1
|
Arditte Hall KA, McGrory CM, Snelson AM, Pineles SL. The associations between repetitive negative thinking, insomnia symptoms, and sleep quality in adults with a history of trauma. Anxiety Stress Coping 2024; 37:394-405. [PMID: 38425171 DOI: 10.1080/10615806.2024.2324266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 02/23/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and sleep disturbance are highly comorbid and repetitive negative thinking (RNT) is associated with both sleep disturbance and PTSD. However, few studies have examined the association between RNT and sleep disturbance in individuals exposed to trauma, with and without PTSD. METHOD Associations between trait-level and trauma-related RNT, insomnia, and sleep quality were investigated in a trauma-exposed MTurk (N = 342) sample. Additionally, PTSD symptom severity was tested as a moderator of the associations between RNT and insomnia and sleep quality. RESULTS Trait-level RNT predicted poorer sleep quality and greater insomnia, regardless of PTSD severity. Trauma-related RNT was also associated with greater insomnia, though the effect was moderated by PTSD severity such that it was significant for participants with low and moderate, but not severe, PTSD. Both trait- and trauma-related RNT were associated with several specific aspects of sleep quality, including: sleep disturbances, daytime dysfunction, use of sleep medications, sleep onset latency, and subjective sleep quality. CONCLUSIONS This study demonstrates significant associations linking RNT with insomnia and sleep disturbance in trauma-exposed individuals. Clinically, results suggest that it may be helpful to target both general and trauma-related RNT in sleep interventions for trauma-exposed individuals with insomnia.
Collapse
Affiliation(s)
| | - Christopher M McGrory
- Women's Health Sciences Division, National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Alana M Snelson
- Women's Health Sciences Division, National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
| | - Suzanne L Pineles
- Women's Health Sciences Division, National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| |
Collapse
|
2
|
Wieman ST, Fields JS, Arditte Hall KA, MacDonald HZ, Liverant GI. Effects of the COVID-19 pandemic on anhedonia, reward exposure and responsiveness, and sleep in college students. J Am Coll Health 2024; 72:351-355. [PMID: 35298368 DOI: 10.1080/07448481.2022.2047705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 02/03/2022] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Abstract
Objective: The COVID-19 pandemic's effects on college student mental health and its underlying mechanisms are not fully understood. Although necessary, physical distancing abruptly restricts interaction with environmental rewards and disrupts sleep patterns, both of which may contribute to psychological symptoms (eg, depression and anhedonia). This study explored differences in psychological symptoms, reward exposure and responsiveness, and sleep before versus during the pandemic. Methods: Eighty-seven college students completed baseline questionnaires and a one-week daily diary paradigm. The sample was divided into two groups based on data collection before (pre-) or after (post-COVID-19) implementation of state-wide COVID-19 physical distancing measures. Results: Findings highlight higher anhedonia, decrements in exposure to social, professional, and exercise related rewards, lower aniticipatory reward responsiveness, and lower sleep efficiency among college students during the initial months of the pandemic. Conclusions: Findings suggest anhedonia, reward system functioning, and sleep may be important targets to mitigate against college student mental health sequelae during COVID-19.
Collapse
Affiliation(s)
- Sarah T Wieman
- Department of Psychology, Suffolk University, Boston, MA, USA
| | | | | | | | | |
Collapse
|
3
|
Li R, Ma Y, Arditte Hall KA, Johnson C, Philpotts LL, Perez GK, Park ER, Hall DL. Representation of race and ethnicity among cancer survivors in trials of cognitive behavioral therapy for insomnia (CBT-I): A systematic review. Support Care Cancer 2023; 32:23. [PMID: 38095732 DOI: 10.1007/s00520-023-08207-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE For cancer survivors, insomnia is highly prevalent and debilitating. Although cognitive behavioral therapy for insomnia (CBT-I) is recognized as a gold standard treatment, it is unclear whether benefits of treatment generalize to racial and ethnic minorities in the USA. This systematic review characterizes the representation of racial and ethnic diversity among cancer survivors in CBT-I clinical trials and provides recommendations for research in sleep/cancer survivorship. METHODS Literature searches were conducted in five electronic databases (PubMed, Cochrane Library via Ovid, PsycINFO via Ovid, Embase, Web of Science Core Collection) using concepts of CBT, insomnia, and cancer survivors. Information about CBT-I intervention details, sample racial demographics, and whether authors explicitly analyzed race and ethnicity were recorded. RESULTS A total of 1673 citations were retrieved, and 967 citations were uploaded to Covidence. Of these, 135 articles went through full-text review and 13 studies were included. Race and ethnicity were reported in 11/13 trials (84.6%). Of those reporting race and ethnicity, 8/11 (72.7%) trials were comprised of samples that were ≥ 85% non-Hispanic White. Among the trials that explicitly analyzed race and ethnicity, CBT-I was more effective among cancer survivors who were White and highly educated, and non-White cancer survivors were less likely to have private insurance and ability to participate in clinical trials. CONCLUSION Non-Hispanic White cancer survivors are overrepresented in CBT-I trials, the best available treatment for insomnia. Underrepresentation of racial and ethnic minorities likely contributes to barriers in access and uptake. Recommendations include implementing sustained efforts to expand diversity in CBT-I clinical trials for cancer survivors.
