos protein in the cortex have been observed. Our objective was to analyze which factors are involved at the neurobiological level in the highly aggressive response of Swiss Webster adult male mice in a vivarium. In this work, we investigated the relationship among dopaminergic receptors, the production of ROS and the expression of c-Fos. Mice with exacerbated aggression were identified by the model of spontaneous aggression (MSA) based on the grouping of young mice and the regrouping of the same animals in adulthood. During the regrouping, we observed different categories of behavior resulting from social stress, such as (i) highly aggressive animals, (ii) defeated animals, and (iii) harmonic groups. To evaluate the dopaminergic system and the c-Fos protein, we quantified the expression of D1 and D2 dopaminergic receptors by Western blotting and fluorescence immunohistochemistry and that of the c-Fos protein by fluorescence immunohistochemistry. The possible production of ROS was also evaluated through the dihydroethidium (DHE) assay. The results showed that aggressive and subordinate mice showed a reduction in the expression of the D1 receptor, and no significant difference in the expression of the D2 receptor was observed between the groups. In addition, aggressive mice exhibited increased production of ROS and c-Fos protein. Based on our results, we suggest that exacerbated aggression is associated with social stress, dysregulation of the dopaminergic system and exacerbated ROS production, which leads to a state of cellular oxidative stress. The overexpression of c-Fos due to social stress suggests an attempt by the cell to produce antioxidant agents to reduce the toxic cellular concentration of ROS.
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Affiliation(s)
- Renata M Felippe
- Laboratory of Innovations in Therapies, Education and Bioproducts, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Gabriel M Oliveira
- Laboratory of Cell Biology, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Rafaela S Barbosa
- Laboratory of Innovations in Therapies, Education and Bioproducts, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Betina D Esteves
- Laboratory of Innovations in Therapies, Education and Bioproducts, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Beatriz M S Gonzaga
- Laboratory of Innovations in Therapies, Education and Bioproducts, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Samuel I M Horita
- Laboratory of Innovations in Therapies, Education and Bioproducts, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.,Laboratory on Thymus Research, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Luciana R Garzoni
- Laboratory of Innovations in Therapies, Education and Bioproducts, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Daniela G Beghini
- Laboratory of Innovations in Therapies, Education and Bioproducts, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Tânia C Araújo-Jorge
- Laboratory of Innovations in Therapies, Education and Bioproducts, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Viviane M S Fragoso
- Laboratory of Innovations in Therapies, Education and Bioproducts, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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19
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Wamser-Nanney R, Walker HE, Nanney JT. Trauma Exposure, Posttraumatic Stress Disorder, and Aggression Among Civilian Females. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP9649-NP9669. [PMID: 31286814 DOI: 10.1177/0886260519860894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Trauma exposure and posttraumatic stress disorder (PTSD) have evinced ties to increased risk for aggressive behavior. However, very little information is known regarding the relations between trauma exposure, PTSD, and aggression among non-veteran women. Furthermore, research has not examined the associations between trauma exposure, PTSD symptoms, and aggression using the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) PTSD criteria. The primary aim of the current study was to investigate the relationships between trauma exposure, PTSD symptoms, and aggression among women. The secondary aim was to examine the specific PTSD symptom clusters in relation to indices of aggression. A total of 217 civilian, trauma-exposed female undergraduate students participated in the study (Mage = 24.30, SD = 6.83, 63.2% White). Higher levels of trauma exposure and PTSD symptoms corresponded with anger (b = .47, 95% CI = [0.11-0.83]; b = .11, 95% CI = [0.05-0.16], respectively) and verbal aggression (b = .50, 95% CI = [0.21-0.78]; b = .06, 95% CI = [0.01-0.10], respectively). PTSD symptoms, but not cumulative trauma exposure, was associated with hostility (b = .23, 95% CI = [0.14-0.59]), whereas physical aggression was only related to trauma exposure (b = .69, 95% CI = [0.31-1.06]). Furthermore, there was a significant indirect effect of cumulative trauma through PTSD symptoms on anger and verbal aggression (b = .15, 95% CI = [0.05-0.32]; b = .09, 95% CI = [0.02-0.20], respectively). Trauma-exposed civilian females with higher levels of PTSD symptoms may be at increased risk for several indices of aggressive behavior. Furthermore, PTSD symptoms may better account for some, but not all, aspects of aggression in trauma-exposed women.
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20
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Varkevisser T, van Lutterveld R, Heesink L, van Honk J, Geuze E. Voxel-based morphometry and cortical thickness in combat veterans suffering from impulsive aggression. Psychol Med 2021; 51:1299-1309. [PMID: 32029023 PMCID: PMC8223237 DOI: 10.1017/s0033291720000033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 10/15/2019] [Accepted: 01/03/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Problems with impulsive aggression occur in many forms of psychiatric dysfunction, and are a common complaint among combat veterans. The present study sought to examine the neuroanatomical correlates of combat-related impulsive aggression. METHODS T1-weighted magnetic resonance images were acquired from 29 male veterans with impulsive aggression and 30 non-aggressive combat controls. Subcortical volumetry was conducted with the amygdala and hippocampus and their main constituent subdivisions as regions-of-interest (ROIs) (basolateral, centromedial amygdala; head, body, tail of hippocampus). Cortical thickness measurements were extracted for the dorsolateral prefrontal cortex, orbitofrontal cortex, and anterior cingulate cortex. Within-group correlations with psychometric measures were also explored. RESULTS No significant group differences in cortical thickness or subcortical grey matter volumes were observed for any of the ROIs. Also, no significant correlations with any of the psychometric measures were recorded. Exploratory whole-brain analysis of cortical thickness revealed a significant group × anxiety interaction effect in a cluster located in the left lingual gyrus. CONCLUSIONS The current findings indicate that problems with impulsive aggression may not be directly associated with alterations in cortical thickness or amygdalar/hippocampal (sub)volumes. The observed interplay between impulsive aggression problems and anxiety-related symptoms is consistent with prior work showing the two phenomena may share the same underlying (neural) mechanisms.
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Affiliation(s)
- Tim Varkevisser
- University Medical Center, Utrecht, The Netherlands
- Brain Research and Innovation Center, Ministry of Defence, Utrecht, The Netherlands
- Utrecht University, Utrecht, The Netherlands
| | - Remko van Lutterveld
- University Medical Center, Utrecht, The Netherlands
- Brain Research and Innovation Center, Ministry of Defence, Utrecht, The Netherlands
| | - Lieke Heesink
- University Medical Center, Utrecht, The Netherlands
- Brain Research and Innovation Center, Ministry of Defence, Utrecht, The Netherlands
- Utrecht University, Utrecht, The Netherlands
| | - Jack van Honk
- Utrecht University, Utrecht, The Netherlands
- University of Cape Town, Cape Town, South Africa
| | - Elbert Geuze
- University Medical Center, Utrecht, The Netherlands
- Brain Research and Innovation Center, Ministry of Defence, Utrecht, The Netherlands
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21
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Harricharan S, McKinnon MC, Lanius RA. How Processing of Sensory Information From the Internal and External Worlds Shape the Perception and Engagement With the World in the Aftermath of Trauma: Implications for PTSD. Front Neurosci 2021; 15:625490. [PMID: 33935627 PMCID: PMC8085307 DOI: 10.3389/fnins.2021.625490] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/11/2021] [Indexed: 12/27/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is triggered by an individual experiencing or witnessing a traumatic event, often precipitating persistent flashbacks and severe anxiety that are associated with a fearful and hypervigilant presentation. Approximately 14–30% of traumatized individuals present with the dissociative subtype of PTSD, which is often associated with repeated or childhood trauma. This presentation includes symptoms of depersonalization and derealization, where individuals may feel as if the world or self is “dream-like” and not real and/or describe “out-of-body” experiences. Here, we review putative neural alterations that may underlie how sensations are experienced among traumatized individuals with PTSD and its dissociative subtype, including those from the outside world (e.g., touch, auditory, and visual sensations) and the internal world of the body (e.g., visceral sensations, physical sensations associated with feeling states). We postulate that alterations in the neural pathways important for the processing of sensations originating in the outer and inner worlds may have cascading effects on the performance of higher-order cognitive functions, including emotion regulation, social cognition, and goal-oriented action, thereby shaping the perception of and engagement with the world. Finally, we introduce a theoretical neurobiological framework to account for altered sensory processing among traumatized individuals with and without the dissociative subtype of PTSD.
