Attentional interference by threat and post-traumatic stress disorder: The role of thought control strategies

Attentional interference by threat is associated with PTSD, but the mechanisms of this relationship remain unclear. Attentional interference might be related to increased use of maladaptive thought control strategies, such as suppressing unwanted thoughts (thought suppression) or replacing threatening thoughts with everyday concerns (worry), which increase PTSD risk. Conversely, attentional interference might be associated with reduced use of adaptive strategies, such as talking about threatening thoughts (social control), which decrease PTSD risk. This study tested if thought control strategies mediate the relationship between attentional interference and PTSD. Sixty-one male Vietnam-era veterans completed measures of PTSD symptoms and thought control strategies. Participants also completed a Visual Search Task measuring attentional interference, which required participants to identify a target letter string among a group of threat or neutral words. Attentional interference by threat was related to PTSD symptoms, and mediation analyses revealed significant indirect effects of attentional interference through thought suppression and worry. Attentional interference was related to re-experiencing and avoidance, but not hyperarousal, symptom clusters. Thought suppression was a unique mediator for re-experiencing, whereas thought suppression and worry both mediated the relationship with avoidance. These results offer evidence for maladaptive thought control strategies as a mechanism linking attentional biases for threat to PTSD.     

Specificity of cognitive emotion regulation strategies: A transdiagnostic examination

Despite growing interest in the role of regulatory processes in clinical disorders, it is not clear whether certain cognitive emotion regulation strategies play a more central role in psychopathology than others. Similarly, little is known about whether these strategies have effects transdiagnostically. We examined the relationship between four cognitive emotion regulation strategies (rumination, thought suppression, reappraisal, and problem-solving) and symptoms of three psychopathologies (depression, anxiety, and eating disorders) in an undergraduate sample (N = 252). Maladaptive strategies (rumination, suppression), compared to adaptive strategies (reappraisal, problem-solving), were more strongly associated with psychopathology and loaded more highly on a latent factor of cognitive emotion regulation. In addition, this latent factor of cognitive emotion regulation was significantly associated with symptoms of all three disorders. Overall, these results suggest that the use of maladaptive strategies might play a more central role in psychopathology than the non-use of adaptive strategies and provide support of a transdiagnostic view of cognitive emotion regulation.     

Are expressive suppression and cognitive reappraisal associated with stress-related symptoms?

Emotion dysregulation is thought to be critical to the development of negative psychological outcomes. Gross (1998b) conceptualized the timing of regulation strategies as key to this relationship, with response-focused strategies, such as expressive suppression, as less effective and more detrimental compared to antecedent-focused ones, such as cognitive reappraisal. In the current study, we examined the relationship between reappraisal and expressive suppression and measures of psychopathology, particularly for stress-related reactions, in both undergraduate and trauma-exposed community samples of women. Generally, expressive suppression was associated with higher, and reappraisal with lower, self-reported stress-related symptoms. In particular, expressive suppression was associated with PTSD, anxiety, and depression symptoms in the trauma-exposed community sample, with rumination partially mediating this association. Finally, based on factor analysis, expressive suppression and cognitive reappraisal appear to be independent constructs. Overall, expressive suppression, much more so than cognitive reappraisal, may play an important role in the experience of stress-related symptoms. Further, given their independence, there are potentially relevant clinical implications, as interventions that shift one of these emotion regulation strategies may not lead to changes in the other.     

Thought Control: Is It Ability, Strategies, or Both That Predicts Posttraumatic Symptomatology in Victims of Interpersonal Trauma?

Cognitive models of PTSD have implicated thought control in the development, maintenance, and recovery from PTSD. The present study extends previous research on thought control (ability and strategies) and it’s relation to posttraumatic stress symptoms (PTSS) in a sample of interpersonal trauma (IPT) survivors. Results revealed that weak thought control ability mediated the relationship between accumulated discrete IPT experiences and PTSS severity. Weak thought control ability was associated with greater use of thought control strategies, and thought control strategies of punishment and suppression added significant variance over and above the effects of accumulated IPT experiences and thought control ability in predicting PTSS severity. Furthermore, weak thought control ability was related to greater PTSS severity through the use of punishment and suppression thought control strategies. The present findings extend previous research and provide further support for theoretical assumptions of current treatment approaches for PTSD.     