Collapse
Affiliation(s)
- Raissa Li
- Health Promotion and Resiliency Intervention Research Center, Massachusetts General Hospital, 100 Cambridge St., 16th Floor, Boston, MA, USA
- Tufts University School of Medicine, Medford, MA, USA
| | - Yan Ma
- Harvard Medical School, Boston, MA, USA
- Division of Preventive Medicine, Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | - Lisa L Philpotts
- Infection Control Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Giselle K Perez
- Health Promotion and Resiliency Intervention Research Center, Massachusetts General Hospital, 100 Cambridge St., 16th Floor, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Elyse R Park
- Health Promotion and Resiliency Intervention Research Center, Massachusetts General Hospital, 100 Cambridge St., 16th Floor, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Daniel L Hall
- Health Promotion and Resiliency Intervention Research Center, Massachusetts General Hospital, 100 Cambridge St., 16th Floor, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
4
|
Wieman ST, Arditte Hall KA, Park ER, Gorman MJ, Comander A, Goldstein MR, Cunningham TJ, Mizrach HR, Juhel B, Li R, Markowitz A, Grandner M, Liverant GI, Hall DL. Treatment-related changes in insomnia, anticipatory pleasure, and depression symptoms: A proof-of-concept study with cancer survivors. Sleep Med 2023; 103:29-32. [PMID: 36739822 PMCID: PMC10006323 DOI: 10.1016/j.sleep.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/06/2022] [Accepted: 01/13/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVE/BACKGROUND Cancer survivors have elevated rates of insomnia and depression. Insomnia increases risk for depression onset, and the Integrated Sleep and Reward (ISR) Model suggests that impairments in reward responding (e.g., ability to anticipate and/or experience pleasure) plays a central role in this relationship. Cognitive behavioral therapy for insomnia (CBT-I) is efficacious for treating chronic insomnia and reducing depression in cancer survivor populations. The effects of CBT-I on anticipatory and consummatory pleasure are theoretically and clinically meaningful, yet remain unexamined. PATIENTS/METHODS This secondary analysis of a pilot RCT (N = 40 cancer survivors with insomnia) explicated changes in anticipatory and consummatory pleasure and depression symptoms following a 4-session, synchronous, virtual CBT-I program versus enhanced usual care (referral to a behavioral sleep medicine clinic + sleep hygiene handout). Linear mixed models examined changes in anticipatory and consummatory pleasure and depression symptoms as predictors of changes in insomnia severity from baseline to post-intervention and 1-month follow-up. RESULTS CBT-I buffered against deterioration in anticipatory pleasure but not consummatory pleasure or depression symptoms. Across conditions, increased anticipatory pleasure was associated with insomnia reduction through 1-month follow-up, even after adjusting for changes in depression symptoms. CONCLUSION CBT-I may improve reward processing deficits in cancer survivors with insomnia. Findings provide support for the ISR Model and implicate pleasure as an important target for insomnia and depression.
Collapse
Affiliation(s)
- Sarah T Wieman
- Suffolk University, Boston, MA, United States; Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | | | - Elyse R Park
- Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Mark J Gorman
- Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Amy Comander
- Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Michael R Goldstein
- Harvard Medical School, Boston, MA, United States; Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Tony J Cunningham
- Harvard Medical School, Boston, MA, United States; Beth Israel Deaconess Medical Center, Boston, MA, United States; Boston College, Chestnut Hill, MA, United States
| | | | - Brooke Juhel
- Massachusetts General Hospital, Boston, MA, United States
| | - Raissa Li
- Massachusetts General Hospital, Boston, MA, United States
| | | | | | | | - Daniel L Hall
- Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| |
Collapse
|
5
|
Hall KAA, Werner KB, Griffin MG, Galovski TE. Exploring Predictors of Sleep State Misperception in Women with Posttraumatic Stress Disorder. Behav Sleep Med 2023; 21:22-32. [PMID: 35007171 PMCID: PMC9271136 DOI: 10.1080/15402002.2021.2024193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Insomnia is a common symptom of posttraumatic stress disorder (PTSD) that is resistant to first-line cognitive behavioral interventions. However, research suggests that, among individuals with PTSD, self-reported sleep impairment is typically more severe than what is objectively observed, a phenomenon termed sleep state misperception. Relatively little research has examined which individuals with PTSD are most likely to exhibit sleep state misperception. This study explored clinical predictors of sleep state misperception in a sample of 43 women with PTSD and clinically significant sleep impairment. METHOD During a baseline assessment, participants' PTSD symptoms were assessed using a clinical interview and their sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI). Objective sleep, self-reported sleep, and PTSD symptoms were then assessed over a 1-week period using actigraphy and daily diaries. RESULTS Consistent with previous research, women in the study exhibited total sleep time (TST), sleep efficiency (SE), and sleep onset latency (SOL) sleep state misperception. For TST and SE, but not SOL, discrepancies between actigraphy and the PSQI were associated with each clinician-rated PTSD symptom cluster, whereas discrepancies between actigraphy and daily diary were only associated with clinician-rated reexperiencing symptoms. The only self-reported PTSD symptom that was uniquely associated with sleep state misperception was nightmares. This association was no longer significant after controlling for sleep-related anxiety. CONCLUSIONS Results suggest that women with more severe reexperiencing symptoms of PTSD, particularly nightmares, may be more likely to exhibit TST and SE sleep state misperception, perhaps due to associated sleep-related anxiety.
Collapse
Affiliation(s)
| | | | - Michael G. Griffin
- Department of Psychology, Center for Trauma Recovery, University of Missouri – St. Louis
| | - Tara E. Galovski
- VA National Center for PTSD, VA Boston Healthcare System, and Boston University School of Medicine
| |
Collapse
|
6
|
Hall DL, Arditte Hall KA, Gorman MJ, Comander A, Goldstein MR, Cunningham TJ, Wieman S, Mizrach HR, Juhel BC, Li R, Markowitz A, Grandner M, Park ER. The Survivorship Sleep Program (SSP): A synchronous, virtual cognitive behavioral therapy for insomnia pilot program among cancer survivors. Cancer 2021; 128:1532-1544. [PMID: 34914845 DOI: 10.1002/cncr.34066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/28/2021] [Accepted: 11/13/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND For cancer survivors, insomnia is prevalent, distressing, and persists for years if unmanaged. Cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment yet can be difficult to access and may require modification to address survivorship-specific barriers to sleep. In this 2-phase study, the authors adapted and assessed the feasibility, acceptability, and preliminary effects of synchronous, virtual CBT-I adapted for cancer survivors (the Survivorship Sleep Program [SSP]). METHODS From April to August 2020, cancer survivors with insomnia (N = 10) were interviewed to refine SSP content and delivery. From October 2020 to March 2021, 40 survivors were recruited for a randomized controlled trial comparing 4 weekly SSP sessions with enhanced usual care (EUC) (CBT-I referral plus a sleep hygiene handout). Feasibility and acceptability were assessed by enrollment, retention, attendance, fidelity, survey ratings, and exit interviews. Insomnia severity (secondary outcome), sleep quality, sleep diaries, and fatigue were assessed at baseline, postintervention, and at 1-month follow-up using linear mixed models. RESULTS The SSP included targeted content and clinician-led, virtual delivery to enhance patient centeredness and access. Benchmarks were met for enrollment (56% enrolled/eligible), retention (SSP, 90%; EUC, 95%), attendance (100%), and fidelity (95%). Compared with EUC, the SSP resulted in large, clinically significant improvements in insomnia severity (Cohen d = 1.19) that were sustained at 1-month follow-up (Cohen d = 1.27). Improvements were observed for all other sleep metrics except sleep diary total sleep time and fatigue. CONCLUSIONS Synchronous, virtually delivered CBT-I targeted to cancer survivors is feasible, acceptable, and seems to be efficacious for reducing insomnia severity. Further testing in larger and more diverse samples is warranted.
