Research Items (62)
Objective: A substantial amount of individuals with substance use disorders (SUD) also meet criteria for posttraumatic stress disorder (PTSD). Prolonged Exposure (PE) is an effective, evidence-based treatment for PTSD, but there is limited data on its use among individuals with current alcohol or drug use disorders. This study evaluated the efficacy of an integrated treatment that incorporates PE (Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure or COPE) among veterans. Method: Military veterans (N = 81, 90.1% male) with current SUD and PTSD were randomized to 12 sessions of COPE or Relapse Prevention (RP). Primary outcomes included the Clinician Administered PTSD Scale (CAPS), PTSD Checklist-Military version (PCL-M), and the Timeline Follow-back (TLFB). Results: On average, participants attended 8 out of 12 sessions and there were no group differences in retention. Intent-to-treat analyses revealed that COPE, in comparison to RP, resulted in significantly greater reductions in CAPS (d = 1.4, p <.001) and PCL-M scores (d = 1.3, p =.01), as well as higher rates of PTSD diagnostic remission (OR = 5.3, p <.01). Both groups evidenced significant and comparable reductions in SUD severity during treatment. At 6-months follow-up, participants in COPE evidenced significantly fewer drinks per drinking day than participants in RP (p =.05). Conclusions: This study is the first to report on the use of an integrated, exposure-based treatment for co-occurring SUD and PTSD in a veteran sample. The findings demonstrate that integrated, exposure-based treatments are feasible and effective for military veterans with SUD and PTSD. Implications for clinical practice are discussed.
Background: Although exposure-based therapy is a well-established, effective treatment for post-traumatic stress disorder (PTSD), some practitioners report reluctance to implement it due to concerns that it may exacerbate symptoms of PTSD and commonly comorbid disorders, such as substance use disorders (SUD). Aim: This study compared the exacerbation of psychological symptoms among participants with comorbid PTSD and SUD who received either SUD treatment alone or SUD treatment integrated with exposure therapy for PTSD. Method: Participants (N = 71) were treatment-seeking, military Veterans with comorbid PTSD and SUD who were randomized to 12 individual sessions of either (1) an integrated, exposure-based treatment (Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure; COPE); or (2) a non-exposure-based, SUD-only treatment (Relapse Prevention; RP). We examined between-group differences in the frequency of statistically reliable exacerbations of PTSD, SUD and depression symptoms experienced during treatment. Results: At each of the 12 sessions, symptom exacerbation was minimal and generally equally likely in either treatment group. However, an analysis of treatment completers suggests that RP participants experienced slightly more exacerbations of PTSD symptoms during the course of treatment. Conclusions: This study is the first to investigate symptom exacerbation throughout trauma-focused exposure therapy for individuals with comorbid PTSD and SUD. Results add to a growing literature which suggests that trauma-focused, exposure-based therapy does not increase the risk of symptom exacerbation relative to non-exposure-based therapy.
- Apr 2019
Introduction Appalachian women live in an insomnia “hotspot,” and have limited access to health services. The most prevalent insomnia treatments, prescription and non-prescription sleep aids, are associated with negative side effects including falls and confusion. Conversely, cognitive behavioral therapy for insomnia (CBT-I) is proven safe and effective for insomnia and may also reduce stress, sleep aid use, and depression symptoms. The purpose of this study was to pilot test Sleep Healthy Using the Internet (SHUTi), a well-validated Internet-based version of CBT-I among Appalachian women ages 45+, and to gather preliminary efficacy data on changes in insomnia severity, perceived stress, depression symptoms, and sleep aid use. Methods We employed a single group, pretest-posttest design. Pre- and post-intervention, participants completed an online survey and a semi-structured, qualitative interview. Quantitative data were analyzed using one-way repeated measures ANOVA or generalized estimating equations where appropriate. Interview data were qualitatively analyzed using a multi-stage coding process. Results Forty-six women enrolled; 38 completed the Internet-based program (retention rate = 82.6%). Mean participant age was 55.1. Positive and statistically significant (p<0.01) improvements were observed on mean score measures for the Insomnia Severity Index (15.1 to 6.5), the Perceived Stress Scale (20 to 14.6), and the Center for Epidemiologic Studies Depression Scale Revised (10: 9.8 to 5.2). The odds of reporting sleep aid use post-intervention were lower than pre-intervention (OR 0.28 [95% CI 0.11-0.74; p=0.01]). Qualitative interviews revealed that insomnia onset was often preceded by an acute social stressor (e.g., death of a child) and perpetuated by a chronic social stressor (e.g., raising a grandchild). Conclusion These pilot findings suggest that Internet-based CBT-I may be a useful, non-pharmacologic treatment that reduces insomnia severity, perceived stress, depression symptoms, and sleep aid use in the health disparities population of Appalachian women. Support (If Any) This project was supported by the Building Interdisciplinary Research Careers in Women's Health Program (NIDA grant: K12DA035150), pilot funding from the Igniting Research Collaborations Grant (University of Kentucky College of Pharmacy) and the University of Kentucky Center for Clinical and Translational Sciences (grant: UL1TROO1998).
- Mar 2019
Background: Posttraumatic stress disorder (PTSD) and alcohol use disorders are highly co-occurring. Several explanatory models of the relation between PTSD and hazardous alcohol use have been identified. However, the exact nature of this relation is not fully understood. Self-disgust may explain the relation between PTSD symptoms and hazardous drinking. Objectives: The goal of the current study was to examine whether there was an indirect effect of probable PTSD on hazardous alcohol use via two domains of self-disgust: (disgust with characteristics of the self, disgust with one’s behavior). Participants were 376 undergraduate students who reported experiencing at least one Diagnostic and Statistical Manual for DSM Disorders, 5th edition-defined traumatic event. Participants completed self-report measures online, which assessed their trauma exposure, PTSD symptoms, self-disgust, and their alcohol use behaviors. Results: Probable PTSD was indirectly associated with an increased likelihood of engaging in hazardous drinking through the pathway of increased disgust toward one’s behaviors. Although probable PTSD was also positively linked to disgust with characteristics of the self, this form of self-disgust was associated with a decreased likelihood of engaging in hazardous drinking, leading to a negative indirect relationship between probable PTSD and hazardous drinking. Conclusions/Importance: Overall, this study suggests that the role of self-disgust in the association between PTSD and hazardous drinking is complex, highlighting the need for further research in this area.
- Nov 2018
Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) are highly prevalent and commonly co-occur. The dual diagnosis of PTSD/AUD is associated with serious negative sequalae, and there are currently no effective pharmacological treatments for this comorbidity. Both PTSD and AUD are characterized by dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which helps modulate stress reactivity. Oxytocin, a neuropeptide that attenuates HPA axis dysregulation, may be beneficial for individuals with co-occurring PTSD/AUD. Thus, the current study examined the effects of intranasal oxytocin (40 IU) as compared with placebo on stress reactivity (e.g., cortisol) as well as subjective alcohol craving in response to a laboratory stress task (Trier Social Stress Task). Participants were 67 male U.S. military veterans with current PTSD and AUD (oxytocin n = 32, placebo n = 35; overall mean age = 49.06 years). Baseline cortisol levels were examined as a moderator of outcome. The findings revealed that oxytocin marginally attenuated cortisol reactivity in response to the stress task. Furthermore, oxytocin’s effect was moderated by baseline cortisol level, such that oxytocin mitigated cortisol reactivity to a greater extent among participants with higher, as compared with lower, baseline cortisol. Oxytocin did not reduce craving. Although preliminary, the findings are the first to examine oxytocin in co-occurring PTSD/AUD. The findings from this study contribute to the growing literature examining the potential utility of oxytocin among individuals with psychiatric disorders, such as PTSD and substance use disorders.
