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Schumm H, Krüger-Gottschalk A, Dyer A, Pittig A, Cludius B, Takano K, Alpers GW, Ehring T. Mechanisms of Change in Trauma-Focused Treatment for PTSD: The Role of Rumination. Behav Res Ther 2021; 148:104009. [PMID: 34823161 DOI: 10.1016/j.brat.2021.104009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/26/2021] [Accepted: 11/16/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Cognitive behavioral therapy (CBT) has been well established in the treatment of posttraumatic stress disorder (PTSD). In recent years, researchers have begun to investigate its underlying mechanisms of change. Dysfunctional cognitive content, i.e. excessively negative appraisals of the trauma or its consequences, has been shown to predict changes in PTSD symptoms over the course of treatment. However, the role of change in cognitive processes, such as trauma-related rumination, needs to be addressed. The present study investigates whether changes in rumination intensity precede and predict changes in symptom severity. We also explored the extent to which symptom severity predicts rumination. METHOD As part of a naturalistic effectiveness study evaluating CBT for PTSD in routine clinical care, eighty-eight patients with PTSD completed weekly measures of rumination and symptom severity. Lagged associations between rumination and symptoms in the following week were examined using linear mixed models. RESULTS Over the course of therapy, both ruminative thinking and PTSD symptoms decreased. Rumination was a significant predictor of PTSD symptoms in the following week, although this effect was at least partly explained by the time factor (e.g., natural recovery or inseparable treatment effects). Symptom severity predicted ruminative thinking in the following week even with time as an additional predictor. CONCLUSIONS The present study provides preliminary evidence that rumination in PTSD is reduced by CBT for PTSD but does not give conclusive evidence that rumination is a mechanism of change in trauma-focused treatment for PTSD.
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Affiliation(s)
- Hannah Schumm
- Department of Psychology, LMU Munich, Leopoldstr. 13, Munich, Germany.
| | | | - Anne Dyer
- ZISG Mannheim, Central Institute of Mental Health, J 5, 68159, Mannheim, Germany.
| | - Andre Pittig
- Translational Psychotherapy, Department of Psychology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Nägelsbachstr. 49a, 91051, Erlangen, Germany.
| | - Barbara Cludius
- Department of Psychology, LMU Munich, Leopoldstr. 13, Munich, Germany.
| | - Keisuke Takano
- Department of Psychology, LMU Munich, Leopoldstr. 13, Munich, Germany.
| | - Georg W Alpers
- Department of Psychology, School of Social Sciences, University of Mannheim, L 13, 17, 68163, Mannheim, Germany.
| | - Thomas Ehring
- Department of Psychology, LMU Munich, Leopoldstr. 13, Munich, Germany.
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2
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Radell ML, Hamza EA, Moustafa AA. Depression in post-traumatic stress disorder. Rev Neurosci 2021; 31:703-722. [PMID: 32866132 DOI: 10.1515/revneuro-2020-0006] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 05/31/2020] [Indexed: 12/12/2022]
Abstract
Major depressive disorder (MDD) symptoms commonly occur after trauma-exposure, both alone and in combination with post-traumatic stress disorder (PTSD). This article reviews recent research on comorbidity between these disorders, including its implications for symptom severity and response to treatment. Despite considerable symptom overlap, the two disorders represent distinct constructs and depend, at least in part, on separate biological mechanisms. Both, however, are also clearly related to stress psychopathology. We recommend that more research focus specifically on the study of individual differences in symptom expression in order to identify distinct subgroups of individuals and develop targeted treatments. However, a barrier to this line of inquiry is the trend of excluding particular patients from clinical trials of new interventions based on symptom severity or comorbidity. Another obstacle is the overreliance on self-report measures in human research. We argue that developing computer-based behavioral measures in order to supplement self-report can help address this challenge. Furthermore, we propose that these measures can help tie findings from human and non-human animal research. A number of paradigms have been used to model MDD-and PTSD-like behavior in animals. These models remain valuable for understanding the biological basis of these disorders in humans and for identifying potential interventions, but they have been underused for the study of comorbidity. Although the interpretation of animal behavior remains a concern, we propose that this can also be overcome through the development of close human analogs to animal paradigms.
