The buffering power of overt socially supportive and unsupportive behaviors from the significant other on posttraumatic stress disorder individuals’ emotional state

Background and objectives: Social support is one of the three strongest predictors of posttraumatic stress disorder (PTSD). In the present study, we aimed to assess the buffering power of overt socially supportive and unsupportive behaviors from the significant other, in a group with PTSD and a comparison group. Design and methods: A total of 46 individuals with PTSD and 42 individuals with obsessive-compulsive disorder (OCD) or panic disorder (PD) completed diagnostic interviews and an anxiety-oriented social interaction with a significant other. Heart rate of participants was continuously measured during this interaction and overt social behaviors from the significant other were recorded on videotape and coded using a validated system. Results: Changes in heart rate in PTSD participants correlated negatively with changes in overt socially supportive behaviors from their significant other (r from ?.36 to ?.50, p?<?.05), while changes in overt unsupportive social behaviors from their significant other did not yield any significant correlation (r from ?.01 to .05, p?>?.05). No such statistically significant association emerged in the group with OCD or PD (r from .01 to ?.27, p?>?.05). Conclusions: This study sustain the buffering power of overt supportive behaviors from the significant other on heart rate changes in PTSD.     

Childhood Trauma Predicts Positive Expressive Suppression During Social Affiliation in Adults With Anxiety and/or Depression: Implications for Social Functioning

Experiencing childhood trauma (CT) can create barriers for developing relationships and is a risk factor for anxiety and depression. Expressive suppression (ES; i.e., reducing expression associated with experiencing emotions) might explain the link between CT and relationship formation difficulties. We examined the association between (1) CT and ES during a dyadic paradigm intended to facilitate connectedness between unacquainted partners and (2) ES and desire for future interaction (DFI). Individuals with an anxiety or depressive disorder diagnosis (N = 77) interacted with a trained confederate; partners answered a series of increasingly intimate questions about themselves. Participant ES for positive and negative emotions, and participant and confederate DFI were collected during the task. Participants completed global anxiety, depression, and CT measures. CT correlated with positive (r = .35, p = .002), but not negative, ES (r = .13, p = .273). In a multiple linear regression model, CT predicted positive ES beyond symptom variables and gender, β = .318, t = 2.59, p = .012. Positive ES correlated with participant (r = ?.38, p = .001) and confederate DFI (r = ?.40, p<.01); and predicted participant DFI beyond symptom variables and ethnicity, β = ?.358, t = ?3.18, p = .002, and confederate DFI, β = ?.390, t = ?3.51, p = .001, beyond symptom variables. Mediation analyses suggested positive ES accounted for the relationship between greater CT severity and less desire for future interaction from participants, 95%CI [?0.26, ?0.02], and confederates, [?0.38, ?0.01]. Positive ES may be an important factor in the reduced capacity to form new social relationships for individuals with a history of CT, anxiety, and depression.     

Are Individuals Always Aware of Their Trauma-Related Intrusive Thoughts? A Study of Meta-Awareness

Individuals are not always aware of their mental content. We tested whether lack of awareness occurs in those who have experienced trauma, with and without posttraumatic stress disorder (PTSD). We also examined the role of proposed cognitive mechanisms (working memory and inhibition) in explaining unnoticed intrusions. Individuals with PTSD (n = 44), and varying levels of symptoms (high posttraumatic stress [PTS]: n = 24; low PTS: n = 37) reported on intrusive thoughts throughout a reading task. Intermittently, participants responded to probes about whether their thoughts were trauma related. Participants were “caught” engaging in unreported trauma-related thoughts (unnoticed intrusions) for between 24 and 27% of the probes in the PTSD and high PTS groups, compared with 15% of occasions in the low PTS group. For trauma-related intrusions only, participants lacked meta-awareness for almost 40% of probes in the PTSD group, which was significantly less than that observed in the other groups (～60%). Contrary to predictions, working memory and response inhibition did not predict unnoticed intrusions. The results suggest that individuals who have experienced significant trauma can lack awareness about the frequency of their trauma-related thoughts. Further research is warranted to identify the mechanisms underpinning the occurrence of unnoticed intrusions.     

