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The interactive effects of emotional clarity and cognitive reappraisal in Posttraumatic Stress Disorder
Abstract
The goal of this investigation was to examine how emotional clarity and a specific emotion regulation strategy, cognitive reappraisal, interact to predict Posttraumatic Stress Disorder (PTSD) symptom severity and positive affect among treatment seeking military Veterans (N=75, 93% male) diagnosed with PTSD. PTSD is a highly relevant context because PTSD features include heightened stress reactivity, diminished ability to differentiate and understand emotions, and reliance on maladaptive forms of emotion regulation. We found that the combination of high levels of emotional clarity and frequent use of cognitive reappraisal were associated with (a) lesser total PTSD severity after accounting for shared variance with positive affect and the extent to which emotions are attended to (attention to emotions), and (b) greater positive affect after accounting for shared variance with total PTSD severity and attention to emotions. This is the first study to demonstrate interactive effects of emotional clarity and cognitive reappraisal.
... Awareness, clarity, and understanding of an emotion (1-3, which we will subsume as comprehension) and compassionate self-support (4, which we will shorten to self-support in the following) are stipulated to impact on the emotion regulation process indirectly by facilitating modification (5) and acceptance/tolerance (6; Berking and Whitley 2014). In support of this assumption, a cross-sectional study demonstrated the interaction of clarity and cognitive reappraisal to be negatively associated with PTSD symptoms (Boden et al. 2012) and an experimental study showed a moderating effect of self-support on the effect of cognitive reappraisal on depressive symptoms (Diedrich et al. 2016). Thus, taking these interactions into account might also inform our understanding of the nature of emotion regulation difficulties that drive psychotic symptoms, such as paranoid ideation. ...
... This is surprising, given the ACE model's assumption that comprehension of emotions and self-support lead to a more focused and targeted attempt to modify emotions (Berking and Whitley 2014) that has been partially confirmed in previous research (e.g. Boden et al. 2012;Diedrich et al. 2016;Kalokerinos et al. 2019). However, these previous studies have mostly tested moderating effects specifically for cognitive reappraisal rather than for modification in general, which might explain the diverging findings. ...
... Future research needs to clarify whether these adaptive patterns of emotion regulation are transdiagnositic or specific to paranoid ideation. Furthermore, it needs to be examined whether other adaptive emotion regulation patterns that are related to other psychopathology, such as PTSD or depressive sypmtoms (Boden et al. 2012;Diedrich et al. 2016), are also associated with paranoid ideation. It must be noted that this study along with the previous research investigates only one-directionally how emotion regulation strategies predict paranoid ideation. ...
Background: Research on emotion regulation and paranoid ideation has mostly focused on isolated regulation strategies and
has remained largely inconclusive. According to the emotion regulation model by Berking and Whitley (in: Afect Regulation Training, Springer, New York 2014) successful modifcation or acceptance/tolerance of emotions requires an adequate
comprehension (awareness, clarity, understanding) of emotions and adequate self-support.
Method: Building on this model, we investigated whether comprehension and self-support strengthen the negative association between modifcation and acceptance/tolerance and paranoid ideation. In study 1, we examined the hypotheses crosssectionally based on questionnaire data from a combined sample (N=125) consisting of people with a psychotic disorder,
people at risk of developing psychosis, and healthy controls. In study 2, we examined the same hypotheses longitudinally by
employing the experience sampling method in people with clinically relevant psychopathology below diagnostic threshold
(N=138).
Results: In study 1, the association between modifcation and paranoid ideation was not moderated by comprehension or
self-support. However, comprehension and self-support moderated the association between acceptance/tolerance and paranoid ideation. In study 2, the interaction efect between comprehension and acceptance/tolerance on paranoid ideation was
confrmed.
Conclusion: The results indicate that comprehending and accepting/tolerating emotions could be protective against paranoid
ideation.
... Thought suppression is theorized to be less effective in modifying emotions relative to cognitive reappraisal (Gross, 1998) and tends to be used by individuals with a history of childhood maltreatment (Krause et al., 2003) and PTSD relative to those without (Beck et al., 2006;Shipherd & Beck, 2005). Conversely, cognitive reappraisal is associated with less severe PTSD symptom presentation (Boden et al., 2012, Boden et al., 2013 and has been described as a marker of resilience among children exposed to adversity (Rodman, Jenness, Weissman, Pine, & McLaughlin, 2019). The concurrent effects of each strategy on PTSD symptoms among adults with childhood maltreatment has not been empirically demonstrated to date. ...
... Cognitive reappraisal entails flexibility in perspective taking (e.g., "I control my emotions by changing the way I think about the situation I'm in"), such that emotional situations are construed in a particular way to change the emotional impact (Boden et al., 2012). Cognitive reappraisal is an adaptive emotion regulation strategy in that unpleasant emotions can be downregulated following stressful events (Gross & John, 2003). ...
... The literature suggests childhood maltreatment is associated with less use of cognitive reappraisal, but increased engagement in cognitive reappraisal may be associated with less PTSD symptoms. Cognitive reappraisal is described as a marker of resilience among children exposed to adversity (Rodman et al., 2019), associated with less severe PTSD symptoms (Boden et al., 2012, Boden et al., 2013, and may contribute to post-traumatic growth (Johnson et al., 2007). A form of cognitive reappraisal, positive reframing, is also associated with greater adjustment (e.g., comfortable discussing trauma) among sexual abuse survivors (Himelein & McElrath, 1996). ...
Emotion regulation strategies may help explain the risk of experiencing
posttraumatic stress disorder (PTSD) symptoms among adults with a history of child
maltreatment. However, no study to date has examined the roles of both thought
suppression and cognitive reappraisal in the association between childhood
maltreatment and PTSD symptoms. Objective. The current study sought to understand
the associations between childhood maltreatment, thought suppression, cognitive
reappraisal, and PTSD symptoms while controlling for negative affect and gender.
Participants and Setting. Data were collected on 660 university students (71% female)
ages 18 - 25 between 2013 and 2014. Participants completed self-report measures of
childhood maltreatment, PTSD symptoms, and emotion regulation strategies. Method.
A structural equation model was tested to examine the direct and indirect effects from
childhood maltreatment to PTSD symptoms via thought suppression and cognitive
reappraisal, over and above gender and negative affect. Results. Childhood
maltreatment was directly associated with PTSD symptoms (β = 0.28, SE = 0.04, p <
.001). Childhood maltreatment also had a significant indirect effect on PTSD via
cognitive reappraisal (β = 0.01, CI 95% [0.00, 0.03]), but not through thought
suppression, although (β = 0.01, CI 95% [-0.00, 0.04]) thought suppression was
significantly positively associated with PTSD symptoms (β = 0.21, SE = 0.04, p < .001).
Conclusion. The present study sheds light on the effect of childhood maltreatment and
two commonly used emotion regulation strategies on PTSD symptoms.
... Bussell and Naus (2010) defined cognitive coping as including positive reappraisal, acceptance, and religious coping. Strategies that rely on cognitive processes have been associated with lower levels of posttraumatic stress, primarily in cross-sectional studies (e.g., Boden et al., 2012;Hanley et al., 2017). ...
... While limited research has identified cognitive coping strategies as useful, almost no research has examined how each cognitive coping strategy predicts subsequent changes in PTSS. The little literature that has examined associations of adaptive cognitive coping and PTSS were cross-sectional (Boden et al., 2012;Hanley et al., 2017). The few studies that examined cognitive coping longitudinally have typically considered only isolated components of cognitive coping for PTSS (Bryant-Davis et al., 2014;Wisco et al., 2013). ...
... Our research sought to determine how different forms of cognitive coping predict change in PTSS longitudinally. Our first hypothesis was partially supported as positive reinterpretation reduced PTSS over time, which is consistent with existing cross-sectional literature (Boden et al., 2012;Hanley et al., 2017;Kleim et al., 2013). Results regarding the direct effects of acceptance and religious coping were not entirely in line with existing literature. ...
... Emotional clarity, the third distinct emotion-perception ability under investigation is a metaunderstanding of the path of one's emotions, including the causes of one's emotions and the biological and mental effects of one's emotions (Boden, Bonn-Miller, Kashdan, Alvarez, & Gross, 2012;Coffey, Berenbaum, & Kerns, 2003). One can be highly specific in naming emotions without having a deeper understanding of their source, and one can have this understanding of emotions without representing them dis-cretely. ...
... While clarity and differentiation do not predict one another (Boden, Thompson, Dizén, Berenbaum, & Baker, 2013), clarity is also related to emotion regulation. Low levels of clarity are related to poorer overall emotion regulation (Gratz & Roemer, 2008;Salovey et al., 1995), because understanding the source and consequences of one's emotions aids development of effective coping and regulation strategies (Boden et al., 2012). ...
When bad things happen people often seek out close others for support to help regulate their negative emotions. The degree to which support providers are responsive to the specific needs of support seekers is associated with many outcomes, including how effective that support is in regulating emotion. The ability of support providers to accurately assess the emotions experienced by support seekers seems crucial, yet few studies have examined the role this type of accuracy plays in support provision. We predicted that individuals who accurately assessed the emotions being experienced by a support seeker would provide more responsive support. Further, we predicted that individual differences in emotion differentiation (perceiving differences between similar emotions), range (experiencing a range of emotions), and clarity (understanding the cause and effect of one's emotions) would facilitate emotional accuracy and, in turn, responsiveness. Participants read scenarios depicting their romantic partners seeking support to help regulate different negative emotions; they then wrote supportive messages and indicated which emotions they thought their partners would be experiencing. Individual differences in emotional range and clarity (but not differentiation) predicted how accurate participants were in gaging the emotions depicted in the scenarios. In turn, accuracy predicted how responsive their messages were, as rated by independent coders. These results suggest that accuracy in perceiving a partner's emotions is crucial for providing responsive support and individual differences in one's own emotional experiences are associated both accuracy and responsiveness. Our findings have implications for research on interpersonal emotion regulation, close relationships, and social support. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
... Cognitive reappraisal can also lead to increases in positive emotion and offers a means for change in patients with low hope. Furthermore, use of this adaptive emotion-regulation strategy can help protect individuals from emotional disorders (Alvarez & Leal, 2010;Larsen & Berenbaum, 2015), diminish the severity of Post-Traumatic Stress Disorder (PTSD) (Boden, Bonn-Miller, Kashdan, Alvarez, & Gross, 2012), and enhance the rate of PTG (Brans, Koval, Verduyn, Lim, & Kuppens, 2013; Orejuela-Dávila, Levens, Sagui-Henson, Tedeschi, & Sheppes, 2019). ...
... Another finding of the current study is the positive and significant relationship between emotion regulation and PTG, which is in line with that of Boden et al. (2012). Confirming that those who use the emotional regulation strategy of cognitive reappraisal to assess the situation in a more positive manner are also more likely to search for opportunities existing amid their stressful situation and look for greater meaning in the incident (Groarke et al., 2017;Jim & Jacobsen, 2008). ...
Background
Despite the negative consequences of breast cancer, many women experience positive changes after diagnosis.
Objective
The aim of this study was to examine the mediating role of emotion regulation between post-traumatic growth (PTG), satisfaction of basic needs and maladaptive schemas.
Method
A total of 210 female patients diagnosed with breast cancer for at least six months were assessed using measures of the PTG Inventory, Basic Psychological Needs Satisfaction Scale, Young Schema Questionnaire–Short Form, and the Emotion Regulation Questionnaire. The collected data was analysed using structural equation modelling by SPSS and Amos 23.0.
Results
Basic needs and maladaptive schema paths to emotion regulation and PTG, and emotion regulation path to PTG were significant. In addition, maladaptive schemas path to emotion regulation was insignificant.
Conclusion
The current results show that focusing on satisfaction of basic needs and using positive emotion regulation strategies positively affect PTG. Additionally, activating maladaptive schemas and using negative emotion regulation strategies have a negative effect on PTG.