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Affiliation(s)
- Milen L Radell
- Department of Psychology, Niagara University, Lewiston, NY, USA
| | - Eid Abo Hamza
- Department of Mental Health, Faculty of Education, Tanta University, Tanta, Egypt
| | - Ahmed A Moustafa
- School of Psychology, Western Sydney University, Sydney, NSW, Australia.,Marcs Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, NSW, Australia.,Department of Human Anatomy and Physiology, The Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
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3
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Kovács LN, Kocsel N, Galambos A, Magi A, Demetrovics Z, Kökönyei G. Validating the bifactor structure of the Ruminative Thought Style Questionnaire-A psychometric study. PLoS One 2021; 16:e0254986. [PMID: 34310621 PMCID: PMC8312922 DOI: 10.1371/journal.pone.0254986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 07/07/2021] [Indexed: 11/19/2022] Open
Abstract
The Ruminative Thought Style Questionnaire (RTSQ) is a self-report measure that aims to capture rumination globally, unbiased by depressive symptoms. We explored its psychometric properties among university students (N = 1123), as the existing models about the factor structure of the RTSQ have been inconclusive. In a second study (N = 320) we tested its convergent validity compared to the Ruminative Response Scale (RRS) and its construct validity compared to the Zung Self-rating Depression Scale (ZSDS). The results of Study 1 suggest that the factor structure of the RTSQ is best described with a 19-item bifactor Exploratory Structural Equation Modelling (ESEM), where most of the variance is explained by the general factor. The model was found to be invariant across genders. The correlations in Study 2 demonstrated that the RTSQ is congruent with the RRS, and that rumination captured by the RTSQ is rather maladaptive, as it was more strongly associated with the brooding subscale of the RRS than with reflective pondering. Significant positive associations were found with depressive symptoms, reaffirming the validity of the RTSQ due to the well-known association between rumination and depressive symptoms. Our results support that RTSQ assesses rumination globally, and it is a valid measure of ruminative thinking style that is rather negatively valenced but does not solely focus on depressive mood and symptoms.
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Affiliation(s)
- Lilla Nóra Kovács
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Natália Kocsel
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Attila Galambos
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Anna Magi
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Gyöngyi Kökönyei
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- SE-NAP2 Genetic Brain Imaging Migraine Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
- Faculty of Pharmacy, Department of Pharmacodynamics, Semmelweis University, Budapest, Hungary
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4
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Brown WJ, Hetzel-Riggin MD, Mitchell MA, Bruce SE. Rumination Mediates the Relationship Between Negative Affect and Posttraumatic Stress Disorder Symptoms in Female Interpersonal Trauma Survivors. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:6418-6439. [PMID: 30556467 DOI: 10.1177/0886260518818434] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Prior research has identified both rumination and negative affect (NA) as dimensional constructs related to the development and maintenance of posttraumatic stress disorder (PTSD). While both dimensions demonstrate significant positive relationships with symptoms of PTSD, the relationship between the two within the context of the disorder has yet to be explored. Consistent with prior research in the social anxiety literature, the present study seeks to examine a model of mediation by which rumination accounts for the significant relationship between NA and PTSD symptoms. Participants included 65 female interpersonal trauma survivors diagnosed with PTSD using structured, clinician-administered interviews. Both NA and rumination were observed as significant predictors of PTSD symptoms, and the variables were significantly associated with each other. However, NA was no longer a significant predictor of PTSD symptoms when rumination was entered into the mediation model, suggesting full mediation of the relationship by rumination. Results from the current study suggest a complex relationship between NA and rumination in interpersonal trauma survivors with PTSD, such that a ruminative cognitive coping style may either mitigate or exacerbate PTSD symptoms in the presence of sustained negative emotion. The current findings provide support for a cognitive model of PTSD, within which PTSD symptoms are influenced via negative, ruminative cognitions. Primary implications of these results include (a) the consideration of assessment of rumination in interpersonal trauma survivors with PTSD in clinical settings; (b) the selection of treatment that may address a ruminative cognitive style in this population, given the mediation between subjective distress and PTSD symptoms by rumination; and (c) the necessity for the validation of this mediation model within other traumatized populations.
