Anxiety sensitivity and posttraumatic stress among traumatic event-exposed youth

Total and factor scores of the Childhood Anxiety Sensitivity Index (CASI) were examined in relation to posttraumatic stress symptom levels within a community-based sample of 68 (43 females) traumatic event-exposed youth between the ages of 10 and 17 years (M_age=14.74 years). Findings were consistent with hypotheses; global anxiety sensitivity (AS) levels, as well as disease, unsteady, and mental incapacitation concerns, related positively to posttraumatic stress levels, whereas social concerns were unrelated to symptom levels. These results suggest that fears of the physical and mental consequences of anxiety are associated with relatively higher levels of posttraumatic stress subsequent to traumatic event exposure. Findings are discussed in terms of potential implications for the role of AS in developmentally sensitive etiological models of posttraumatic stress disorder (PTSD).     

Peritraumatic dissociation and experiential avoidance as predictors of posttraumatic stress symptomatology

This study examined whether peritraumatic dissociation serves as a proxy risk factor for experiential avoidance in its relationship with posttraumatic stress disorder (PTSD) symptomatology. One hundred eighty-five trauma survivors completed measures that assessed for peritraumatic dissociation, experiential avoidance, and PTSD symptom severity. The results indicated that peritraumatic dissociation and experiential avoidance were significantly related to PTSD symptomatology at baseline. However, after initial levels of PTSD symptomatology were taken into account, only experiential avoidance was related to PTSD symptoms both 4- and 8-weeks later. These results indicate that peritraumatic dissociation is not a proxy risk factor for experiential avoidance and contributes to the growing body of literature indicating that experiential avoidance is an important factor related to the psychological symptoms experienced by trauma survivors.     

Associations between lower order anxiety sensitivity dimensions and DSM-5 posttraumatic stress disorder symptoms

Anxiety sensitivity (AS), a well-established individual difference variable reflecting a tendency to fear bodily sensations associated with arousal, has been implicated in the development and maintenance of posttraumatic stress disorder (PTSD). Despite these associations, little research has examined the relations between AS subfactors (eg physical, cognitive, and social) and PTSD symptoms and none have examined these associations in the context of DSM-5 (Diagnostic Statistical Manual of Mental Disorders, Fifth Edition) PTSD clusters (ie intrusion, avoidance, negative alterations in cognitions/mood, and arousal). Participants included 50 veterans presenting to an outpatient Veteran Affairs Clinic for psychological services. Upon intake, veterans completed a brief battery of self-report questionnaires to assist with differential diagnosis and treatment planning. Results revealed unique associations between lower order AS dimensions, in particular the cognitive concerns dimension, and all four DSM-5 PTSD symptom clusters. Given the malleable nature of AS cognitive concerns, as well as the growing number of veterans in need of care, future research should determine the extent to which targeting this cognitive risk factor reduces PTSD symptom severity among veterans.     

Maternal posttraumatic stress symptoms and infant emotional reactivity and emotion regulation

The current study examined associations between maternal posttraumatic stress disorder (PTSD) symptoms and infant emotional reactivity and emotion regulation during the first year of life in a primarily low-income, urban, ethnic/racial minority sample of 52 mother–infant dyads. Mothers completed questionnaires assessing their own trauma exposure history and current PTSD and depressive symptoms and their infants’ temperament when the infants were 6 months old. Dyads participated in the repeated Still-Face Paradigm (SFP-R) when the infants were 6 months old, and infant affective states were coded for each SFP-R episode. Mothers completed questionnaires assessing infant trauma exposure history and infant current emotional and behavioral symptoms when the infants were 13 months old. Maternal PTSD symptoms predicted infants’ emotion regulation at 6 months as assessed by (a) infant ability to recover from distress during the SFP-R and (b) maternal report of infant rate of recovery from distress/arousal in daily life. Maternal PTSD symptoms also predicted maternal report of infant externalizing, internalizing, and dysregulation symptoms at 13 months. Maternal PTSD was not associated with measures of infant emotional reactivity. Neither maternal depressive symptoms nor infant direct exposure to trauma accounted for the associations between maternal PTSD symptoms and infant outcomes. These findings suggest that maternal PTSD is associated with offspring emotion regulation difficulties as early as infancy. Such difficulties may contribute to increased risk of mental health problems among children of mothers with PTSD.     