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Affiliation(s)
- Sherain Harricharan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Homewood Research Institute, Guelph, ON, Canada
| | - Margaret C McKinnon
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Homewood Research Institute, Guelph, ON, Canada.,Mood Disorders Program, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Ruth A Lanius
- Homewood Research Institute, Guelph, ON, Canada.,Department of Psychiatry, Western University, London, ON, Canada.,Department of Neuroscience, Western University, London, ON, Canada.,Imaging Division, Lawson Health Research Institute, London, ON, Canada.,The Brain and Mind Institute, London, ON, Canada
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22
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Esopenko C, Meyer J, Wilde EA, Marshall AD, Tate DF, Lin AP, Koerte IK, Werner KB, Dennis EL, Ware AL, de Souza NL, Menefee DS, Dams-O'Connor K, Stein DJ, Bigler ED, Shenton ME, Chiou KS, Postmus JL, Monahan K, Eagan-Johnson B, van Donkelaar P, Merkley TL, Velez C, Hodges CB, Lindsey HM, Johnson P, Irimia A, Spruiell M, Bennett ER, Bridwell A, Zieman G, Hillary FG. A global collaboration to study intimate partner violence-related head trauma: The ENIGMA consortium IPV working group. Brain Imaging Behav 2021; 15:475-503. [PMID: 33405096 PMCID: PMC8785101 DOI: 10.1007/s11682-020-00417-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 12/11/2022]
Abstract
Intimate partner violence includes psychological aggression, physical violence, sexual violence, and stalking from a current or former intimate partner. Past research suggests that exposure to intimate partner violence can impact cognitive and psychological functioning, as well as neurological outcomes. These seem to be compounded in those who suffer a brain injury as a result of trauma to the head, neck or body due to physical and/or sexual violence. However, our understanding of the neurobehavioral and neurobiological effects of head trauma in this population is limited due to factors including difficulty in accessing/recruiting participants, heterogeneity of samples, and premorbid and comorbid factors that impact outcomes. Thus, the goal of the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) Consortium Intimate Partner Violence Working Group is to develop a global collaboration that includes researchers, clinicians, and other key community stakeholders. Participation in the working group can include collecting harmonized data, providing data for meta- and mega-analysis across sites, or stakeholder insight on key clinical research questions, promoting safety, participant recruitment and referral to support services. Further, to facilitate the mega-analysis of data across sites within the working group, we provide suggestions for behavioral surveys, cognitive tests, neuroimaging parameters, and genetics that could be used by investigators in the early stages of study design. We anticipate that the harmonization of measures across sites within the working group prior to data collection could increase the statistical power in characterizing how intimate partner violence-related head trauma impacts long-term physical, cognitive, and psychological health.
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Affiliation(s)
- Carrie Esopenko
- Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, 07107, USA.
- Department of Health Informatics, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, 07107, USA.
| | - Jessica Meyer
- Department of Psychiatry, Summa Health System, Akron, OH, 44304, USA
| | - Elisabeth A Wilde
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
| | - Amy D Marshall
- Department of Psychology, Pennsylvania State University, University Park, PA, 16802, USA
| | - David F Tate
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
| | - Alexander P Lin
- Department of Clinical Spectroscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Inga K Koerte
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität, 80336, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Kimberly B Werner
- College of Nursing, University of Missouri, St. Louis, MO, 63121, USA
| | - Emily L Dennis
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
| | - Ashley L Ware
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- Department of Psychology, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Nicola L de Souza
- School of Graduate Studies, Biomedical Sciences, Rutgers, The State University of New Jersey, Newark, NJ, 07103, USA
| | | | - Kristen Dams-O'Connor
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Dan J Stein
- Department of Psychiatry and Neuroscience Institute, South African Medical Research Council Unit on Risk & Resilience in Mental Disorders, University of Cape Town, Cape Town, 7501, South Africa
| | - Erin D Bigler
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- Department of Psychology, Brigham Young University, Provo, UT, 84602, USA
| | - Martha E Shenton
- College of Nursing, University of Missouri, St. Louis, MO, 63121, USA
- Departments of Psychiatry and Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Veterans Affairs, Boston Healthcare System, Boston, MA, 02130, USA
| | - Kathy S Chiou
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, 68588, USA
| | - Judy L Postmus
- School of Social Work, University of Maryland, Baltimore, USA
| | - Kathleen Monahan
- School of Social Welfare, Stony Brook University, Stony Brook, NY, 11794-8231, USA
| | | | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, V1V 1V7, Canada
| | - Tricia L Merkley
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- Department of Psychology, Brigham Young University, Provo, UT, 84602, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Carmen Velez
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
| | - Cooper B Hodges
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
- Department of Psychology, Brigham Young University, Provo, UT, 84602, USA
| | - Hannah M Lindsey
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
- Department of Psychology, Brigham Young University, Provo, UT, 84602, USA
| | - Paula Johnson
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
- Neuroscience Center, Brigham Young University, Provo, UT, 84602, USA
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, 90089, USA
- Denney Research Center Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, 90089, USA
| | - Matthew Spruiell
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Esther R Bennett
- Rutgers University School of Social Work, New Brunswick, NJ, 08901, USA
| | - Ashley Bridwell
- Barrow Concussion and Brain Injury Center, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Glynnis Zieman
- Barrow Concussion and Brain Injury Center, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Frank G Hillary
- Department of Psychology, Pennsylvania State University, University Park, PA, 16802, USA
- Social Life and Engineering Sciences Imaging Center, University Park, PA, 16802, USA
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23
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Puhalla A, Flynn A, Vaught A. Shame as a Moderator between Emotion Dysregulation and Posttraumatic Stress Disorder Severity among Combat Veterans Seeking Residential Treatment. J Affect Disord 2021; 283:236-242. [PMID: 33561805 DOI: 10.1016/j.jad.2021.01.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 01/10/2021] [Accepted: 01/30/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Growing evidence suggests that emotion dysregulation may be predictive of posttraumatic stress disorder (PTSD) severity, with emotional non-acceptance, lack of counter strategies, impulse control deficits, and lack of emotional awareness all being positive predictors. However, findings have been mixed. This may be due to no previous study examining the association between emotion dysregulation and PTSD severity with shame, a maintaining factor of PTSD, as a potential moderator. METHODS The present study examined the relationship between emotion dysregulation, shame, and PTSD severity among 78 male combat veterans (mean age = 42.19) upon their admission to a residential combat PTSD program. RESULTS Results demonstrated that shame and all facets of emotion dysregulation (except lack of emotional awareness & clarity) were positively associated with PTSD severity. Shame moderated the relationship between lack of emotional awareness and strategies. Among those at or below the sample mean on shame, lack of access to strategies was a positive predictor of PTSD severity. Comparatively, among those with high levels of shame, emotional awareness predicted greater PTSD severity, while among those with low levels of shame, emotional awareness predicted lower PTSD severity. LIMITATIONS Limitations included reliance on self-report questionnaires and an all-male sample. CONCLUSIONS Thus, emotion dysregulation may only predict PTSD severity among those reporting lower levels of shame, suggesting the importance of addressing shame as well as emotion dysregulation deficits among those with PTSD. Moreover, emotional awareness may be either a risk or protective factor depending on levels of shame.
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Affiliation(s)
| | - Aidan Flynn
- Coatesville Veterans Affairs Medical Center (CVAMC), Coatesville, PA, USA
| | - Amanda Vaught
- Coatesville Veterans Affairs Medical Center (CVAMC), Coatesville, PA, USA
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24
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Christ NM, Elhai JD, Forbes CN, Gratz KL, Tull MT. A machine learning approach to modeling PTSD and difficulties in emotion regulation. Psychiatry Res 2021; 297:113712. [PMID: 33548858 DOI: 10.1016/j.psychres.2021.113712] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/03/2021] [Indexed: 12/25/2022]
Abstract
Despite evidence for the association between emotion regulation difficulties and posttraumatic stress disorder (PTSD), less is known about the specific emotion regulation abilities that are most relevant to PTSD severity. This study examined both item-level and subscale-level models of difficulties in emotion regulation in relation to PTSD severity using supervised machine learning in a sample of U.S. adults (N=570). Participants were recruited via Amazon's Mechanical Turk (MTurk) and completed self-report measures of emotion regulation difficulties and PTSD severity. We used five different machine learning algorithms separately to train each statistical model. Using ridge and elastic net regression results in the testing sample, emotion regulation predictor variables accounted for approximately 28% and 27% of the variance in PTSD severity in the item- and subscale-level models, respectively. In the item-level model, four predictor variables had notable relative importance values for PTSD severity. These items captured secondary emotional responding, experiencing emotions as out-of-control, difficulties modulating emotional arousal, and low emotional granularity. In the subscale-level model, lack of access to effective emotion regulation strategies, lack of emotional clarity, and emotional nonacceptance subscales had the highest relative importance to PTSD severity. Results from analyses modeling a probable diagnosis of PTSD based on DERS items and subscales are presented in supplemental findings. Findings have implications for developing more efficient, targeted emotion regulation interventions for PTSD.