Childhood Cancer and Brain Tumor Late Effects: Relationships with Family Burden and Survivor Psychological Outcomes

This study examines illness-specific family burden as a mediator of the association between late effects of childhood cancer and survivors’ emotional and behavioral outcomes. Childhood cancer survivors (n?=?65; ages 10–17) two or more years off-treatment completed measures assessing internalizing and PTSD symptoms. Parents reported on illness-specific family burden, late effects severity, and survivor internalizing/externalizing problems. Providers documented the number of late effects. Illness-specific family burden was correlated with provider-reported late effects (r?=?.29, p?<?.05) and parent report of severe late effects (r?=?.56, p?<?.01). Results supported an indirect effect of illness-specific family burden on number of late effects and parent-reported survivor internalizing problems, p?<?.05. Indirect effects were not found in models predicting PTSD and externalizing problems. Illness-specific family burden is an important intervention target for reducing internalizing problems in childhood cancer survivors with late effects.     

The relationship between DRM and misinformation false memories

This research investigated the relationship between false memories induced by two different paradigms (misinformation and Deese–Roediger–McDermott [DRM]). The misinformation effect refers to the phenomenon that a person’s recollection of a witnessed event can be altered after exposure to misleading information about the event. DRM false memory represents the intrusion of words that are semantically related but not actually presented in the study session. Subjects (N = 432) completed both misinformation and DRM false memory tests. Results showed a small but significant correlation (r = .12, p = .02) between the misinformation and DRM false memories. Furthermore, using signal detection theory, we found that the discrimination ability index (d′) was related to both the misinformation and DRM false memories (r = ?.12 and ?.13, p = .01), while the response bias was related only to DRM false memory (r = ?.46, p < .001). These results suggest that misinformation and DRM false memories generally involve different mechanisms and that their shared mechanism may involve the global discrimination ability.     

Interpersonal Functioning and Trauma: The Role of Empathy in Moderating the Association of PTSD and Interpersonal Functioning

Research demonstrates consistent associations between symptoms of posttraumatic stress disorder (PTSD) and reductions in interpersonal functioning. Moderators of this association, however, remain relatively unexplored. The current study aimed to examine the extent to which aspects of empathic responding may influence the relation between PTSD symptom dimensions and interpersonal functioning in students exposed to significant trauma. Participants (N = 94, 85.1% female, 86.2% White/Non-Hispanic) completed an initial screening to assess for trauma exposure and associated symptoms of PTSD. Interpersonal functioning and dimensions of empathic responding were measured using a series of self-report and lab-based tasks. Hierarchical regression models provided evidence for a consistent association between post-trauma arousal-reactivity and reductions in interpersonal functioning. Results also indicated a moderating effect of affective empathy (β = −.37, p = .010, f² = .086). Simple slopes and Johnson-Neyman plots identified an association between arousal-reactivity and functioning at low (β = 1.57, p < .001, f² = .301) versus high (β = .31, p = .417, f² = .008) levels of empathic response to a positively valenced film. Results offer preliminary support for a potential buffering effect of affective empathy on interpersonal functioning in individuals reporting chronic, trauma-related symptoms.     

Testing Clinical Intuitions About Barriers to Improvement in Cognitive-Behavioral Therapy for Panic Disorder