Connections among symptoms of obsessive-compulsive disorder and posttraumatic stress disorder: a case series

Theoretical, clinical, and empirical implications of the functional connections between symptoms of obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are abundant. As such, four cases are presented here of men and women who met criteria for comorbid OCD and PTSD. All had been diagnosed with treatment-resistant OCD and were seeking treatment from an OCD specialty clinic or institute, all reported a history of traumatic experiences prior to the onset of OCD, and all appeared to demonstrate negative treatment outcomes. Upon examination, it appeared that symptoms of OCD and PTSD were connected such that decreases in OCD-specific symptoms related to increases in PTSD-specific symptoms, and increases in OCD-specific symptoms related to decreases in PTSD-specific symptoms. Speculations about the function of OCD symptoms in relation to post-traumatic psychopathology are put forth; and theoretical, research, and treatment implications are discussed.     

Emotion dysregulation and adolescent psychopathology: a prospective study

Background

Emotion regulation deficits have been consistently linked to psychopathology in cross-sectional studies. However, the direction of the relationship between emotion regulation and psychopathology is unclear. This study examined the longitudinal and reciprocal relationships between emotion regulation deficits and psychopathology in adolescents.

Methods

Emotion dysregulation and symptomatology (depression, anxiety, aggressive behavior, and eating pathology) were assessed in a large, diverse sample of adolescents (N = 1065) at two time points separated by seven months. Structural equation modeling was used to examine the longitudinal and reciprocal relationships between emotion dysregulation and symptoms of psychopathology.

Results

The three distinct emotion processes examined here (emotional understanding, dysregulated expression of sadness and anger, and ruminative responses to distress) formed a unitary latent emotion dysregulation factor. Emotion dysregulation predicted increases in anxiety symptoms, aggressive behavior, and eating pathology after controlling for baseline symptoms but did not predict depressive symptoms. In contrast, none of the four types of psychopathology predicted increases in emotion dysregulation after controlling for baseline emotion dysregulation.

Conclusions

Emotion dysregulation appears to be an important transdiagnostic factor that increases risk for a wide range of psychopathology outcomes in adolescence. These results suggest targets for preventive interventions during this developmental period of risk.     

The role of anxiety sensitivity in the relationship between posttraumatic stress symptoms and negative outcomes in trauma-exposed adults

Background: The development of posttraumatic stress symptoms (PTSs) following a trauma is related to impairment, diminished quality of life, and physical health issues. Yet it is not clear why some trauma-exposed individuals experience negative outcomes while others do not. The purpose of this study was to determine the role of several influential factors related to PTS severity and negative outcomes. Methods: One hundred and twenty-two trauma-exposed adults were administered the following self-report measures: the Posttraumatic Stress Disorder Checklist-Civilian, the Trauma History Questionnaire-Short, the Anxiety Sensitivity Index-3, Depression and Anxiety Stress Scale 21, Sheehan Disability Scale, World Health Organization Quality of Life-BREF, and an abbreviated Patient Health Questionnaire. Primary Results: PTS severity was positively correlated with depressive symptom severity (r = 0.54, p < 0.001), chronicity of the most distressing trauma (r = 0.21, p = 0.017), and number of traumas (r = 0.22, p = 0.012). Main effects were found for PTS severity (β = ?0.38, p < 0.01) and anxiety sensitivity (AS; β = ?0.39, p < 0.01) on quality of life. No interaction was found between PTS severity and AS with any negative outcome. PTS severity mediated the relationship between AS and physical health issues (0.05; 95% CI: 0.02–0.08). Conclusion: This study helps clarify the role of various factors in the relationship between trauma and negative outcomes. Clinical and research implications are discussed.     