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Affiliation(s)
- Nicole M Christ
- Department of Psychology, University of Toledo, 2801 W. Bancroft St., Toledo, Ohio 43606, USA
| | - Jon D Elhai
- Department of Psychology, University of Toledo, 2801 W. Bancroft St., Toledo, Ohio 43606, USA.
| | - Courtney N Forbes
- Department of Psychology, University of Toledo, 2801 W. Bancroft St., Toledo, Ohio 43606, USA
| | - Kim L Gratz
- Department of Psychology, University of Toledo, 2801 W. Bancroft St., Toledo, Ohio 43606, USA
| | - Matthew T Tull
- Department of Psychology, University of Toledo, 2801 W. Bancroft St., Toledo, Ohio 43606, USA
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25
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Liu N, Cao Y, Qiao H, Ma H, Li J, Luo X, Li CSR, Zhang Y, Zhang N. Traumatic Experiences and PTSD Symptoms in the Chinese Male Intrafamilial Physical Violence Perpetrators: A Comparative and Structural Equation Modeling Study. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:2841-2861. [PMID: 29562817 PMCID: PMC7480215 DOI: 10.1177/0886260518764103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We aimed to compare traumatic experiences among the groups of perpetrators with or without violent pedigree, and establish a structural model of posttraumatic stress disorder (PTSD) symptoms as mediators of traumatic experiences and severe intrafamilial physical violence among Chinese male perpetrators. A cross-sectional survey and a face-to-face interview were conducted to examine intimate partner violence (IPV) perpetration and violent pedigree, childhood maltreatment, other traumatic events, PTSD symptoms, and severe intrafamilial physical violence in a community sample of 229 abusive men and 303 controlled men in China. Using structural equation modeling (SEM) techniques, the scores of the questionnaires were entered into the theoretical model and calculated. Findings demonstrated that the numbers of the traumatic events in four groups were significantly different with a declining trend, and the SEM data had an adequate fit. The loadings of pathways from childhood witness domestic violence (DV) to severe physical violence (SPV) were more salience than other pathways, and the indirect effect of every pathway, except for the childhood witness DV to PTSD symptoms, on severe intrafamilial physical violence in the model was significant. The results suggest that PTSD symptoms cluster as mediator of the intergenerational transmission of SPV perpetration in Chinese abusive men. Childhood witness IPV has effects on adulthood perpetration of IPV.
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Affiliation(s)
- Na Liu
- Department of Medical Psychology, Nanjing Medical University, Affiliated Nanjing Brain Hospital, Nanjing, Jiangsu Province, P.R. China
- Mental Health Institute, Second Xiangya Hospital of Central South University, Changsha, Hunan Province, P.R. China
| | - Yuping Cao
- Mental Health Institute, Second Xiangya Hospital of Central South University, Changsha, Hunan Province, P.R. China
| | - Huifen Qiao
- Department of Medical Psychology, Nanjing Medical University, Affiliated Nanjing Brain Hospital, Nanjing, Jiangsu Province, P.R. China
| | - Hui Ma
- Department of Medical Psychology, Nanjing Medical University, Affiliated Nanjing Brain Hospital, Nanjing, Jiangsu Province, P.R. China
| | - Jijun Li
- Department of Medical Psychology, Nanjing Medical University, Affiliated Nanjing Brain Hospital, Nanjing, Jiangsu Province, P.R. China
| | - Xingguang Luo
- Department of Psychiatry, Yale University School of medicine, New Haven, CT, USA
| | - Chiang-shan Ray Li
- Department of Psychiatry, Yale University School of medicine, New Haven, CT, USA
| | - Yalin Zhang
- Mental Health Institute, Second Xiangya Hospital of Central South University, Changsha, Hunan Province, P.R. China
| | - Ning Zhang
- Department of Medical Psychology, Nanjing Medical University, Affiliated Nanjing Brain Hospital, Nanjing, Jiangsu Province, P.R. China
- Nanjing Neuropsychiatric Institute; Nanjing, Jiangsu Province, P.R. China
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26
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Miles SR, Hammond FM, Neumann D, Silva MA, Tang X, Kajankova M, Dillahunt-Aspillaga C, Nakase-Richardson R. Evolution of Irritability, Anger, and Aggression after Traumatic Brain Injury: Identifying and Predicting Subgroups. J Neurotrauma 2021; 38:1827-1833. [PMID: 33470179 DOI: 10.1089/neu.2020.7451] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The current prospective, multi-center, longitudinal cohort study examined how veterans/service members (V/SM) changed in their irritability, anger, and aggression (IAA) scores from admission to discharge in post-acute rehabilitation settings. The goals were to identify trajectory subgroups, and explore if there were different predictors of the subgroups. V/SM (n = 346) from five Veterans Affairs TBI Model Systems Polytrauma Rehabilitation Centers participated. The sample was mostly men (92%) and identified as white (69%), black (13%), and other races (18%). Median age was 28 years, and 78% had sustained a severe TBI. Staff rated IAA at admission and discharge using the Mayo-Portland Adaptability Inventory-4 item#15. Four IAA trajectory subgroups were identified: (1) no IAA at admission or discharge (n = 89, 25.72%), (2) resolved IAA (n = 61, 17.63%), (3) delayed onset IAA (n = 31, 8.96%), and (4) persistent IAA (n = 165, 47.69%). Greater post-traumatic stress disorder (PTSD) symptoms were the only consistent predictor of belonging to all the subgroups who had IAA compared with the no IAA subgroup. We conclude that IAA had different trajectories after a TBI. The majority of V/SM had persistent impairment from IAA, a quarter of the sample had no impairment from IAA, and fewer participants had resolving or worsening IAA. Findings emphasize the importance of educating providers and family of the different ways and times that IAA can manifest after TBI. Timely diagnosis and treatment of PTSD symptoms during and after rehabilitation are critical treatment targets.
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Affiliation(s)
- Shannon R Miles
- Mental Health and Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, Florida, USA.,Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Rehabilitation Hospital of Indiana, Indianapolis, Indiana, USA
| | - Dawn Neumann
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Rehabilitation Hospital of Indiana, Indianapolis, Indiana, USA
| | - Marc A Silva
- Mental Health and Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, Florida, USA.,Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.,Department of Internal Medicine Pulmonary and Sleep Medicine Division, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.,Department of Psychology, University of South Florida, Tampa, Florida, USA
| | - Xinyu Tang
- Tampa VA Research and Education Foundation, Inc., Tampa, Florida, USA
| | - Maria Kajankova
- Department of Rehabilitation and Human Performance, Brain Injury Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christina Dillahunt-Aspillaga
- Rehabilitation and Mental Health Counseling Program, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Risa Nakase-Richardson
- Mental Health and Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, Florida, USA.,Department of Internal Medicine Pulmonary and Sleep Medicine Division, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.,TBI Center of Excellence, James A. Haley Veterans' Hospital, Tampa, Florida, USA
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27
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Worthen M, Rathod SD, Cohen G, Sampson L, Ursano R, Gifford R, Fullerton C, Galea S, Ahern J. Risk and Protective Factors for Difficulty Controlling Violent Behavior in National Guard and Reserve Service Members. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:1049-1067. [PMID: 29294977 DOI: 10.1177/0886260517737552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Violent behavior is an important problem for military service members and veterans. A representative cohort of U.S. Reserve and National Guard personnel (N = 1,293) were interviewed to assess self-reported problems controlling violent behavior, deployment traumas, posttraumatic stress disorder (PTSD), alcohol abuse, and social support. Poisson regression models were used to estimate the associations of violent behavior with risk and protective factors. Problems controlling violent behavior were uncommon among male (3.3%) and female (1.7%) service members. Adjusted prevalence ratios (aPR) showed associations between violent behavior and deployment traumas (aPR = 1.67, 95% confidence interval [CI] = [1.34, 2.08]), PTSD (aPR = 9.95, 95% CI = [5.09, 19.48]), and PTSD symptom severity (aPR for each additional PTSD symptom = 1.07, 95% CI = [1.06, 1.09]). Social support was associated with lower prevalence of violent behavior (aPR = 0.62, 95% CI = [0.52, 0.76]). The association between violent behavior and alcohol abuse was not statistically significant (aPR = 1.94, 95% CI = [0.92, 4.09]). Results were consistent when the population was restricted to personnel who had deployed to a war zone. Problems controlling violent behavior were less common in this cohort than has been documented in other studies. Associations of violent behavior with risk and protective factors are consistent with prior research.
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Affiliation(s)
| | | | - Gregory Cohen
- Columbia University Mailman School of Public Health, New York, NY, USA
- Boston University School of Public Health, MA, USA
| | | | - Robert Ursano
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Robert Gifford
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Carol Fullerton
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Sandro Galea
- Boston University School of Public Health, MA, USA
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28
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Parameters of Aggressive Behavior in a Treatment-Seeking Sample of Military Personnel: A Secondary Analysis of Three Randomized Controlled Trials of Evidence-Based PTSD Treatments. Behav Ther 2021; 52:136-148. [PMID: 33483111 DOI: 10.1016/j.beth.2020.03.007] [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: 08/25/2019] [Revised: 03/22/2020] [Accepted: 03/25/2020] [Indexed: 10/24/2022]
Abstract
Aggressive behavior is prevalent among veterans of post-9/11 conflicts who have posttraumatic stress disorder (PTSD). However, little is known about whether PTSD treatments reduce aggression or the direction of the association between changes in PTSD symptoms and aggression in the context of PTSD treatment. We combined data from three clinical trials of evidence-based PTSD treatment in service members (N = 592) to: (1) examine whether PTSD treatment reduces psychological (e.g., verbal behavior) and physical aggression, and; (2) explore temporal associations between aggressive behavior and PTSD. Both psychological (Estimate = -2.20, SE = 0.07) and physical aggression (Estimate = -0.36, SE = 0.05) were significantly reduced from baseline to posttreatment follow-up. Lagged PTSD symptom reduction was not associated with reduced reports of aggression; however, higher baseline PTSD scores were significantly associated with greater reductions in psychological aggression (exclusively; ß = -0.67, 95% CI = -1.05, -0.30, SE = -3.49). Findings reveal that service members receiving PTSD treatment report substantial collateral changes in psychological aggression over time, particularly for participants with greater PTSD symptom severity. Clinicians should consider cotherapies or alternative ways of targeting physical aggression among service members with PTSD and alternative approaches to reduce psychological aggression among service members with relatively low PTSD symptom severity when considering evidence-based PTSD treatments.