- Sep 2018
Research has yet to establish a relationship between posttraumatic mental contamination and suicide risk, despite theoretical overlap. The present study examined relationships between posttraumatic mental contamination and suicide risk via posttraumatic stress symptom clusters and appraisals of perceived burdensomeness and thwarted belongingness. Trauma-exposed participants (N = 183) completed measures of posttraumatic mental contamination, posttraumatic stress symptoms, thwarted belongingness, perceived burdensomeness, and suicide risk. Findings revealed significant indirect effects of posttraumatic mental contamination on suicide risk via all posttraumatic stress symptom clusters. Significant serial indirect effects of posttraumatic mental contamination on suicide risk were observed via posttraumatic avoidance and arousal/reactivity and, subsequently, via thwarted belongingness and perceived burdensomeness. Serial models via posttraumatic re-experiencing and negative cognitions/mood symptoms were nonsignificant. Results suggest that posttraumatic mental contamination may increase suicide risk via posttraumatic stress symptom severity, and maladaptive interpersonal appraisals may explain these links through distinct symptom pathways. Implications for posttraumatic suicide risk are discussed.
- Mar 2018
Research suggests important associations between emotion regulation difficulties and posttraumatic stress disorder (PTSD) symptomology, with prospective studies indicating that emotion regulation difficulties may lead to increased PTSD symptoms. Peritraumatic dissociation is considered an important and consistent predictor of PTSD symptoms. The present study examines whether peritraumatic dissociation accounts for associations between facets of emotion regulation difficulties and PTSD symptoms. Adult women with a history of sexual victimization participated in an interview to assess past-month PTSD symptoms and self-report questionnaires to assess peritraumatic dissociation and emotion regulation difficulties. Results showed a partial indirect effect of three facets of emotion regulation difficulties (i.e., nonacceptance of negative emotional responses, limited access to emotion regulation strategies perceived as effective in the context of distress, and impulse control difficulties when experiencing negative emotions) on PTSD symptoms through peritraumatic dissociation. Reverse indirect effects models were also explored. The present study offers preliminary evidence that peritraumatic dissociation by traumatized individuals may signal the presence of specific emotion regulation deficits, which may indicate increased risk of heightened PTSD severity.
Individuals with obsessive-compulsive disorder often identify psychosocial stress as a factor that exacerbates their symptoms, and many trace the onset of symptoms to a stressful period of life or a discrete traumatic incident. However, the pathophysiological relationship between stress and obsessive-compulsive disorder remains poorly characterized: it is unclear whether trauma or stress is an independent cause of obsessive-compulsive disorder symptoms, a triggering factor that interacts with a preexisting diathesis, or simply a nonspecific factor that can exacerbate obsessive-compulsive disorder along with other aspects of psychiatric symptomatology. Nonetheless, preclinical research has demonstrated that stress has conspicuous effects on corticostriatal and limbic circuitry. Specifically, stress can lead to neuronal atrophy in frontal cortices (particularly the medial prefrontal cortex), the dorsomedial striatum (caudate), and the hippocampus. Stress can also result in neuronal hypertrophy in the dorsolateral striatum (putamen) and amygdala. These neurobiological effects mirror reported neural abnormalities in obsessive-compulsive disorder and may contribute to an imbalance between goal-directed and habitual behavior, an imbalance that is implicated in the pathogenesis and expression of obsessive-compulsive disorder symptomatology. The modulation of corticostriatal and limbic circuits by stress and the resultant imbalance between habit and goal-directed learning and behavior offers a framework for investigating how stress may exacerbate or trigger obsessive-compulsive disorder symptomatology.
Objective: Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) represent major public health concerns, particularly among veterans. They are associated with significant distress and impairment, and are highly comorbid. Little is known, however, about what role the temporal order of diagnostic onset may play in severity of presenting symptomatology and treatment outcomes. The aim of this study, therefore, was to examine treatment outcomes by order of onset. Method: Participants were 46 U.S. military veterans (91.3% male) enrolled in a larger randomized controlled trial examining the efficacy of an integrated, exposure-based treatment (Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure; COPE). Participants were grouped into 2 categories: (a) primary PTSD (i.e., PTSD developed before the onset of SUD) or (b) primary SUD (i.e., SUD developed before the onset of PTSD). Results: No significant associations between order of onset and baseline symptomatology were observed. The findings revealed that participants with primary PTSD were significantly more likely than participants with primary SUD to report higher levels of PTSD symptoms at the end of treatment. However, there was no effect of order of onset on SUD outcomes. Conclusions: The findings suggest that individuals with earlier PTSD onset are a particularly high-risk group in terms of their trauma-related symptoms. Implications for treatment of comorbid PTSD/SUD are discussed. (PsycINFO Database Record
- Aug 2017
Research has linked mental contamination to symptoms of posttraumatic stress disorder (PTSD). However, less research has examined how mental contamination relates to other factors observed among individuals with these symptoms. This study examined relationships among mental contamination, posttraumatic stress (PTS) symptoms, mood-dependent risky behaviors, and help-seeking attitudes among 232 trauma-exposed undergraduates. Participants completed self-report measures of mental contamination, contact contamination, PTS symptoms, mood-dependent risky behaviors, and help-seeking attitudes. While accounting for effects of contact contamination, biological sex, and unwanted sexual contact, results indicated mental contamination was positively linked to PTS symptoms. When accounting for PTS symptoms, mental contamination demonstrated a significant positive relationship with negative mood-dependent risky behaviors, and a trend-level positive relationship with positive mood-dependent risky behaviors. Mental contamination was indirectly linked to greater risky behaviors (negative and positive) through increased PTS symptoms. Mental contamination also demonstrated a positive indirect effect on help-seeking attitudes through increased PTS symptoms. Mental contamination exhibited a negative direct effect on help-seeking attitudes, suggesting mental contamination was associated with reduced help-seeking attitudes even after accounting for a positive association between PTS symptoms and help-seeking attitudes. These findings underscore the importance of understanding mental contamination in relation to trauma exposure and associated pathology.
Objective: Identifying factors that influence treatment outcomes of emerging integrated interventions for co-occurring posttraumatic stress disorder (PTSD) and substance use disorder is crucial to maximize veterans' health. Dyadic adjustment suffers among individuals with PTSD and substance use disorder and may be an important mechanism of change in treatment. This exploratory study examined the association between dyadic adjustment and treatment outcomes in individual integrated treatment for co-occurring PTSD and substance use disorder. Methods: Participants were treatment-seeking veterans (N = 15) participating in a larger randomized controlled trial examining the efficacy of a novel integrated treatment for co-occurring PTSD and substance use disorder. Multiple regression analyses controlling for baseline symptom severity and independent sample t-tests were used to examine the relation between dyadic adjustment and treatment outcome variables including PTSD, substance use disorder, and depression symptom severity. Results: Baseline dyadic adjustment was associated with session 12 PTSD symptom severity as measured by both the Clinician-Administered PTSD Scale (CAPS) and PTSD Checklist (PCL), such that participants with high dyadic adjustment had significantly lower session 12 CAPS and PCL scores compared to participants with low dyadic adjustment. Baseline dyadic adjustment was not associated with session 12 depression symptoms or frequency of substance use. Conclusions: These findings suggest that while the primary determinant of treatment outcome in this sample is the application of an evidence-based intervention, dyadic adjustment may play a role in individual treatment outcome for some treatment-seeking veterans. Data from this study were derived from clinical trial NCT01365247.