Social anxiety and posttraumatic stress in combat veterans: relations to well-being and character strengths

There are few studies examining the relationship between psychopathology and positive experiences and traits. Although initial studies suggest persons with posttraumatic stress disorder (PTSD) are at increased risk for excessive social anxiety, there have been no studies to date evaluating how these conditions might interact to affect positive experiences and traits. Using self-report scales, informant ratings, and experience-sampling methodologies, we examined the association of social anxiety with well-being and character strengths in veterans with and without PTSD. Controlling for PTSD and trait negative affect, social anxiety was negatively related to global ratings of well-being and character strengths. Social anxiety also accounted for incremental variance in day-to-day well-being (i.e., daily affect balance, percentage of pleasant days, positive social activity, self-esteem, gratitude) over a 14-day assessment period. Although veterans with PTSD reported lower levels of global and daily well-being and character strengths than veterans without PTSD, a diagnosis of PTSD failed to exhibit unique relationships with these constructs. Building on a growing body of work, these data suggest that social anxiety is uniquely associated with disturbances in positive experiences, events, and traits. Our findings support the value of directly addressing social anxiety in the study and treatment of PTSD.     

Peritraumatic dissociation mediates the relationship between acute panic and chronic posttraumatic stress disorder

Although peritraumatic dissociation predicts subsequent posttraumatic stress disorder (PTSD), little is understood about the mechanism of this relationship. This study examines the role of panic during trauma in the relationship between peritraumatic dissociation and subsequent PTSD. Randomized eligible admissions to 4 major trauma hospitals across Australia (n = 244) were assessed during hospital admission and within one month of trauma exposure for panic, peritraumatic dissociation and PTSD symptoms, and subsequently re-assessed for PTSD three months after the initial assessment (n = 208). Twenty (9.6%) patients met criteria for PTSD at 3-months post injury. Structural equation modeling supported the proposition that peritraumatic derealization (a subset of dissociation) mediated the effect of panic reactions during trauma and subsequent PTSD symptoms. The mediation model indicated that panic reactions are linked to severity of subsequent PTSD via derealization, indicating a significant indirect relationship. Whereas peritraumatic derealization is associated with chronic PTSD symptoms, this relationship is influenced by initial acute panic responses.     

Revised reinforcement sensitivity theory: The impact of FFFS and stress on driving

This study investigated the effect of a fear-based personality trait, as conceptualized in Gray’s revised reinforcement sensitivity theory (RST) by the strength of the Fight/Flight/Freeze system (FFFS), on young people’s driving simulator performance under induced psychosocial stress. Seventy-one young drivers completed the Jackson-5 questionnaire of RST traits, followed by a psychosocial stress or relaxation induction procedure (random allocation to groups) and then a city driving simulator task. Some support was found for the hypothesis that higher FFFS sensitivity would result in poorer driving performance under stress, in terms of significantly poorer hazard responses, possibly due to an increased attentional focus on the aversive cues inherent in the stress induction leaving reduced attentional capacity for the driving task. These results suggest that stress may lead to riskier driving behaviour in individuals with fearful RST personality styles.     

Emotion dysregulation and posttraumatic stress disorder: a test of the incremental role of difficulties regulating positive emotions

Background and Objectives: Literature provides support for the role of emotion dysregulation in the development and course of posttraumatic stress disorder (PTSD) among women victims of intimate partner violence (IPV). However, a dearth of studies have examined the contribution of emotion dysregulation stemming from positive emotions to PTSD. Extending research, the current study examined (1) the bivariate association of difficulties regulating positive emotions to PTSD symptom severity, and (2) the incremental role of difficulties regulating positive emotions in PTSD symptom severity beyond difficulties regulating negative emotions.

Design: Participants were 210 women victims of IPV involved in the criminal justice system because of their partners’ arrest (M age?=?36.14, 48.6% African American).

Methods: Participants completed empirically-supported self-report measures assessing difficulties regulating positive and negative emotions and PTSD symptom severity.

Results: Difficulties regulating positive and negative emotions (overall and across each of the specific dimensions) were significantly positively associated with PTSD symptom severity. Moreover, difficulties regulating positive emotions demonstrated an incremental relation to PTSD symptom severity beyond the variance accounted for by difficulties regulating negative emotions.

Conclusions: Our findings suggest the potential utility of targeting difficulties regulating positive emotions in interventions for PTSD among women victims of IPV.     