Collapse
Affiliation(s)
- Daniel L Hall
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Kimberly A Arditte Hall
- Department of Psychology and Philosophy, Framingham State University, Framingham, Massachusetts
| | - Mark J Gorman
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Amy Comander
- Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Michael R Goldstein
- Harvard Medical School, Boston, Massachusetts.,Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Tony J Cunningham
- Harvard Medical School, Boston, Massachusetts.,Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Department of Psychology and Neuroscience, Boston College, Chestnut Hill, Massachusetts
| | - Sarah Wieman
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Department of Psychology, Suffolk University, Boston, Massachusetts
| | - Helen R Mizrach
- Harvard Medical School, Boston, Massachusetts.,Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Brooke C Juhel
- Harvard Medical School, Boston, Massachusetts.,Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Raissa Li
- Harvard Medical School, Boston, Massachusetts.,Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Alexandros Markowitz
- Harvard Medical School, Boston, Massachusetts.,Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael Grandner
- Department of Psychiatry, The University of Arizona, Tucson, Arizona
| | - Elyse R Park
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
7
|
Liverant GI, Gallagher MW, Arditte Hall KA, Rosebrock LE, Black SK, Kind S, Fava M, Kaplan GB, Kamholz BW, Pineles SL, Sloan DM. Suppression and acceptance in unipolar depression: Short-term and long-term effects on emotional responding. Br J Clin Psychol 2021; 61:1-17. [PMID: 34268773 DOI: 10.1111/bjc.12323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/12/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Transdiagnostic treatments increasingly include emotion regulation training focused on use of emotional suppression and acceptance. Despite the frequent use of these treatments in depression, little is known about the effects of these strategies in this population. DESIGN An experimental study. METHODS Eighty Veterans with unipolar depression participated in a study examining effects of these strategies on emotional responding (subjective, behavioural, and physiological). Physiological measures included: heart rate (HR), respiration (Resp), skin conductance (SC), and corrugator electromyography. On Day 1, participants were randomised to one of three conditions (acceptance, suppression, or control) and underwent an autobiographical sad mood induction. On Day 2, participants underwent a similar mood induction one week later. RESULTS The suppression group demonstrated reduced physiological reactivity (Resp and SC) on Day 1. However, the suppression group reported decreased positive affect on Day 2. CONCLUSIONS Results support short-term effectiveness and longer term costs from suppression use among depressed individuals. Findings may inform application of transdiagnostic emotion regulation treatments and suggest suppression functions differently in depressed versus other clinical populations.
Collapse
Affiliation(s)
| | | | | | | | - Shimrit K Black
- Boston University School of Medicine, Massachusetts, USA.,VA Boston Healthcare System, Massachusetts, USA
| | - Shelley Kind
- Department of Psychology, Suffolk University, Boston, Massachusetts, USA
| | - Maurizio Fava
- Harvard Medical School, Boston, Massachusetts, USA.,Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gary B Kaplan
- Boston University School of Medicine, Massachusetts, USA.,VA Boston Healthcare System, Massachusetts, USA
| | - Barbara W Kamholz
- Boston University School of Medicine, Massachusetts, USA.,VA Boston Healthcare System, Massachusetts, USA
| | - Suzanne L Pineles
- Boston University School of Medicine, Massachusetts, USA.,VA National Center for PTSD, Women's Health Sciences Division, Veterans Affairs Boston Healthcare System, Massachusetts, USA
| | - Denise M Sloan
- Boston University School of Medicine, Massachusetts, USA.,VA Boston Healthcare System, Massachusetts, USA.,VA National Center for PTSD, Boston, Massachusetts, USA
| |
Collapse
|
8
|
Arditte Hall KA, DeLane SE, Anderson GM, Lago TR, Shor R, Wang W, Rasmusson AM, Pineles SL. Plasma gamma-aminobutyric acid (GABA) levels and posttraumatic stress disorder symptoms in trauma-exposed women: a preliminary report. Psychopharmacology (Berl) 2021; 238:1541-1552. [PMID: 33620549 DOI: 10.1007/s00213-021-05785-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 02/04/2021] [Indexed: 12/16/2022]
Abstract
RATIONALE Aberrations in the stress response are associated with posttraumatic stress disorder (PTSD) symptom development, maintenance, and severity. Gamma-aminobutyric acid (GABA), the brain's primary inhibitory neurotransmitter, may play a key role in stress recovery. OBJECTIVES In this preliminary study, we examined whether plasma GABA levels differed between women with PTSD and trauma-exposed healthy controls. METHODS Thirty participants provided plasma samples during two phases of the menstrual cycle: the early follicular phase and the mid-luteal phase. During each phase, blood was drawn after 45 min of rest, and after mild and moderately stressful psychophysiological tasks. Plasma GABA levels were measured using HPLC-mass spectrometry (LC-MS/MS). RESULTS In analyses using PTSD diagnosis as a categorical group variable, women with and without a diagnosis of PTSD did not differ in plasma GABA levels (ps > .18). However, in analyses examining PTSD symptom severity as a continuous variable, there was a trend-level positive association between more severe PTSD symptoms and higher plasma GABA levels across the four blood draws (p = .06). In analyses examining DSM-IV PTSD symptom clusters separately, dysphoria symptoms were positively and significantly associated with plasma GABA levels (p = .03). Similarly, there was a trend-level positive association between avoidance cluster symptoms and plasma GABA levels (p = .06). Plasma GABA levels were not modulated by experimentally induced stress or menstrual cycle phase. CONCLUSIONS Dysregulation in GABA may be a neurobiological marker and/or potential treatment target for women with PTSD symptom profiles characterized by prominent dysphoria and avoidance cluster symptoms.