Efforts to improve the efficiency of prolonged exposure (PE) therapy for posttraumatic stress disorder (PTSD) have demonstrated that reducing the length of imaginal exposures does not negatively affect treatment outcome. A recent adaptation of PE, called Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure [COPE], integrates substance use disorder treatment with PE in the same timeframe (twelve 90-minute sessions, 8 of which include imaginal exposure). The current study, which represents a subanalysis of a larger randomized controlled trial, examined how the length of imaginal exposures (nonrandomized and measured continually) related to PTSD, substance use, and depression in a sample of military veterans (N = 31) who completed the COPE treatment. Participants completed an average of 11.5 of the 12 therapy sessions and 7.2 of the 8 imaginal exposures during treatment. Results of 3 linear mixed models indicate that PTSD, substance use, and depressive symptoms all improved over the course of treatment (ps < .001; η(2) ranged between .17 and .40), and that the length of imaginal exposures did not significantly interact with any outcome. Although preliminary, the findings suggest that it may be feasible to shorten imaginal exposures without mitigating treatment gains. Implications for treatment are discussed.
- Mar 2017
Mental health symptoms differ among women with forcible rape (FR) compared to drug- or alcohol-facilitated/incapacitated rape (DAFR/IR) histories, but differences in suicidal ideation are unknown. The differences in suicidal ideation based on FR and DAFR/IR history were examined in national samples of college (n = 2,000) and household-residing (n = 3,001) women. For both college women and household-residing women, FR and DAFR/IR were associated with recent suicidal ideation. Differences emerged when examined indirectly through recent posttraumatic stress disorder, drug abuse, and alcohol abuse. Therefore, it is important to examine both FR and DAFR/IR when assessing suicidal ideation.
Objective: Increasing evidence supports the efficacy of trauma-focused exposure therapy in the treatment of posttraumatic stress disorder (PTSD) and co-occurring substance use disorders. Little is known, however, about the mechanisms of change in treatment for patients with PTSD and co-occurring substance use disorders. The aim of the present study was to examine whether within- and between-session habituation of distress and substance craving during imaginal exposure relates to treatment outcomes among U.S. military veterans with PTSD and a co-occurring substance use disorder (N = 54). Method: Veterans received Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure, a manualized integrated treatment combining prolonged exposure with cognitive-behavioral therapy for substance use disorders as part of a larger randomized clinical trial. Self-reported distress and craving ratings were collected during each imaginal exposure session. Results: Data were analyzed using a series of random intercept and slope multilevel linear and generalized linear models. Results revealed that between-session habituation of distress and craving was associated with greater improvement in PTSD symptoms during treatment. Between-session habituation of craving was also associated with a marginally greater reduction in frequency of substance use among participants still reporting use during treatment. Within-session habituation of distress was unrelated to treatment outcome. Conclusion: Together, these findings indicate that habituation in both distress and craving may be important in maximizing treatment outcome for patients with PTSD and comorbid substance use disorders. (PsycINFO Database Record
Background and objectives: A growing literature provides evidence for the use of integrated treatments (e.g., Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure; COPE); however, no known studies have applied COPE via telehealth. Method: COPE was delivered via telehealth to treat one black female veteran with combat trauma and alcohol use disorder. Results: The patient demonstrated significant reductions in alcohol consumption and PTSD and depressive symptoms. Conclusions and scientific significance: Although preliminary, findings demonstrate that integrated treatment via telehealth is feasible and effective, and may be useful for female veterans reluctant to seek services at male-dominated VAMCs. (Am J Addict 2016;XX:1-2).
- Jan 2017
Suicide risk is highly prevalent among individuals with posttraumatic stress disorder (PTSD). Self-disgust, defined as disgust directed internally and comprised of disgust with oneself (disgusting self) and with one’s behaviors (disgusting ways), may impact this increased risk. The present study examined self-disgust as a putative mechanism linking PTSD symptoms with suicide risk. A sample of 347 trauma-exposed undergraduates completed measures of PTSD symptoms, suicide risk, self-disgust, and depressive symptoms. Controlling for depressive symptoms, a process model indicated PTSD symptoms were positively linked to suicide risk via increased disgusting self but not disgusting ways. Process models examining individual PTSD symptom clusters revealed positive, indirect links between all PTSD symptom clusters except alterations in arousal and reactivity and suicide risk via disgusting self. These findings expand on growing literature documenting the importance of self-disgust in trauma-related pathology by identifying connections with suicide risk. Future directions and clinical considerations are discussed.
- Oct 2016
Objective: A growing literature documents frequent sexual problems among Operations Enduring/Iraqi Freedom (OEF/OIF) veterans with post-traumatic stress disorder (PTSD). However, there has been no examination of how (1) sexual problems may be affected by evidenced-based psychotherapy for PTSD or (2) how the presence of sexual problems might impact effectiveness of evidenced-based psychotherapy for PTSD. As such, the present study investigated associations among symptoms of PTSD, depression, and problems with sexual desire and arousal among 45 male OEF/OIF veterans receiving behavioral activation and therapeutic exposure (BA-TE), an evidence-based behavior therapy targeting co-occurring symptoms of PTSD and depression. Method: Participants completed clinical interviews and several questionnaires including measures of sexual arousal, sexual desire, PTSD symptoms, and depression symptoms at baseline and after completion of 8 sessions of BA-TE treatment. A records review was also conducted to assess for relevant medication use. Results: Overall, sexual desire and sexual arousal problems did not improve during the course of treatment. Moreover, veterans with co-occurring sexual problems at baseline evidenced significantly less improvement in symptoms of PTSD and depression across treatment as compared to veterans without sexual problems. Conclusions: These findings suggest that veterans with co-occurring symptoms of PTSD and sexual problems may require additional assessment and treatment considerations in order to improve their treatment outcomes for both primary psychiatric symptoms as well as sexual problems. Future research on combination treatments of medication for sexual problems and psychotherapy for PTSD is needed.
- Jul 2016
Affective lability, or the instability of emotional states, is associated with heightened levels of trauma-related emotional responding and posttraumatic stress disorder (PTSD) symptoms. However, the impact of affective lability, specifically on habituation to idiographic trauma cues, has yet to be examined among trauma-exposed individuals. The current study examined differential response trajectories to trauma-related imaginal exposure as a function of affective lability. Specifically, 72 women with a history of sexual victimization participated in a laboratory-based study involving a single session of repeated imaginal exposures to idiographic traumatic event cues. As hypothesized, participants higher in affective lability reported less reduction in trauma-cue elicited posttraumatic stress symptoms across exposure trials. Given these results, it will be important to continue to extend these laboratory findings to better understand how elevated affective lability is related to response to trauma-focused exposure therapy among individuals with PTSD or other trauma-related psychopathology (e.g., borderline personality disorder).