... Empirical research examining the relationships among clarity, attention, and emotion regulation have found that reappraisal is (a) positively associated with attention (Boden, Bonn-Miller, Kashdan, Alvarez, & Gross, 2012;Boden & Thompson, 2015) and (b) positively associated with clarity in a nonclinical adult sample (Boden & Thompson, 2015), but not related to clarity among college students (Gross & John, 2003) and people with posttraumatic stress disorder (Boden et al., 2012). Suppression is negatively associated with attention (Boden & Thompson, 2015;Gross & John, 2003) and clarity (Boden & Thompson, 2015;Gross & John, 2003). ...
... Empirical research examining the relationships among clarity, attention, and emotion regulation have found that reappraisal is (a) positively associated with attention (Boden, Bonn-Miller, Kashdan, Alvarez, & Gross, 2012;Boden & Thompson, 2015) and (b) positively associated with clarity in a nonclinical adult sample (Boden & Thompson, 2015), but not related to clarity among college students (Gross & John, 2003) and people with posttraumatic stress disorder (Boden et al., 2012). Suppression is negatively associated with attention (Boden & Thompson, 2015;Gross & John, 2003) and clarity (Boden & Thompson, 2015;Gross & John, 2003). ...
The present study examined the relationships among attention to emotion, emotional clarity, emotion regulation, and job satisfaction, and tested whether the plausible associations between emotional processes (e.g., attention to emotion, emotional clarity) and job satisfaction can be mediated by emotion regulation in a sample of Chinese medical staff. In total, 1,766 medical staff in Guangdong province completed questionnaires including the demographics, the Minnesota Satisfaction Questionnaire, Emotional Clarity, Attention to Emotion, and the Emotion Regulation Questionnaire. Results showed significant direct effect of emotional clarity, but not attention to emotion on job satisfaction. Cognitive reappraisal significantly mediated the associations between emotional processes (e.g., attention to emotion, emotional clarity) and job satisfaction whereas expressive suppression was not a statistically significant mediator. These results suggest that attention to emotion and emotional clarity contribute to job satisfaction by increasing certain emotion regulation strategies such as reappraisal. Intervention or medical education programs targeting enhancing emotional clarity and reappraisal may be beneficial for increasing job satisfaction of medical staff in China.
... However, only 4 out of the 57 studies included in the metaanalysis involved veterans, and only one of those studies exclusively evaluated post-9/11 veterans. Within veterans in general, Boden et al. (2012) found that in the context of high emotional clarity (awareness of one's own emotions), the use of adaptive strategies such as cognitive reappraisal is predictive of reduced PTSD severity. It is possible that cognitive reappraisal may have a direct impact on particular PTSD symptom clusters, such as avoidance or numbing. ...
... Findings were consistent with this hypothesis such that at low levels of cognitive reappraisal, greater PTSD symptoms were associated with greater alcohol use-these effects were not present at high levels of cognitive reappraisal. This is consistent with some prior research on veteran populations (Boden et al., 2012). However, Sippel et al. (2016) did not find any differences between post-9/11 veterans with and without PTSD on cognitive reappraisal using the same measure but also did not explore alcohol use as an outcome variable. ...
Background:
Rates of comorbid alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD) are increasing among post-9/11 veterans, and emotion regulation problems have been identified as a feature of both disorders. However, no studies to date have explored how individual differences in emotion regulation may moderate the relationship between PTSD symptoms and alcohol use. We evaluated how two core emotion regulation strategies - one adaptive (i.e., cognitive reappraisal) and one maladaptive (i.e., expressive suppression) are related to PTSD symptoms and alcohol use over one-year.
Methods:
A total of 71 post-9/11 veterans (12 female, 59 male) completed a baseline screening and at least two follow-up assessments over the course of 12 months which included measures of emotion regulation, PTSD symptoms, and alcohol use. A mixed growth model was utilized to determine if changes in PTSD symptoms covaried with alcohol use over time and whether this relation was moderated by frequency of use of emotion regulation strategies.
Results:
In general, higher PTSD symptoms were significantly associated with greater alcohol use, but cognitive reappraisal moderated this relationship. Specifically, at low cognitive reappraisal, greater PTSD symptoms were associated with greater alcohol use. At high cognitive reappraisal, there was no significant association between PTSD symptoms and alcohol use.
Conclusions:
Findings from the present study suggest that baseline individual differences in cognitive reappraisal influence the relation between PTSD symptoms and alcohol use. For post-9/11 veterans, high levels of cognitive reappraisal may serve as a protective factor against ongoing alcohol use.
... We predicted that expressive suppression would mediate this link. Prior evidence of the relationship between cognitive reappraisal and psychopathology has been somewhat mixed (Boden, Bonn-Miller, Kashdan, Alvarez, & Gross, 2012;Forkmann et al., 2014). For instance, Forkmann et al. (2014) found that cognitive reappraisal was unrelated to suicidal ideation in their mixed-gender sample. ...
... For instance, Forkmann et al. (2014) found that cognitive reappraisal was unrelated to suicidal ideation in their mixed-gender sample. However, other work has found that cognitive reappraisal is negatively related to psychopathology in males (Boden et al., 2012) and females (Troy, Wilhelm, Shallcross, & Mauss, 2010). Given the ambiguity in the literature, we remained agnostic about whether cognitive reappraisal would attenuate the relation between disordered eating and suicidality. ...
Abstract
Objective
Although disordered eating is robustly associated with suicidal thoughts, it is not well understood why these conditions relate to each other. Emotion dysregulation is a shared risk factor for disordered eating and suicidal thoughts. Individuals with dysregulated emotions struggle to select appropriate strategies to modulate emotions and the strategies they use might explain some of the shared variances. Thus, we examined whether emotion regulation strategies mediated the relationship between disordered eating and suicidal ideation.
Method
Adult participants (N = 230) completed questionnaires on current disordered eating symptoms, emotion regulation strategies, and current suicidal ideation.
Results
Disordered eating symptoms positively associated with suicidal ideation. In addition, expressive suppression mediated the relation between disordered eating symptoms and current suicidal ideation. No relation was found for cognitive reappraisal.
Conclusions
The use of expressive suppression as an emotion regulation strategy may be related to increased suicidal ideation in individuals who express concerns about eating.
... Reappraisal of an emotionally negative event to be less emotionally meaningful and intense has been shown to be effective at reducing PTSD symptoms [64,65]. For example, veterans with PTSD who were successfully trained to use reappraisal strategies and were self-aware of the emotions they were experiencing had lower PTSD symptom severity and greater positive affect [64]. ...
... Reappraisal of an emotionally negative event to be less emotionally meaningful and intense has been shown to be effective at reducing PTSD symptoms [64,65]. For example, veterans with PTSD who were successfully trained to use reappraisal strategies and were self-aware of the emotions they were experiencing had lower PTSD symptom severity and greater positive affect [64]. ...
This perspective piece reviews the clinical condition of posttraumatic stress disorder (PTSD), which is currently increasing due to the COVID-19 pandemic, and recent research illustrating how olfaction is being incorporated into virtual reality (VR) platforms. I then discuss the latest work examining the potential of olfactory virtual reality (OVR) for the treatment of PTSD. From this foundation I suggest novel ways in which OVR may be implemented in PTSD therapy and harnessed for preventing the development of PTSD. Perceptual and chemical features of olfaction that should be considered in OVR applications are also discussed.
... Emotional clarity also enables the accurate targeting of coping strategies by allowing people to select appropriate coping strategies based on accurate emotional information (Linehan, 2015). For example, in a study of veterans with PTSD, the use of cognitive reappraisal was only helpful in reducing PTSD for those who were high in emotional clarity (Boden, Bonn-Miller, Kashdan, Alvarez, & Gross, 2012). ...
... Conversely, people who are defused may be better able to identify the presence, causes, and consequences of aversive internal events, increasing emotional clarity (Walser & Westrup, 2007). Consistent with our model, the emotion labeling that occurs when having emotional clarity has been linked with reduced distress associated with unpleasant emotions (e.g., Pennebaker & Seagal, 1999) as well as implementing appropriate coping behaviors or self-regulatory strategies (e.g., Boden et al., 2012). Further, in our model, PTSD symptoms mediated the relation between emotional non-clarity and goal dysregulation while non-clarity did not directly contribute to goal dysregulation. ...
When cognitively fused, people have difficulty accepting and clearly perceiving their internal experiences. Following trauma, emotional non-acceptance and emotional non-clarity have been associated with post-trauma functioning. The aim of the present study was to integrate theory and research on cognitive fusion and post-trauma functioning to evaluate a theory-based model in which emotion dysregulation—specifically, emotional non-acceptance and emotional non-clarity—mediated the association between cognitive fusion and post-trauma functioning in a veteran sample. Participants were 149 veterans with a history of military-related trauma. Veterans completed measures of cognitive fusion, emotion dysregulation, posttraumatic stress disorder (PTSD) symptoms, and life satisfaction. Overall, emotion dysregulation and PTSD symptoms mediated the fusion-post-trauma functioning association in theoretically consistent ways. More specifically, fusion was related to PTSD through emotional non-clarity and fusion was related to goal dysregulation through emotional non-acceptance and PTSD. Our findings indicate that fusion impacts different aspects of post-trauma functioning through different mediators. How these different pathways could impact clinical decision making are discussed.
... Refs. [25][26][27]. Even in non-clinical populations, those who cannot effectively regulate their emotional responses to meet the demands of their environment experience longer and more severe emotional distress [28]. ...
Spaceflight to Mars will by far exceed the duration of any previous mission. Although behavioral health risks are routinely highlighted among the most serious threats to crew safety, understanding of specific emotional responses most likely to occur and interfere with mission success has lagged in comparison to other risk domains. Even within the domain of behavioral health, emotional constructs remain to be ‘unpacked’ to the same extent as other factors such as attention and fatigue. The current paper provides a review of previous studies that have examined emotional responses in isolated, confined, extreme environments (ICE) toward informing a needed research agenda. We include research conducted during space flight, long-duration space simulation analogs, and polar environments and utilize a well-established model of emotion and emotion regulation to conceptualize specific findings. Lastly, we propose four specific directions for future research: (1) use of a guiding theoretical framework for evaluating emotion responses in ICE environments; (2) leveraging multi-method approaches to improve the reliability of subjective reports of emotional health; (3) a priori selection of precise emotional constructs to guide measure selection; and (4) focusing on positive in addition to negative emotion in order to provide a more complete understanding of individual risk and resilience.
... Indeed, there have been a few attempts to identify individual difference moderators of the well-documented adaptive role of emotional clarity (e.g. Boden, Bonn-Miller, Kashdan, Alvarez, & Gross, 2012;Vine & Marroquín, 2018;Vine, Aldao, & Nolen-Hoeksema, 2014). One plausible moderator that has not been sufficiently explored is neuroticism and the closely-related trait negative affectivity, which are both characterised by a tendency to experience negative emotions. ...
Low emotional clarity has been a target for psychological interventions due to its association with increased internalising symptoms. However, theory suggests that very high emotional clarity may also lead to increased symptoms, particularly in combination with high levels of neuroticism. As an initial empirical test of this hypothesis, the present study examined curvilinear associations of emotional clarity with internalising symptoms (i.e. dysphoria, social anxiety, panic, traumatic intrusions) and a moderating role of neuroticism/negative affect in the association across two student samples and two clinical samples (total N = 920). Evidence of curvilinear associations and moderation varied across samples, with some supporting evidence in three samples. Specifically, neuroticism/negative affect moderated the curvilinear association of emotional clarity with traumatic intrusions in Clinical Sample 2 as well as the linear association between emotional clarity and dysphoria in Student Sample 2 and Clinical Sample 1. Simple slope analyses indicated that high emotional clarity was not consistently associated with lower symptoms. Also, the hypothesised quadratic effects of emotional clarity were found in Student Sample 2 and Clinical Sample 1 for panic, and in Clinical Sample 1 for dysphoria. Implications and limitations of these findings for conceptualisations of emotional clarity and current treatments were discussed.
... As a consequence, individual differences in neurobiology may help uncover correlates of disease-states across a wide spectrum, while recently, emotion dysregulation has been proposed as a trans-diagnostic feature that can be studied in this fashion ( Fernandez et al., 2016). In the context of those with PTSD, prior research has found substantial evidence for individual variability among trauma-exposed individuals in the extent to which they use emotion regulation ( Shepherd and Wild, 2014) and are effective in down-regulation ( Boden et al., 2012), including some of our prior work that demonstrated greater habitual use of reappraisal among combat-exposed veterans was related to decreased amygdala responding during the act of reappraisal ( Fitzgerald et al., 2017). Further, regulatory flexibility-defined by the ability to utilize regulation strategies in varied settings-is an important individual difference factor that strongly predicts psychological health and well-being across populations ( Bonanno and Burton, 2013), including resilience to trauma ( Bonanno and Diminich, 2013). ...