Although clinical intuitions influence psychotherapeutic practice and are a rich source of novel hypotheses for research, many remain to be empirically tested. This study evaluates whether clinicians’ beliefs about barriers to progress in cognitive-behavioral therapy (CBT) for panic disorder are supported by data. Data from a randomized-controlled trial comparing CBT to panic-focused psychodynamic psychotherapy (PFPP) for adults with primary panic disorder (N = 161) were used to evaluate 15 factors endorsed by clinicians as impediments to CBT in a recent survey. Panic severity was assessed before, during (at Weeks 1, 5, and 9), and at termination of treatment (Week 12) using the Panic Disorder Severity Scale. Hierarchical linear modeling revealed that none of the perceived barriers were predictive of poor outcome. Contrary to clinicians’ intuitions, dissociation during panic attacks was associated with greater symptomatic improvement in both treatment arms (β = ?0.69, p < .05), above the effect of established predictors. Moderation analyses revealed that when patients had PTSD diagnosed with the Anxiety Disorders Interview Schedule (β = 1.71, p < .05) or less severe panic disorder (β = 0.45, p = .04), they changed more rapidly in CBT than in PFPP. Overall, clinician agreement was inversely related to the strength of a predictor (r = ?.24, p = .39). Although clinical intuitions can be useful as clinical and empirical signals, such beliefs should be critically examined before informing practice. Dialogue between academics and clinicians might be enhanced through research that incorporates input from front-line practitioners.     

Fear conditioning in posttraumatic stress disorder: evidence for delayed extinction of autonomic, experiential, and behavioural responses

Aversive conditioning has been proposed as an important factor involved in the etiology of posttraumatic stress disorder (PTSD). However, it is not yet fully understood exactly which learning mechanisms are characteristic for PTSD. PTSD patients (n=36), and healthy individuals with and without trauma exposure (TE group, n=21; nTE group, n=34), underwent a differential fear conditioning experiment consisting of habituation, acquisition, and extinction phases. An electrical stimulus served as the unconditioned stimulus (US), and two neutral pictures as conditioned stimuli (CS+, paired; CS-, unpaired). Conditioned responses were quantified by skin conductance responses (SCRs), subjective ratings of CS valence and US-expectancy, and a behavioural test. In contrast to the nTE group, PTSD patients showed delayed extinction of SCRs to the CS+. Online ratings of valence and US-expectancy as well as the behavioural test confirmed this pattern. These findings point to a deficit in extinction learning and highlight the role of affective valence appraisals and cognitive biases in PTSD. In addition, there was some evidence that a subgroup of PTSD patients had difficulties in learning the CS-US contingency, thereby providing preliminary evidence of reduced discrimination learning.     

Adolescent Sense of Control: A Downward Extension of the Shapiro Control Inventory to Pre- and Early Adolescents

The most commonly used measures of perceived control for young adolescents are dated, psychometrically flawed, or focused on particular domains. To address the need for a general purpose measure of control for this age range, the overall sense of control (OSOC) and the domains of control (DOC) subscales of the Shapiro Control Inventory (D. H. Shapiro, 1994), designed for use with adults, were modified. Exploratory factor analyses suggested that the adapted OSOC and DOC scales consisted of internally consistent 1-factor structures, accounting for 32% and 29% of the variance, respectively. In Study 1, results from 310 preadolescents (9–13 years old) indicated that a higher sense of control was related to lower stress, OSOC, r(308) = ?.52, p < .001; DOC, r(308) = ?.23, p < .001; and depression, OSOC, r(308) = ?.63, p < .001; DOC, r(308) = ?.33, p < .001. In study 2, results from 195 adolescents (11–15 years old) showed that a higher sense of control was associated with lower stress, r(193) = ?.55, p < .001, and depression, r(193) = ?.60, p < .001, concurrently. The results suggest that these 2 revised measures of adolescent perceived control exhibited good content and predictive validities.     

The smart gut: Tracking affective associative learning with measures of “liking”, facial electromyography, and preferential looking

We demonstrate here that initially neutral items can acquire specific value based on their associated outcomes, and that responses of physiological systems to such previously meaningless stimuli can rapidly reflect this associative history. Each participant participated in an associative learning task in which four neutral abstract pictures were each repeatedly paired with one of four foods that varied in valence and magnitude. Over the course of learning, participants’ “liking” ratings of and preferences for each picture came to reflect the value of the food with which it was paired. The abstract pictures also elicited physiological responses characteristic of the foods with which they were paired, including changes in facial electromyography (EMG) and preferential looking. A logistic modeling procedure showed that learning parameters, such as the rate at which participants learned the values associated with the pictures, were similar across food outcomes of different value.     