Child sexual abuse (CSA) is a causal agent in many negative adulthood outcomes, including the risk for life-threatening behaviors such as suicide ideation and suicide attempts. Traumatic events such as CSA may pose risk in the healthy development of cognitive and emotional functioning during childhood. In fact, high impulsivity, a risk factor for suicidal behavior, is characteristic of CSA victims. The current study aims to understand the relations among CSA, impulsivity, and frequency of lifetime suicide attempts among a female patient sample admitted for suicidal behavior. Participants included 177 female patients between the ages of 18 and 63 years admitted at two hospitals in Buenos Aires, Argentina. Number of previous suicide attempts and CSA were assessed via structured interviews, while impulsivity was assessed with the Barratt Impulsiveness Scale (BIS-11). A model of structural equations was employed to evaluate the role of impulsivity in the relation between CSA and suicide attempts. CSA (β=.18, p<.05) and impulsivity (β=.24, p<.05) were associated with the number of previous suicide attempts. However, impulsivity was not significantly associated with CSA (β=.09, p>.05). CSA and impulsivity are independently associated with lifetime suicide attempts among female patients with recent suicidal behavior.
- Mar 2016
Objective: Social functioning is negatively impacted by the presence of PTSD, while increasing risk of suicidal behavior among individuals with PTSD. However, little research has examined the specific role of social functioning in the association between PTSD and suicidal behavior. Method: Parallel multiple indirect effects analyses were performed to understand the unique indirect effects of four aspects of social functioning. Results: Indirect effects of PTSD on suicidal ideation were significant through three pathways: interpersonal conflict, perceived family support, and interpersonal apprehension. Perceived family support was the only indirect pathway significantly associated with suicide attempt. Conclusion: Findings suggest that social functioning should be assessed and potentially targeted during treatment to help modify the risk for suicidal behavior among individuals with PTSD.
- Feb 2016
The current review provides a detailed analysis of the burgeoning literature examining the role of disgust in understanding posttraumatic stress symptomatology. Research in this area generally converges to suggest (1) posttraumatic stress is associated with the experience of elevated disgust, (2) individual differences in disgust vulnerabilities may relate to increased posttraumatic stress symptom levels, (3) retrospective report of peritraumatic disgust is related to posttraumatic stress symptom levels, and (4) posttraumatic stress symptom levels appear to be associated with increased disgust, including in response to traumatic event cues. Importantly, much of this research suggests observed relations between disgust and posttraumatic stress are at least somewhat unique from relations between fear/anxiety and posttraumatic stress. Future research is now needed to identify mechanisms involved in these relations in order to inform the prevention and treatment of disgust-related posttraumatic stress disorder.
Objective: Emerging evidence identifies disgust as a common and persistent reaction following sexual victimization that is linked to posttraumatic stress disorder (PTSD). Importantly, evidence suggests that compared with fear, disgust may be less responsive to repeated exposure, which may have implications for the treatment of PTSD. The current study sought to fill a gap in the existing literature by examining reductions in sexual trauma cue-elicited disgust and anxiety upon repeated imaginal exposure. Method: Seventy-two women with a history of sexual victimization completed a single laboratory-based session that involved repeated imaginal exposure to idiographic disgust- and fear-focused sexual trauma scripts. Results: Results demonstrated that although anxiety and disgust declined at similar rates across exposure trials (t = -.24, p = .81), ratings of disgust (B0 = 61.93) were elevated compared with ratings of anxiety at initiation (B0 = 51.03; t = 4.49, p < .001) of exposure even when accounting for severity of PTSD symptoms. Moreover, change in disgust significantly predicted improvement in script-elicited PTSD symptoms across the course of exposure for individuals exhibiting significant decline in anxiety (B = .006, t = 2.00, p = .048). Change in script-elicited PTSD symptoms was minimal (and was not predicted by the decline in disgust) for individuals exhibiting less change in anxiety (B = -.002, t = -0.46, p = .65). Conclusion: These results add to an increasing literature documenting the importance of disgust in the development, maintenance, and treatment of sexual-trauma-related PTSD. (PsycINFO Database Record
Background: Cholecystokinin (CCK) is a neuropeptide that has been implicated in understanding the acquisition and extinction of fear. Research on CCK in anxiety has primarily focused on understanding panic attacks and panic disorder. Emerging data suggests that CCK may also hold promise in understanding the development and maintenance of posttraumatic stress disorder (PTSD). Method: The present study examined whether a single nucleotide polymorphism in the promoter region of the CCK gene (C>T; rs1799923) was associated with an increased prevalence of PTSD as well as with severity of PTSD symptoms among a sample of 457 combat veterans. Results: Results demonstrated that participants with either the heterozygous or homozygous T allele had an increased prevalence of PTSD relative to participants with the CC genotype (OR=2.17; 95% CI [1.37-3.43]). Limitations: The relatively small sample size precluded examination of racial/ethnic differences. Findings were also limited by the absence of a systematic assessment of comorbid anxiety psychopathology. Conclusions: These data offer preliminary evidence supporting an association between the rs1799923 polymorphism in the CCK gene and PTSD. Additional research is needed to better understand the nature of this relationship.
The diagnosis of posttraumatic stress disorder (PTSD) has undergone several significant changes corresponding with the recent implementation of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Many of these changes reflect a growing recognition that PTSD is characterized by a wide range of negative affective experiences that were underrepresented in prior conceptualizations of the disorder. The present study examined the prevalence and correlates of a new Criterion D symptom (D4-Negative Affect), which is aimed at assessing subjective problems with persistent negative emotion states (e.g., fear, anger, shame, guilt, horror) among a sample of 1,522 U.S. adults with a history of interpersonal trauma recruited from a national online panel. The prevalence of D4-Negative Affect was very high among individuals with assault-related PTSD (AR-PTSD) and in particular, was significantly higher than among PTSD negative individuals. Moreover, specific problems with anger, shame, and fear were significantly and uniquely associated with AR-PTSD. Important differences also emerged as a function of gender and interpersonal trauma history. These findings provide initial empirical support for the expanded emphasis on assessing a wide range of negative affective experiences that may be associated with PTSD in DSM-5. © The Author(s) 2015.
Extant work suggests that trauma-exposed adolescents are at risk for problematic drinking. Although work conducted with adults suggests that trauma-exposed individuals drink to reduce negative affectivity, no work has yet examined alcohol use outcome expectancies (AOEs) among trauma-exposed adolescents. The current study examined positive AOEs as a function of trauma history among 63 community-recruited youths (Mage = 15.92; 46% girls). Findings indicated that trauma exposure predicted elevated tension-reduction AOEs. Furthermore, the indirect effect of tension-reduction expectancies accounted for a significant proportion of the relation between trauma exposure and alcohol use frequency. These preliminary data are discussed in terms of future research efforts.
Victims of drug- or alcohol-facilitated/incapacitated rape (DAFR/IR) are substantially less likely to seek medical, rape crisis, or police services compared with victims of forcible rape (FR); however, reasons for these disparities are poorly understood. The current study examined explanatory mechanisms in the pathway from rape type (FR vs. DAFR/IR) to disparities in post-rape service seeking (medical, rape crisis, criminal justice). Participants were 445 adult women from a nationally representative household probability sample who had experienced FR, DAFR/IR, or both since age 14. Personal characteristics (age, race, income, prior rape history), rape characteristics (fear, injury, loss of consciousness), and post-rape acknowledgment, medical concerns, and service seeking were collected. An indirect effects model using bootstrapped standard errors was estimated to examine pathways from rape type to service seeking. DAFR/IR-only victims were less likely to seek services compared with FR victims despite similar post-rape medical concerns. FR victims were more likely to report fear during the rape and a prior rape history, and to acknowledge the incident as rape; each of these characteristics was positively associated with service seeking. However, only prior rape history and acknowledgment served as indirect paths to service seeking; acknowledgment was the strongest predictor of service seeking. Diminished acknowledgment of the incident as rape may be especially important to explaining why DAFR/IR victims are less likely than FR victims to seek services. Public service campaigns designed to increase awareness of rape definitions, particularly around DAFR/IR, are important to reducing disparities in rape-related service seeking. © The Author(s) 2015.