Collapse
Affiliation(s)
- Kimberly A Arditte Hall
- Department of Psychology & Philosophy, Framingham State University, 100 State Street, Framingham, MA, 01701, USA.
| | - Sumaiya E DeLane
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, 02130, USA
| | - George M Anderson
- Child Study Center, Yale University School of Medicine, New Haven, CT, 06519, USA
| | | | - Rachel Shor
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, 02130, USA
| | - Weiwei Wang
- MEDKEC Keck Biotechnology Services, Yale University School of Medicine, New Haven, CT, 06519, USA
| | - Ann M Rasmusson
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, 02130, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Suzanne L Pineles
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, 02130, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| |
Collapse
|
9
|
Abstract
BACKGROUND Depression and insomnia commonly co-occur. Yet, little is known about the mechanisms through which insomnia influences depression. Recent research and theory highlight reward system dysfunction as a potential mediator of the relationship between insomnia and depression. This study is the first to examine the impact of insomnia on reward learning, a key component of reward system functioning, in clinical depression. METHODS The sample consisted of 72 veterans with unipolar depression who endorsed sleep disturbance symptoms. Participants completed the Structured Clinical Interview for DSM-IV, self-report measures of insomnia, depression, and reward processing, and a previously validated signal detection task (Pizzagalli et al., 2005, Biological Psychiatry, 57(4), 319-327). Trial-by-trial response bias (RB) estimates calculated for each of the 200 task trials were examined using linear mixed-model analyses to investigate change in reward learning. RESULTS Findings demonstrated diminished rate and magnitude of reward learning in the Insomnia group relative to the Hypersomnia/Mixed Symptom group across the task. Within the Insomnia group, participants with more severe insomnia evidenced the lowest rates of reward learning, with increased RB across the task with decreasing insomnia severity. CONCLUSIONS Among individuals with depression, insomnia is associated with decreased ability to learn associations between neutral stimuli and rewarding outcomes and/or modify behavior in response to differential receipt of reward. This attenuated reward learning may contribute to clinically meaningful decreases in motivation and increased withdrawal in this comorbid group. Results extend existing theory by highlighting impairments in reward learning specifically as a potential mediator of the association between insomnia and depression.
Collapse
Affiliation(s)
| | | | - Sarah T Wieman
- Department of Psychology, Suffolk University, Boston, MA, USA
| | - Suzanne L Pineles
- National Center for PTSD, Women's Health Sciences Division, Veterans Affairs Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Diego A Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
| |
Collapse
|
10
|
Arditte Hall KA, Werner KB, Griffin MG, Galovski TE. The effects of cognitive processing therapy + hypnosis on objective sleep quality in women with posttraumatic stress disorder. Psychol Trauma 2020; 13:652-656. [PMID: 32915043 DOI: 10.1037/tra0000970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective: Insomnia, characterized by difficulty falling and staying asleep, is a common and debilitating symptom of posttraumatic stress disorder (PTSD) that is resistant to first-line, trauma-focused therapies. Previous research has found that sleep-directed hypnosis improves subjective sleep quality, particularly sleep onset latency, in women with PTSD. However, it cannot be assumed that improvements in subjective sleep reports correspond with objectively measured sleep improvements, because research has indicated a lack of agreement across these measures. The current study examined the effects of sleep-directed hypnosis plus cognitive processing therapy (hypCPT) on objective indices of sleep quality measured with actigraphy. Method: Forty-five women with PTSD were randomized to receive sleep-directed hypCPT or sleep and psychiatric symptom monitoring plus CPT (ssmCPT). Pre- and posttreatment, participants completed 1 week of daily actigraphy assessments of nocturnal sleep onset latency, waking after sleep onset, and total sleep time. Results: Overall improvement in objective sleep indices was not observed. Despite this, at posttreatment, treatment completers receiving hypCPT took significantly less time to fall asleep than did women receiving ssmCPT. Conclusions: More research is needed to understand and reduce the discrepancy between subjectively and objectively assessed sleep impairments in PTSD. Nevertheless, results indicate that adding sleep-directed hypnosis to trauma-focused therapy may be of some use for individuals with PTSD-related insomnia. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
|
11
|
Pineles SL, Nillni YI, Pinna G, Webb A, Arditte Hall KA, Fonda JR, Irvine J, King MW, Hauger RL, Resick PA, Orr SP, Rasmusson AM. Associations between PTSD-Related extinction retention deficits in women and plasma steroids that modulate brain GABA A and NMDA receptor activity. Neurobiol Stress 2020; 13:100225. [PMID: 32490055 PMCID: PMC7256058 DOI: 10.1016/j.ynstr.2020.100225] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 04/14/2020] [Accepted: 04/25/2020] [Indexed: 12/25/2022] Open
Abstract
Several studies have demonstrated poor retention of extinction learning among individuals with posttraumatic stress disorder (PTSD). Gonadal hormone signaling in brain appears to influence the retention of extinction learning differently in women with and without PTSD. Women with PTSD, compared to trauma-exposed women without PTSD, show relative deficits in extinction retention during the mid-luteal phase (mLP) of the menstrual cycle, compared to the early follicular phase (eFP). A PTSD-related reduction in conversion of progesterone to its GABAergic metabolites allopregnanolone (Allo) and pregnanolone (PA) may contribute to these findings. The current study in trauma-exposed women with (n = 9) and without (n = 9) PTSD investigated associations between extinction retention and plasma Allo + PA levels, as well as the ratio of Allo + PA to 5α-dihydroprogesterone (5α-DHP), the immediate steroid precursor for Allo. The study also investigated the relationship between extinction retention and the ratio of Allo + PA to dehydroepiandrosterone (DHEA), an adrenally-derived GABAA receptor antagonist. Study participants completed differential fear-conditioning during both the eFP and mLP of the menstrual cycle. Analyses revealed a strong positive relationship between resting plasma Allo + PA levels and extinction retention during the mLP in the women with, but not without, PTSD (e.g., diagnosis X Allo + PA interaction controlling for early extinction: β = −.0008, p = .003). A similar pattern emerged for the Allo + PA to 5α-DHP ratio (β = -.165, p = .071), consistent with a PTSD-related block in production of Allo and PA at the enzyme 3α-hydroxysteroid dehydrogenase. The ratio of Allo + PA to DHEA appeared to influence extinction retention only during the eFP when Allo + PA and DHEA levels are comparable and thus may compete for effects on GABAA receptor function. This study aligns with male rodent PTSD models linking experimental reductions in brain Allo levels to deficits in extinction retention and suggests that targeting PTSD-related deficits in GABAergic neurosteroid synthesis may be therapeutic.