After diagnosis, veterans with posttraumatic stress disorder (PTSD) display significant variability in the natural course of illness (Bonanno et al., 2012)). Cross-sectional work reveals that abnormal neural response during emotion reactivity-measured using the late positive potential (LPP)-correlates with PTSD symptom severity; however, whether the LPP during emotional reactivity and regulation predicts symptoms over time is unknown. The current study examined the LPP during emotion reactivity and regulation as predictors of PTSD symptoms over one year in OEF/OIF/OND combat-exposed veterans. At baseline, participants completed an Emotion Regulation Task (ERT) during electroencephalogram recording. The Clinician Administered PTSD Scale (CAPS) was completed at baseline (N=86), 6-months (N=54) and 1-year (N=49) later. During ERT, participants viewed negative pictures; partway through they were instructed to "reappraise" (i.e., reduce negative affect/regulate) or "look" (i.e., passively react). Change in LPP during emotional reactivity (ΔLPP-E) and reappraisal (ΔLPP-R) were calculated and used in multilevel mixed modeling to predict CAPS over time. Findings demonstrated that deficiency in reappraisal (ΔLPP-R) predicted more overall symptoms over time, while greater neural responses to emotion (ΔLPP-E) and greater change in neural response as a function of reappraisal (ΔLPP-R) predicted a decline in avoidance symptoms over time. Together, results support the utility of neural markers of emotional reactivity and regulation as predictors of PTSD symptoms-and change in symptoms-across one year.
... Finally, advances in the acknowledgement of the central and peripheral mechanisms underlying emotion regulation processes might contribute to advancement in the psychological interventions in a clinical population in which emotion dysregulation plays an essential role, such as depression, anxiety, borderline personality disorder (Neacsiu, Eberle, Kramer, Wiesmann, & Linehan, 2014), bipolar disorder (Gruber, Hay, & Gross, 2014), or post-traumatic stress disorder (Boden, Bonn-Miller, Kashdan, Alvárez, & Gross, 2012). Therefore, extending the cumulative findings in terms of emotion regulation in general, and cognitive reappraisal in particular, might be an important contribution coming from basic research to progress in clinical psychology and psychopathology . 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 ...
Increased attention among the research community in exploring underlying mechanisms of emotion regulation has prompted a growth of experimental works in this field. Empirical studies have mainly focused on self‐reports, brain imaging, and electrophysiological measures, with only a few works exploring peripheral physiology. Additionally, most of such studies have not considered the specific stimuli content, even though prior literature has shown relevant differences in psychophysiological and subjective responses depending on picture categories. The current study assessed several peripheral correlates (startle amplitude, electrodermal changes, heart rate) of emotion regulation processes in a sample of 122 healthy participants. The task consisted of voluntary reappraisal of negative emotions prompted by unpleasant pictures (threat to others and victims), compared to a nonregulation control condition (looking at exemplars of the same categories and household objects). Results showed an effect of emotion regulation instructions in all psychophysiological and subjective measures. In peripheral physiology, greater responses were observed specifically when increasing negative emotions, concurring with previous research. Regarding specific content, our findings evidence a similar emotion regulation pattern, independently of the unpleasant category, suggesting a plausible effect of cognitive variables (such as cognitive effort) during voluntary reappraisal for both categories.
... Decentering also reduced the association between parasympathetic inflexibility (a broad physiological risk factor for psychopathology) and subsequent depressive symptoms in a sample of undergraduates (Stange, Hamilton, Fresco, & Alloy, 2017). Likewise, higher levels of cognitive reappraisal attenuated the association of emotional reactivity with depressive symptoms in a community sample of adolescents (Shapero, Abramson, & Alloy, 2016), and of emotional clarity with PTSD symptoms among veterans with PTSD (Boden, Bonn-Miller, Kashdan, Alvarez, & Gross, 2012). On the other hand, on occasions when people engaged in more rumination than was typical for them, the association of negative events and depressive symptoms that day was stronger, and on occasions when participants engaged in more dampening than usual, the association between positive events and decreased depressive symptoms that day was weakened (Li et al., 2016). ...
Dysfunctional affective processes are central to the experience of internalizing disorders (e.g., depression, anxiety, and related disorders). Specifically, extreme positive affect and elevated negative affect each have unique and robust patterns of associations with internalizing symptoms. This article examines affect as both an individual difference and a within-person dynamic process that unfolds over time. Recent research is reviewed that clarifies the hierarchical structure of affect and facet-level associations with symptoms, affect-laden traits that confer risk for internalizing psychopathology, models of emotion regulation, and how emotion regulation abilities and strategies contribute to or detract from psychological well-being. Several measurement challenges in this literature are identified and discussed, including possible conceptual and content overlap, mood-state distortion, naturalistic assessment in daily life, and the benefits and limitations of self-reported affective experience.
... Moreover, the processes that may underlie the association between alexithymia and PTSD symptoms remain largely unexplored. Some studies suggest that secondary effects of alexithymia on emotion regulation and coping strategies may account for the association between trait alexithymia and PTSD development (Boden et al., 2012;Gaher et al., 2016). However, recent findings raise the possibility that alexithymia may directly influence PTSD development via associated deficits in emotional memory processing (Frewen et al., 2008b;Jelinek et al., 2010;Minshew and D'Andrea, 2015). ...
Posttraumatic stress disorder (PTSD) is often considered to be a disorder of memory as patients suffer from fragmented uncontrollable memories (intrusions) whilst experiencing difficulties in intentionally retrieving details of the traumatic event. Recent research suggests that trait-related deficits in the identification of emotional states (alexithymia) may impact emotional memory processes in a way that promotes intrusion formation in PTSD. Therefore, we investigated the influence of alexithymia on intrusive re-experiencing and emotional recognition memory in a prospective analog study. Twenty-six healthy participants took part in a laboratory experiment, which combined two independent paradigms. Participants were exposed to a traumatic film (first session) and completed an episodic memory task comprising neutral and emotional stimuli (second session). In between sessions, participants recorded intrusive memories of the film. Individuals with higher trait alexithymia reported an increased number of intrusions on the day of film presentation. Moreover, analyses of memory performance revealed a negative correlation between alexithymia and emotional recognition memory. Further analyses suggest that reduced emotional recognition memory, as evident in individuals with higher trait alexithymia, may, in turn, be associated with enhanced intrusive re-experiencing. As such, the current findings provide first indications regarding the role of alexithymia in emotional learning and PTSD. Future studies should further investigate these associations as well as potential implications for the treatment of PTSD.
... It is interesting to note that adults with high SPS and high QCP showed enhanced amygdala activity in response to negative stimuli, in addition to stronger (Boden et al. 2012, Gross 1998. A few meta-analyses to date have shown that cognitive reappraisal exerts its effects via brain regions associated with cognitive control (the dmPFC, vmPFC, dlPFC, and vlPFC), selfreflection (posterior parietal areas), and modulation of emotion in the bilateral amygdala (Buhle et al. 2014, Diekhof et al. 2011). ...
Objective: This study examined the neural correlates of adult sensory processing sensitivity (SPS) and its interaction with subjective ratings of quality of childhood parenting (QCP). Method: Fourteen women (ages 18-25) underwent fMRI while viewing positive, negative and neutral images from the standard International Affective Picture System (IAPS) and completed the Highly Sensitive Person (HSP) Scale. (HSP) Scale, a neuroticism scale, and measures of quality of recalled childhood parenting. Results: In response to emotional (versus neutral) IAPS images, the SPS x QCP interaction (and also of SPS directly controlling for neuroticism) showed significant positive neural correlations in the hippocampus, entorhinal area, hypothalamus, and temporal/parietal areas, which process emotional memory, learning, physiological homeostasis, awareness, reflective thinking, and integration of information. For positive stimuli only, SPS showed significant correlations with areas involved in reward processing (VTA, SN, caudate), self-other integration (insula and IFG), calm (PAG), and satiation (subcallosal AC); and to a greater extent with increasing QCP. For negative images, the SPS x QCP interaction showed significant activation in the amygdala and PFC (involved in emotion and self-control), without diminished reward activity. Conclusions: SPS (and its interaction with childhood environment) is positively associated with activation of brain regions associated with depth of processing, memory, and physiological regulation in response to emotional stimuli. Results support differential susceptibility, vantage sensitivity and HSP models suggesting that SPS is associated with environmental sensitivity so that positive environments (such as high QCP) may provide benefits, such as adaptive responsivity (with awareness, arousal, self-control and calm) to emotionally evocative stimuli.
... Most prior studies have conceptualized emotional clarity as a stable individual difference and measured it with retrospective global self-report questionnaires (e.g., Boden et al., 2012;Gohm & Clore, 2002;). The most frequently used measures of emotional clarity are multidimensional self-report questionnaires such as the 20-item Toronto Alexithymia Scale (TAS-20;Bagby et al., 1994), the Trait-Meta Mood Scale ( Salovey et al., 1995), and the Difficulties in Emotion Regulation Scale (Gratz & Roemer, 2004), which include one or more subscales assessing emotional clarity. ...
Although emotional clarity contributes to effective emotion regulation and has been suggested as a target for transdiagnostic interventions, little is known about how emotional clarity impacts symptoms and emotion regulation success in daily life. The present study examined the association of emotional clarity with internalizing symptoms (i.e., depression, social anxiety, panic, and worry) in a clinical sample assessed in naturalistic settings over the course of 10 days, examining both within-person and between-person models. In addition, emotion regulation success was tested as a mediator of the association between emotional clarity and symptoms. The sample consisted of 129 diagnostically heterogeneous adults currently seeking or receiving mental health treatment. Multilevel structural equation modeling indicated that momentary emotional clarity was not significantly associated with subsequent momentary internalizing symptoms at either level, with the exception of a negative association with panic at the between-person level. However, lower momentary emotional clarity was indirectly associated with greater subsequent momentary internalizing symptoms via less successful momentary emotion regulation at both levels, and for some symptoms there was evidence of a bidirectional feedback loop. Overall, the present study provides support for the transdiagnostic nature of emotional clarity and clarifies the mechanisms by which emotional clarity may impact symptoms over time in daily life. Theoretical and clinical implications for the role of emotional clarity in psychopathology are discussed.
... These findings suggest that baseline levels of emotional clarity do not affect the degree to which an individual will benefit from MBSR or CBGT. This was unexpected given the aforementioned research which found that emotional clarity and cognitive reappraisal interact to predict lower severity of symptoms in a sample of individuals with PTSD (Boden et al., 2012). However, this research was cross-sectional and not in the context of treatment. ...
We examined (1) differences between controls and patients with social anxiety disorder (SAD) in emotional clarity and attention to emotions; (2) changes in emotional clarity and attention to emotions associated with cognitive-behavioral group therapy (CBGT), mindfulness-based stress reduction (MBSR), or a waitlist (WL) condition; and (3) whether emotional clarity and attention to emotions moderated changes in social anxiety across treatment. Participants were healthy controls (n = 37) and patients with SAD (n = 108) who were assigned to CBGT, MBSR, or WL in a randomized controlled trial. At pretreatment, posttreatment, and 12-month follow-up, patients with SAD completed measures of social anxiety, emotional clarity, and attention to emotions. Controls completed measures at baseline only. At pretreatment, patients with SAD had lower levels of emotional clarity than controls. Emotional clarity increased significantly among patients receiving CBGT, and changes were maintained at 12-month follow-up. Emotional clarity at posttreatment did not differ between CBGT and MBSR or between MBSR and WL. Changes in emotional clarity predicted changes in social anxiety, but emotional clarity did not moderate treatment outcome. Analyses of attention to emotions were not significant. Implications for the role of emotional clarity in the treatment of SAD are discussed.