Anxiety psychopathology, one of the most prevalent classes of disorder among youth, is linked to detrimental outcomes. Accordingly, identifying factors that influence vulnerability to anxiety disorders is important. One promising factor, given emerging evidence for its transdiagnostic nature, is anxiety sensitivity (AS); however, relatively little is known about the linkage between AS and indicators of generalized anxiety disorder (GAD), particularly among youth. The aim of the current investigation was to address this gap in the literature using a community-based sample of adolescents aged 10–17 years (n = 165; M age = 14.49 years, SD = 2.26). Results indicated global AS and the AS-physical concerns dimension were significantly associated with worry, generalized anxiety symptoms, and GAD diagnosis assessed via a structured clinical interview, above and beyond key theoretically-relevant covariates. These findings add to a growing body of work underscoring the relevance of AS for multiple types of anxiety-related disorders among youth.
- Dec 2014
Objective: Few studies have examined sexual dysfunction among Operations Enduring/Iraqi Freedom (OEF/OIF) veterans with posttraumatic stress disorder (PTSD). The present study investigated predictors of erectile dysfunction [ED] and self-reported sexual problems among 150 male combat veterans seeking outpatient treatment for PTSD within the Veterans Affairs healthcare system. Method: Participants completed clinical interviews and several questionnaires including measures of sexual arousal and sexual desire. A medical records review was also conducted to document evidence of an ED diagnosis or associated medication use. Results: An ED diagnosis was present for 12% of the sample, and 10% were taking associated medications. Sexual arousal problems were reported by sixty-two percent of partnered veterans. Sexual desire problems were endorsed by 63% of the total sample, and by 72% of partnered veterans. Age was the only significant predictor of ED diagnosis or medication use. Age, race, PTSD diagnosis (versus subclinical symptoms), depression, and social support predicted self-reported sexual arousal problems; while race, combat exposure, social support, and avoidance/numbing symptoms of PTSD predicted self-reported sexual desire problems. Conclusions: Sexual problems are common among male OEF/OIF combat veterans seeking treatment for PTSD. Moreover, avoidance/numbing symptoms robustly predicted sexual desire problems. These findings highlight the importance of expanding assessment of sexual dysfunction and support the need for additional research in this area.
- Oct 2014
The 11th edition of the International Classification of Diseases (ICD–11) is under development, and current proposals include major changes to trauma-related psychiatric diagnoses, including a heavily restricted definition of posttraumatic stress disorder (PTSD) and the addition of complex PTSD (CPTSD). We aimed to test the postulates of CPTSD in samples of 2,695 community participants and 323 trauma-exposed military veterans. CPTSD prevalence estimates were 0.6% and 13% in the community and veteran samples, respectively; one quarter to one half of those with PTSD met criteria for CPTSD. There were no differences in trauma exposure across diagnoses. A factor mixture model with two latent dimensional variables and four latent classes provided the best fit in both samples: Classes differed by their level of symptom severity but did not differ as a function of the proposed PTSD versus CPTSD diagnoses. These findings should raise concerns about the distinctions between CPTSD and PTSD proposed for ICD–11.
The Facial Action Coding System (Ekman & Friesen) has shown promise as a behavioral measure of emotional experience. The current study examined the degree of (de)synchrony between self-reported and facial expressions of fear, disgust, and sadness in response to a traumatic event-relevant film among individuals who had experienced a traumatic motor vehicle accident. Given high rates of comorbidity between posttraumatic stress symptoms (PTSS) and depressive symptoms, the potential impacts of both PTSS and depressive symptoms on emotional responding were examined. Results demonstrated synchrony between self-reported and facial expressions of disgust and sadness; however, no association between measures of fear was observed. Furthermore, depressive symptoms were associated with greater fear responding and PTSS were associated only with self-reported fear. Together, results support the importance of examining discrete negative emotions, rather than broad valence categories, when examining fear-based responding in traumatic event-exposed populations. Additional research examining the psychometric properties of the Facial Action Coding System as a measure of discrete emotional experiences among traumatic event-exposed individuals is needed to advance multimodal assessment approaches that yield incremental information for understanding emotional responding in this population.
Contamination concerns have been linked to increased posttraumatic stress symptoms. The present study offered a preliminary test of the roles of domain-specific contamination aversions in posttraumatic stress. Fifty women with a history of sexual or physical assault were recruited from the community and assessed for posttraumatic stress symptom severity and individual differences in mental contamination, direct contamination aversion [aversion to normative contaminants (e.g., garbage)], indirect contamination aversion [aversion to perceived contaminants (e.g., handrails)], and symptoms of contamination-based obsessive–compulsive disorder. We observed large and significant relations between posttraumatic stress symptoms and all forms of contamination fears and aversions among participants reporting sexual trauma, but minimal and non-significant relations among victims of physical assault. Exploratory tests revealed that the effects of basic contamination aversions on posttraumatic stress symptom severity were largely mediated by mental contamination. The present study suggests that contamination fears and aversions (i.e., normal or perceived) are highly related to posttraumatic stress symptoms among sexual trauma victims and highlights the importance of assessing and targeting feelings and evaluations related to contamination when treating posttraumatic stress symptoms among sexual trauma victims.
Research suggests that moral disgust, shame, and guilt are present in posttraumatic psychopathology. However, it is unclear that these emotional states are responsive to empirically supported interventions for posttraumatic stress symptoms (PTSS). This study explored the relations among moral disgust, shame, guilt, and PTSS, and examined comprehensive distancing (CD) as a novel intervention for these emotional states in undergraduates with elevated PTSS. Participants were randomly assigned to use a CD or a cognitive challenge task in response to personalized scripts of a traumatic event. Both interventions were associated with decreases in disgust, moral disgust, shame, and guilt. Contrary to predictions, there were no significant differences between the exercises in the reduction of negative emotions. In addition, PTSS severity was correlated with trauma-related guilt as well as state guilt and shame, but not trait or state measures of disgust or moral disgust. This proof of concept project sets the stage for further research examining CD as an alternative or adjunctive intervention for posttraumatic stress reactions with strong features of moral disgust, shame, and guilt.
Research indicates changes in HPA-axis activity across puberty. The current study extends existing work by evaluating pubertal status and cortisol level in a novel social environment (research laboratory) while controlling for several important biological, behavioral, and psychological variables. Participants were 30 girls (ages 9-16 years) from the United States. Pubertal status was assessed via the Pubertal Development Scale. Salivary samples were collected at laboratory-introduction and a matched at-home period; laboratory-introduction levels were regressed on basal cortisol levels to create standardized residual scores. After controlling for covariates, pubertal status was positively associated with residualized cortisol values. Findings indicate more advanced puberty related to greater cortisol response to the laboratory; data are discussed in terms of future research and building biopsychosocial models of the puberty-psychopathology linkage.