Social support, coping, life events, and posttraumatic stress symptoms among former peacekeepers: a prospective study

This study examined both cross-sectionally and longitudinally the relationship between social support, coping strategies, additional stressful life events, and symptoms of posttraumatic stress disorder (PTSD) among Dutch former peacekeeping soldiers. Two groups of peacekeepers were investigated: 311 peacekeepers who participated in the peacekeeping operation in Lebanon between 1979 and 1985, and 499 peacekeepers who were deployed after 1990. These peacekeepers completed a questionnaire in 1996 and again in 1998. The results show that more negative social contacts and fewer positive social contacts were associated with more PTSD symptom severity. More use of the coping strategies ‘wishful thinking’ and ‘accepting responsibility’ was related to more PTSD symptoms. Conversely, more planful problem solving and seeking social support was related to less PTSD symptom severity. In addition, a bilateral relationship was found between additional stressful life events and PTSD symptom severity. The results indicate that social support and coping strategies may be valuable aspects of prevention and intervention programs.     

Control beliefs as a mediator of the relation between stress and depressive symptoms among inner-city adolescents

Adolescents' control beliefs were examined as a mediator of the relation between stress and depressive symptoms among a diverse sample of 445 inner-city adolescents. Results indicated that control beliefs significantly mediate the relation between stress and depressive symptoms. The specific direct effects of six individual stress domains (peer, family, school, neighborhood, economic, discrimination) on control beliefs and depressive symptoms were also examined. Results showed that (1) economic stress relates to adolescents' control beliefs, (2) family stress relates to adolescent depressive symptoms, and (3) peer stress relates to both control beliefs and depressive symptoms. Secondary analyses revealed that control beliefs significantly mediate the specific relations between peer stress and depressive symptoms. Results were not found to vary across ethnic groups. The implications of these findings for adolescent mental health and preventive interventions targeting depression are discussed.     

Assaultive violence and the risk of posttraumatic stress disorder following a subsequent trauma

Breslau, Peterson, and Shultz (2008) reported that prior trauma alone, in the absence of PTSD, did not predict an increased PTSD risk, relative to no prior trauma. Only prior trauma that resulted in PTSD predicted an increased PTSD risk following a subsequent trauma. Recently, Cougle, Resnick, and Kilpatrick (2009) proposed that the effect of prior trauma might vary by type of prior trauma, a possibility not considered in Breslau et al. They report that childhood sexual or physical assault, in the absence of PTSD, increased the PTSD risk following a subsequent trauma. This report examines the PTSD effects of prior assaultive violence, using data from Breslau et al. (1998). The study assessed PTSD in relation to up to three events. Analysis was performed on the subset with PTSD assessment for two distinct events, the earliest trauma and a subsequent trauma (n = 967), using as reference persons with no prior trauma (n = 972). Neither prior assaultive violence nor other prior traumas, in the absence of PTSD, influenced the subsequent risk of PTSD. In contrast, prior PTSD increased considerably the PTSD risk of a subsequent trauma. The limitations in Cougle et al. (2009) and in this study and future research directions are discussed.     

Sleep disturbance and emotion dysregulation as transdiagnostic processes in a comorbid sample

Sleep disturbance and emotion dysregulation have been identified as etiologic and maintaining factors for a range of psychopathology and separate literatures support their relationships to anxiety, depression, PTSD, and alcohol dependence (AD) symptom severity. Previous studies have examined these relationships in isolation, failing to account for the high rates of comorbidity among disorders. It is not yet known whether these processes uniquely predict symptom severity in each of these domains. Participants were 220 patients in residential substance abuse treatment, who had experienced a potentially traumatic event and exceeded screening cutoffs for probable PTSD and problematic alcohol use. Controlling for emotion dysregulation and the interrelationships among the outcome variables, insomnia was uniquely associated with anxiety (B = .27, p < .001), depression (B = .25, p < .001), PTSD (B = .22, p < .001), and AD (B = .17, p = .01) symptom severity. Similarly, controlling for insomnia, emotion dysregulation was uniquely associated with anxiety (B = .40, p < .001), depression (B = .47, p < .001), PTSD (B = .38, p < .001), and AD (B = .26, p < .001) symptom severity. Insomnia and emotion dysregulation appear to be transdiagnostic processes uniquely associated with symptom severity across a number of different domains and might be important treatment targets for individuals with PTSD and AD.     