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Affiliation(s)
- Wilson J Brown
- Pennsylvania State University, The Behrend College, Erie, USA
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5
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Hoppen TH, Heinz-Fischer I, Morina N. If only… a systematic review and meta-analysis of social, temporal and counterfactual comparative thinking in PTSD. Eur J Psychotraumatol 2020; 11:1737453. [PMID: 32341763 PMCID: PMC7170331 DOI: 10.1080/20008198.2020.1737453] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 11/03/2022] Open
Abstract
Comparative thinking is ubiquitous in human cognition. Empirical evidence is accumulating that PTSD symptomatology is linked to various changes in social, temporal and counterfactual comparative thinking. However, no systematic review and meta-analysis in this line of research have been conducted to this date. We searched titles, abstracts and subject terms of electronic records in PsycInfo and Medline from inception to January 2019 with various search terms for social, temporal and counterfactual comparative thinking as well as PTSD. Journal articles were included if they reported a quantitative association between PTSD and social, temporal and/or counterfactual comparative thinking in trauma-exposed clinical or sub-clinical samples. A total of 36 publications were included in the qualitative synthesis. The number of publications on the association between PTSD and social and temporal comparative thinking was too scarce to warrant a meta-analytic review. A narrative review of available literature suggests that PTSD is associated with distortions in social and temporal comparative thinking. A meta-analysis of 24 independent samples (n = 4423) assessing the association between PTSD and the frequency of counterfactual comparative thinking yielded a medium to large positive association of r =.464 (p <.001, 95% CI =.404; .520). Higher study quality was associated with higher magnitude of association in a meta-regression. Most studies collected data cross-sectionally, precluding conclusions regarding causality. Overall, study quality was found to be moderate. More longitudinal and experimental research with validated comparative thinking measures in clinical samples is needed to acquire a more sophisticated understanding of the role of comparative cognitions in the aetiology and maintenance of PTSD. Comparative thinking might be a fruitful avenue for a better understanding of posttraumatic reactions and improving treatment.
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Affiliation(s)
- Thole H. Hoppen
- Institute of Psychology, University of Münster, Münster, Germany
| | | | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany
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6
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Elhai JD, Yang H, Dempsey AE, Montag C. Rumination and negative smartphone use expectancies are associated with greater levels of problematic smartphone use: A latent class analysis. Psychiatry Res 2020; 285:112845. [PMID: 32045821 DOI: 10.1016/j.psychres.2020.112845] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/29/2020] [Accepted: 02/02/2020] [Indexed: 01/26/2023]
Abstract
Problematic smartphone use (PSU) is related to psychopathology symptoms, such as depression and anxiety. However, less is known about how responses to and coping with psychopathology correlate with PSU. We conducted a web survey of 286 American college students, querying depression and anxiety symptoms, rumination (a coping process to avoid negative emotion), PSU, and expectancies about smartphone use for mood alleviation. We conducted latent class analysis (LCA) of PSU symptom ratings, finding support for two latent subgroups of participants, involving mild and severe PSU, especially distinguished by severity of withdrawal symptoms. Rumination and negative smartphone use expectancies (i.e., to reduce distress) positively related to the more symptomatic PSU class. Results are discussed in context of the I-PACE theoretical model of problematic internet use (PIU). We emphasize the importance of response variables in I-PACE, such as internet-related cognitive bias and coping, over background psychopathology variables in influencing PIU and PSU.