Posttraumatic Stress Symptoms,Aggression, and Substance Use Coping among Young Adults

This study examined how the symptom clusters of posttraumatic stress disorder (PTSD) were related to substance use and self-reported aggression in a college sample. There were 358 participants (ages 18–24) who completed surveys to assess PTSD symptoms, substance use as coping, and aggression. Hierarchical regressions tested for the effects of PTSD symptoms (total symptoms as well as cluster symptoms) on self-reported aggression, along with the main and interaction effects of substance use coping on these relationships. The hyperarousal cluster of PTSD was the only group of symptoms significantly related to aggression. There was an interaction between avoidance symptoms and substance use coping on aggression such that under conditions of high substance use coping, aggression increased regardless of avoidance symptoms; however, the relationship between avoidance and aggression was stronger under conditions of low substance use coping, with greater aggression as avoidance symptoms and low substance use coping increased.     

When are adaptive strategies most predictive of psychopathology?

In recent work, we showed that putatively adaptive emotion regulation strategies, such as reappraisal and acceptance, have a weaker association with psychopathology than putatively maladaptive strategies, such as rumination, suppression, and avoidance (e.g., Aldao & Nolen-Hoeksema, 2010; Aldao, Nolen-Hoeksema, & Schweizer, 2010). In this investigation, we examined the interaction between adaptive and maladaptive emotion regulation strategies in the prediction of psychopathology symptoms (depression, anxiety, and alcohol problems) concurrently and prospectively. We assessed trait emotion regulation and psychopathology symptoms in a sample of community residents at Time 1 (N = 1,317) and then reassessed psychopathology at Time 2 (N = 1,132). Cross-sectionally, we found that the relationship between adaptive strategies and psychopathology symptoms was moderated by levels of maladaptive strategies: adaptive strategies had a negative association with psychopathology symptoms only at high levels of maladaptive strategies. In contrast, adaptive strategies showed no prospective relationship to psychopathology symptoms either alone or in interaction with maladaptive strategies. We discuss the implications of this investigation for future work on the contextual factors surrounding the deployment of emotion regulation strategies.     

Religious coping,general coping strategies,perceived social support,PTSD symptoms,resilience, and posttraumatic growth among survivors of the 2010 earthquake in Haiti

This study examines the relationships between coping strategies, perceived social support, resilience, PTSD symptoms, and posttraumatic growth (PTG) in a sample of 256 survivors of the 2010 Haiti earthquake. The results of the bivariate analysis suggested a significant positive correlation between PTG and resilience, PTSD symptoms, perceived social support, positive religious coping, and active coping. There was a significant positive relationship between perceived social support and resilience and between resilience and active coping. PTSD symptoms were positively correlated with both positive and negative religious coping. Results of the multiple regression analysis indicated that positive religious coping, active coping, perceived social support, resilience, and PTSD symptoms accounted for 34% of the variance in the participants’ PTG. The strongest predictor of PTG was positive religious coping, followed by active coping, perceived social support, resilience, PTSD symptoms, and negative religious coping. Implications and recommendations for future research were discussed.     

Relationships among Proactive Coping,Posttrauma Gratitude,and Psychopathology in a Traumatized College Sample

Scant previous research has examined associations of proactive coping and psychopathology, although two preliminary findings suggest that proactive coping might be negatively associated with posttraumatic stress disorder (PTSD) and general depression symptom level. This study examined associations of proactive coping with PTSD and anhedonic depression in a sample of 169 traumatized undergraduates. As expected, women tended to report more severe PTSD symptoms and less life threat than men. No other gender differences were found. Most important, proactive coping and posttrauma state gratitude were independently negatively associated with PTSD symptom level, after controlling for trauma history and female gender. Further, proactive coping was independently negatively associated with anhedonic depression, beyond the effect of traumatic life threat. The implications of the findings for models of posttrauma psychopathology development are discussed.     