... Given its utility in decreasing negative affect, reappraisal is a core skill taught in cognitive behavioral therapy (CBT) to reduce distress and symptoms caused by negative automatic thoughts and situational stressors (Barlow et al. 2011;Beck et al. 1979). Some research using self-report dispositional measures of reappraisal (i.e., trait-like questionnaires that assess one's general or overall use of reappraisal) show that the tendency to employ reappraisal is related to decreased risk for psychopathology, as well as increased life satisfaction and well-being (e.g., Boden et al. 2012;D'Avanzato et al. 2013;Gross and John 2003). In addition, results from experimental paradigms in which participants are instructed to reappraise indicate that reappraisal decreases the experience of negative emotions (Gross 1998;Sheppes et al. 2011;Webb et al. 2012). ...
Recent research has investigated how adaptive emotion regulation (ER) strategies and maladaptive ER strategies interact to predict symptoms, but little is known about how specific strategies interact with one another when used in daily life. The present investigation used daily diary data collected over two weeks from an unselected student sample (N = 109) to examine how reappraisal, a putatively adaptive ER strategy, interacts on a given occasion (within-person) and across occasions (between-person) with putatively maladaptive ER strategies (rumination, experiential avoidance, expressive suppression) to predict daily depression and social anxiety symptoms. Results revealed between-person interactions of reappraisal with rumination and experiential avoidance, wherein reappraisal was most negatively related to symptoms for individuals who frequently used rumination and experiential avoidance. There was a similar within-person interaction between reappraisal and expressive suppression. Implications for assessing daily and retrospective ER are discussed, as well as future directions for studying ER in daily life.
... Clarity about one's own emotions is a key component of emotional regulation (Gratz and Roemer, 2004). On the other hand, a lack of emotional clarity, known in its most severe form as alexithymia, hinders emotion regulation (Vine and Aldao, 2014) and is associated with affective disorders including depression (Honkalampi et al., 2004;van Randenborgh et al, 2012); post-traumatic stress disorder (PTSD; Boden et al., 2012), obsessive-compulsive disorder (OCD; Kang et al., 2012), and anxiety disorders (De Berardis et al., 2008;Karukivi et al., 2010). Alexithymia is a dimensional personality characteristic that involves skill deficits in monitoring, identifying and describing emotions (Taylor, 2000). ...
Background:
An inability to identify or describe internal emotional experience has been linked to a range of affective disorders. Despite burgeoning research on mindfulness-based interventions and their possible effects on emotion regulation, the effects of such interventions on emotional clarity is unclear. This review examines the evidence for the effect of mindfulness-based interventions on self-reported emotional clarity.
Method:
Published studies indexed by PsycINFO, PubMed and Scopus, as available in April 2017, were systematically reviewed. Interventions that included mindfulness practice or philosophy, and reported a suitable measure of emotional clarity at pre- and post-intervention were selected. A random-effects meta-analysis was performed. Subgroup comparisons were also conducted to test for differences between clinical and non-clinical samples, between specific and approximate measures of emotional clarity, and between controlled and uncontrolled trials.
Results:
Seventeen studies met the criteria for inclusion. The overall estimated effect size for pre- to post-intervention was small to moderate, Hedges' g = 0.42, 95% CI [0.25, 0.59] and for between groups results was small to large, Hedges' g = 0.52, 95% CI [0.15, 0.90].
Limitations:
Studies varied substantially in design quality and study characteristics. Furthermore, while interventions in the reviewed studies all had mindfulness components, many had other components in addition to mindfulness. Consequently, this review is limited by the heterogeneity of studies and results should be interpreted with caution.
Conclusions:
There is preliminary evidence to suggest that mindfulness-based interventions may increase emotional clarity. However, more homogenous and targeted experiments are required to confirm these initial findings.
... Difficulties with various aspects of the emotion regulation process have been linked to several forms of psychopathology, including depression, anxiety, eating disorders, and substance abuse (for a review, see Aldao et al. 2010). Posttraumatic stress disorder (PTSD) is one condition where emotion regulation difficulties appear to be particularly relevant (Ehring and Quack 2010;Boden et al. 2012;Morina et al. 2008;Moore et al. 2008;Price et al. 2006;Tull et al. 2007). ...
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.
... The results of the association of reappraisal indicated that reappraisal was associated with lower suicidality, lower psychosis/dissociation, lower deficits in executive control, higher tertiary positive appraisal, PTG, lower negative appraisal, lower PTSD, and CTD. The results were consistent across different analytic methods replicating and adding to previous studies (e.g., Boden, Bonn-Miller, Kashdan, Alvarez, & Gross, 2012). For suppression, the results of path analysis found that it had negative effects on PTG, which may be different from previous findings that found no significant relation between suppression and PTG (Larsen & Berenbaum, 2015). ...
One of the relatively ignored variables in most refugees’ trauma studies is the role of the damaged identities. We extended the model of identity as a dynamic non-linear system in the context of identity traumas and tested it in Syrian refugees. We empirically explored the effects of identity salience and cumulative stressors and traumas (CST), as mediated by appraisal and emotional regulation, on posttraumatic growth (PTG) and mental health of Syrian internally displaced (IDP) and refugees. We utilized data previously collected from 502 Syrian IDPS (195) and refugees in the Nederland (111) and Egypt (196). The data included measures of PTG, CST, PTSD, cumulative trauma disorders (CTD), emotion regulation (reappraisal and suppression) and identity salience. CST measure contains subscales for negative and positive tertiary appraisal. The analysis included descriptives, correlations, curve-estimation regression, path analysis, and multigroup structural invariance. Results indicated that increased identity salience was significantly related to higher reappraisal, higher PTG and a higher positive appraisal and significant effects on a lower negative appraisal. It had a significant impact on a lower CTD and PTSD. Increased CST was associated with higher PTSD, CTD, and especially CTD-suicidality, and CTD-psychosis/dissociation. The model was strictly invariant across genders. We discussed a paradigm shift to identity-focused assessment and interventions for refugees.
... Indeed, reappraisal has been found to positively influence emotions, well-being, and relationships, with those who cognitively reappraise a situation experiencing and expressing greater positive emotion and lesser negative emotion (Gross & John, 2013). Moreover, research has shown that when veterans use reappraisal, their symptoms of PTSD reduce (Boden et al., 2013;Boden, Bonn-Miller, Kashdan, Alvarez, & Gross, 2012;Hyer, McCranie, Boudewyns, & Sperr, 1996). ...
https://onlinelibrary.wiley.com/doi/abs/10.1002/cpp.2182
Aim:
Although most veterans have a successful transition to civilian life when they leave the military, some struggle to cope and adjust to the demands and challenges of civilian life. This study explores how a variety of psychosocial factors influence veteran adjustment to civilian life in Scotland, UK, and which of these factors predict a poor adjustment.
Methods:
One hundred and fifty‐four veterans across Scotland completed a set of questionnaires that measured veteran adjustment difficulty, quality of life, mental health, stigma, self‐stigma, attitude towards help‐seeking, likelihood of help‐seeking, experiential avoidance, reappraisal and suppression.
Results:
Veteran adjustment difficulty and quality of life were significantly correlated to a number of psychosocial factors. Mental health, experiential avoidance and cognitive reappraisal were found to be predictors of veteran adjustment difficulty, and experiential avoidance and cognitive reappraisal partially mediated the relationship between mental health and veteran adjustment, with experiential avoidance being the stronger mediator.
Discussion:
Our findings suggest that early assessment of experiential avoidance and cognitive reappraisal and the provision of relevant emotion regulation skills training could potentially reduce the veteran's need for more complex (and costly) psychological interventions in the future. Implications for veterans, as well as the services and professionals involved with veteran transition and health care are discussed.
... Indeed, reappraisal has been found to positively influence emotions, well-being, and relationships, with those who cognitively reappraise a situation experiencing and expressing greater positive emotion and lesser negative emotion (Gross & John, 2013). Moreover, research has shown that when veterans use reappraisal, their symptoms of PTSD reduce (Boden et al., 2013;Boden, Bonn-Miller, Kashdan, Alvarez, & Gross, 2012;Hyer, McCranie, Boudewyns, & Sperr, 1996). ...
Aim:
Although most veterans have a successful transition to civilian life when they leave the military, some struggle to cope and adjust to the demands and challenges of civilian life. This study explores how a variety of psychosocial factors influence veteran adjustment to civilian life in Scotland, UK, and which of these factors predict a poor adjustment.
Methods:
One hundred and fifty‐four veterans across Scotland completed a set of questionnaires that measured veteran adjustment difficulty, quality of life, mental health, stigma, self‐stigma, attitude towards help‐seeking, likelihood of help‐seeking, experiential avoidance, reappraisal and suppression.
Results:
Veteran adjustment difficulty and quality of life were significantly correlated to a number of psychosocial factors. Mental health, experiential avoidance and cognitive reappraisal were found to be predictors of veteran adjustment difficulty, and experiential avoidance and cognitive reappraisal partially mediated the relationship between mental health and veteran adjustment, with experiential avoidance being the stronger mediator.
Discussion:
Our findings suggest that early assessment of experiential avoidance and cognitive reappraisal and the provision of relevant emotion regulation skills training could potentially reduce the veteran's need for more complex (and costly) psychological interventions in the future. Implications for veterans, as well as the services and professionals involved with veteran transition and health care are discussed.
... Moreover, it changes the perception of personal meaning of such occurrences to positively impact social behaviors. As an effective technique to suppress negative emotions, it helps to improve life satisfaction (Gong et al., 2013); moreover, it is closely related to wellbeing and mental health (Boden et al., 2012;Xu et al., 2020). ...
This study aimed to explore the mechanism of college students’ meaning of life. The Emotion Regulation Questionnaire, the Gratitude Questionnaire Six-Item Form, the General Wellbeing Schedule, the Meaning in Life Questionnaire were used as measurement instruments. In total, 1,312 valid responses were obtained. The results showed that the cognitive reappraisal and expression suppression strategies were significantly positively and negatively correlated with gratitude, subjective wellbeing, and the sense of life meaning, respectively. Further, Emotion regulation strategies can affect college students’ sense of life meaning through three paths: the mediating effect of gratitude; the mediating effect of subjective wellbeing; the chain mediating effect of gratitude and subjective wellbeing. This study illuminated the roles of gratitude, and subjective wellbeing in influencing the sense of life meaning among the Chinese college students. Limitations and future research directions are discussed.
... Observed effect sizes for this association ranged from r .16 to 0.76, with significant heterogeneity in effect sizes across studies, Q (20) Lastly, analyses examined correlation statistics on the association between posttraumatic stress and each of the alexithymia subdimensions. After adjusting to account for random variance, weighted mean effect sizes suggested a moderate association between posttraumatic stress and difficulties in identifying feelings, ES ¯ Zr 0.36, SE Zr 0.02, 95% CI [0.31, 0.40], k 19, FSN 49; a slightly smaller association between posttraumatic stress and Freeman et al., 2000 (A) Ramirez et al., 2001Jakupcak et al., 2006 Freeman et al., 2000 (B) Brady et al., 2017Reynolds et al., 2017Gaher et al., 2016Simpson et al., 2006Miller & Johnson, 2012Zeng et al., 2018Frewen et al., 2008Evren et al., 2010Frewen et al., 2012Mazza et al., 2015Yehuda et al., 1997Cloitre et al., 2002 (A) Cloitre et al., 2002 (B) Spitzer et al., 2007Demers et al., 2015Boden et al., 2012Schechter et al., 2015Simeon et al., 2009 Total 30 40 50 60 70 80 Figure 1. Alexithymic trait severity in individuals with PTSD. ...
Objective:
Improving treatment outcomes for posttraumatic stress necessitates consideration of factors that may impede treatment progress. Previous research suggests alexithymia-an emotion-processing deficit characterized by difficulties in identifying, describing, and attending to emotional information-may be a therapeutically relevant correlate of posttraumatic stress.
Method:
Building upon previous work in this area, meta-analysis was used to investigate (a) how alexithymic traits typically present among those with a posttraumatic stress disorder (PTSD) diagnosis, (b) the strength of association between alexithymic trait severity and posttraumatic stress severity independent of diagnosis, and (c) alexithymia subdimensions most closely associated with posttraumatic stress. A total of 43 samples encompassing 5,069 participants were included in analyses.