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29
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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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30
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Gilbar O, Ford J. Indirect effects of PTSD and complex PTSD in the relationship of polyvictimization with intimate partner violence victimization and perpetration among men in mandated treatment. Eur J Psychotraumatol 2020; 11:1794653. [PMID: 33408805 PMCID: PMC7747802 DOI: 10.1080/20008198.2020.1794653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background: Polyvictimization is associated with posttraumatic stress disorder (PTSD), severe impairment, and re-victimization, including due to intimate partner violence (IPV), but polyvictmization's role in the perpetration of IPV is less clear. Objective: To examine the indirect effect of PTSD and complex PTSD in the relationship between polyvictimization and IPV perpetration. Method: Polyvictims were identified by cluster analysis of self-reported lifetime victimization history data in a random national sample (N = 234) of men at 66 clinical treatment centers for domestic violence perpetrators in Israel. Results: Four sub-groups were identified: low exposure to abuse and physical neglect (C1, N = 105), and three polyvictim sub-groups characterized by multiple forms of past exposure to neglect and verbal abuse (C2, N = 38), to verbal and physical abuse without neglect (C3, N = 46), or to neglect and both verbal and physical abuse (C4, N = 28). Participants also were characterized as having low exposure to traumatic events across the lifespan (cluster L5, N=156), or high exposure to traumatic events across the lifespan (cluster L6, N=78). Complex PTSD symptoms had an indirect effect in the relationship between membership in the C3 and C4 polyvictimization clusters (β=.45, p<.05, β=.60, p<.05; respectively) and severity of psychological IPV victimization, as well as between C3 polyvictimization cluster membership and severity of psychological IPV perpetration (β=.32, p<.05). In contrast, PTSD symptoms had no indirect effect in any relationship between cluster membership and IPV outcomes. High lifetime trauma exposure also was directly associated with sexual IPV victimization. Conclusions: Complex PTSD may be a mechanism linking polyvictimization to the severity of both IPV victimization and perpetration. Clinical implications are discussed.
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Affiliation(s)
- Ohad Gilbar
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
| | - Julian Ford
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
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31
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Miles SR, Kent TA, Stanley M, Thompson KE, Sharp C, Niles BL, Young-McCaughan S, Mintz J, Roache JD, Litz BT, Hale WJ, Stanford MS, Keane TM, Peterson AL. Manage Emotions to Reduce Aggression: A Pilot Study of a Brief Treatment to Help Veterans Reduce Impulsive Aggression. J Nerv Ment Dis 2020; 208:897-903. [PMID: 32947454 DOI: 10.1097/nmd.0000000000001229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Veterans with posttraumatic stress disorder (PTSD) report more aggression than civilians with PTSD. Because emotion regulation difficulties mediated the relationship between PTSD symptoms and impulsive aggression in veterans, we developed an intervention to increase emotion regulation skills. This pilot study tested the feasibility and acceptability of a three-session treatment, Manage Emotions to Reduce Aggression (MERA), and examined its effectiveness at reducing aggression and emotion dysregulation. Male combat veterans with PTSD and impulsive aggression completed assessments before and 4 weeks after MERA. Overt Aggression Scale measured frequency of aggression; Difficulties in Emotion Regulation Scale assessed emotion dysregulation. Most veterans (95%) who completed MERA and the posttreatment assessment (n = 20) reported MERA was helpful. Veterans in the intent-to-treat sample demonstrated a significant decrease in their frequency of aggression (Cohen's d = -0.55) and emotion dysregulation (Cohen's d = -0.55). MERA may be an innovative treatment that helps veterans reduce aggression.
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Affiliation(s)
| | | | | | | | - Carla Sharp
- Department of Psychology, University of Houston, Houston, Texas
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32
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Stoddard SA, Meier-Austic E, Epstein-Ngo Q, Walton M, Carter PM, Heinze JE, Zimmerman MA, Cunningham R. Substance use and mental health predictors of patterns of non-partner youth violence among high-risk urban youth. Drug Alcohol Depend 2020; 213:108117. [PMID: 32585420 PMCID: PMC7736059 DOI: 10.1016/j.drugalcdep.2020.108117] [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: 01/16/2019] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study examined the association between baseline substance use and mental health, and non-partner violence trajectories among youth presenting to an urban emergency department who screened positive for drug use. Non-partner violence is physically violent victimization or aggression involving someone other than a dating partner. METHODS Group-based trajectory modeling was used to identify longitudinal trajectories of non-partner violence in N = 599 youth (14-24 years old) at baseline, 6, 12, 18 and 24 month follow-ups. Multinomial logistic regression analyses were used to examine associations between baseline substance use and mental health conditions (i.e., anxiety, depression, and post-traumatic stress disorder [PTSD]), and non-partner violence trajectories. RESULTS Six trajectory groups were identified for non-partner violence. Binge drinking and cannabis, illicit drug, nonmedical prescription stimulant, and polysubstance use in the 30 days leading up to their initial ED visit were associated with the likelihood of medium to high non-partner violence group membership during the two years following their ED visit. Post-traumatic stress disorder (PTSD) and depression/anxiety at baseline were also associated with greater risk of belonging to medium to high non-partner violence trajectory groups. CONCLUSIONS Our findings highlight distinct trajectories of violent behavior, with roughly 60 % of young adults belonging to one of the non-partner violence groups. Although general trajectory trends were of decreasing violent behavior, the constellation of baseline risk factors differentially predicted group membership. These findings indicate that violence does not operate in a vacuum; interventions to reduce violence should also address previous trauma, substance use, and mental health issues.
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Affiliation(s)
- Sarah A. Stoddard
- School of Nursing, University of Michigan, 400 N Ingalls Room 4341, Ann Arbor, Michigan, 48109,University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, Michigan, 48109
| | - Elizabeth Meier-Austic
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109
| | - Quyen Epstein-Ngo
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48105
| | - Maureen Walton
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48105,University of Michigan Addiction Research Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Rd., Ann Arbor, Michigan, 48109
| | - Patrick M. Carter
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan, 48109,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48105,Hurley Medical Center, Department of Emergency Medicine, 1 Hurley Plaza, Flint, Michigan, 48503
| | - Justin E, Heinze
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, Michigan, 48109,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan, 48109
| | - Marc A. Zimmerman
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, Michigan, 48109,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan, 48109
| | - Rebecca Cunningham
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan, 48109,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48105,Hurley Medical Center, Department of Emergency Medicine, 1 Hurley Plaza, Flint, Michigan, 48503
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33
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Post-traumatic stress spectrum symptoms in parents of children affected by epilepsy: Gender differences. Seizure 2020; 80:169-174. [PMID: 32593140 DOI: 10.1016/j.seizure.2020.06.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To investigate psychopathological reaction to traumatic stress, addressing in particular gender difference, in parental couples of children affected by epilepsy. METHODS 50 mothers and 50 fathers, paired for one's child, of children followed at the Pediatric Unit of a major Italian University Hospital with a diagnosis of epilepsy were enrolled, screened by means of the Semi-structured Clinical Interview for DSM-5 (SCID-5) and filled the Trauma and Loss Spectrum Self-Report (TALS-SR), an international instrument to evaluate post-traumatic stress symptomatology. RESULTS 25 % of the total sample presented a diagnosis of PTSD with a statistically higher prevalence of mothers (36 % and 14 %, respectively; p = .021). Furthermore, 44 % (48 % mothers and 40 % fathers) presented a partial PTSD. Important gender differences emerged also for all cluster dimensions of the TALS-SR except for the Avoidance. Finally, the analysis of the single items of the TALS-SR evidenced that in mothers subgroup prevail cognitive symptoms of fear and sadness as well as somatic manifestations. CONCLUSIONS Our results point out the differences between mothers and fathers in trauma response and underline the need to develop gender targeted models of healthcare prevention and assistance.