Racial/ethnic differences moderate associations of coping strategies and posttraumatic stress disorder symptom clusters among women experiencing partner violence: a multigroup path analysis

Background: Past research underscores the key role of coping strategies in the development, maintenance, and exacerbation of posttraumatic stress disorder (PTSD) symptoms. The goal of the current study was to extend existing literature by examining whether race/ethnicity moderates the relations among coping strategies (social support, problem-solving, avoidance) and PTSD symptom clusters (intrusion, avoidance, numbing, arousal).

Methods: Participants were 369 community women (134 African Americans, 131 Latinas, 104 Whites) who reported bidirectional aggression with a current male partner. Multigroup path analysis was utilized to test the moderating role of race/ethnicity in a model linking coping strategies to PTSD symptom clusters.

Results: The strength and direction of relations among coping strategies and PTSD symptom clusters varied as a function of race/ethnicity. Greater social support coping was related to more arousal symptoms for Latinas and Whites. Greater problem-solving coping was related to fewer arousal symptoms for Latinas. Greater avoidance coping was related to more symptoms across many of the PTSD clusters for African Americans, Latinas, and Whites, however, these relations were strongest for African Americans.

Conclusion: Results provide support for the moderating role of race/ethnicity in the relations among coping strategies and PTSD symptom clusters, and highlight potential targets for culturally informed PTSD treatments.     

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.     

PTSD青少年执行功能缺陷的情绪特异性

已有研究表明PTSD青少年存在执行功能缺陷,但尚不清楚这种缺陷是否具有情绪特异性。以2008年汶川地震重灾区汉旺中学PTSD、非PTSD以及非灾区青少年各28名为被试,探讨震后PTSD青少年执行功能缺陷是否具有情绪特异性。实验1采用经典Stroop范式,结果发现3组被试的Stroop效应量无显著差异;实验2采用情绪Stroop范式,结果发现PTSD组对地震信息的Stroop效应量显著大于非PTSD组和控制组。整个研究表明,震后PTSD青少年的执行功能缺陷具有情绪特异性。     

Role of thought-related beliefs and coping strategies in the escalation of intrusive thoughts: an analog to obsessive-compulsive disorder

Cognitive-behavioral models of obsessive-compulsive disorder (OCD) assume that obsessions have their origin in normal intrusive thoughts. These models propose that certain beliefs, such as thought-action fusion (TAF) beliefs, combined with the use of ineffective coping strategies, such as thought suppression, lead to the development of OCD. The purpose of the current study was to examine the relationship between these variables in a non-clinical sample in addition to exploring the effects of an alternative, acceptance-based coping strategy. This study explored the relationship between TAF beliefs, thought suppression, and OC-consistent symptoms via mediational analyses. Results showed that thought suppression mediated the relationship between TAF beliefs and OC-consistent symptoms. This study also experimentally examined the effects of various coping strategies (suppression, acceptance, or monitor-only) on the frequency of a distressing intrusion and appraisal ratings (e.g., anxiety, guilt, responsibility) after a TAF induction. Spontaneous suppression in the monitor-only group made comparisons of the experimental data difficult. However, analyses provided preliminary evidence suggesting that thought suppression is related to more intrusions, higher levels of anxiety, and negative appraisals, whereas an acceptance-based approach may be a useful alternative. Additional findings, limitations of the current study, and directions for future research are discussed.     

Overgeneral memory extends to pictorial retrieval cues and correlates with cognitive features in posttraumatic stress disorder

Individuals with posttraumatic stress disorder (PTSD) show overgeneral memory (OGM) when retrieving autobiographical memories to word cues. We investigated whether OGM extends to picture cues and whether it is related to PTSD symptoms and cognitions. Trauma survivors with (n = 29) and without (n = 26) PTSD completed the standard Autobiographical Memory Test (AMT) and a novel picture version. Compared to the no-PTSD group, the PTSD group showed OGM in both test versions. Pictures facilitated specific memory retrieval, but this effect was no longer significant when verbal intelligence or depressive symptoms were controlled. OGM correlated with PTSD symptoms and perceived self-change; with intrusive memories, their perceived "nowness," responses to intrusions (thought suppression, rumination, dissociation), and negative interpretations of symptoms.     