Results:
Results suggest individuals diagnosed with PTSD tend to experience alexithymic traits that, while just below the clinical cutoff, are 1.32 standard deviations more severe than the general population. These alexithymic traits are particularly prominent in male and veteran samples and for difficulties in identifying feelings. Independent of diagnosis, posttraumatic stress was moderately associated with alexithymic traits, and stronger associations were noted between posttraumatic stress and difficulties in identifying feelings than between posttraumatic stress and difficulties in describing feelings or externally oriented thinking.
Conclusions:
Results attest to the importance of considering, conceptualizing, and treating posttraumatic stress and alexithymia in tandem. Implications for ongoing treatment development for posttraumatic stress are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
... Myerson states that simple language can reduce complexity and make difficult concepts accessible (Ivanova, 2018). Others link Clarity to emotional awareness and emotional intelligence (Bodet et al., 2011), mindfulness and wellbeing (Hanley & Garland, 2017), and conscientiousness (Campbell et al., 1996). Clarity principles were used to: ...
Creative Leadership (CL) is a leadership model comprising the three values of Empathy, Clarity and Creativity, which are considered baseline operational and leadership attributes in a Fourth Industrial Revolution (4IR) world. This paper presents a case study charting the application of CL principles within delivery of a complex research project involving international collaboration between The Helen Hamlyn Centre for Design (HHCD) at London's Royal College of Art (RCA), a strategic partner-TATA Consultancy Services (TCS), and an airline client [the Airline]. The purpose of the design research was to improve the operational efficiency of the Airline, whilst improving staff and customer experience. This addressed three discrete, yet interlinked areas of delivery within the Airline Operations Control Centre (OCC), namely Technology, Environment and People. The three values of CL-Empathy, Clarity and Creativity-were exercised to align physical, technological and psychological factors. These were implemented in the design of a UX technology that made complex information accessible at a glance, and the redesign of the OCC office environment to enable better communication and personal wellbeing. This paper captures the process and outcomes, whilst reflecting on the efficacy of the CL model as a progressive framework for innovation, growth and development.
... Regulation by cognitive or arousal reappraisal, which aims to change the type of stress response, encourages individuals to reconceptualize stress as a coping tool (57). This technique has been explored in both therapeutic contexts (58), resulting in decreased PTSD symptom severity (59), and academic contexts (41), showing effectiveness in improving student outcomes (60). Compared to other regulation strategies, specifically suppression, cognitive reappraisal was associated with lesser symptom severity in PTSD (58) and lower levels of academic burnout (56). ...
Background:
Trigger warnings - advance notification of content so recipients may prepare for ensuing distress - feature in discussions in higher education. Students' expectations for warnings in some circumstances are recognised and some educators and institutions have adopted use. Medical education necessitates engagement with potentially distressing topics. Little is known about medical students' expectations regarding warnings in education.
Methods:
All students from a 4-year graduate-entry UK medical degree programme were contacted via digital message outlining study details and were openly sampled. Qualitative methodology was chosen to explore participant expectations, experiences, and meanings derived from experiences. Students participated in semi-structured interviews exploring perspectives on functions, benefits, and drawbacks of trigger warnings in classroom-based medical education. We analysed interview transcripts using thematic analysis.
Results:
Thirteen semi-structured, qualitative interviews were undertaken. Themes in the following areas were identified; 1) students' experiences influence understanding of trauma and trigger warnings, 2) warnings as mediators of learning experiences , 3) professional responsibilities in learning, 4) exposure to content, 5) professional ethos in medical education, 6) how to issue trigger warnings. Students recognised the term "trigger warning" and that warnings are an accommodation for those affected by trauma. Students' conceptualisation of warnings was influenced by personal experiences and peer interactions both within and outside education. Students expressed both support and concerns about use of warnings and their ability to influence learning, assuming of responsibility and professional development.
Discussion:
Diverse student opinions regarding warnings were identified. Most students suggested that warnings be used prior to topics concerning recognised traumas. Incremental exposure to distressing content was recommended. Students should be supported in managing own vulnerabilities and needs, while also experiencing sufficient formative exposure to develop resilience. Greater understanding of trauma prevalence and impacts, and underpinnings of warnings amongst students and educators is recommended to optimise education environments and professional development.
... Emotional clarity has been found to predict PTSD symptom severity over and above awareness, other facets of alexithymia, and emotion dysregulation (Ehring & Quack, 2010;Tull et al., 2007). Furthermore, clarity interacts with ER strategies to predict PTSD severity (Boden et al., 2012). Consistent with the notion of regulatory flexibility (Bonanno & Burton, 2013), emotional clarity may help individuals identify situations in which engaging with emotional material (e.g., trauma-cues) is adaptive. ...
Objective:
Emotion regulation (ER) plays a prominent role in the development and maintenance of posttraumatic stress disorder (PTSD). Although links between ER strategies and PTSD symptoms are well documented, recent advancements in ER research emphasize the need to move beyond examining ER strategies as isolated processes. Instead, there is a growing movement to understand ER repertoires, or the patterns in which individuals report habitually using the multiple ER strategies available to them. Additionally, awareness and clarity of one's emotional experiences might play a key role in the effective use of ER strategies.
Method:
The current study examined person-centered repertoires of the habitual use of eleven ER strategies among 372 undergraduates exposed to Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) Criterion A trauma-and their relations to PTSD symptoms, emotional awareness, and emotional clarity.
Results:
Latent profile analysis yielded a three-profile solution (Adaptive, Average, and Maladaptive Regulators) and profiles differed on mean levels PTSD symptoms. Emotional clarity, but not emotional awareness, emerged as a significant predictor of profile classification, even after adjusting for negative affect.
Conclusions:
Findings suggest that emotional clarity might help foster healthy repertoires of ER strategy use and buffer against the development of PTSD among trauma-exposed individuals. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... These findings are in line with the common symptom profile of the dissociative subtype of PTSD, which is marked by emotional detachment, numbness, and blunted arousal. Such notions would also be consistent with dissociation being strongly negatively correlated with self-concept clarity (Evans, Reid, Preston, Palmier-Claus, & Sellwood, 2015), as well as cognitive reappraisal gains being partially dependent on having increased emotional clarity (Boden, Bonn-Miller, Kashdan, Alvarez, & Gross, 2012). This appears to be supported by an RCT evaluating changes in PTSD symptoms and diagnosis among 121 chronic PTSD patients randomly assigned to cognitive therapy, waitlist, or emotion-focused supportive therapy, which targeted clarifying the patient's emotions without cognitive restructuring or elaboration of the trauma memories (Ehlers et al., 2014). ...
Background
Post-traumatic stress disorder affects 9% of individuals across their lifetime and increases nearly fourfold to 35% in Canadian public safety personnel (PSP). On-the-job experiences of PSP frequently meet criteria for traumatic events, making these individuals highly vulnerable to exposures of trauma and the negative consequences of PTSD. Few studies have reported on the clinical characteristics of Canadian samples of PSP and even fewer have examined the dissociative subtype of PTSD, which is associated with more severe, chronic traumatic experiences, and worse outcomes.
Objective
This study aimed to characterize dissociative symptoms, PTSD symptom severity, and other clinical variables among Canadian PSP with presumptive PTSD.
Methods
We sampled current and past PSP in Canada from both inpatient and outpatient populations (N = 50) that were enrolled in a psychological intervention. Only baseline testing data (prior to any intervention) were analysed in this study, such as PTSD symptom severity, dissociative symptoms, emotion dysregulation, and functional impairment.
Results
In our sample, 24.4% self-reported elevated levels of dissociation, specifically symptoms of depersonalization and derealization. Depersonalization and derealization symptoms were associated with more severe PTSD symptoms, greater emotion dysregulation, and functional impairment.
Conclusions
Nearly a quarter of this sample of Canadian PSP reported experiencing elevated levels of PTSD-related dissociation (depersonalization and derealization). These high levels of depersonalization and derealization were consistently positively associated with greater illness severity across clinical measures. It is imperative that dissociative symptoms be better recognized in patient populations that are exposed to chronic traumatic events such as PSP, so that treatment interventions can be designed to target a more severe illness presentation.
... . In the wider PTSD literature, reappraisal has been differentially found to have negative(Aase et al., 2018;Boden et al., 2012;Jenness et al., 2016) and positive (Canetti et al., 2016; Meiser-Stedman et al., 2014; Scarpa et al., 2009; Valdez & Lilly, 2012; Wilson & Scarpa, 2012) associations with PTSD symptom severity, while Seligowski et al.'s (2015) meta-analysis found that reappraisal did not have any effect on post-traumatic stress symptoms. Wells and Sembi (2004a) have described negative appraisal as a maladaptive strategy in the metacognitive model of PTSD, and it is possible, therefore, that the varying findings across the literature regarding the association between reappraisal and PTSD symptoms may be due to the helpfulness of this strategy being dependent upon whether the thoughts are reappraised as positive or negative in nature. ...
The metacognitive model of PTSD implicates metacognitive beliefs, meta-memory beliefs, and metacognitive control strategies in perpetuating and maintaining symptoms of PTSD. Despite this expanding area of research, the evidence for the metacognitive model of PTSD has not been reviewed. A systematic review according to the PRISMA statement was conducted. Searches across Medline, PubMed and PsycNET, as well as reference lists of the included studies (2004-March 2020) yielded 221 records. Two independent reviewers screened articles, which were included where the impact of the constructs of interest on PTSD symptoms were investigated within the framework of the metacognitive model for PTSD. Eighteen articles were included in the review. Eleven studies were determined to have good methodological robustness. Metacognitive therapy for PTSD demonstrated reductions in symptoms from pre- to post-treatment, which were maintained at follow-up. Predictors of greater PTSD symptom severity included metacognitive beliefs, meta-memory beliefs, and worry, punishment, thought suppression, experiential avoidance, and rumination. Overall, support was found for the validity of the metacognitive model of PTSD.
... Additionally, emotional clarity (or the lack thereof) may show interactive or additive influence when investigated alongside other variables. For instance, researchers reported the beneficial influence of combined high levels of emotional clarity and the use of cognitive reappraisal on PTSD (Boden et al., 2012). In contrast, problems with emotional clarity lead to fears regarding anxiety-related sensations which results in higher PTSD symptom levels (Viana et al., 2018). ...
The present study tested the impact of family context on psychological functioning and its mediating and moderating variables in a sample of Filipino emerging adults who have been exposed to Typhoon Haiyan. Particularly, the current study examined the moderating role of trauma type in the indirect effect family functioning (FF) on Posttraumatic Stress Disorder (PTSD) symptoms via emotion regulation difficulties (ERD). Trauma-exposed students (N = 324, aged 19–28 years) from various regions devastated by Typhoon Haiyan participated in this study. The mediation analyses demonstrated that out of the six aspects of ERD, nonacceptance of emotional responses (Nonacceptance) and lack of emotional clarity (Clarity) successfully mediated the association between low FF and higher PTSD scores. Subsequent moderated mediation analysis showed that Typhoon Haiyan survivors with additional exposure to interpersonal trauma showed higher levels of PTSD symptoms from the indirect impact of unhealthy family functioning via difficulties in accepting negative emotional responses. This study demonstrates the continued relationship of family functioning and psychological adjustment occurring in emerging adulthood and suggests the role of trauma type as a potential contextual factor in further understanding the relationship between emotion regulation difficulties and PTSD symptoms. Empirical contributions and clinical implications are discussed.
... As described above, one of the hallmark symptoms of PTSD involves alterations in cognition and mood, where individuals with PTSD frequently experience persistent negative traumarelated emotions and associated changes in perception of the self and the world (Foa et al., 1999;Cox et al., 2014;Frewen et al., 2017). Here, cognitive functions such as emotion regulation may be negatively impacted in individuals with PTSD, as multisensory integration of internal and external sensory information plays a pivotal role in generating adaptive emotional responses when individuals interact with the external world (Cloitre et al., 2005;Ehring and Quack, 2010;Boden et al., 2012;Ford, 2017). Indeed, several neurophysiological studies in PTSD reveal that PTSD is often associated with extreme sensory processing patterns, including sensory hypersensitivity and hyposensitivity to stimuli associated with traumatic memories (such as specific sounds, images, touch stimulation) (Näätänen and Alho, 1995;Grillon and Morgan, 1999;Shalev et al., 2000;Engel-Yeger et al., 2013). ...