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34
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Albrechet-Souza L, Schratz CL, Gilpin NW. Sex differences in traumatic stress reactivity in rats with and without a history of alcohol drinking. Biol Sex Differ 2020; 11:27. [PMID: 32393336 PMCID: PMC7216391 DOI: 10.1186/s13293-020-00303-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/24/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Alcohol misuse and post-traumatic stress disorder (PTSD) are highly comorbid, and treatment outcomes are worse in individuals with both conditions. Although more men report experiencing traumatic events than women, the lifetime prevalence of PTSD is twice as high in females. Despite these data trends in humans, preclinical studies of traumatic stress reactivity have been performed almost exclusively in male animals. METHODS This study was designed to examine sex differences in traumatic stress reactivity in alcohol-naive rats (experiment 1) and rats given intermittent access to 20% ethanol in a 2-bottle choice paradigm for 5 weeks (experiment 2). Animals were exposed to predator odor (bobcat urine) and tested for contextual avoidance 24 h later; unstressed controls were never exposed to predator odor. We evaluated changes in physiological arousal using the acoustic startle response (ASR) test at day 2 post-stress and anxiety-like behavior measured in the elevated plus-maze (EPM) at day 17 post-stress. In experiment 3, time course of corticosterone response was examined in male and female rats following exposure to predator odor stress. RESULTS Alcohol-naive males and females exposed to predator odor displayed blunted weight gain 24 h post-stress, but only a subset of stressed animals exhibited avoidance behavior. In alcohol-drinking animals, the proportion of avoiders was higher in males than females, and predator odor exposure increased ASR in males only. Stressed females exhibited blunted ASR relative to unstressed females and stressed males, regardless of alcohol drinking history. Alcohol-experienced females presented lower anxiety-like behavior and higher general activity in the EPM in comparison with alcohol-experienced males. Plasma corticosterone levels were higher in females immediately after predator odor exposure until 60 min post-stress relative to males. CONCLUSIONS We report robust sex differences in behavioral and endocrine responses to bobcat urine exposure in adult Wistar rats. Also, males with a history of chronic moderate alcohol drinking exhibited increased traumatic stress reactivity relative to alcohol-drinking females. Our findings emphasize the importance of considering sex as a biological variable in the investigation of traumatic stress effects on physiology and behavior.
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Affiliation(s)
- Lucas Albrechet-Souza
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA. .,Alcohol & Drug Center of Excellence, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
| | - Connor L Schratz
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Nicholas W Gilpin
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA.,Alcohol & Drug Center of Excellence, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA.,Neuroscience Center of Excellence, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA.,Southeast Louisiana Veterans Health Care System (SLVHCS), New Orleans, LA, USA
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35
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Flanigan ME, Aleyasin H, Li L, Burnett CJ, Chan KL, LeClair KB, Lucas EK, Matikainen-Ankney B, Durand-de Cuttoli R, Takahashi A, Menard C, Pfau ML, Golden SA, Bouchard S, Calipari ES, Nestler EJ, DiLeone RJ, Yamanaka A, Huntley GW, Clem RL, Russo SJ. Orexin signaling in GABAergic lateral habenula neurons modulates aggressive behavior in male mice. Nat Neurosci 2020; 23:638-650. [PMID: 32284606 PMCID: PMC7195257 DOI: 10.1038/s41593-020-0617-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 03/02/2020] [Indexed: 11/30/2022]
Abstract
Heightened aggression is characteristic of multiple neuropsychiatric disorders and can have various negative effects on patients, their families and the public. Recent studies in humans and animals have implicated brain reward circuits in aggression and suggest that, in subsets of aggressive individuals, domination of subordinate social targets is reinforcing. In this study, we showed that, in male mice, orexin neurons in the lateral hypothalamus activated a small population of glutamic acid decarboxylase 2 (GAD2)-expressing neurons in the lateral habenula (LHb) via orexin receptor 2 (OxR2) and that activation of these GAD2 neurons promoted male-male aggression and conditioned place preference for aggression-paired contexts. Moreover, LHb GAD2 neurons were inhibitory within the LHb and dampened the activity of the LHb as a whole. These results suggest that the orexin system is important for the regulation of inter-male aggressive behavior and provide the first functional evidence of a local inhibitory circuit within the LHb.
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Affiliation(s)
- Meghan E Flanigan
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hossein Aleyasin
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Long Li
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - C Joseph Burnett
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenny L Chan
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine B LeClair
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elizabeth K Lucas
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, NC, USA
| | - Bridget Matikainen-Ankney
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Romain Durand-de Cuttoli
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aki Takahashi
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Laboratory of Behavioral Neuroendocrinology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Caroline Menard
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry and Neuroscience, Faculty of Medicine and CERVO Brain Research Center, Université Laval, Ville de Québec, QC, Canada
| | - Madeline L Pfau
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sam A Golden
- Department of Biological Structure, University of Washington, Seattle, WA, USA
| | - Sylvain Bouchard
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erin S Calipari
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Eric J Nestler
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ralph J DiLeone
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Akihiro Yamanaka
- Department of Neuroscience II, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan
| | - George W Huntley
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Roger L Clem
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Scott J Russo
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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36
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Gilbar O. Examining the boundaries between ICD-11 PTSD/CPTSD and depression and anxiety symptoms: A network analysis perspective. J Affect Disord 2020; 262:429-439. [PMID: 31744734 DOI: 10.1016/j.jad.2019.11.060] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 09/20/2019] [Accepted: 11/10/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Two newly identified sibling disorders - ICD-11 PTSD and CPTSD - have been well validated in the last few years. Although these trauma-related disorders are suggested to be neatly separated from depression and anxiety, no study has used a network analysis to examine those definitions' construct validity when they also interplay with symptoms of depression and anxiety. Additionally, no research has focused upon the specific boundaries between these four disorders' symptoms, the bridges between them, and the ways they influence each other among clinical populations. METHODS A sample of 234 men drawn randomly from a national sample of 1,600 Jewish men receiving treatment for domestic violence in Israel completed the ICD-11 International Trauma Questionnaire (ITQ) and Brief Symptom Inventory (BSI). RESULTS The ICD-11 CPTSD, depression and anxiety clustering network results revealed, within the EGA, a four-cluster solution in which PTSD and CPTSD symptoms are differentiated from two other distinct clusters of anxiety and depression symptoms. Feelings of worthlessness and avoiding internal reminders of the experience were the most central symptoms. LIMITATIONS Due to the use of a cross-sectional design, causal interpretation of the network correlation between symptoms should be made cautiously. CONCLUSIONS These findings strengthen the approach that ICD-11 PTSD and CPTSD have a distinct construct; however, they also reflect a strong positive connection to anxiety and depression symptoms and no clear boundaries between disorders. Specifically, dysphoria/avoidance-related symptoms act as a bridge between the disorders, which may be important targets for specific assessments and related interventions.
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Affiliation(s)
- Ohad Gilbar
- Boston University, VA Medical Center, Boston, United States; The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat-Gan, Israel.
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37
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Lifetime PTSD is associated with impaired emotion recognition in veterans and their offspring. Psychiatry Res 2020; 284:112666. [PMID: 31727441 DOI: 10.1016/j.psychres.2019.112666] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 10/28/2019] [Accepted: 10/28/2019] [Indexed: 01/03/2023]
Abstract
PTSD is associated with emotion dysregulation. Studies have found inconsistent impaired facial emotion recognition ability (ERA) in patients with PTSD and intergenerational transmission of PTSD has been reported, although no studies exist regarding ERA. Our objective was to characterise the facial ERA of a group of traumatised war veterans with, and without lifetime PTSD, and also of their respective adult offspring. Sixty-one veterans with, and without lifetime PTSD and 73 offspring were tested for ERA of seven basic facial emotions expressions, 40 years after veterans had been exposed to war-related trauma. Veterans with lifetime PTSD showed impairment of recognition of all emotions, irrespective of the type, when compared with veterans without PTSD. This result was maintained after adjusting for potential confounders-including depressive symptoms. Offspring of veterans with lifetime PTSD also showed impaired recognition of all emotions, including after adjustment for the same variables. Offspring of veterans with lifetime PTSD also showed specific impairment in recognising the emotions of happiness and disgust. These results confirm that PTSD has negative effects with regards to emotion regulation and also on the next generation. This could result in this population being at increased risk of suffering from relationship problems and psychopathology.