Objective Escape and avoidance behaviors play a prominent role in the maintenance and possibly development of panic disorder, yet the literature regarding the etiology of these emotion-regulation strategies is relatively underdeveloped. The current study experimentally tests hypotheses that parental modeling of escape during a well-established, panic-relevant, biological challenge increases panic-relevant escape and avoidance among offspring. Method Fifty physically and psychologically healthy early adolescents (28 females; Mage = 11.58; 86% Caucasian) stratified by gender, were randomly assigned to observe one of their parents (39 females; Mage = 40.04) either: a) model completing a 3-min voluntary hyperventilation exercise (no escape modeling group); or b) model premature termination of a similar procedure (escape modeling group). Results Offspring in the escape modeling group demonstrated a stronger escape response by discontinuing their own challenge sooner than those in the no escape modeling group (r = .70). No group differences emerged in terms of avoidance responding, as indexed by nearly identical responding in terms of delay time before initiating the challenge, respiration rate, and self-reported willingness to engage in a second proposed challenge. Conclusions Results suggest that parental behaviors may play an important role in the development of some forms of panic-relevant responding. These preliminary findings may have important implications for future prevention programs targeting parents and at-risk youth.
Specific parenting behaviors, in the context of offspring bodily arousal, relate to elevated risk for panic symptomatology. Research with adults also suggests anxiety sensitivity (AS) plays an important role in this relationship. However, very limited research has been conducted with adolescents. To address this gap in the literature, the current study evaluated the interplay between AS and arousal-reactive as well as arousal non-reactive childhood learning experiences in predicting panic symptomatology among a community sample of 10–17 year old adolescents (n = 153). Findings indicated arousal-reactive learning experiences were associated with increased panic symptomatology, but only among youth high in AS. Further, this model evidenced relative specificity in that arousal non-reactive learning experiences did not interact with AS to predict panic symptomatology. The current findings add to the literature seeking to elucidate the interplay between specific parenting behaviors and offspring characteristics as they relate to elevated risk for panic-related outcomes.
- Dec 2013
People with either posttraumatic stress disorder (PTSD) or alcohol dependence (AD) are apt to report problems in their social networks, including low perceived support and elevated conflict. However, little research has examined social networks among people with comorbid PTSD/AD despite evidence suggesting these two conditions commonly co-occur and are linked to particularly severe problems. To test the hypothesis that people with comorbid PTSD/AD experience particularly elevated social network problems, individuals with lifetime diagnoses of PTSD, AD, comorbid PTSD/AD, or no lifetime history of Axis I psychopathology in the National Comorbidity Survey-Replication were compared on four dimensions of social networks: (1) Closeness, (2) Conflict, (3) Family Support, and (4) Apprehension. Persons with PTSD, AD, or comorbid PTSD/AD endorsed more problems with the Conflict, Family Support, and Apprehension factors compared to people with no history of Axis I psychopathology. Moreover, individuals with comorbid PTSD/AD endorsed greater Apprehension and significantly less Family Support compared to the other three groups. Results suggest people with comorbid PTSD/AD experience increased problems with their family as well as greater concerns about enlisting social support than even people with PTSD or AD alone. Treatments for people suffering from comorbid PTSD/AD should consider assessing for and possibly targeting family support and apprehension about being close to others.
- Aug 2013
Disgust sensitivity and feelings of mental contamination have both been independently linked to posttraumatic stress symptoms following sexual assault. Theory suggests that feelings of mental contamination may arise, at least in part, as a result of interpreting feelings of disgust experienced in relation to sexual assault to mean that one has been contaminated or tainted by the experience. This study involved an initial test of this model by examining relations among disgust sensitivity, feelings of mental contamination, and posttraumatic stress symptom severity among a sample of female sexual assault victims. Results suggested that one mechanism through which disgust sensitivity might relate to posttraumatic stress symptom severity is through its association with increased feelings of mental contamination. These findings highlight the importance of assessing feelings of disgust and mental contamination among victims of sexual assault, and the need for future research to elucidate the nature of these relations with posttraumatic stress.
- Apr 2013
Independent lines of evidence have linked posttraumatic stress symptomatology to both peritraumatic disgust (i.e., disgust experienced during a traumatic event) and posttraumatic disgust reactivity in response to traumatic event cues among individuals exposed to traumatic events. Much of this work suggests disgust, defined as a rejection/revulsion response aimed at distancing oneself from a potential source of contamination, may be important in understanding the nature of posttraumatic stress reactions even after accounting for the more frequently studied affective states of fear and anxiety. The current investigation provided a preliminary test of a model of disgust in posttraumatic stress among a sample of 54 community-recruited women with a history sexual victimization. Both peritraumatic disgust (r = .31) and posttraumatic disgust reactivity (r = .42) in response to an idiographic traumatic event script were significantly associated with posttraumatic stress symptom severity. After accounting for variability-associated peritraumatic fear and posttraumatic anxious reactivity, an indirect effect of peritraumatic disgust through posttraumatic disgust reactivity also was found, suggesting that one mechanism through which peritraumatic disgust relates to posttraumatic stress is through its relation with increased posttraumatic disgust reactivity. These findings highlight the importance of further elucidating the nature of disgust in relation to traumatic events and subsequent posttraumatic stress reactions.
- Dec 2012
Disgust and mental contamination (or feelings of dirtiness and urges to wash in the absence of a physical contaminant) are increasingly being linked to traumatic event exposure and posttraumatic stress (PTS) symptomatology. Evidence suggests disgust and mental contamination are particularly relevant to sexual assault experiences; however, there has been relatively little direct examination of these relations. The primary aim of the current study was to assess disgust and mental contamination-based reactivity to an individualized interpersonal assault-related script-driven imagery procedure. Participants included 22 women with a history of traumatic sexual assault and 19 women with a history of traumatic non-sexual assault. Sexual assault and PTS symptom severity predicted greater increases in disgust, feelings of dirtiness, and urges to wash in response to the traumatic event script. Finally, assault type affected the association between PTS symptom severity and increases in feelings of dirtiness and urges to wash in response to the traumatic event script such that these associations were only significant among sexually assaulted individuals. These findings highlight the need for future research focused on elucidating the nature of the relation between disgust and mental contamination and PTS reactions following various traumatic events.
- Oct 2012
Poor sleep quality has been linked to posttraumatic stress disorder (PTSD). This study provided a test of how poor sleep quality relates to real-time assessment of anxious reactivity to idiographic traumatic event cues. Script-driven imagery (SDI) was employed to examine reactivity to traumatic event cues among 46 women (mean age = 27.54 years, SD = 13.62; 87% Caucasian) who had experienced either physical or sexual assault. We tested 3 hypotheses: (a) individuals with PTSD would report greater anxiety reactions to SDI than trauma-exposed individuals without PTSD, (b) poorer sleep quality would be positively related to anxiety reactions to SDI, and (c) there would be an interaction between PTSD and sleep quality such that individuals with PTSD and relatively poor sleep quality would report greater anxious reactivity to SDI than would be expected from each main effect alone. Poor sleep quality and PTSD were related to elevated anxious reactivity to trauma cues (sr(2) = .06). In addition, sleep quality was negatively associated with anxious reactivity among people without PTSD (sr(2) =.05). The current findings, in combination with longitudinal evidence, suggest that poor sleep quality following exposure to a traumatic event may be a risk factor for anxious reactivity to traumatic event cues.