Collapse
Affiliation(s)
- Suzanne L Pineles
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, 02130, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Yael I Nillni
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, 02130, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Graziano Pinna
- The Psychiatric Institute, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Andrea Webb
- The Charles Stark Draper Laboratory, Inc., Cambridge, MA, 02139, USA
| | | | - Jennifer R Fonda
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System Boston, MA, 02130, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, 02118, USA
| | - John Irvine
- The MITRE Corporation, Bedford, MA, 01730, USA
| | - Matthew W King
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, 02130, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Richard L Hauger
- Center of Excellence for Stress and Mental Health, San Diego VA Healthcare System, San Diego, CA, 9216, USA.,Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Patricia A Resick
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, 27701, USA
| | - Scott P Orr
- Psychiatry Department, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, 02129, USA
| | - Ann M Rasmusson
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, 02130, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| |
Collapse
|
12
|
Arditte Hall KA, Coleman K, Timpano KR. Associations Between Social Anxiety and Affective and Empathic Forecasts: A Replication and Extension in a Mechanical Turk Sample. Behav Ther 2020; 51:365-374. [PMID: 32402253 DOI: 10.1016/j.beth.2019.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 05/30/2019] [Accepted: 06/04/2019] [Indexed: 11/18/2022]
Abstract
People often overestimate the intensity and duration of their future emotions, referred to as an impact bias. Impact biases have been documented in predictions people make about their own emotions, as well as the others' emotions (i.e., affective and empathic forecasting, respectively). Recent studies have shown that negative impact biases may be stronger, and positive impact biases may be attenuated, in individuals with symptoms of social anxiety. The current study sought to replicate and extend these findings in a Mechanical Turk (MTurk) sample. MTurk is a particularly interesting online platform for such research because of the unusually high prevalence of social anxiety among MTurk users. Within a computer-based survey, 93 MTurk users read vignettes in which a second-person narrator elicited either disgust, anger, or happiness from another person. After each vignette, participants predicted how the narrator (i.e., affective forecasts) and the other person (i.e., empathic forecasts) would feel. Overall, results confirmed the existence of associations between social anxiety symptoms and negative affective and empathic forecasting biases, though no significant relations were found between social anxiety symptoms and positive forecasting biases. Negative affective and empathic forecasting biases were significantly correlated. Age and gender were also examined as potential predictors and moderators of hypothesized effects. Though younger age and female gender were associated with specific forecast ratings, controlling for these variables did not alter the associations between social anxiety and affective or empathic forecasts and no moderation effects were found. Overall, results provide additional support for the relevance of impact biases to social anxiety and suggest that they may be useful targets of intervention.
Collapse
Affiliation(s)
- Kimberly A Arditte Hall
- VA National Center for PTSD; VA Boston Healthcare System; Boston University School of Medicine.