Cognitive Load Undermines Thought Suppression in Acute Stress Disorder

Thought suppression studies demonstrate that attempts to suppress can be undermined by cognitive load. We report the first instance in which this has been tested experimentally in a sample of recently traumatized individuals. Individuals with and without acute stress disorder (ASD) were recruited following recent trauma and randomized to load or no load conditions (N = 56). They monitored intrusive memories during baseline, suppression, and think anything phases. The impact of suppression and load on self-reported intrusions, attention bias (dot-probe), and memory priming (word-stem task) was assessed. The ASD load group were less able to suppress memories (d = 0.32, CI₉₅ [− 0.15, 0.83], p = .088) than the ASD no load group (d = 0.63, CI₉₅ [0.08, 1.24], p < .001). In the think anything phase, the ASD load group reported more intrusions than the ASD no load or non-ASD groups (with and without load). No consistent findings were observed in relation to attentional bias. ASD load individuals exhibited stronger priming responses for motor vehicle accident and assault words than all other groups (ds between 0.35–0.73). Working memory did not moderate any outcomes of interest. The findings indicate that cognitive load interferes with suppression and may enhance access to trauma memories and associated material. The study extends previous research by demonstrating these effects for the first time in a clinical sample of recent survivors of trauma.     

The effects of anxiety on the perception of word phrases

This study was designed to determine if anxiety in intermediate grade school children would influence their perceptual reading pattern of word phrases. The 107 fifth- and sixth-grade students had phrase reading scores significantly associated with age, sex, and grade level in the expected direction. Higher anxiety scores significantly limited student perception among 3-, 4-, and 5-word length phrases (r's from ?.37 to ?.40, p < .01). Anxiety test data increased by 10 to 13% the amount of predictive variance accounted for beyond predictions obtained established by age, sex, and grade level in combination (p < .01). R's ranged from .56 to .58.     

Temperamental Vulnerability and Suicide Risk After Attempted Suicide

The aim was to extend recent findings of suggested temperamental features in attempted suicide and to explore possible domains of vulnerability to suicide risk after attempted suicide. Fifty-four psychiatric inpatients hospitalized after a suicide attempt underwent lumbar puncture for analysis of CSF 5-HIAA concentration and also completed the Karolinska Scales of Personality (KSP) before discharge from the hospital. Suicide attempters scored high on Somatic Anxiety, Psychic Anxiety, and Muscular Tension, and low on Socialization, findings that support recent findings in suicide attempters followed up after an emergency room visit. Five patients committed early suicide, i.e., within 3 years, and the overall long-term suicide mortality after attempted suicide was 13%. There were significant correlations between survival time among early suicides and CSF 5-HIAA (r = .87;p = .054), and the following KSP scale t scores: Somatic Anxiety (r = ?.96;p < .05), Impulsivity (r = ?.88; p < .05), and Socialization (r = .90; p < .05). KSP Socialization showed correlations with CSF 5-HIAA (r = .89; p = .046) among the early suicides. Features of temperamental vulnerability to suicide risk after attempted suicide might involve anxiety proneness, impulsivity, low socialization, and low CSF 5-HIAA.     

The Comorbidity of Post-traumatic Stress Disorder and Suicidality in Vietnam Veterans

Vietnam veterans (N = 232) recruited from three sources were assessed for suicidal thinking and behaviors, and symptoms of posttraumatic stress disorder (PTSD) and depression. Findings support the notion that suicidal thoughts are prevalent in this group, with veterans in psychotherapy reporting a greater likelihood of such symptoms (82.6%) than veterans in the community (35.7%) or those seeking assistance through a veteran's outreach center (66.7%). Thoughts of ending one's life and a previous suicide attempt were significantly correlated with a diagnosis of PTSD (r = .53, p < .001; and r = .33, p < .001, respectively). Veterans with a diagnosis of PTSD and depression or dysthymia were also more likely to report suicidal thinking and behaviors than veterans with only one of the diagnoses.     