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38
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Augsburger M, Maercker A. Associations between trauma exposure, posttraumatic stress disorder, and aggression perpetrated by women. A meta‐analysis. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2020. [DOI: 10.1111/cpsp.12322] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Andreas Maercker
- Department of Psychology University of Zurich Zurich Switzerland
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Gilbar O, Dekel R, Hyland P, Cloitre M. The role of complex posttraumatic stress symptoms in the association between exposure to traumatic events and severity of intimate partner violence. CHILD ABUSE & NEGLECT 2019; 98:104174. [PMID: 31563703 DOI: 10.1016/j.chiabu.2019.104174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 08/25/2019] [Accepted: 09/02/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Symptoms of both posttraumatic stress disorder (PTSD) and disturbances in self-organization (DSO) have been suggested to play a role in the association between an individual's childhood physical abuse and neglect and his/her perpetration of IPV in adulthood; however, the two have yet to be studied in one model. Thus, we aimed to examine the interrelations among childhood exposure to violence and physical neglect, exposure to trauma across one's lifetime, ICD-11 CPTSD symptoms (i.e., PTSD and DSO), and IPV severity. METHODS Participants were 234 men drawn randomly from a national sample of 1600 mandated men receiving treatment for domestic violence in Israel. They completed measures of potentially traumatic exposure, symptoms of CPTSD, child abuse and neglect, and IPV. Structural equation modeling (SEM) was used to examine possible direct and indirect effects of the study variables. RESULTS Results confirmed the indirect role of CPTSD symptoms in the association between the following types of traumatic exposure - childhood exposure to violence (B = .03, β = .05, SE = .01, p = .05, CI 90% [.041, .143]), childhood exposure to physical neglect (B = .04, β = .04, SE = .02, p < .01, CI 90% [.014, .092]), and lifetime exposure to potentially traumatic events, or PTEs (B = .04, β = .09, SE = .01, p < .001, CI 90% [.006, .074]) - and the perpetration of psychological IPV as an adult. No significant results were found in relation to the perpetration of physical IPV. CONCLUSIONS The current cross-sectional study findings suggest a preliminary direction regarding the possible direct and indirect effects of ICD-11CPTSD on the severity of IPV psychological perpetration. The clinical implications include the need to focus on both PTSD and DSO symptoms in order to help reduce these potential risk factors for psychological IPV perpetration.
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Affiliation(s)
- Ohad Gilbar
- Boston University, National Center for PTSD, VA Medical Center, Boston, USA; The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat-Gan, Israel.
| | - Rachel Dekel
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat-Gan, Israel.
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland.
| | - Marylene Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Healthcare System, Palo Alto, CA, USA; Department of Psychiatry and Behavioral Science, Stanford University, Palo Alto, CA, USA.
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Miles SR, Dillon KH, Jacoby VM, Hale WJ, Dondanville KA, Wachen JS, Yarvis JS, Peterson AL, Mintz J, Litz BT, Young‐McCaughan S, Resick PA. Changes in anger and aggression after treatment for PTSD in active duty military. J Clin Psychol 2019; 76:493-507. [DOI: 10.1002/jclp.22878] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shannon R. Miles
- James A. Haley Veterans’ Hospital Tampa Florida
- Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine University of South Florida Tampa Florida
| | - Kirsten H. Dillon
- Research and Development Durham VA Medical Center Durham North Carolina
- Department of Psychiatry and Behavioral Sciences Duke University Medical Center Durham North Carolina
| | - Vanessa M. Jacoby
- Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center at San Antonio San Antonio Texas
| | - Willie J. Hale
- Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center at San Antonio San Antonio Texas
- Department of Psychology University of Texas at San Antonio San Antonio Texas
| | - Katherine A. Dondanville
- Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center at San Antonio San Antonio Texas
| | - Jennifer Schuster Wachen
- National Center for PTSD VA Boston Healthcare System Boston Massachusetts
- Department of Psychiatry Boston University School of Medicine Boston Massachusetts
| | - Jeffrey S. Yarvis
- Department of Behavioral Health Carl R. Darnall Army Medical Center Fort Hood Texas
| | - Alan L. Peterson
- Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center at San Antonio San Antonio Texas
- Research and Development Service South Texas Veterans Health Care System San Antonio Texas
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center at San Antonio San Antonio Texas
- Department of Epidemiology and Biostatistics University of Texas Health Science Center at San Antonio San Antonio Texas
| | - Brett T. Litz
- Department of Psychiatry Boston University School of Medicine Boston Massachusetts
- Massachusetts Veterans Epidemiological Research and Information Center VA Boston Healthcare System Boston Massachusetts
| | - Stacey Young‐McCaughan
- Department of Psychiatry and Behavioral Sciences University of Texas Health Science Center at San Antonio San Antonio Texas
| | - Patricia A. Resick
- Department of Psychiatry and Behavioral Sciences Duke University Medical Center Durham North Carolina
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Ceresoli-Borroni G, Liranso T, Brittain ST, Connor DF, Evans CJ, Findling RL, Hwang S, Fry N, Candler SA, Robb AS, Saylor KE, Nasser A, Schwabe S. Application of the Impulsive Aggression Diary in Adolescents with Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 2019; 29:599-607. [PMID: 31343272 DOI: 10.1089/cap.2018.0089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: Impulsive aggression (IA) is a maladaptive form of aggressive behavior that is an associated feature of neuropsychiatric disorders, including attention-deficit/hyperactivity disorder (ADHD). As one of the most common forms of aggressive behavior, IA is a serious clinical concern. Recognition, monitoring, and management of IA symptoms are complicated by the lack of IA-specific psychometric instruments and evidence-based treatments. A recently developed electronic observer-reported outcome instrument has been validated in children for monitoring the frequency of 15 IA-related behaviors in the context of ADHD. This study seeks to first determine if the behaviors included in the pediatric IA diary are applicable to adolescents with ADHD, and second, compare the reliability of adolescent versus parent reporters. Methods: We evaluated the utility of the pediatric IA diary through concept elicitation and cognitive interviews with 17 pairs of parents and adolescents (aged 13-17 years) with IA and ADHD, supplemented with 15 new behaviors potentially applicable to adolescents. Results: The behaviors most frequently reported by adolescents included arguing (93.8%), raising their voice/shouting/yelling (93.8%), hitting others (87.5%), slamming (87.5%), pushing/shoving (81.3%), breaking (75.0%), fighting (75.0%), throwing (75.0%), and cursing (68.8%). The behaviors most commonly reported by parents included raising their voice/shouting/yelling (94.1%), arguing (88.2%), being disrespectful/mean/rude (88.2%), slamming (88.2%), throwing (88.2%), cursing (82.4%), hitting others (82.4%), pushing/shoving (82.4%), breaking (76.5%), name-calling (76.5%), and threatening (70.6%). Of all commonly reported behaviors, only being "disrespectful/mean/rude" and "breaking" are not part of the pediatric IA diary, likely due to the imprecision of these terms. No significant usability issues were found for the IA diary device. Conclusions: These findings suggest that the 15-item pediatric IA diary should be applicable to adolescent populations to appropriately characterize IA behaviors in individuals with ADHD. Furthermore, this study indicated that parents may be more reliable reporters of IA behavior than adolescents.
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Affiliation(s)
| | - Tesfaye Liranso
- Department of Clinical Research, Supernus Pharmaceuticals, Inc., Rockville, Maryland
| | - Scott T Brittain
- Department of Clinical Research, Supernus Pharmaceuticals, Inc., Rockville, Maryland
| | - Daniel F Connor
- Department of Psychiatry, Division of Child & Adolescent Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut
| | | | - Robert L Findling
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland.,Department of Psychiatry and Behavioral Sciences, Kennedy Krieger Institute, Baltimore, Maryland
| | - Steve Hwang
- Department of Research Science, Endpoint Outcomes, Boston, Massachusetts
| | - Nicholas Fry
- Department of Clinical Research, Supernus Pharmaceuticals, Inc., Rockville, Maryland
| | - Shawn A Candler
- Department of Clinical Research, Supernus Pharmaceuticals, Inc., Rockville, Maryland
| | - Adelaide S Robb
- Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.,Department of Psychiatry and Behavioral Sciences, Children's National Medical Center, Washington, District of Columbia
| | | | - Azmi Nasser
- Department of Clinical Research, Supernus Pharmaceuticals, Inc., Rockville, Maryland
| | - Stefan Schwabe
- Department of Clinical Research, Supernus Pharmaceuticals, Inc., Rockville, Maryland
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42
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Cowden Hindash AH, Lujan C, Howard M, O'Donovan A, Richards A, Neylan TC, Inslicht SS. Gender Differences in Threat Biases: Trauma Type Matters in Posttraumatic Stress Disorder. J Trauma Stress 2019; 32:701-711. [PMID: 31590206 DOI: 10.1002/jts.22439] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 04/06/2019] [Accepted: 04/11/2019] [Indexed: 12/12/2022]
Abstract
Women are diagnosed with posttraumatic stress disorder (PTSD) at twice the rate of men. This gender difference may be related to differences in PTSD experiences (e.g., more hypervigilance in women) or types of trauma experienced (e.g., interpersonal trauma). We examined whether attentional threat biases were associated with gender, PTSD diagnosis, and/or trauma type. Participants were 70 civilians and veterans (38 women, 32 men; 41 with PTSD, 29 without PTSD) assessed with the Clinician Administered PTSD Scale for DSM-IV who completed a facial dot-probe attention bias task and self-report measures of psychiatric symptoms and trauma history. Factorial ANOVA and regression models examined associations between gender, PTSD diagnosis, index trauma type, lifetime traumatic experiences, and attentional threat biases. Results revealed that compared to women without PTSD and men both with and without PTSD, women with PTSD demonstrated attentional biases toward threatening facial expressions, d = 1.19, particularly fearful expressions, d = 0.74. Psychiatric symptoms or early/lifetime trauma did not account for these attentional biases. Biases were related to interpersonal assault index traumas, ηp 2 = .13, especially sexual assault, d = 1.19. Trauma type may be an important factor in the development of attentional threat biases, which theoretically interfere with trauma recovery. Women may be more likely to demonstrate attentional threat biases due to higher likelihood of interpersonal trauma victimization rather than due to gender-specific psychobiological pathways. Future research is necessary to clarify if sexual assault alone or in combination with gender puts individuals at higher risk of developing PTSD.