Effects of exposure to community violence on school functioning: The mediating role of posttraumatic stress symptoms

This study investigated the association between exposure to community violence (ECV) and school functioning, as well as posttraumatic stress (PTS) symptoms as a potential mediator of the relationship. PTS symptoms are commonly associated with ECV, and are characterized by difficulty regulating emotions and behaviors. Thus, PTS symptomatology may be one mechanism through which community violence impacts school functioning. The community-based sample included 47 low-income African American children (aged 10-13). Results revealed that ECV was inversely related to academic performance and attendance. Symptoms of posttraumatic stress emerged as a mediator of the relation between ECV and academic performance. Results have implications for urban students who face violence in their communities, and emphasize the need for school-based mental health services.     

Change in sleep symptoms across Cognitive Processing Therapy and Prolonged Exposure: A longitudinal perspective

Sleep disturbance is a core component in posttraumatic stress disorder (PTSD). Although cognitive-behavioral treatments for PTSD reduce the severity of sleep symptoms, they do not lead to complete remission. The present study examines the impact of Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) on subjective measures of sleep disturbance from treatment randomization through long-term follow-up (LTFU). Participants were 171 female rape victims with PTSD who were randomly assigned to CPT, PE, or Minimal Attention (MA). After 6-weeks, the MA group was randomized to CPT or PE. Sleep symptoms were assessed at baseline, post-MA, post-treatment, 3-months, 9-months and LTFU using the Pittsburgh Sleep Quality Index (PSQI) and nightmare and insomnia items from the Clinician Administered PTSD Scale. Change in sleep during MA, from pre- to post-treatment for CPT and PE, and from post-treatment through LTFU was assessed using piecewise hierarchical linear modeling with the intent-to-treat sample. Controlling for medication, sleep improved during CPT and PE compared to MA, and treatment gains were maintained through LTFU. CPT and PE were equally efficacious and improvements persist over LTFU, yet, neither produced remission of sleep disturbance. Overall, sleep symptoms do not remit and may warrant sleep-specific treatments.     

Understanding the relationship between posttraumatic stress disorder and trauma cognitions: The impact of thought control strategies

Several models of PTSD suggest that dysfunctional beliefs play an important role in the maintenance of PTSD. This study examined whether thought control strategies intermediated in the relationship between PTSD and dysfunctional cognitions. It was hypothesized that PTSD would be positively associated with dysfunctional cognitions and that negative thought control strategies (worry and self-punishment) would partially account for this relationship. These maladaptive strategies were predicted to be associated with increased levels of PTSD and more trauma-related beliefs. Additionally, it was predicted that positive thought control strategies (social control and reappraisal) would be associated with decreased levels of PTSD and fewer trauma-related beliefs. Finally, because the literature supports distraction as both an adaptive and a maladaptive thought control strategy, no a priori hypothesis was made. Results support worry and self-punishment as maladaptive intervening variables in the association between PTSD and dysfunctional cognitions, resulting in greater levels of PTSD and trauma cognitions. Social control and distraction emerged as adaptive strategies, resulting in lower levels of PTSD and trauma cognitions, while reappraisal showed no relationship with PTSD severity. Although the results are cross-sectional, continued focus on the effects of thought control strategies as meditational maintenance variables over time appears warranted.     

Neuroticism and self-criticism associated with posttraumatic stress disorder in a nationally representative sample

Broad and specific psychological traits may uniquely differentiate trauma victims with PTSD from trauma victims without PTSD, but there is a need for representative, population-based research. We investigated elevated neuroticism and self-criticism in association with the presence versus absence of PTSD in a nationally representative sample of adults who experienced a traumatic stressor. Respondents were from the National Comorbidity Survey Part II (N=5877) (). Individuals who experienced one or more traumatic events were selected (N=3238). In separate regression analyses, elevated levels of neuroticism and self-criticism were each significantly associated with PTSD among men and women who had experienced one or more traumatic events. After controlling for types of traumas experienced and other previously identified factors (Bromet, Sonnega, & Kessler, 1998. American Journal of Epidemiology, 147, 353-361), neuroticism remained significantly associated with PTSD in women and both neuroticism and self-criticism remained significant in men. Evidence from this nationally representative sample of adults who experienced traumatic events suggests that self-criticism and especially the broad personality domain of neuroticism may represent robust psychological dimensions associated with the presence of PTSD.