Attention, heart rate, and startle response during exposure to trauma-relevant pictures: a comparison of recent trauma victims and patients with posttraumatic stress disorder

Victims of a recent trauma were compared with posttraumatic stress disorder (PTSD) patients and healthy controls to assess whether a specific anxiety response and an attentional bias were evident initially or only in chronic PTSD. Heart rate (HR) and startle response were measured, and a dot-probe task was carried out using trauma-relevant pictures. Severely affected recent trauma victims and chronic PTSD patients showed HR acceleration to trauma-related material, which was the only significant group difference. A bias away from trauma-related material was related to severity of intrusions in recent trauma victims, and the bias toward trauma-related material increased with amplitude of the HR response in PTSD patients. A specific anxiety reaction is present initially in severely affected trauma victims.     

Impact of Treatment Setting and Format on Symptom Severity Following Cognitive Processing Therapy for Posttraumatic Stress Disorder

Preliminary data suggest cognitive processing therapy (CPT) significantly reduces posttraumatic stress disorder (PTSD) symptom severity among military personnel and veterans when delivered over 12 days and combined with daily recreational activities (Bryan et al., 2018). The present study aimed to examine how therapy pace (i.e., daily vs. weekly sessions) and setting (i.e., clinic vs. recreational) impacts change in PTSD symptom severity. Forty-five military personnel and veterans diagnosed with PTSD chose to receive CPT (a) daily at a recreational facility with recreational programming, (b) daily on a university campus without recreational programming, and (c) weekly on a university campus without recreational programming. PTSD symptom severity was assessed with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) and the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5). Reductions in CAPS-5 and PCL-5 scores were large and statistically significant across all three settings (Cohen’s ds > 2.1). As compared to reductions in CAPS-5 and PCL-5 scores in daily therapy at a recreational facility (CAPS-5: d = 1.63–2.40; PCL-5: d = 1.99–2.17), reductions in CAPS-5 and PCL-5 scores were significantly larger in daily therapy on campus, CAPS-5: t(80) = –2.9, p = .005, d = 2.23–2.69; PCL-5: t(78) = 2.6, p = .010, d = 2.54–4.43, but not weekly therapy on campus, CAPS-5: t(80) = 0.2, p = .883, d = 1.04–2.47; PCL-5: t(78) = 1.0, p = .310, d = 1.77–3.44. Participants receiving daily therapy on campus and weekly therapy on campus also had higher rates of clinically significant improvement and good end-state functioning. Results support the effectiveness of CPT across multiple treatment settings and formats and suggest that daily CPT may be less effective when delivered in combination with recreational activities.     

The Effects of Warnings and Speeding on Scale Scores and Convergent Validity of Conscientiousness

We examined the effects of warnings and speeding on scale scores and convergent validity of a measure of Conscientiousness in a faking context (N = 329). A completely crossed 2 × 2 experimental design was used in which instructions (no warning or a warning) and speeding (with or without a time limit) were manipulated. No statistically significant effects on scale scores or convergent validity were evidenced for speeding. Warning participants did decrease Conscientiousness scores by almost 1 standard deviation (d = .91). Warnings also moderated the relationship between self- and observer-ratings of Conscientiousness such that the relationship between self- and observer-ratings was statistically significant and positive in the warned conditions (r _partial = .29, p < .01, n = 136), but this same relationship was statistically nonsignificant (r _partial = ?.14, p > .05, n = 148) in the unwarned conditions.     