BACKGROUND AND OBJECTIVES: Both emotional reactivity to traumatic event cues and difficulties regulating emotion have been linked to posttraumatic stress symptom severity. The current study uniquely extended these two lines of research by examining the degree to which these two factors alone, and in combination, account for variability in posttraumatic stress symptom severity. METHOD: Self-reported emotion regulation difficulties, and both subjective and physiological reactivity in response to a script-driven imagery procedure, were assessed among a community sample of 21 adult women with a history of interpersonal assault. Relationships with an interview-based measure of posttraumatic stress symptom severity were examined. RESULTS: Results were consistent with hypotheses. Both traumatic event-related emotional reactivity and emotion regulation difficulties independently predicted posttraumatic stress symptom severity. A significant interaction also emerged such that traumatic event-related emotional reactivity and posttraumatic stress symptom severity were only significantly associated at relatively elevated levels of emotion regulation difficulties. LIMITATIONS: Limitations included the use of a self-report questionnaire to assess emotion regulation difficulties, relatively small sample size, and lack of evidence regarding generalizability across gender or other traumatic event types. CONCLUSIONS: These results highlight that the interaction of heightened emotional reactivity and difficulties regulating emotion may be particularly influential in posttraumatic stress symptom severity.
Theory implicates peritraumatic fear-based interoceptive conditioning in the development of panic spectrum problems subsequent to traumatic event exposure. Relatively little empirical work has directly investigated this hypothesis. The current study tested the hypothesis that level of peritraumatic fear would predict anxious reactivity to a well-established 3-min voluntary hyperventilation procedure administered to 63 adolescents who had experienced a DSM-IV-TR-defined traumatic event. This relation was examined after controlling for variance accounted for by posttraumatic stress symptoms, sex, age, anxiety sensitivity, general symptoms of psychopathology, and both peritraumatic helplessness and disgust. As predicted, peritraumatic fear was related to anxious reactivity to hyperventilation-elicited bodily arousal. Specificity tests suggested this relation was specific to peritraumatic fear. Prospective research is now needed to better elucidate the relation between peritraumatic fear and subsequent development of anxious reactivity to bodily arousal and panic spectrum problems.
- Jul 2012
Avoidance coping and symptoms of posttraumatic stress disorder (PTSD) covary. However, relatively little research has examined the bi-directional relation between these constructs among individuals in treatment for PTSD. The current longitudinal study examined the reciprocal associations between avoidance coping and PTSD symptom severity during and after residential PTSD treatment among a sample of 1073 military veterans (88.9% male; M(age) = 52.39 years) with chronic, treatment-resistant PTSD. Greater avoidance coping at intake predicted more severe PTSD symptoms at discharge, and severity of PTSD symptoms at discharge predicted increased avoidance at follow-up. Conversely, PTSD symptom severity at intake was not related to avoidance coping at discharge, and in turn avoidance coping at discharge was not related to PTSD symptom severity at follow-up. These findings offer a number of important clinical implications including evidence suggesting avoidance may predict poorer treatment response among individuals seeking treatment for chronic PTSD, and that greater end-of-treatment PTSD symptom severity may predict increased avoidance following treatment.
- Mar 2012
Emerging evidence has documented comorbidity between posttraumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD) among individuals with a history of traumatic events. There is growing recognition of the importance of disgust in each of these conditions independently. No study, however, has examined the potential role of disgust in these conditions following traumatic event exposure. The current study examined the unique role of peritraumatic fear, self-focused disgust, and other-focused disgust in predicting posttraumatic stress symptoms and contamination-based OC symptoms among 49 adult women (M(age)=28.37, SD=13.86) with a history of traumatic interpersonal victimization. Results demonstrated that intensity of peritraumatic self-focused disgust was significantly related to contamination-based OC symptoms while peritraumatic fear and other-focused disgust were related to posttraumatic stress symptoms. These results highlight the need for future research aimed at elucidating the nature of the association between disgust experienced during traumatic events and subsequent psychopathology.
- Oct 2011
Based on the personal and societal costs of long-term sleep medication use, it is important to understand factors that may play a role in use of medications to manage sleep. One such factor is fear of the consequences of anxiety-related sensations, or anxiety sensitivity. Participants in the current study included 205 unscreened adults who completed questionnaires including the well-established Pittsburgh Sleep Quality Index and the Anxiety Sensitivity Index. Results from multiple linear regressions suggested sleep medication use was related to levels of anxiety sensitivity, specifically to the physical and social concerns factors. Importantly, this finding holds above and beyond the variance attributed to sex, negative affect, anxious arousal, and subjective sleep quality. These findings provide a first-step toward understanding links between anxiety sensitivity and use of medications to manage sleep. Results are discussed in relation to research and clinical implications. KeywordsAnxiety sensitivity–Sleep–Sleep medications–Sleep quality
- Sep 2011
Contemporary comorbidity theory postulates that people suffering from posttraumatic stress symptoms may use substances to cope with negative affect generally and posttraumatic stress symptoms specifically. The present study involves the examination of the unique relation between past two-week posttraumatic stress symptom frequency and motives for marijuana use after accounting for general levels of negative affectivity as well as variability associated with gender. Participants were 61 marijuana-using adolescents (M(age)=15.81) who reported experiencing lifetime exposure to at least one traumatic event. Consistent with predictions, past two-week posttraumatic stress symptoms significantly predicted coping motives for marijuana use and were not associated with social, enhancement, or conformity motives for use. These findings are consistent with theoretical work suggesting people suffering from posttraumatic stress use substances to regulate symptoms.
- Jul 2011
Posttraumatic stress disorder (PTSD) is associated with significant impairment and lowered quality of life. The emotional Stroop task (EST) has been one means of elucidating some of the core deficits in PTSD, but this literature has remained inconsistent. We conducted a meta-analysis of EST studies in PTSD populations in order to synthesize this body of research. Twenty-six studies were included with 538 PTSD participants, 254 non-trauma exposed control participants (NTC), and 276 trauma exposed control participants (TC). PTSD-relevant words impaired EST performance more among PTSD groups and TC groups compared to NTC groups. PTSD groups and TC groups did not differ. When examining within-subject effect sizes, PTSD-relevant words and generally threatening words impaired EST performance relative to neutral words among PTSD groups, and only PTSD-relevant words impaired performance among the TC groups. These patterns were not found among the NTC groups. Moderator analyses suggested that these effects were significantly greater in blocked designs compared to randomized designs, toward unmasked compared to masked stimuli, and among samples exposed to assaultive traumas compared to samples exposed to non-assaultive traumas. Theoretical and clinical implications are discussed.
- Jun 2011
Posttraumatic stress symptoms and self-reported sleep problems reliably covary. The current study investigated how posttraumatic stress symptom clusters (i.e., hyperarousal, avoidance, and reexperiencing) relate to trouble initiating and maintaining sleep and nightmares. Participants included traumatic event-exposed respondents from the NCS-R. Results suggested that posttraumatic stress symptom severity is related to trouble initiating and maintaining sleep and nightmares. Investigation of symptom clusters indicated that reexperiencing symptoms were related to trouble initiating and maintaining sleep and nightmares, while hyperarousal symptoms were related to trouble maintaining sleep and nightmares. Findings partially support both reexperiencing and hyperarousal-based models of the relation between sleep and posttraumatic stress.