| | | | | |
Collapse
|
13
|
Arditte Hall KA, Mitchell KS. The Affective Control Scale: Factor structure and associations with posttraumatic stress symptoms in trauma-exposed male veterans. Psychol Trauma 2020; 14:812-820. [PMID: 32202843 DOI: 10.1037/tra0000575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is characterized by broad-based difficulties with emotion. However, the extent to which the disorder is associated with fear of particular emotions remains less well understood. The Affective Control Scale (ACS) is a frequently used measure of fear of emotion, but relatively little work has been done to validate this measure, particularly for use in psychiatric research. This study examined the ACS's factor structure and its associations with PTSD symptoms among trauma-exposed male veterans. METHOD Participants (N = 347) completed online assessments, including the ACS and the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). RESULTS The data supported a bifactor structure with 1 general fear of emotion factor and 4 specific fear of emotion factors (i.e., fear of anger, fear of positive affect, fear of depressed mood, and fear of anxiety). Fear of emotion was positively associated with all 4 DSM-5 PTSD symptom clusters. After controlling for general fear of emotion, fear of particular emotion states was associated with some specific PTSD symptoms. CONCLUSION Both general and specific fears of emotion were associated with specific PTSD symptoms in trauma-exposed veterans. Despite this, results support the use of a modified ACS total score, capturing general fear of emotion, rather than the subscale scores, capturing fear of specific emotions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Collapse
|
14
|
Werner KB, Arditte Hall KA, Griffin MG, Galovski TE. Predicting Attentional Impairment in Women With Posttraumatic Stress Disorder Using Self-Reported and Objective Measures of Sleep. J Clin Sleep Med 2019; 15:1329-1336. [PMID: 31538604 PMCID: PMC6760408 DOI: 10.5664/jcsm.7930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES There is growing evidence to support sleep impairment as a core feature of posttraumatic stress disorder (PTSD). Sleep impairment in PTSD is associated with severe distress and poorer treatment outcomes. Therefore, specific attention to this symptom of PTSD is warranted and accurate assessment of sleep impairment is critical. The current study investigated the association between self-reported and objective assessment of sleep and sustained attention in women with PTSD. METHODS Study participants include 50 treatment-seeking, female, interpersonal violence survivors who have PTSD. Nocturnal sleep duration was measured with self-report sleep diaries and objective actigraphy assessment over the course of 7 nights. Sustained attention during daytime was measured by the Psychomotor Vigilance Task (PVT). RESULTS Results indicated that self-reported nocturnal sleep duration, but not objective or global sleep quality measures, best predicted attentional deficits as indicated by lapses and inverse reaction time on the PVT. Daily sleep diaries predicted 19% and 14% of the variance in attentional lapses and inverse reaction time, respectively. CONCLUSIONS In a sample of women with PTSD, self-reported nocturnal sleep duration predicted deficits in sustained attention. Conversely, sleep duration as measured by actigraphy and global sleep quality, did not predict sustained attention. Findings suggest that assessing sleep impairment on a daily basis may provide clinically relevant information in evaluating daytime symptoms and provide guidance in targeting this particularly troublesome symptom in the treatment of PTSD. CITATION Werner KB, Arditte Hall KA, Griffin MG, Galovski TE. Predicting attentional impairment in women with posttraumatic stress disorder using self-reported and objective measures of sleep. J Clin Sleep Med. 2019;15(9):1329-1336.
Collapse
Affiliation(s)
- Kimberly B. Werner
- University of Missouri – St. Louis, Missouri Institute of Mental Health, Saint Louis, Missouri
| | | | - Michael G. Griffin
- Department of Psychology, Center for Trauma Recovery, University of Missouri – Saint Louis, Saint Louis, Missouri
| | - Tara E. Galovski
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| |
Collapse
|
15
|
Arditte Hall KA, Davison EH, Galovski TE, Vasterling JJ, Pineles SL. Associations Between Trauma-Related Rumination and Symptoms of Posttraumatic Stress and Depression in Treatment-Seeking Female Veterans. J Trauma Stress 2019; 32:260-268. [PMID: 31009555 DOI: 10.1002/jts.22385] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 11/07/2018] [Accepted: 11/15/2018] [Indexed: 12/12/2022]
Abstract
Trauma-related rumination is a cognitive style characterized by repetitive negative thinking about the causes, consequences, and implications of a traumatic experience. Frequent trauma-related rumination has been linked to posttraumatic stress disorder (PTSD) and depression in civilian samples but has yet to be examined among military veterans. This study extended previous research by examining trauma-related rumination in female veterans who presented to a Veterans Affairs women's trauma recovery clinic (N = 91). The study had two main aims: (a) to examine associations between trauma-related rumination and specific PTSD symptoms, adjusting for the overlap between trauma-related rumination and other relevant cognitive factors, such as intrusive trauma memories and self-blame cognitions; and (b) to assess associations between trauma-related rumination, PTSD, and depression, adjusting for symptom comorbidity. At intake, patients completed a semistructured interview and self-report questionnaires. Primary diagnoses were confirmed via medical record review. Trauma-related rumination was common, with more than 80% of patients reporting at least sometimes engaging in this cognitive style in the past week. After adjusting for other relevant cognitive factors, trauma-related rumination was significantly associated with several specific PTSD symptoms, rp s = .33-.48. Additionally, the severity of trauma-related rumination was associated with overall PTSD symptom severity, even after adjusting for comorbid depression symptoms, rp 2 = .35. In contrast, the association between trauma-related rumination and depressive symptom severity was not significant after adjusting for comorbid PTSD symptoms, rp 2 = .008. These results highlight trauma-related rumination as a unique contributing factor to the complex clinical presentation for a subset of trauma-exposed veterans.
Collapse
Affiliation(s)
- Kimberly A Arditte Hall
- VA National Center for PTSD, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA.,VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Eve H Davison
- VA National Center for PTSD, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA.,VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Tara E Galovski
- VA National Center for PTSD, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA.,VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Jennifer J Vasterling
- VA National Center for PTSD, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA.,VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Suzanne L Pineles
- VA National Center for PTSD, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA.,VA Boston Healthcare System, Boston, Massachusetts, USA
| |
Collapse
|
16
|
Hudiburgh SE, Shaw AM, Arditte Hall KA, Timpano KR. Anxiety Sensitivity Differentially Predicts Factors of Interpersonal-Psychological Suicide Risk: A Consideration of Specificity. Suicide Life Threat Behav 2019; 49:264-277. [PMID: 29108113 DOI: 10.1111/sltb.12421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 09/07/2017] [Indexed: 11/28/2022]
Abstract
Recent studies have identified anxiety sensitivity (AS) as a risk factor for suicidality; however, limited work has been performed to understand this risk within the context of the interpersonal-psychological theory of suicide (IPTS; Joiner, 2005). The current study examined the relationship between overall AS, each AS subfactor (cognitive, social, and physical), and the three IPTS domains (perceived burdensomeness, thwarted belongingness, and acquired capability). While each AS subfactor uniquely predicted one IPTS domain, greater overall AS only predicted greater acquired capability, suggesting that assessment of AS at the subfactor level may offer us more information about an individual's interpersonal suicide risk.