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Affiliation(s)
- Jon D Elhai
- Academy of Psychology and Behavior, Tianjin Normal University, No. 57-1 Wujiayao Street, Hexi District, Tianjin, 300074, China; Department of Psychology, University of Toledo, 2801 West Bancroft Street, Toledo, Ohio, 43606, USA; Department of Psychiatry, University of Toledo, 3000 Arlington Avenue, Toledo, Ohio, 43614, USA.
| | - Haibo Yang
- Academy of Psychology and Behavior, Tianjin Normal University, No. 57-1 Wujiayao Street, Hexi District, Tianjin, 300074, China
| | - Abigail E Dempsey
- Department of Psychology, University of Toledo, 2801 West Bancroft Street, Toledo, Ohio, 43606, USA
| | - Christian Montag
- Department of Molecular Psychology, Institute of Psychology and Education, Ulm University, 89081 Ulm, Germany
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7
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Makovac E, Fagioli S, Rae CL, Critchley HD, Ottaviani C. Can't get it off my brain: Meta-analysis of neuroimaging studies on perseverative cognition. Psychiatry Res Neuroimaging 2020; 295:111020. [PMID: 31790922 DOI: 10.1016/j.pscychresns.2019.111020] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 12/12/2022]
Abstract
Perseverative cognition (i.e. rumination and worry) describes intrusive, uncontrollable, repetitive thoughts. These negative affective experiences are accompanied by physiological arousal, as if the individual were facing an external stressor. Perseverative cognition is a transdiagnostic symptom, yet studies of neural mechanisms are largely restricted to specific clinical populations (e.g. patients with major depression). The present study applied activation likelihood estimation (ALE) meta-analyses to 43 functional neuroimaging studies of perseverative cognition to elucidate the neurobiological substrates across individuals with and without psychopathological conditions. Task-related and resting state functional connectivity studies were examined in separate meta-analyses. Across task-based studies, perseverative cognition engaged medial frontal gyrus, cingulate gyrus, insula, and posterior cingulate cortex. Resting state functional connectivity studies similarly implicated posterior cingulate cortex together with thalamus and anterior cingulate cortex (ACC), yet the involvement of ACC distinguished between perseverative cognition in healthy controls (HC) and clinical groups. Perseverative cognition is accompanied by the engagement of prefrontal, insula and cingulate regions, whose interaction may support the characteristic conjunction of self-referential and affective processing with (aberrant) cognitive control and embodied (autonomic) arousal. Within this context, ACC engagement appears critical for the pathological expression of rumination and worry.
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Affiliation(s)
- Elena Makovac
- Centre for Neuroimaging Science, Kings College London, London, UK.
| | - Sabrina Fagioli
- Department of Education, University of Roma Tre, Rome, Italy; Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Charlotte L Rae
- School of Psychology, University of Sussex, Falmer, UK; Sackler Centre for Consciousness Science, University of Sussex, Falmer, UK
| | - Hugo D Critchley
- Sackler Centre for Consciousness Science, University of Sussex, Falmer, UK; Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK
| | - Cristina Ottaviani
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy; Department of Psychology, Sapienza University of Rome, Rome, Italy
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8
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Kocsel N, Köteles F, Szemenyei E, Szabó E, Galambos A, Kökönyei G. The association between perseverative cognition and resting heart rate variability: A focus on state ruminative thoughts. Biol Psychol 2019; 145:124-133. [PMID: 31051207 DOI: 10.1016/j.biopsycho.2019.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 04/08/2019] [Accepted: 04/13/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Two studies were conducted to shed light on the associations between trait and state rumination and worry and a time-domain metric of heart rate variability, the root mean square of successive differences (RMSSD) of cardiac interbeat-interval (IBI). METHOD Study 1 involved 130 healthy adults (118 females; mean age = 23.4 ± 3.59 years), while 72 healthy participants (58 females; mean age = 22.2 ± 1.79 years) were involved in Study 2. RMSSD was calculated from a 5-min baseline recording and state ruminative thoughts were assessed during measurement. Trait perseverative cognitions were measured using self-reported questionnaires. RESULTS In Study 1, we found that a higher level of state but not trait ruminative thoughts showed weak negative association with lnRMSSD. In Study 2, we replicated the results of Study 1 and we found that trait reflection moderated the relationship between state rumination and lnRMSSD. CONCLUSION State rumination may reflect actual cardiovascular activity better than trait preservative cognitions, although trait reflection could be a protective factor.