Post-traumatic stress disorder (PTSD) is triggered by an individual experiencing or witnessing a traumatic event, often precipitating persistent flashbacks and severe anxiety that are associated with a fearful and hypervigilant presentation. Approximately 14-30% of traumatized individuals present with the dissociative subtype of PTSD, which is often associated with repeated or childhood trauma. This presentation includes symptoms of depersonalization and derealization, where individuals may feel as if the world or self is "dream-like" and not real and/or describe "out-of-body" experiences. Here, we review putative neural alterations that may underlie how sensations are experienced among traumatized individuals with PTSD and its dissociative subtype, including those from the outside world (e.g., touch, auditory, and visual sensations) and the internal world of the body (e.g., visceral sensations, physical sensations associated with feeling states). We postulate that alterations in the neural pathways important for the processing of sensations originating in the outer and inner worlds may have cascading effects on the performance of higher-order cognitive functions, including emotion regulation, social cognition, and goal-oriented action, thereby shaping the perception of and engagement with the world. Finally, we introduce a theoretical neurobiological framework to account for altered sensory processing among traumatized individuals with and without the dissociative subtype of PTSD.
... For instance, increased positive affect, combined with fewer posttrauma cognitions, could play a role in reducing PTSD symptom severity following positive memory processing. Such hypotheses need empirical examinations, although they are supported by established interactive effects of affect and cognitions on PTSD symptoms (e.g., cognitive reappraisal and emotional clarity; Boden et al., 2012). Furthermore, the current study had a modest sample size (resulting in limited power to detect significant relationships), was not a full longitudinal design (i.e., we had assessments across two timepoints), and had low baseline PTSD symptom severity, which may have influenced variation in scores over a short period; such methodological parameters could have influenced study findings. ...
Objective:
Posttraumatic stress disorder (PTSD) symptoms may impact cognitive processes underlying encoding and retrieval of positive memories. Contractor and colleagues thus proposed a Positive Memory-PTSD model outlining hypothesized pathways (e.g., improved cognitions and affect) linking active processing of positive memories and PTSD symptoms. In the current study, we empirically explored direct and indirect pathways of the Positive Memory-PTSD model including relations between presence/types of processing memory methodology, posttrauma maladaptive cognitions, positive/negative affect, and PTSD symptom severity.
Methods:
We randomly assigned 65 students reporting trauma histories to time-matched narrating (identifying and sharing details of elicited positive memories), writing (identifying and writing details of elicited positive memories), or control conditions. Participants completed self-report measures (T0) and repeated their assigned task condition and self-report measures 6-8 days later (T1).
Results:
Half-longitudinal models demonstrated direct associations of (1) being in the narrating versus other conditions with decreases in posttrauma maladaptive cognitions and negative affect, and increases in positive affect; and (2) increases in posttrauma maladaptive cognitions and negative affect with greater PTSD symptom severity. Although, when controlling for posttrauma maladaptive cognitions and negative/positive affect, being in the narrating versus other conditions was associated with decreases in PTSD symptom severity, these constructs did not explain examined relations.
Conclusions:
Results suggest beneficial impacts of narrating positive memories on PTSD symptom severity (accounting for cognitions/affect) and improved cognitions/affect, and a need to examine moderating variables (e.g., emotion regulation) in the Positive Memory-PTSD model. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... Similarly, in the context of viewing possibly traumatising material, positive reappraisal was found to be negatively associated with PTSD symptoms in adolescents exposed to media depicting a terrorist attack [99]. Along the same lines, cognitive reappraisal was associated with lesser total PTSD severity and greater positive affect [100], lower depression and lower state and trait anxiety [101], fewer subsequent trauma-related intrusions [102], and more effective down regulation of negative emotions [103]. ...
This study aimed to extend previous research on the experiences and factors that impact law enforcement personnel when working with distressing materials such as child sexual abuse content. A sample of 22 law enforcement personnel working within one law enforcement organisation in England, United Kingdom participated in anonymous semi-structured interviews. Results were explored thematically and organised in the following headings: “Responses to the material”, “Impact of working with distressing evidence”, “Personal coping strategies” and “Risks and mitigating factors”. Law enforcement professionals experienced heightened affective responses to personally relevant material, depictions of violence, victims’ displays of emotions, norm violations and to various mediums. These responses dampened over time due to desensitisation. The stress experienced from exposure to the material sometimes led to psychological symptoms associated with Secondary Traumatic Stress. Job satisfaction, self-care activities, the coping strategies used when viewing evidence, detachment from work outside working hours, social support and reducing exposure to the material were found to mediate law enforcement professionals’ resilience. Exposure to distressing material and the risks associated with this exposure were also influenced by specific organisational procedures implemented as a function of the funding available and workload. Recommendations for individual and organisational practices to foster resilience emerged from this research. These recommendations are relevant to all organisations where employees are required to view distressing content.
... Without being able to identify and differentiate between one's emotions or understand causes and consequences associated with those emotions, the ability to use appropriate ER strategies may be compromised (Van Beveren et al., 2019). In support of this notion, greater levels of interoceptive awareness (Füstös et al., 2012) and emotional clarity (Barrett et al., 2001;Boden et al., 2012) have been associated with greater use and efficacy of cognitive reappraisal. As such, parents who are adept in these ER skills may be better equipped to reappraise stressful situations and engage in supportive response behaviors. ...
Background
Parental emotion regulation (ER) and emotion socialization have been identified as key factors contributing to children's emotional competence; however, only a handful of studies have assessed the relationship between these constructs.
Objective
The goal of the present study was to determine whether parental ER would predict parents' self‐reported emotion socialization practices above and beyond the influence of personality.
Method
Parents completed a series of self‐report measures online. After data cleaning, 104 mothers of children between the ages of 8 and 12 years were retained for analyses.
Results
Hierarchal regressions revealed that mothers who reported higher levels of ER skills and more frequent use of cognitive reappraisal were more likely to report engaging in supportive response behaviors when controlling for personality. Moreover, maternal reappraisal was significantly and inversely associated with reports of unsupportive emotion socialization.
Conclusion
Findings provide evidence to support the association between maternal ER and emotion socialization behaviors.
Implications
Results are discussed with respect to their implications for emotion‐focused interventions aimed at promoting supportive parenting practices.
... Moreover, although emotion regulation is an integrated and systematic process consisting of clear emotion identification and subsequent selection and implementation of emotion regulation strategies, most studies did not address emotional clarity and emotion regulation strategy simultaneously. Only one study suggested the association between emotional clarity and emotion regulation strategies by examining the interaction effect of emotional clarity and cognitive reappraisal in predicting PTSD (Boden et al., 2012). A few recent studies have begun to investigate the sequential effect of emotion regulation in depression using a mediation model (Vine and Aldao, 2014;Boden and Thompson, 2015), but no studies have found the mediation effect of emotion regulation strategies in the relationship between emotional clarity and PTSD. ...
Difficulties in emotion regulation reportedly contribute to the development and maintenance of PTSD following exposure to natural disasters. Based on the extended process model of emotion regulation, the present study hypothesized that maladaptive emotion regulation strategies will mediate the relationship between emotional clarity and posttraumatic stress symptoms in a sample of earthquake survivors. A total of 195 adult residents of Gyeongju and Pohang, southeastern coastal cities in Korea, who had experienced recent earthquakes participated in an online survey study. They completed questionnaires assessing emotional clarity, emotion regulation, and posttraumatic stress symptoms a year and 10 months after the Gyeongju earthquake and 7 months after the Pohang earthquake. Bootstrapping procedures were used to test for a mediation effect. The results suggest that emotional clarity was indirectly associated with posttraumatic stress symptoms through maladaptive emotion regulation strategies, especially catastrophizing. The findings suggest that individuals with low emotional clarity tend to use maladaptive strategies, catastrophizing in particular, which may contribute to posttraumatic stress symptoms. This may reflect the mechanism underlying emotional clarity and offer suggestions for target of treatment in the management of long-term psychological difficulties in earthquake survivors. Replication of the current results in a sample of patients diagnosed with PTSD is necessary to better understand the development and progression of the disorder, as well as effective interventions for PTSD.
... ER used effectively (e.g., engaging in reappraisal) has been shown to improve physiological reactivity to acute stress (Jamieson, Mendes, & Nock, 2013) and decrease symptom severity in Post-Traumatic Stress Disorder (Boden, Bonn-Miller, Kashdan, Alvarez, & Gross, 2012). Used ineffectively (e.g., engaging in suppression), ER has been associated with increased physical and depressive symptoms in response to occupational stress (Jin-Kyoung, Jung-Im, & Do-Young, 2014;Golkar et al., 2014). ...
How students regulate emotions and the effects of emotion regulation (ER) on academic outcomes is gaining attention in educational psychology research. However, little is known about factors that explain their relationship and inform intervention. Two studies therefore examined the role of school burnout in explaining the relationship between ER strategies (reappraisal, suppression) and academic outcomes (GPA, absenteeism) among undergraduate students. Study 1 (N = 550) investigated ER strategies as antecedents to the effects of school burnout on academic outcomes. Significant indirect effects emerged to show that school burnout mediated the relationships between ER and GPA and absenteeism. Study 2 (N = 509) examined the temporal relationship between ER strategies, school burnout, GPA and absenteeism at two time points. Findings indicated that ER strategies preceded the effects of school burnout. School burnout, in turn, was identified as the mechanism linking (mediating) ER strategies to academic outcomes. Limitations, clinical applications, and future directions are outlined.
Objectives: The purpose of the present research was to evaluate the effects of working life on emotional self-awareness by making a comparison between working women and non-working in terms of their emotional self-awareness levels.
Methods: This research consists of two studys. In the first stage, Emotional Self-Awareness subscale of the Emotional Quotient Map was translated into Turkish and psychometric characteristics of the scale were investigated comprehensively (n=1551). Out of these participants, 98 people took place in the retest study, which was scheduled to be administered 15 days after the first application, and 102 people participated in the discriminant and criterion validity study. In order to examine the factor structure, explanatory and confirmatory factor analyses were performed. Additionally, correlation coefficient was calculated for the test-retest reliability and for discriminant and criterion validities. Results of these analyses suggest the scale has met the basic psychometric requirements and has a valid structure.
The second part of the study was conducted with 146 women working in various revenue-generating jobs and 163 non-working women, a total of 309 participants between 19-73 ages. Two-way analyses of variance were carried out to compare emotional self-awareness scores in association with socio-demographic variables. A comparison of the two groups’ scores reveals that women working in revenue-generating jobs tend to be more emotionally self-aware then women who do not work. The findings were discussed in line with the related literature.
Objective
This study examined whether expressive suppression (ES), a maladaptive regulation strategy, was more strongly associated with PTSD diagnosis and symptom clusters in veterans than cognitive reappraisal (CR), an adaptive regulation strategy.
Method
In a cohort study, 746 participants recruited from VHA facilities completed Clinician Administered PTSD Scale-IV, Emotion Regulation Questionnaire, and Patient Health Questionnaire. Participants were categorized into groups: Current, Remitted/Lifetime, and Never PTSD.
Results
One-way ANOVA revealed significant differences between Current PTSD and both Remitted and Never PTSD for ES, but not CR. The Remitted and Never PTSD groups did not vary significantly from each other and were collapsed into one group for regressions. Adjusting for sex, race, employment, and comorbid depression, binary logistic regression showed ES, but not CR, was associated with increased likelihood of Current PTSD (p < .001, OR: 1.43). ES was also significantly associated with increased odds of meeting criteria for all symptom clusters (ps < .001). CR was not significantly associated with meeting criteria for Current PTSD or any symptom cluster.
Limitations
Cross-sectional design and use of self-report limit causality inferences that can be drawn.
Conclusions
ES is associated with increased odds of Current PTSD diagnosis and symptom clusters. Veterans in the Remitted and Never PTSD groups did not differ significantly. Greater suppression of emotional expression is more strongly linked with PTSD criteria in veterans than decreased cognitive reappraisal.