Collapse
Affiliation(s)
| | | | - Kimberly A Arditte Hall
- National Center for PTSD/VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | | |
Collapse
|
17
|
Arditte Hall KA, Quinn ME, Vanderlind WM, Joormann J. Comparing cognitive styles in social anxiety and major depressive disorders: An examination of rumination, worry, and reappraisal. Br J Clin Psychol 2018; 58:231-244. [PMID: 30484868 DOI: 10.1111/bjc.12210] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/31/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Social anxiety disorder (SAD) and major depressive disorder (MDD) are commonly occurring and frequently comorbid disorders. Though individuals with SAD and MDD are more likely to engage in rumination and worry, relatively few studies have compared individuals with SAD, MDD, or both disorders on their use of these cognitive styles. Similarly, the extent to which the disorders differ in their use of reappraisal remains unclear. Thus, the current study sought to systematically examine rumination, worry, and reappraisal in individuals with and without SAD, MDD, or both disorders. METHODS The study comprised 330 participants recruited from the community (n = 54 with SAD, n = 61 with MDD, n = 69 with comorbid SAD/MDD, and n = 146 healthy controls). Following confirmation of diagnostic status via clinical interview, participants completed measures of rumination, worry, and reappraisal. RESULTS Healthy controls reported less use of rumination (i.e., brooding and reflection) and worry than individuals with a psychiatric diagnosis. Individuals with SAD or MDD did not differ from each other, but participants in both groups reported less rumination, particularly brooding, than individuals with comorbid SAD/MDD. Diagnostic group differences in reappraisal only emerged when reappraisal was considered alongside other cognitive styles. Further, moderation analyses indicated that reappraisal was only associated with SAD or MDD when participants also reported high levels of rumination and worry. CONCLUSIONS Results support transdiagnostic conceptualizations of rumination and worry. They also suggest that reappraisal is only useful when it is used by people who experience frequent and habitual negative cognitions. PRACTITIONER POINTS Individuals with SAD or MDD report more rumination and worry than healthy controls, but do not differ from each other in their reliance on these cognitive styles. Individuals with comorbid SAD/MDD endorse more rumination than individuals with SAD or MDD alone, even after adjusting for differences in symptom severity. Reappraisal may only predict diagnostic group status when considered alongside other cognitive styles. In particular, high reappraisal may be associated with reduced risk of psychiatric disorder, but only when rumination and worry are also high. LIMITATIONS The study was limited by its cross-sectional design and reliance on self-report measures. Participants were diagnosed using DSM-IV-TR criteria for SAD and MDD.
Collapse
Affiliation(s)
- Kimberly A Arditte Hall
- VA National Center for PTSD at VA Boston Healthcare System, Massachusetts, USA.,Boston University School of Medicine, Massachusetts, USA
| | | | | | | |
Collapse
|
18
|
Abstract
PURPOSE OF REVIEW We review recent research addressing neurocognitive and information processing abnormalities in posttraumatic stress disorder (PTSD), including studies informing direction of causality. We additionally consider neurocognition in the context of co-morbid mild traumatic brain injury (TBI) and psychosocial treatments for PTSD. RECENT FINDINGS Learning, memory, attention, inhibitory functions, and information processing biases frequently accompany PTSD, reflecting potential bi-directional relationships with PTSD. Although mild TBI is associated with increased risk of PTSD development and maintenance, TBI does not typically contribute significantly to sustained neurocognitive deficits in individuals with PTSD. Whereas better learning and memory is associated with mildly enhanced response to psychosocial interventions, such interventions may also improve neurocognitive performance and can be effectively provided to patients with TBI history. PTSD is associated with cognitive abnormalities in processing both emotionally relevant and emotionally neutral information and, although mild, may underlie some PTSD symptom expression.
Collapse
Affiliation(s)
- Jennifer J Vasterling
- Psychology (116B), National Center for PTSD at VA Boston Healthcare System, 150 S. Huntington Ave., Boston, MA, 02130, USA.
- Boston University School of Medicine, Boston, MA, USA.
| | - Kimberly A Arditte Hall
- Psychology (116B), National Center for PTSD at VA Boston Healthcare System, 150 S. Huntington Ave., Boston, MA, 02130, USA
- Boston University School of Medicine, Boston, MA, USA
| |
Collapse
|
19
|
Japuntich SJ, Arditte Hall KA, Joos CM, Rasmusson AM, Pineles SL. Methods to reduce false reporting of substance abstinence in clinical research. Int J Methods Psychiatr Res 2018; 27:e1603. [PMID: 29314410 PMCID: PMC6877230 DOI: 10.1002/mpr.1603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 11/01/2017] [Accepted: 11/13/2017] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Substance use may influence study results in human subjects research. This study aims to report the concordance between self-report and biochemical assessments of substance use and test the effect of methods to reduce false reports of abstinence in trauma-exposed women participating in a research study. METHODS In this pilot study, substance use was assessed during telephone prescreening and via self-report and biochemical verification (i.e., urine toxicology and alcohol breathalyzer tests) at an in-person evaluation. Due to the high number of participants who tested positive for substances despite self-reporting abstinence during prescreening, study procedures were modified to disincentivize false self-reports of substance use two thirds of the way through recruitment. New potential participants were explicitly informed during prescreening and informed consent that a positive drug or alcohol test during screening would result in exclusion from the study and withholding of payment. RESULTS Prior to modifying study methods, 20% of participants who had reported abstinence during the telephone prescreen had a positive substance use test at the in-person visit. Modifying study procedures resulted in an 81% decrease in positive substance use assessments. CONCLUSIONS Adoption of this methodology may decrease inadvertent confounding of clinical research outcomes by undetected and/or misreported substance use.