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Affiliation(s)
- Alexandra H Cowden Hindash
- Stress and Health Research Program, San Francisco Veteran Affairs Medical Center, San Francisco, California, USA.,Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA.,Veterans Health Administration Advanced Fellowship in Women's Health, San Francisco Veteran Affairs Medical Center, San Francisco, California, USA
| | - Callan Lujan
- Stress and Health Research Program, San Francisco Veteran Affairs Medical Center, San Francisco, California, USA
| | - Meghan Howard
- Stress and Health Research Program, San Francisco Veteran Affairs Medical Center, San Francisco, California, USA
| | - Aoife O'Donovan
- Stress and Health Research Program, San Francisco Veteran Affairs Medical Center, San Francisco, California, USA.,Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Anne Richards
- Stress and Health Research Program, San Francisco Veteran Affairs Medical Center, San Francisco, California, USA.,Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Thomas C Neylan
- Stress and Health Research Program, San Francisco Veteran Affairs Medical Center, San Francisco, California, USA.,Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Sabra S Inslicht
- Stress and Health Research Program, San Francisco Veteran Affairs Medical Center, San Francisco, California, USA.,Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
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43
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Ceresoli-Borroni G, Liranso T, Brittain ST, Connor DF, Evans CJ, Findling RL, Hwang S, Candler SA, Robb AS, Nasser A, Schwabe S. A Novel Assessment Tool for Impulsive Aggression in Children with Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 2019; 29:592-598. [PMID: 31369291 PMCID: PMC6786341 DOI: 10.1089/cap.2019.0035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: To establish the validity and reliability of a provisional 30-item impulsive aggression (IA) diary in children (ages 6-12 years, inclusive) with attention-deficit/hyperactivity disorder (ADHD). Methods: The provisional 30-item IA diary was administered for 14 days to parents of children with ADHD and IA symptoms (n = 103). Key inclusion criteria: confirmed ADHD diagnosis; signs of IA as measured by a Retrospective-Modified Overt Aggression Scale (R-MOAS) score ≥20 and an Aggression Questionnaire score of -2 to -5. Analyses included inter-item correlations, exploratory factor analysis (EFA), item response theory (IRT) modeling, internal consistency, test-retest reliability (TRT), concurrent validity (estimated by correlation between the IA diary and the R-MOAS/Nisonger Child Behavior Rating Form), and known-groups methods. Results: The prevalence rates of 15 (50.0%) items were found to be too low (<1%) for analysis; three items with prevalence rates ≤1% were retained, as content validity was deemed high by clinical experts. The remaining 12 behavior items had prevalence rates of 2.7%-73.6%. EFA and IRT models confirmed two subdomains in the IA diary included within a general domain of IA behavior frequency, yielding a single total behavioral frequency score (TBFS). Internal consistency was high for this TBFS (marginal reliability = 0.86 and α = 0.73). TRT for the TBFS, based on the intraclass correlation coefficient, was 0.8. Concurrent validity of TBFS with R-MOAS ranged from r = 0.49 to r = 0.62. Conclusion: The final 15-item IA diary is a reliable, psychometrically validated IA measurement tool that will allow clinicians and researchers to assess the frequency of IA behavior.
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Affiliation(s)
| | - Tesfaye Liranso
- Department of Clinical Research, Supernus Pharmaceuticals, Inc., Rockville, Maryland
| | - Scott T. Brittain
- Department of Clinical Research, Supernus Pharmaceuticals, Inc., Rockville, Maryland
| | - Daniel F. Connor
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut
| | | | - Robert L. Findling
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Kennedy Krieger Institute, Baltimore, Maryland
| | - Steve Hwang
- Department of Research Science, Endpoint Outcomes, Boston, Massachusetts
| | - Shawn A. Candler
- Department of Medical Affairs, Supernus Pharmaceuticals, Inc., Rockville, Maryland
| | - Adelaide S. Robb
- Department of Psychiatry and Behavioral Sciences, Children's National Medical Center, Washington, District of Columbia
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, District of Columbia
| | - Azmi Nasser
- Department of Clinical Research, Supernus Pharmaceuticals, Inc., Rockville, Maryland
| | - Stefan Schwabe
- Department of Research and Development, Supernus Pharmaceuticals, Inc., Rockville, Maryland
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44
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Khamis V. Posttraumatic stress disorder and emotion dysregulation among Syrian refugee children and adolescents resettled in Lebanon and Jordan. CHILD ABUSE & NEGLECT 2019; 89:29-39. [PMID: 30612072 DOI: 10.1016/j.chiabu.2018.12.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 12/11/2018] [Accepted: 12/17/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Since the outbreak of the conflict in Syria, many people, including children and adolescents, have fled their homes into neighboring countries. Little research exists on the psychosocial adjustment of refugee children and adolescents resettled in Lebanon and Jordan. OBJECTIVE This study investigated the prevalence and predictors of PTSD and emotion dysregulation in Syrian refugee children and adolescents who resettled in Lebanon and Jordan. It was hypothesized that a combination of pre-trauma variables (age and gender), trauma-specific variables (traumatic events and time spent in host country, and host country), and post-trauma variables (coping strategies, family relationships, and school environment) would be associated with PTSD and emotion dysregulation. PARTICIPANTS AND SETTING Participants were 1000 Syrian refugee children and adolescents aged 7-18 years attending formal and non-formal schools representing various governorates in Lebanon and Jordan. METHODS The trauma exposure scale, DSM-IV criteria for the assessment of PTSD, the Difficulties in Emotion Regulation Scale Short Form, Kidcope, Family relationship scales, and school environment scale were administered in an interview format with children and adolescents at school by two trained psychologists. Multivariate binary logistic regression was used to predict PTSD whereas hierarchical multiple regression was used to predict emotion dysregulation. RESULTS Results indicated that 45.6% of the refugees have developed PTSD with excessive risk for comorbidity with emotion dysregulation. Emotion dysregulation was reported by older refugee children and adolescents. The prevalence of PTSD was higher in refugee children and adolescents who had resettled in Lebanon than for those who had resettled in Jordan. Refugee children and adolescents who were exposed to higher levels of war atrocities evidenced the greatest prevalence of PTSD and emotion dysregulation. PTSD symptomatology and emotion dysregulation in children and adolescents varied according to coping styles, family relationships, and school environment. Both decreased significantly with the passage of time spent in host country. CONCLUSIONS The results may be used to formulate cognitive-behavioral coping interventions that can lead to optimal developmental outcomes in the posttrauma environment.
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Affiliation(s)
- Vivian Khamis
- American University of Beirut, Faculty of Arts & Sciences, Department of Education, Bliss Street-P.O. Box 11-0236, Beirut, Lebanon.
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45
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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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46
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Anger, social support, and suicide risk in U.S. military veterans. J Psychiatr Res 2019; 109:139-144. [PMID: 30537566 DOI: 10.1016/j.jpsychires.2018.11.026] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 11/23/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
Abstract
There have been considerable efforts to understand, predict, and reduce suicide among U.S. military veterans. Studies have shown that posttraumatic stress disorder (PTSD), major depression (MDD), and traumatic brain injury (TBI) increase risk of suicidal behavior in veterans. Limited research has examined anger and social support as factors linked to suicidal ideation, which if demonstrated could lead to new, effective strategies for suicide risk assessment and prevention. Iraq/Afghanistan era veterans (N = 2467) were evaluated in the ongoing Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC) multi-site Study of Post-Deployment Mental Health on demographic and psychological variables. Analyses revealed that suicidal ideation in veterans was positively associated with anger and negatively associated with social support. These results remained significant in multivariate logistic regression models controlling for relevant variables including PTSD, MDD, and TBI. Examining interrelationships among these variables, the analyses revealed that the association between PTSD and suicidal ideation was no longer statistically significant once anger was entered in the regression models. Further, it was found that TBI was associated with suicidal ideation in veterans with MDD but not in veterans without MDD. These findings provide preliminary evidence that suicide risk assessment in military veterans should include clinical consideration of the roles of anger and social support in addition to PTSD, MDD, and TBI. Further, the results suggest that suicide prevention may benefit from anger management interventions as well as interventions aimed at bolstering social and family support as treatment adjuncts to lower suicide risk in veterans.