Posttraumatic stress disorder (PTSD) and elevated levels of substance use (SU) regularly co-occur and are increasingly viewed as functionally related. While PTSD and SU may be comorbid for a variety of reasons, central theoretical work posits that individuals with PTSD use substances to regulate affective experiences. In particular, two theories of psychopathology and SU comorbidity - the Self Medication Hypothesis and the Negative Reinforcement Model - make distinct predictions about the role of SU in regulating affective or emotional experiences. Laboratory methods employed to study PTSD and SU are well suited to test these unique predictions by using in vivo, experimental paradigms. The current review delineates the distinct predications made by these models and reviews the common methods used to study PTSD-SU comorbidity in the laboratory. Studies that have employed these methods are then reviewed and discussed in relation to theoretical predictions. Evidence supports facets of both the Self Medication Hypothesis and the Negative Reinforcement Model, suggesting a complex relation between PTSD and SU, which may be influenced by the particular substance of use, type of affective experience, and related factors such as substance-related withdrawal and risk taking propensity.
Models of traumatic event-related emotional reactivity have primarily focused on fear. Emerging research points to the importance of advancing our currently limited understanding of how anger and disgust relate to certain types of traumatic experiences, such as interpersonal violence (IPV). The current study compared anger, disgust, and anxiety in response to an ideographic neutral and traumatic event script between IPV victims and those exposed to a non-interpersonally-relevant traumatic event. Victims of IPV evidenced greater anger and disgust in response to the traumatic event script compared to the non-IPV group after accounting for variability in posttraumatic stress symptoms and negative affect. No differences emerged in terms of anxiety responding. These findings suggest reminders of IPV may be particularly likely to elicit anger and disgust, in addition to anxiety, which may have implications for the treatment of IPV-related posttraumatic stress.
Adolescent alcohol use is a critical public health concern; accordingly, a considerable body of work exists identifying developmentally salient risk and protective factors. One area receiving increasing attention among adults is the linkage between specific constellations of anxiety psychopathology and alcohol use problems. Relatively less is known about such linkages among adolescents, despite the onset of both anxiety-type problems and alcohol use during this developmental period. The current review presents a detailed summary and analysis of the empirical literature focused on specific forms of anxiety psychopathology as they relate to alcohol use among adolescents, and provides a number of specific recommendations for future work with an emphasis on the utility of experimental psychopathology techniques for clarifying basic questions and forwarding this body of work.
- Oct 2010
The goals of the current study were to examine the prevalence of secondary stressors related to Hurricane Katrina and to determine their impact on posttraumatic stress disorder (PTSD) symptoms among a sample of high school students. In addition, the moderating role of problem substance use was examined to determine whether it increased the risk of PTSD symptoms in the face of secondary stressors. A total of 271 ethnically and socioeconomically diverse adolescents completed an anonymous survey. Results indicated that problem substance use potentiated the positive relation between secondary stressors and PTSD symptoms, specifically symptoms of re-experiencing. The findings highlight the need for school-based assessment of and interventions for the long-term psychological effects of disasters.
- Sep 2010
More than 70 million people in the United States experience primary insomnia (PI) at some point in their life, resulting in an estimated $65 billion in health care costs and lost productivity. PI is therefore one of the most common health care problems in the United States. To mollify the negative effects of PI, scholars have sought to evaluate and improve treatments of this costly health care problem. A breadth of research has demonstrated that cognitive behavioral therapy (CBT) is an effective intervention for PI. The goal of this article is to provide an overview of CBT for PI, including evidence regarding treatment efficacy, effectiveness, and practitioner considerations.
Social anxiety evidences significant comorbidity with alcohol use disorders and alcohol-related problems. In an effort to better understand this co-occurrence, researchers are beginning to evaluate specific drinking-related factors, including alcohol use motives, among socially anxious individuals. Drawing on Cooper's (1994) 4-factor model of drinking motives (enhancement, social, conformity, coping), a growing body of work suggests that socially anxious individuals may consume alcohol in an effort to cope with their anxious symptoms; however, no study to date has examined these relations among youth. Accordingly, we examined alcohol use motives as a function of social anxiety in a community-based sample of 50 adolescents ages 12 to 17 years (Mage = 16.35, SD = 1.10). As predicted, heightened social anxiety was associated with elevated coping-related drinking motives. More important, other alcohol-use motives did not vary as a function of social anxiety. Collectively, these findings uniquely extend research conducted with adults, and suggest socially anxious youth may be motivated to use alcohol to manage their anxious arousal.
- Jun 2010
Evidence documents elevated rates of various types of drug use among people with posttraumatic stress disorder (PTSD). However, relatively little research has specifically examined crystal methamphetamine (CM) use among individuals with PTSD. The present study examined the relation between PTSD diagnostic status, PTSD symptom severity within symptom type clusters, and CM use histories among traumatic event-exposed individuals with versus without PTSD. Consistent with expectations, individuals with PTSD were significantly more likely to report CM use than trauma-exposed individuals without PTSD. Additionally, CM users with PTSD reported a longer duration of CM use than trauma-exposed CM users without PTSD. Finally, PTSD avoidance and hyperarousal symptoms, but not re-experiencing, were related to CM use. The potential clinical and research implications of the findings are discussed.
- Mar 2010
Research has increasingly suggested disgust is related to sexual assault. The current study uniquely contributed to this literature by comparing retrospective ratings of disgust reported by 63 adolescents (ages 10.08 to 17.92 years) in relation to sexual and physical assaults. As hypothesized, participants were more likely to endorse the presence of disgust during sexual as compared to physical assault. The intensity of disgust was also rated higher by sexual assault victims. Additionally, adolescents who reported exposure to both types of assault rated the sexual assault as more disgusting. These findings support ongoing work linking disgust to sexual assault. Directions for future research are considered in order to further our understanding of the implications of an association between disgust and sexual assault for the development and maintenance of posttraumatic stress symptoms. Read More: http://guilfordjournals.com/doi/abs/10.1521/ijct.2010.3.1.11?journalCode=ijct
- Aug 2009
Research suggests that individuals with posttraumatic stress disorder (PTSD) selectively attend to threat-relevant information. However, little is known about how initial detection of threat influences the processing of subsequently encountered stimuli. To address this issue, we used a rapid serial visual presentation paradigm (RSVP; Raymond, J. E., Shapiro, K. L., & Arnell, K. M. (1992). Temporary suppression of visual processing in an RSVP task: An attentional blink? Journal of Experimental Psychology: Human Perception and Performance, 18, 849-860) to examine temporal allocation of attention to threat-related and neutral stimuli in individuals with PTSD symptoms (PTS), traumatized individuals without PTSD symptoms (TC), and non-anxious controls (NAC). Participants were asked to identify one or two targets in an RSVP stream. Typically processing of the first target decreases accuracy of identifying the second target as a function of the temporal lag between targets. Results revealed that the PTS group was significantly more accurate in detecting a neutral target when it was presented 300 or 500ms after threat-related stimuli compared to when the target followed neutral stimuli. These results suggest that individuals with PTSD may process trauma-relevant information more rapidly and efficiently than benign information.
- Dec 2008
Cognitive theories of posttraumatic stress disorder (PTSD) suggest that associative memory processes may play a crucial role in the development and maintenance of the disorder. In the current study we examined the effect of associative pair rehearsal on recall ability for threatening and non-threatening information using the retrieval-practice paradigm in individuals with PTSD, traumatized controls (TC), and non-traumatized controls (NAC). Across word type, NACs demonstrated a typical retrieval-induced forgetting effect. However, individuals with PTSD benefited less from rehearsal, and failed to inhibit recall of unpracticed words in practiced categories. Participants in the TC group displayed a retrieval-induced forgetting effect similar to those individuals in the PTSD group. These findings are consistent with research indicating that individuals with PTSD may derive less benefit from rehearsal and display general inhibitory difficulties when compared to non-traumatized controls.