Seeing the silver lining: potential benefits of trauma exposure in college students

In the current study we compare college students exposed to a potentially traumatic event (PTE) meeting self-report criteria for Posttraumatic Stress Disorder (PTSD), PTE-exposed students not meeting criteria for PTSD, and non-exposed students on measures of perceived social support, self-esteem, and optimism (i.e., personal resources) and report use of specific coping strategies. Results indicate that the PTE-exposed/probable PTSD group reported fewer personal resources, greater use of avoidance-focused coping, and less use of approach-focused coping than the other two groups. The PTE-exposed/no PTSD group reported greater perceived social support and less use of avoidance-focused coping than the non-exposed group. We discuss the findings' implications for the prevention and treatment of trauma-related psychopathology.     

The association between gender, coping style and whiplash related symptoms in sufferers of whiplash associated disorder

The aim of the present study was to examine specifically whether the relationship between coping style and symptoms of whiplash injury change as a function of gender. A total of 1709 sufferers of whiplash associated disorder (1349 women, 360 men) belonging to the Danish Society for Polio, Traffic and Accident Victims completed questionnaires measuring demographic and psychological factors (including coping style), and symptoms of whiplash trauma (including pain). Men and women were not found to differ significantly in their use of coping strategies, however emotion focused coping strategies were related significantly more strongly to whiplash related symptoms in men compared to women. Women were found to display more symptoms related to whiplash injury compared to men. Possible reasons for the present findings are discussed in light of related research indicating mood as a potential moderating variable in the relationship between maladaptive coping style and degree of symptoms related to injury in men.     

Cultural Differences in the Reciprocal Relations between Emotion Suppression Coping,Depressive Symptoms and Interpersonal Functioning among Adolescents

The current study examined the prospective relations between emotion suppression and maladjustment (i.e., depressive symptoms, family stress events, peer stress events, and family and peer support) among Vietnamese American (n = 372) and European American adolescents (n = 304). We found that at baseline Vietnamese Americans adolescents reported greater use of emotion suppression coping than European American adolescents. Multi-group structural equation modeling indicated that for European American teens emotion suppression was significantly related to increased depression symptoms and decreased quality of peer relationships. In contrast, for the Vietnamese Americans teens emotion suppression relations to later maladjustment was either nonsignificant or attenuated relative to the European American. These findings suggest ethnic group differences in both the utilization, and consequences and function of emotion suppression among Vietnamese American and European American adolescents.     

Role of event centrality and emotion regulation in posttraumatic stress disorder symptoms among internally displaced persons

Background: Event centrality and emotion regulation in relation to posttraumatic stress disorder (PTSD) have been documented in various global samples especially in Western cultures; but internally displaced persons (IDPs) still constitute an underrepresented population in psychotraumatology literature. This study tested the roles of event centrality and emotion regulation strategies (cognitive reappraisal and expressive suppression) in PTSD symptoms among IDPs in Nigeria.

Design: The multi-group cross-sectional design was adopted.

Methods: Tiv language versions of the Centrality of Events Scale, Emotion Regulation Questionnaire, and Harvard Trauma Questionnaire were completed by 859 IDPs in two camps located in Benue State, North-central region of Nigeria.

Results: Hierarchical multiple linear regression results indicated that event centrality positively predicted PTSD symptoms. Cognitive reappraisal was a negative predictor of PTSD symptoms while expressive suppression was a positive predictor of PTSD symptoms. Bonferroni corrections indicated that expressive suppression was the strongest predictor of total PTSD symptoms, avoidance/numbing symptoms, and hyper-arousal symptoms; but event centrality was the most robust predictor of PTSD intrusion/re-experiencing symptoms.

Conclusion: The findings underscore recent developments in psychotraumatology indicating that the extent to which individual differences impact the development of PTSD is essential in clinical psychology research and practice.