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Affiliation(s)
- Natália Kocsel
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; SE-NAP2 Genetic Brain Imaging Migraine Research Group, Semmelweis University, Budapest, Hungary; Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - Ferenc Köteles
- Institution of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Eszter Szemenyei
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Edina Szabó
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
| | - Attila Galambos
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
| | - Gyöngyi Kökönyei
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; SE-NAP2 Genetic Brain Imaging Migraine Research Group, Semmelweis University, Budapest, Hungary; Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary.
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9
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Adams SW, Allwood MA, Bowler RM. Posttraumatic Stress Trajectories in World Trade Center Tower Survivors: Hyperarousal and Emotional Numbing Predict Symptom Change. J Trauma Stress 2019; 32:67-77. [PMID: 30667549 DOI: 10.1002/jts.22357] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 08/17/2018] [Accepted: 08/27/2018] [Indexed: 01/01/2023]
Abstract
There is a paucity of knowledge concerning the underlying symptomatology of heterogeneous posttraumatic stress symptom (PTSS) trajectories following mass trauma, such as a terrorist attack. This study examined longitudinal PTSS trajectories using latent growth mixture modeling in 2,355 World Trade Center (WTC) tower survivors surveyed by the WTC Health Registry an average of 2.5, 5.5, and 10.5 years after the September 11, 2001 terrorist attacks. Covariates included sociodemographic characteristics, WTC-related exposure, and other traumas/stressors. Four curvilinear PTSS trajectories were identified: low symptom (74.9%), recovering (8.0%), worsening (6.7%), and chronic (10.4%). The majority of WTC survivors (85.3%) maintained stable symptom trajectories over time, with PTSS changes occurring less often. Although WTC-related exposure was associated with initial PTSS severity, exposure was not associated with chronicity or change of PTSS over time. Male gender and a higher number of post-WTC disaster life-stressors were associated with worsening symptom severity over time. Individuals with more severe hyperarousal symptoms at Wave 1, particularly of anxious arousal, were more likely to have PTSS that worsened over time, adjusted odds ratio (aOR) = 1.55. Less severe emotional numbing symptoms, particularly of dysphoria, at Wave 1, were marginally significantly associated with subsequent PTSS recovery, aOR = 0.75. Interventions that target hyperarousal and emotional numbing symptoms may mitigate a worsening of symptoms and facilitate posttraumatic recovery following future mass traumas, such as terrorist attacks. Further clinical implications are discussed.
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Affiliation(s)
- Shane W Adams
- Department of Psychology, John Jay College of Criminal Justice of The City University of New York, New York, New York, USA.,Department of Psychology, The Graduate Center of The City University of New York, New York, New York, USA
| | - Maureen A Allwood
- Department of Psychology, John Jay College of Criminal Justice of The City University of New York, New York, New York, USA.,Department of Psychology, The Graduate Center of The City University of New York, New York, New York, USA
| | - Rosemarie M Bowler
- Department of Psychology, San Francisco State University, San Francisco, California, USA
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10
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Erwin MC, Mitchell MA, Contractor AA, Dranger P, Charak R, Elhai JD. The relationship between distress tolerance regulation, counterfactual rumination, and PTSD symptom clusters. Compr Psychiatry 2018; 82:133-140. [PMID: 29477706 DOI: 10.1016/j.comppsych.2018.01.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 12/17/2017] [Accepted: 01/28/2018] [Indexed: 11/18/2022] Open
Affiliation(s)
- Meredith Claycomb Erwin
- Department of Psychology, University of Toledo, 2801 West Bancroft Street, MS #948, Toledo, OH 43606, United States
| | - Melissa A Mitchell
- Summa Health Traumatic Stress Center, St. Thomas Campus, 444 North Main Street, Akron, OH 44310, United States
| | - Ateka A Contractor
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX 76203, United States
| | - Paula Dranger
- Counseling Services, and Sexual Assault Awareness and Facilitative Education Office (SAAFE), Valparaiso University, 1602 LaPorte Ave., Valparaiso, IN 46383, United States
| | - Ruby Charak