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47
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Cunningham KC, Grossmann JL, Seay KB, Dennis PA, Clancy CP, Hertzberg MA, Berlin K, Ruffin R, Dedert EA, Gratz KL, Calhoun PS, Beckham JC, Kimbrel NA. Nonsuicidal Self-Injury and Borderline Personality Features as Risk Factors for Suicidal Ideation Among Male Veterans With Posttraumatic Stress Disorder. J Trauma Stress 2019; 32:141-147. [PMID: 30694575 PMCID: PMC7262676 DOI: 10.1002/jts.22369] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 11/08/2022]
Abstract
U.S. veterans are at increased risk for suicide compared to their civilian counterparts and account for approximately 20% of all deaths by suicide. Posttraumatic stress disorder (PTSD) and borderline personality features (BPF) have each been associated with increased suicide risk. Additionally, emerging research suggests that nonsuicidal self-injury (NSSI) may be a unique risk factor for suicidal behavior. Archival data from 728 male veterans with a PTSD diagnosis who were receiving care through an outpatient Veterans Health Administration (VHA) specialty PTSD clinic were analyzed. Diagnosis of PTSD was based on a structured clinical interview administered by trained clinicians. A subscale of the Personality Assessment Inventory was used to assess BPF, and NSSI and suicidal ideation (SI) were assessed by self-report. Findings revealed that NSSI (58.8%) and BPF (23.5%) were both relatively common in this sample of male veterans with PTSD. As expected, each condition was associated with significantly increased odds of experiencing SI compared to PTSD alone, odds ratios (ORs) = 1.2-2.6. Moreover, co-occurring PTSD, NSSI, and BPF were associated with significantly increased odds of experiencing SI compared with PTSD, OR = 5.68; comorbid PTSD and NSSI, OR = 2.57; and comorbid PTSD and BPF, OR = 2.13. The present findings provide new insight into the rates of NSSI and BPF among male veterans with PTSD and highlight the potential importance of these factors in suicide risk.
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Affiliation(s)
- Katherine C. Cunningham
- Durham Veterans Affairs Medical Center; Durham, North Carolina, USA,The VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, North Carolina, USA
| | | | | | - Paul A. Dennis
- Durham Veterans Affairs Medical Center; Durham, North Carolina, USA,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center; Durham, North Carolina, USA
| | | | - Michael A. Hertzberg
- Durham Veterans Affairs Medical Center; Durham, North Carolina, USA,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center; Durham, North Carolina, USA
| | - Kate Berlin
- Durham Veterans Affairs Medical Center; Durham, North Carolina, USA
| | - Rachel Ruffin
- Durham Veterans Affairs Medical Center; Durham, North Carolina, USA
| | - Eric A. Dedert
- Durham Veterans Affairs Medical Center; Durham, North Carolina, USA,The VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, North Carolina, USA,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center; Durham, North Carolina, USA
| | - Kim L. Gratz
- Department of Psychology, University of Toledo; Toledo, Ohio, USA
| | - Patrick S. Calhoun
- Durham Veterans Affairs Medical Center; Durham, North Carolina, USA,The VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, North Carolina, USA,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center; Durham, North Carolina, USA,VA Center for Health Services Research in Primary Care; Durham, North Carolina, USA
| | - Jean C. Beckham
- Durham Veterans Affairs Medical Center; Durham, North Carolina, USA,The VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, North Carolina, USA,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center; Durham, North Carolina, USA
| | - Nathan A. Kimbrel
- Durham Veterans Affairs Medical Center; Durham, North Carolina, USA,The VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, North Carolina, USA,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center; Durham, North Carolina, USA
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48
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Nonsuicidal self-injury among adolescents and young adults with prolonged exposure to violence: The effect of post-traumatic stress symptoms. Psychiatry Res 2018; 270:510-516. [PMID: 30347378 DOI: 10.1016/j.psychres.2018.10.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 08/14/2018] [Accepted: 10/08/2018] [Indexed: 01/02/2023]
Abstract
Less is known about nonsuicidal self-injury (NSSI) among adolescents and young adults living in areas under prolonged political violence. This study aims to explore the frequencies of NSSI as well as the severity of post-traumatic stress symptoms (PTSS), depression, anxiety, and sleep problems among 889 Palestinian adolescents and young adults. The participants completed self-report questionnaires assessing NSSI, PTSS, depression, anxiety symptoms, and sleep difficulties. The results found that 13.8% of the total sample are frequently engaging in some form of NSSI behavior. Moreover, 43.1% exhibited severe symptoms of PTSD, and almost one-third of the sample reported severe symptoms of depression (30.1%); more than two-thirds of the sample (68.4%) experience sleep difficulties. Those who engage in NSSI were found to be at higher risk for sleep problems, depression, and PTSS. Avoidance/numbing, as well as hyperarousal symptoms clusters of PTSS, were significantly associated with NSSI above and beyond depressive symptoms. These results suggest that NSSI is frequently a sequelae of prolonged exposure to trauma and violence, and highlight the importance of routine assessment of this behavior. It is crucial to be familiar with the association between PTSS, sleep difficulties, and NSSI in a clinical setting to implement programs focusing on preventing these domains.
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49
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Kois LE, Blakey SM, Gardner BO, McNally MR, Johnson JL, Hamer RM, Elbogen EB. Neuropsychological correlates of self-reported impulsivity and informant-reported maladaptive behaviour among veterans with posttraumatic stress disorder and traumatic brain injury history. Brain Inj 2018; 32:1484-1491. [PMID: 30036112 DOI: 10.1080/02699052.2018.1497205] [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: 10/28/2022]
Abstract
OBJECTIVE Frontal lobe deficits resulting from traumatic brain injury (TBI) and/or posttraumatic stress disorder (PTSD) have been linked to impulsive behaviour. We sought to examine whether neuropsychological performance predicted self-reported impulsivity and informant-reported maladaptive behaviour. METHOD We administered the Delis-Kaplan Executive Function System (D-KEFS) to 116 Iraq/Afghanistan-era veterans diagnosed with a history of TBI and PTSD. RESULTS Poorer performance on D-KEFS Stroop Task (both colour and word, separately) and Trail making (letter sequencing and motor speed) tasks and higher PTSD symptom severity were associated with higher self-reported impulsivity. Trail making letter sequencing performance was negatively associated with informant-reported maladaptive behaviour. Regression analyses revealed PTSD symptom severity and Trail making letter sequencing best predicted self-reported impulsivity, even when accounting for age, sex, and education. Only Trail making letter sequencing predicted informant-reported maladaptive behaviour when accounting for other variables in the model. CONCLUSIONS Attention and processing speed impairments and PTSD symptom severity appear to be important predictors of impulsivity and problematic behaviour among veterans. Findings have implications for theoretical models of aggression and violence and inform the assessment and treatment of individuals with TBI and PTSD.
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Affiliation(s)
- Lauren E Kois
- a Department of Psychology, John Jay College , City University of New York , New York , NY , USA
| | - Shannon M Blakey
- b Department of Psychology and Neuroscience , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Brett O Gardner
- c Institute of Law, Psychiatry, and Public Policy , University of Virginia , Charlottesville , VA , USA
| | - Matthew R McNally
- d Department of Psychology , West Virginia University , Morgantown , WV , USA
| | - Jacqueline L Johnson
- e Department of Psychiatry , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Robert M Hamer
- e Department of Psychiatry , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Eric B Elbogen
- f Department of Psychiatry and Behavioral Sciences , Duke University School of Medicine , Durham , NC , USA
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50
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Van Voorhees EE, Moore DA, Kimbrel NA, Dedert EA, Dillon KH, Elbogen EB, Calhoun PS. Association of posttraumatic stress disorder and traumatic brain injury with aggressive driving in Iraq and Afghanistan combat veterans. Rehabil Psychol 2018; 63:160-166. [PMID: 29553791 DOI: 10.1037/rep0000178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE Aggressive driving contributes to the high rates of postdeployment motor vehicle-related injury and death observed among veterans, and veterans cite problems with anger, aggressive driving, and road rage as being among their most pressing driving-related concerns. Both posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) have been associated with driving-related deficits in treatment-seeking samples of veterans, but the relative contribution of each of these conditions to problems with aggressive driving in the broader population of combat veterans is unclear. METHOD χ2 and logistic regression analyses were used to examine the relative association of PTSD, TBI, and co-occurring PTSD and TBI to self-reported problems with road rage in a sample of 1,102 veterans living in the mid-Atlantic region of the United States who had served in Afghanistan or Iraq. RESULTS Results indicate that controlling for relevant demographic variables, PTSD without TBI (odds ratio = 3.44, p < .001), and PTSD with co-occurring TBI (odds ratio = 4.71, p < .001) were associated with an increased risk of road rage, but TBI without PTSD was not. CONCLUSIONS Our findings suggest that PTSD, with or without comorbid TBI, may be associated with an increased risk of aggressive driving in veterans. Clinical implications for treating problems with road rage are discussed, including use of interventions targeting hostile interpretation bias and training in emotional and physiological arousal regulation skills. (PsycINFO Database Record
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Affiliation(s)
| | | | | | | | - Kirsten H Dillon
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
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