Bidirectional Relationships Between Posttraumatic Stress Disorder and Social Functioning During Cognitive Processing Therapy

This study investigated temporal relationships between posttraumatic stress symptoms and two indicators of social functioning during cognitive processing therapy. Participants were 176 patients (51.5% female, M age = 39.46 [SD = 11.51], 89.1% White, 42.6% active duty military/veteran) who participated in at least two assessment time points during a trial of cognitive processing therapy. Posttraumatic stress disorder (PTSD) symptoms (PTSD Checklist for DSM-IV) and interpersonal relationship and social role functioning problems (Outcome Questionnaire–45) were assessed prior to each of 12 sessions. Multivariate multilevel lagged analyses indicated that interpersonal relationship problems predicted subsequent PTSD symptoms (b = .22, SE = 0.09, cr = 2.53, p = .01, pr = .46) and vice versa (b = .05, SE = 0.02, cr = 2.11, p = .04, pr = .16); and social role functioning problems predicted subsequent PTSD symptoms (b = .21, SE = 0.10, cr = 2.18, p = .03, pr = .16) and vice versa (b = .06, SE = 0.02, cr = 3.08, p < .001, pr = .23). Military status moderated the cross-lag from social role functioning problems to PTSD symptoms (b = –.35, t = –2.00, p = .045, pr = .16). Results suggest a robust association between PTSD symptoms and social functioning during cognitive processing therapy with a reciprocal relationship between PTSD symptoms and social functioning over time. Additionally, higher social role functioning problems for patients with military status indicate smaller reductions in PTSD symptoms from session to session.     

Posttraumatic stress and depression: potential pathways to disease burden among heart failure patients

Background and Objectives: Posttraumatic stress disorder (PTSD) and Major Depressive Disorder (MDD) are associated with high disease burden. Pathways by which PTSD and MDD contribute to disease burden are not understood. Design: Path analysis was used to examine pathways between PTSD symptoms, MDD symptoms, and disease burden among 251 low-income heart failure patients. Methods: In Model 1, we explored the independent relationship between PTSD and MDD symptoms on disease burden. In Model 2, we examined the association of PTSD symptoms and disease burden on MDD symptoms. We also examined indirect associations of PTSD symptoms on MDD symptoms, mediated by disease burden, and of PTSD symptoms on disease burden mediated by MDD symptoms. Results: Disease burden correlated with PTSD symptoms (r = .41; p < .001) and MDD symptoms (r = .43; p < .001) symptoms. Both models fit the data well and displayed comparable fit. MDD symptoms did not mediate the association of PTSD symptoms with disease burden. Disease burden did mediate the relationship between PTSD symptoms and MDD symptoms. Conclusions: Results support the importance of detection of PTSD in individuals with disease. Results also provide preliminary models for testing longitudinal data in future studies.     

Brief Imaginal Exposure for PTSD: Trajectories of Change in Distress

Preliminary evidence shows that brief, condensed imaginal exposure only interventions can be effective in the treatment of PTSD, but we need to understand its mechanisms of action. Consistent with extinction learning and retrieval processes, the present study examined whether a pattern of between-session distress reduction observed during standard prolonged exposure (PE) therapy would be observed and predict outcome. Sixty-three patients with PTSD were enrolled in two clinical trials using our treatment protocol consisting of six daily 50-min sessions focusing on imaginal exposure and processing only. Individual patient trajectories of distress reduction were examined over the course of the five imaginal exposure sessions (Sessions 2-6). Overall, significant linear distress reduction was observed for anticipatory (d = 1.18), peak (d = 1.83), and ending imaginal exposure distress (d = 1.21). Consistent with extinction learning, the steeper slope of peak distress (d = 1.03) and end distress (d = 0.68) across imaginal exposure sessions strongly predicted decreases in PTSD symptoms. Distress reduction across sessions was predicted by higher baseline avoidance and hyperarousal but not reexperiencing symptoms. This condensed format of daily 50-min sessions without in vivo exposure may be operating via similar extinction learning processes as longer protocols. Our clinical observations suggest that the brief daily format may offer the advantage of allowing each session to build on the previous one to promote meaningful shifts in the retrieval of the trauma memory. Brief imaginal exposure and processing may be a viable option for PTSD patients in settings where brief interventions are needed. Understanding potential change processes and baseline predictors of change brings us closer toward precision medicine in treating PTSD.