Objective:
Numerous researchers have suggested that certain coping styles (e.g., maladaptive cognitive coping strategies) interfere with recovery from traumatic experiences and contribute to the onset/maintenance of posttraumatic stress disorder (PTSD). Further, given that individuals with PTSD have a high rate of smoking (e.g., Mahaffey et al., 2016) and that maladaptive coping strategies in general are associated with lower smoking quit rates, it is possible that use of maladaptive cognitive coping strategies are particularly problematic for the recovery of smokers with PTSD. The present study examined whether specific cognitive coping strategies are associated with poorer outcome among smokers with PTSD following an integrated treatment for both disorders.
Method:
Patients with chronic PTSD and nicotine dependence (N = 142) received up to 12 sessions of smoking cessation counseling combined with varenicline or integrated prolonged exposure therapy and cessation counseling combined with varenicline. We hypothesized that greater maladaptive, and lower adaptive, cognitive coping strategies at baseline would moderate degree of improvement in smoking and PTSD outcomes through to follow-up.
Results:
Multilevel modeling revealed that neither maladaptive nor adaptive cognitive coping strategies moderated smoking abstinence outcomes over the course of the study (ps ≥ .271). However, greater use of catastrophizing and lower use of positive reappraisal at baseline were associated with less improvement in the hyperarousal PTSD symptom cluster over the course of the study (ps ≤ .01).
Conclusions:
These findings suggest that maladaptive cognitive coping strategies are not necessarily a contraindication for overall outcomes in integrated PTSD and smoking treatment, although they may influence improvement in hyperarousal symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Background
Emotion regulation (ER) is associated with posttraumatic stress symptoms (PTSS). However, most findings are from cross-sectional studies and are hence unable to clarify whether deficits in ER longitudinally contribute to the worsening and maintenance of PTSS. In addition, no studies consider the process of how ER affects PTSS. To further clarify causal pathways, we tested prospective associations between ER and subsequent PTSS by gender in individuals who had experienced traumatic events.
Methods
We used data from an online survey of 1,794 Japanese participants aged 18–83 years who had experienced at least one traumatic event. They completed the Emotion Regulation Skills Questionnaire at baseline, as well as the PTSD Checklist for DSM-5 at baseline and four months later.
Results
Multi-group structural equation modeling by gender revealed that participants’ ER predicted their PTSS four months later, even after controlling for symptoms at baseline. The findings indicate that identifying undesired emotions and then dealing with them decreases subsequent PTSS. ER had a greater effect on later PTSS in males than in females.
Limitations
The use of an online survey and the exclusive use of self-report instruments might limit the generalizability of our results and the validity of the assessment.
Conclusions
Deficits in ER likely contribute to worsening and maintenance of PTSS. The process of identifying and subsequently dealing with emotions may be important for the clinical suppression of PTSS.
Studies have found that anxiety is among the common negative emotions in individuals with substance use disorders. Anxiety affects drug abstention motivation, but the mechanism underlying this effect is still unclear. The current study aimed to examine the relationship among anxiety, regulatory emotional self-efficacy, psychological resilience and drug abstention motivation in an attempt to explore the mechanism underlying drug abstention motivation. The participants were 732 men with substance use disorders who were sent to compulsory rehabilitation in China. All participants completed measures of anxiety, regulatory emotional self-efficacy, psychological resilience and drug abstention motivation through questionnaires. The results indicated that anxiety negatively predicts drug abstention motivation. Regulatory emotional self-efficacy mediates the relationship between anxiety and drug abstention motivation. In addition, psychological resilience moderates the mediation between anxiety and regulatory emotional self-efficacy. The current results are not only helpful for understanding the relationship between anxiety and drug abstention motivation from the perspective of emotion but also of great significance for guiding individuals with substance use disorders in enhancing their drug abstention motivation by reducing negative emotion.
Objective: This study aims to investigate the relationship between emotion regulation methods and post-traumatic stress symptoms in children. Method: 712 children aged 8-14 years, (Mage=11.45, SD=1.37; 32.9% male) who experienced an explosion accident completed the Trauma Screening Questionnaire (TSQ) and the Emotion Regulation Questionnaire (ERQ). Results: Results showed that expressive suppression was positive significantly associated with cognitive reappraisal (r = 0.27, p < 0.001) and positive significantly associated with post-traumatic stress symptoms (r = 0.13, p < 0.01).
Cognitive Reactivity (CR), an established diathesis for depression, has been defined as the within-person strength of association between sad affect and dysfunctional attitudes. Watson and Tellegen (1985) proposed that sad affect is a combination of high negative affect (NA) and low positive affect (PA). The current study integrated the CR and the affect literatures by examining the differential and conjoint roles of cognitive reactivity to high negative affect (CR-highNA) and cognitive reactivity to low positive affect (CR-lowPA). In the current study, college student participants completed daily diary measures of CR-highNA, CR-lowPA, and CR to sadness (CR-Sad). Results showed that naturally occurring NA and PA accounted for the relation of sadness to dysfunctional cognitions. Further, the relation of depressive symptoms to CR-Sad was explained by high levels of CR-highNA and CR-lowPA. Born out of the integration of research on CR and affective structures, the current results have implications for both theory and treatment of depression.
Background
Although a burgeoning line of research identifies emotion regulation difficulties as a potential maintenance factor for posttraumatic stress disorder (PTSD), little is known in regard to what emotion regulation strategies individuals with PTSD use in their daily lives, their predictors, and their consequences on later PTSD symptoms.
Method
The current study utilized ecological momentary assessment (EMA) design to explore prospective relationships between maladaptive and adaptive emotion regulation strategy use and PTSD symptoms in participants with PTSD (N = 30). Participants completed 4 EMAs per day over 8 days, assessing stressors, emotional response, and emotion regulation strategy use.
Results
Individuals with PTSD most commonly used avoidance as an emotion regulation strategy. Multilevel modeling indicated that baseline PTSD symptoms predicted maladaptive emotion regulation strategy use. After covarying for morning PTSD symptoms, maladaptive emotion regulation prospectively predicted increased PTSD symptoms later in the day. Adaptive emotion regulation strategies did not uniquely predict later PTSD symptoms.
Conclusion
In line with conceptualizations of difficulties in emotion regulation as a transdiagnostic maintenance factor in PTSD, findings indicate that maladaptive emotion regulation strategies in response to stressors exacerbate PTSD symptoms. The use of adaptive emotion regulation strategies had no positive or negative impact on subsequent PTSD symptoms.
Limitations
Future studies should utilize longer-term prospective designs.
The association between moral injury and the development of serious social, behavioral, and psychological problems has been demonstrated in a limited but growing body of literature. At present, there is a dearth of evidence pertaining to the mechanism in explaining the relationship between moral injury and posttraumatic stress disorder. This study seeks to examine the serial mediating roles of meaning making and change in situational beliefs in the relationship between moral injury and PTSD. A sample of 737 police officers deployed on fieldwork who have experienced at least one morally injurious event were given psychometric scales assessing moral injury, meaning making, change in situational beliefs, and PTSD. Serial mediation analysis reveals that the positive association between the experience of morally injurious events and PTSD could be accounted for by the decrease in meaning making process and lack of change in situational beliefs. The findings highlight the importance of meaning making and changing situational beliefs in resolving inconsistent thoughts or actions against one’s moral code (i.e., moral injury) that ultimately affects one’s psychological health.
Addressing shortcomings of the self-report Toronto Alexithymia Scale (TAS), two studies were conducted to reconstruct the item domain of the scale. The first study resulted in the development of a new twenty-item version of the scale—the TAS-20. The TAS-20 demonstrated good internal consistency and test-retest reliability, and a three-factor structure theoretically congruent with the alexithymia construct. The stability and replicability of this three-factor structure were demonstrated in the second study with both clinical and nonclinical populations by the use of confirmatory factor analysis.
In two samples of college students (Ns = 116 and 141), this research investigated the ways in which individuals differ in their experience of emotion. Four latent traits emerged from scales assessing such differences—Intensity, Attention, Expression, and Clarity. In both samples, these latent traits were found to be involved in reports of personality, well-being, coping, and explanatory style. Clarity was positively associated with measures of positive well-being and nega- tively associated with measures of negative well-being. Individuals who experi- ence intense emotions (Intensity), who attend to them often (Attention), or who notably express them (Expression), reported coping by focusing on and venting their emotions and by seeking social support. Individuals who are adept at iden- tifying their emotions (Clarity) reported engaging in active, planful coping and in positive reinterpretations of events. Individuals high on Clarity made self- affirming attributions for good events.
Several literatures converge on the idea that approach and positive affect related to goal pursuit are managed by one self-regulatory system and that avoidance (or withdrawal) and negative affect related to threats are managed by a second self-regulatory system. After briefly reviewing these literatures, the authors consider the relation of these themes to the broader domain of personality. In particular, they map individual differences in the responsivity of the approach system onto the personality dimension of extraversion and map individual differences in the responsivity of the withdrawal system onto the dimension of neuroticism. This mapping requires a slight refocusing of current conceptions of extraversion and neuroticism. However, such a refocusing brings a gain as well as a cost: In particular, it would embed these dimensions more explicitly in a process-oriented conceptualization of action control.
Increasing interest in individual differences related to emotion is evident in the recent appearance of a large number of self-report instruments designed to assess aspects of the feeling experience. In this article, the authors review a sample of 18 of these scales and report technical information on each (e.g., length, format, reliability, construct validity, and correlates). They propose that this domain of individual differences can be usefully structured into five conceptual categories, including measures of absorption, attention, clarity, intensity, and expression. The measures were administered to a sample of individuals, and the coherence of the proposed categories was examined through hierarchical cluster analyses. The results confirmed the proposed structure of this domain of individual difference measures. The authors argue for the usefulness of an individual differences approach to theory testing and specify some of the information-processing roles that might be played by the categories of individual differences found in the data.
This article describes the concept of posttraumatic growth. its conceptual founda- tions, a/id supporting empirical evidence. Posttraumatic growth is the experience of positive change that occurs as a result of the struggle with highly challenging life cri- ses. It is manifested in a variety ofways, including an increased appreciationfor life in general, more meaningful interpersonal relationships, an increased sense ofpersonal strength. cha/lged priorities, and a richer existential and spiritual life. Although the term is ne..", the idea that great good can come from great suffering is ancient. We pro- pose a nlOdelfor understanding the process ofposttraumatic growth in which individ- ual characteristics, support and disclosure, a/Id more centrally, significant cognitive processing involving cognitive structures threatened or nullified by the traumatic events, play an important role. It is also suggested that posttraumatic growth mutually interacts with life wisdoma,1d the development of the life narrative, and that it is an on- going process, not a static outcome. In his memoir, No Such Thing as a Bad Day, Hamil- ton Jordan (2000) described some of the changes he experienced following his battle with cancer:
How might a practice that has its roots in contemplative traditions, seeking heightened awareness through meditation, apply to trauma-related mental health struggles among military veterans? In recent years, clinicians and researchers have observed the increasing presence of mindfulness in Western mental health treatment programs. Mindfulness is about bringing an attitude of curiosity and compassion to present experience. This review addresses the above question in a detailed manner with an emphasis on the treatment of military veterans suffering from posttraumatic stress disorder (PTSD) and related psychopathology. In addition, the integration of mindfulness with current empirically supported treatments for PTSD is discussed with specific attention to directions for future research in this area. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Individuals differ considerably in their emotion experience. Some experience emotions in a highly differentiated manner, clearly distinguishing among a variety of negative and positive discrete emotions. Others experience emotions in a relatively undifferentiated manner, treating a range of like-valence terms as interchangeable. Drawing on self-regulation theory, we hypothesised that indivi-duals with highly differentiated emotion experience should be better able to regulate emotions than individuals with poorly differentiated emotion experience. In particular, we hypothesised that emotion differentiation and emotion regulation would be positively related in the context of intense negative emotions, where the press for emotion regulation is generally greatest. To test this hypothesis, parti-cipants' negative and positive emotion differentiation was assessed using a 14-day diary protocol. Participants' regulation of negative and positive emotions was assessed using laboratory measures. As predicted, negative emotion differentiation was positively related to the frequency of negative emotion regulation, particularly at higher levels of emotional intensity.