- Department of Psychological Science, The University of Texas Rio Grande Valley, ELABN 361, 1201 West University Drive, Edinburg, TX 78539, United States
| | - Jon D Elhai
- Department of Psychology, University of Toledo, 2801 West Bancroft Street, MS #948, Toledo, OH 43606, United States; Department of Psychiatry, University of Toledo, 3000 Arlington Avenue, Toledo, OH 43606, United States
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11
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Viana AG, Paulus DJ, Garza M, Lemaire C, Bakhshaie J, Cardoso JB, Ochoa-Perez M, Valdivieso J, Zvolensky MJ. Rumination and PTSD symptoms among trauma-exposed Latinos in primary care: Is mindful attention helpful? Psychiatry Res 2017; 258:244-249. [PMID: 28843627 DOI: 10.1016/j.psychres.2017.08.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 08/09/2017] [Accepted: 08/18/2017] [Indexed: 11/29/2022]
Abstract
The present investigation examined the moderating role of mindful attention in the relation between rumination and posttraumatic stress (PTS) symptoms (i.e., re-experiencing, avoidance, arousal, and total PTSD symptoms) among trauma-exposed Latinos in a primary care medical setting. It was hypothesized that mindful attention would moderate, or lessen, the relation between rumination and all facets of PTS, even after controlling for clinically relevant covariates. Participants included 182 trauma-exposed adult Latinos (89.0% female; Mage = 37.8, SD = 10.6% and 95.1% reported Spanish as their first language) attending a community-based integrated healthcare clinic in the Southwestern United States. Mindful attention was a significant moderator of relations between rumination and all PTS facets. Specifically, rumination and PTSD symptoms were significantly related yet only in the context of low (vs. high) levels of mindful attention. Mindfulness-based skills may offer incremental value to established treatment protocols for traumatic stress, especially when high levels of rumination are present. Rumination may also serve to identify those who are at greatest risk for developing PTSD after trauma exposure and, therefore, most likely to benefit from mindfulness-based strategies.
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Affiliation(s)
- Andres G Viana
- Department of Psychology, University of Houston, Houston, TX, USA.
| | - Daniel J Paulus
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Monica Garza
- Legacy Community Health Services, Houston, TX, USA
| | - Chad Lemaire
- Legacy Community Health Services, Houston, TX, USA
| | - Jafar Bakhshaie
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Jodi Berger Cardoso
- Jodi Berger Cardoso, School of Social Work, University of Houston, Houston, TX, USA
| | | | | | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA; The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX, USA.
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12
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Buchholz KR, Bruce SE, Koucky EM, Artime TM, Wojtalik JA, Brown WJ, Sheline YI. Neural Correlates of Trait Rumination During an Emotion Interference Task in Women With PTSD. J Trauma Stress 2016; 29:317-24. [PMID: 27472504 PMCID: PMC4988896 DOI: 10.1002/jts.22112] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Rumination, defined as repetitive, negative, self-focused thinking, is hypothesized to be a transdiagnostic factor that is associated with depression, anxiety, and posttraumatic stress disorder (PTSD). Theory has suggested that in individuals with PTSD, rumination serves as a cognitive avoidance factor that contributes to the maintenance of symptoms by inhibiting the cognitive and emotional processing of the traumatic event, subsequently interfering with treatment engagement and outcome. Little is known about the neural correlates of rumination in women with PTSD. The current study utilized functional magnetic resonance imaging (fMRI) to examine neural correlates during an emotion interference task of self-reported rumination in women with PTSD. Women with PTSD (39 participants) were recruited at a university-based trauma clinic and completed a clinical evaluation that included measures of PTSD symptoms, rumination, and depressive symptoms, as well as a neuroimaging session in which the participants were administered an emotion interference task. There was a significant relationship between self-reported rumination and activity in the right orbital frontal cortex, BA 11; t(37) = 5.62, p = .004, k = 46 during the task. This finding suggested that women with PTSD, who had higher levels of rumination, may experience greater difficulty inhibiting negative emotional stimuli compared to women with lower levels of rumination.