Collapse
Affiliation(s)
- Sandra J. Japuntich
- Centers for Behavioral and Preventive MedicineThe Miriam HospitalProvidenceRhode IslandUSA
- Department of Psychiatry and Human BehaviorAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Kimberly A. Arditte Hall
- National Center for PTSD, Women's Health Sciences DivisionVA Boston Healthcare SystemBostonMassachusettsUSA
- Department of PsychiatryBoston University School of MedicineBostonMassachusettsUSA
| | - Celina M. Joos
- Department of PsychologyPennsylvania State UniversityState CollegePennsylvaniaUSA
| | - Ann M. Rasmusson
- National Center for PTSD, Women's Health Sciences DivisionVA Boston Healthcare SystemBostonMassachusettsUSA
- Department of PsychiatryBoston University School of MedicineBostonMassachusettsUSA
| | - Suzanne L. Pineles
- National Center for PTSD, Women's Health Sciences DivisionVA Boston Healthcare SystemBostonMassachusettsUSA
- Department of PsychiatryBoston University School of MedicineBostonMassachusettsUSA
| |
Collapse
|
20
|
Arditte Hall KA, Joormann J, Siemer M, Timpano KR. The impact bias in self and others: Affective and empathic forecasting in individuals with social anxiety. Behav Res Ther 2018; 106:37-46. [PMID: 29758391 DOI: 10.1016/j.brat.2018.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 04/18/2018] [Accepted: 05/03/2018] [Indexed: 12/01/2022]
Abstract
People tend to overestimate the intensity and duration of affect (i.e., impact bias) when making predictions about their own and others' responding, termed affective and empathic forecasting, respectively. Research links impact biases to clinical symptoms of affective disorders, but little work has been done to examine how social anxiety is related to affective and empathic forecasting biases. The current investigation included two studies examining these associations in independent samples of young adults with dimensionally distributed social anxiety symptoms. Study 1 (N = 100) examined the associations between social anxiety and affective and empathic forecasts in response to a series of novel hypothetical vignettes in which a second-person narrator (i.e., the self) elicited anger, disgust, or happiness from another person (i.e., the other). Study 2 utilized an innovative experimental paradigm involving N = 68 participant dyads. Overall, results supported the existence of affective and empathic forecasting biases. Further, symptoms of social anxiety were associated with the tendency to overestimate one's own and others' negative affect and underestimate others' positive affect. Such forecasting biases may help to explain the avoidance that is characteristic of individuals with social anxiety and could represent a fruitful target of cognitive behavioral intervention.
Collapse
|
21
|
Arditte Hall KA, Bartlett BA, Iverson KM, Mitchell KS. Eating disorder symptoms in female veterans: The role of childhood, adult, and military trauma exposure. ACTA ACUST UNITED AC 2018; 10:345-351. [DOI: 10.1037/tra0000301] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
22
|
Arditte Hall KA, Bartlett BA, Iverson KM, Mitchell KS. Military-related trauma is associated with eating disorder symptoms in male veterans. Int J Eat Disord 2017; 50:1328-1331. [PMID: 28940217 PMCID: PMC5944843 DOI: 10.1002/eat.22782] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 08/30/2017] [Accepted: 09/04/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Eating disorders are understudied among male veterans, who may be at increased risk due to the high rates of trauma exposure and experiences of multiple traumatization in this population. This study sought to examine the associations between specific types of trauma (i.e., childhood physical abuse, adult physical assault, childhood sexual abuse, adult sexual assault, and military-related trauma) and eating disorder symptoms in a large, nationally-representative sample of trauma-exposed male veterans. METHOD Survey data were collected from N = 642 male veterans. Traumatic experiences in childhood and adulthood were assessed using the Trauma History Screen and the National Stressful Events Survey. Eating disorder symptoms were assessed with the Eating Disorder Diagnostic Scale. Analyses also controlled for age and body mass index. RESULTS Multiple traumatization was associated with increased eating disorder symptoms. However, military-related trauma was the only trauma type that was uniquely associated with eating disorder symptoms when controlling for other trauma types. Examination of different types of military-related trauma indicated that this association was not driven by exposure to combat. DISCUSSION Noncombat, military-related trauma was associated with eating disorder symptom severity in male veterans. Results highlight the need for better assessment of eating disorder symptoms in this population.
Collapse
Affiliation(s)
- Kimberly A. Arditte Hall
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | | | - Katherine M. Iverson
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Karen S. Mitchell
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| |
Collapse
|
23
|
Arditte Hall KA, De Raedt R, Timpano KR, Joormann J. Positive memory enhancement training for individuals with major depressive disorder. Cogn Behav Ther 2017; 47:155-168. [DOI: 10.1080/16506073.2017.1364291] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kimberly A. Arditte Hall
- National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, 150 S. Huntington Ave. (116B), Boston, MA 02130, USA
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL 33146, USA
| | - Rudi De Raedt
- Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, B-9000, Ghent, Belgium
| | - Kiara R. Timpano
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL 33146, USA
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT 06511, USA
| |
Collapse
|
24
|
Abstract
Obsessive-compulsive disorder (OCD) commonly co-occurs with depression, resulting in heightened severity and poorer treatment response. Research on the associations between specific obsessive-compulsive symptoms (OCS) and depressive symptoms has utilized measures that have not fully considered the relationship across OCS dimensions. Little is known about which factors explain the overlap between OCS and depressive symptoms. OCS and depressive symptoms may be related via depressive cognitive styles, such as rumination or dampening (i.e., down-regulating positive emotions). We evaluated the associations of OCS dimensions with depressive symptoms and cognitive styles. We also examined the indirect effects of rumination and dampening in the relationship between OCS and depressive symptoms. Participants (N = 250) completed questionnaires online. Greater depressive symptoms, rumination, and dampening were associated with greater levels of all OCS dimensions. Path analysis was utilized to examine a model including the direct effect of depressive symptoms on overall OCS and two indirect effects (through rumination and dampening). There was a significant indirect effect of depressive cognitive styles on the relationship between OCS and depressive symptoms, through rumination and dampening. Replication in a clinical sample and experimental manipulations may bear important implications for targeting depressive cognitive styles in treatments for OCD and depression.
Collapse
|
25
|
Pineles SL, Arditte Hall KA, Rasmusson AM. Gender and PTSD: different pathways to a similar phenotype. Curr Opin Psychol 2017; 14:44-48. [DOI: 10.1016/j.copsyc.2016.11.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 11/03/2016] [Accepted: 11/08/2016] [Indexed: 01/13/2023]
|