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Affiliation(s)
- Katherine R. Buchholz
- Department of Psychology, University of Missouri-St. Louis, St. Louis, Missouri, USA
| | - Steven E. Bruce
- Department of Psychology, University of Missouri-St. Louis, St. Louis, Missouri, USA,Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Ellen M. Koucky
- Department of Psychology, University of Missouri-St. Louis, St. Louis, Missouri, USA
| | - Tiffany M. Artime
- Department of Psychology, University of Missouri-St. Louis, St. Louis, Missouri, USA
| | - Jessica A. Wojtalik
- Department of Psychology, University of Missouri-St. Louis, St. Louis, Missouri, USA
| | - Wilson J. Brown
- Department of Psychology, University of Missouri-St. Louis, St. Louis, Missouri, USA
| | - Yvette I. Sheline
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
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Gallagher HC, Richardson J, Forbes D, Harms L, Gibbs L, Alkemade N, MacDougall C, Waters E, Block K, Lusher D, Baker E, Bryant RA. Mental Health Following Separation in a Disaster: The Role of Attachment. J Trauma Stress 2016; 29:56-64. [PMID: 26749321 DOI: 10.1002/jts.22071] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Short-term separation from close family members during a disaster is a highly salient event for those involved. Yet, its subsequent impact on mental health has received little empirical attention. One relevant factor may be attachment style, which influences patterns of support-seeking under threatening conditions. Individuals (N = 914) affected by the 2009 Victorian bushfires in southeastern Australia were assessed for disaster experiences, depression, posttraumatic stress disorder (PTSD) symptoms, and attachment style 3-4 years after the fires. Using multigroup structural equation modelling, individuals who reported separation from close family members during the bushfires (n = 471) were compared to those who reported no separation (n = 443). Cross-sectional results indicated that separated individuals had higher levels of PTSD symptoms. Furthermore, attachment anxiety was more strongly positively associated with depression among separated (b = 0.62) versus not separated individuals (b = 0.32). Unexpectedly, among separated individuals, attachment avoidance had a statistically weaker association with depression (b = 0.17 vs. b = 0.35) and with PTSD symptoms (b = 0.06 vs. b = 0.22). These results suggest that attachment anxiety amplifies a negative reaction to separation; meanwhile, for avoidant individuals, separation in times of danger may facilitate defensive cognitive processes.
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Affiliation(s)
- H Colin Gallagher
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - John Richardson
- Emergency Services, Australian Red Cross, Melbourne, Australia.,Jack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - David Forbes
- Phoenix Australia: Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Louise Harms
- Department of Social Work, University of Melbourne, Melbourne, Australia
| | - Lisa Gibbs
- Jack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Nathan Alkemade
- Phoenix Australia: Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Colin MacDougall
- Jack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Southgate Institute for Health, Society and Equity and School of Medicine, Flinders University, Adelaide, Australia
| | - Elizabeth Waters
- Jack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Karen Block
- Jack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Dean Lusher
- Centre for Transformative Innovation, Swinburne University of Technology, Melbourne, Australia
| | - Elyse Baker
- Jack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Richard A Bryant
- Emergency Services, Australian Red Cross, Melbourne, Australia.,School of Psychology, University of New South Wales, Sydney, Australia
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Persistent Complex Bereavement Disorder Symptom Domains Relate Differentially to PTSD and Depression: A Study of War-Exposed Bosnian Adolescents. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2015; 44:1361-73. [DOI: 10.1007/s10802-015-0107-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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