This study examined how elevated levels of worry and anhedonic depression are associated with affect intensity, attention
to emotion, and clarity of emotion. University students (N=923) completed the Affect Intensity Measure, the Trait Meta Mood Scale, the Penn State Worry Questionnaire and the anhedonic
depression subscale from the Mood and Anxiety Symptom Questionnaire. Control individuals with worry and depression scores
below the median (n=158) were compared with three distress groups—elevated worry without elevated depression (n=58), elevated depression without elevated worry (n=35), and elevated levels of both worry and depression (n=39). The control and distress groups each differed significantly from one another, and these differences could not be accounted
for by gender or neuroticism. Controls resembled individuals described in past research as being cerebral, the depression-only
group resembled individuals described as being cool, the worry-only group resembled individuals described as hot, and the
dual-distress group resembled individuals described as overwhelmed.
KeywordsDepression–Worry–Emotion–Emotional awareness–Affect intensity
Two different hypotheses regarding the relationship between emotion regulation and PTSD are described in the literature. First, it has been suggested that emotion regulation difficulties are part of the complex sequelae of early-onset chronic interpersonal trauma and less common following late-onset or single-event traumas. Second, PTSD in general has been suggested to be related to emotion regulation difficulties. Bringing these two lines of research together, the current study aimed to investigate the role of trauma type and PTSD symptom severity on emotion regulation difficulties in a large sample of trauma survivors (N=616). In line with the hypotheses, PTSD symptom severity was significantly associated with all variables assessing emotion regulation difficulties. In addition, survivors of early-onset chronic interpersonal trauma showed higher scores on these measures than survivors of single-event and/or late-onset traumas. However, when controlling for PTSD symptom severity, the group differences only remained significant for 2 out of 9 variables. The most robust findings were found for the variable "lack of clarity of emotions." Implications for future research, theoretical models of trauma-related disorders, and their treatment will be discussed.
Some people are adept at using discrete emotion categories (anxious, angry, sad) to capture their felt experience; other people merely communicate how good or bad they feel. We theorized that people who are better at describing their emotions might be less likely to self-medicate with alcohol. During a 3-week period, 106 underage social drinkers used handheld computers to self-monitor alcohol intake. From participants' reported experiences during random prompts, we created an individual difference measure of emotion differentiation. Results from a 30-day timeline follow-back revealed that people with intense negative emotions consumed less alcohol if they were better at describing emotions and less reliant on global descriptions. Results from ecological momentary assessment procedures revealed that people with intense negative emotions prior to drinking episodes consumed less alcohol if they were better at describing emotions. These findings provide support for a novel methodology and dimension for understanding the influence of emotions on substance-use patterns.
In this article, the authors present evidence regarding a dissociative subtype of PTSD, with clinical and neurobiological features that can be distinguished from nondissociative PTSD. The dissociative subtype is characterized by overmodulation of affect, while the more common undermodulated type involves the predominance of reexperiencing and hyperarousal symptoms. This article focuses on the neural manifestations of the dissociative subtype in PTSD and compares it to those underlying the reexperiencing/hyperaroused subtype. A model that includes these two types of emotion dysregulation in PTSD is described. In this model, reexperiencing/hyperarousal reactivity is viewed as a form of emotion dysregulation that involves emotional undermodulation, mediated by failure of prefrontal inhibition of limbic regions. In contrast, the dissociative subtype of PTSD is described as a form of emotion dysregulation that involves emotional overmodulation mediated by midline prefrontal inhibition of the same limbic regions. Both types of modulation are involved in a dynamic interplay and lead to alternating symptom profiles in PTSD. These findings have important implications for treatment of PTSD, including the need to assess patients with PTSD for dissociative symptoms and to incorporate the treatment of dissociative symptoms into stage-oriented trauma treatment.
Previous research has found that understanding one's emotions and attending to them are 2 dimensions of emotional awareness. In this research, we examined whether improved subscales for measuring clarity of and attention to emotions could be developed by selecting the best items from 2 frequently used measures of emotional awareness. Using multidimensional scaling and confirmatory factor analysis, we analyzed the Toronto Alexithymia Scale-20 (Bagby, Parker, & Taylor, 1994) and the Trait Meta-Mood Scale (Salovey, Mayer, Goldman, Turvey, & Palfai, 1995) data from 867 college students. Results supported distinct clarity and attention constructs. New subscales were internally consistent and fared as well as or better than previous versions in terms of internal consistency and convergent validity.
Cognitive processing therapy (CPT) was developed to treat the symptoms of posttraumatic stress disorder (PTSD) in rape victims. CPT is based on an information processing theory of PTSD and includes education, exposure, and cognitive components. Nineteen sexual assault survivors received CPT, which consists of 12 weekly sessions in a group format. They were assessed at pretreatment, posttreatment, and 3- and 6-month follow-up. CPT subjects were compared with a 20-subject comparison sample, drawn from the same pool who waited for group therapy for at least 12 weeks. CPT subjects improved significantly from pre- to posttreatment on both PTSD and depression measures and maintained their improvement for 6 months. The comparison sample did not change from the pre- to the posttreatment assessment sessions.
A previous paper described the development of the twenty-item Toronto Alexithymia Scale (TAS-20) and reported preliminary evidence of reliability and factorial validity of the scale. This paper describes a study that further evaluated the construct validity of the TAS-20 by examining its relationship with measures of personality traits theoretically related or unrelated to the alexithymia construct, as well as its relationship with an observer-rated measure of alexithymia. Evidence of convergent and discriminant validity of the TAS-20 was demonstrated in samples of university students by a pattern of correlations with the scales of the NEO Personality Inventory and separate measures of psychological mindedness and need-for-cognition that was consistent with theoretical predictions. The concurrent validity of the scale was demonstrated by positive correlations with observer-ratings of alexithymia in a sample of behavioural medicine out-patients.
Addressing shortcomings of the self-report Toronto Alexithymia Scale (TAS), two studies were conducted to reconstruct the item domain of the scale. The first study resulted in the development of a new twenty-item version of the scale--the TAS-20. The TAS-20 demonstrated good internal consistency and test-retest reliability, and a three-factor structure theoretically congruent with the alexithymia construct. The stability and replicability of this three-factor structure were demonstrated in the second study with both clinical and nonclinical populations by the use of confirmatory factor analysis.
Although interaction effects are frequently found in experimental studies, field researchers report considerable difficulty in finding theorized moderator effects. Previous discussions of this discrepancy have considered responsible factors including differences in measurement error and use of nonlinear scales. In this article we demonstrate that the differential efficiency of experimental and field tests of interactions is also attributable to the differential residual variances of such interactions once the component main effects have been partialed out. We derive an expression for this residual variance in terms of the joint distribution of the component variables and explore how properties of the distribution affect the efficiency of tests of moderator effects. We show that tests of interactions in field studies will often have less than 20% of the efficiency of optimal experimental tests, and we discuss implications for the design of field studies.
The purpose of this study was to measure the longitudinal course of specific symptoms of posttraumatic stress disorder (PTSD) and related symptoms of alcohol and substance abuse and the effects of alcohol and substances on the symptoms of PTSD.
A structured interview for the assessment of PTSD and alcohol and substance abuse, as well as other factors such as life stressors and treatment, was administered to 61 Vietnam combat veterans with PTSD.
Onset of symptoms typically occurred at the time of exposure to combat trauma in Vietnam and increased rapidly during the first few years after the war. Symptoms plateaued within a few years after the war, following which the disorder became chronic and unremitting. Hyperarousal symptoms such as feeling on guard and feeling easily startled developed first, followed by avoidant symptoms and finally by symptoms from the intrusive cluster. The onset of alcohol and substance abuse typically was associated with the onset of symptoms of PTSD, and the increase in use paralleled the increase of symptoms. Patients reported a tendency for alcohol, marijuana, heroin, and benzodiazepines to make PTSD symptoms better, while cocaine made symptoms in the hyperarousal category worse. There was no relationship between treatment interventions and the natural course of PTSD.
These findings suggest that symptoms of PTSD begin soon after exposure to trauma, that hyperarousal symptoms are the first symptoms to occur, that the natural course of alcohol and substance abuse parallels that of PTSD, and that specific substances have specific effects on PTSD symptoms.
This study examined the prevalence and predictors of posttraumatic stress disorder (PTSD) symptoms in 70 men and women treated with bone marrow transplantation for cancer. Findings indicated that the number of symptoms present ranged from 0 to a possible high of 17 (M = 3.0, SD = 3.9). As predicted. lower social support and higher avoidance coping I month pretransplant predicted greater PTSD symptom severity an average of 7 months posttransplant. These variables remained significant predictors of symptom severity even after accounting for pretransplant levels of psychological distress. Additional analyses indicated the presence of a significant interaction between social support and avoidance coping, with patients high in avoidance coping and low in social support reporting the most severe symptoms. These findings identify patients at risk for psychological disturbance posttransplant and can serve to guide future intervention efforts.
We examined the psychometric properties of the PTSD Checklist (PCL), a self-report instrument designed to assess symptoms of posttraumatic stress disorder. Three hundred ninety-two participants recruited in a university setting completed the PCL in addition to several well-established self-report instruments designed to assess various forms of psychopathology (e.g., depression, general anxiety, PTSD). Ninety participants returned for readministration of selected measures. Findings provided support for psychometric properties of the PCL, including internal consistency, test-retest reliability, convergent validity, and discriminant validity. Additional strengths of the PCL are discussed.
This article describes the concept of posttraumatic growth, its conceptual foundations, and supporting empirical evidence. Posttraumatic growth is the experience of positive change that occurs as a result of the struggle with highly challenging life crises. It is manifested in a variety of ways, including an increased appreciation for life in general, more meaningful interpersonal relationships, an increased sense of personal strength, changed priorities, and a richer existential and spiritual life. Although the term is new, the idea that great good can come from great suffering is ancient. We propose a model for understanding the process of posttraumatic growth in which individual characteristics, support and disclosure, and more centrally, significant cognitive processing involving cognitive structures threatened or nullified by the traumatic events, play an important role. It is also suggested that posttraumatic growth mutually interacts with life wisdom and the development of the life narrative, and that it is an on-going process, not a static outcome.
Foreword James S. Grotstein Acknowledgements Introduction Graeme Taylor 1. The development and regulation of affects Graeme Taylor, Michael Bagby and James Parker 2. Affect dysregulation and alexithymia Michael Bagby and Graeme Taylor 3. Measurement and validation of the alexithymia construct Michael Bagby and Graeme Taylor 4. Relations between alexithymia, personality, and affects James Parker and Graeme Taylor 5. The neurobiology of emotion, affect regulation and alexithymia James Parker and Graeme Taylor 6. Somatoform disorders Graeme Taylor 7. Anxiety and depressive disorders and a note on personality disorders Michael Bagby and Graeme Taylor 8. Substance use disorders Graeme Taylor 9. Eating disorders Graeme Taylor 10. Affects and alexithymia in medical illness and disease Graeme Taylor 11. Treatment considerations Graeme Taylor 12. Future directions James Parker, Michael Bagby and Graeme Taylor References Index.
This study examined the relationship between emotional intelligence and life satisfaction. To determine the nature of this relationship, personality constructs known to predict life satisfaction were also assessed (positive and negative affect). Emotional intelligence was assessed in 107 participants using a modified version of the Trait Meta-Mood Scale [TMMS; Salovey, P, Mayer, J., Goldman, S., Turvey, C. & Palfai, T.1995. Emotional attention, clarity and repair: exploring emotional intelligence using the Trait Meta-Mood Scale. In J. W. Pennebaker (Ed), pp. 125–154. Washington, DC: American Psychological Association] and the Twenty-Item Toronto Alexithymia Scale [TAS-20; J. Psychosom Res, 38 (1994) 26]. Life satisfaction was assessed using the Satisfaction With Life Scale [SWLS; J. Pers. Social Psycol., 69 (1985) 71]. Only the Clarity sub-scale of the TMMS (which indexes perceived ability to understand and discriminate between moods and emotions), and the Difficulty Identifying Feelings sub-scale of the TAS-20 were found to significantly correlate with life satisfaction. Subsequent analyses revealed that only the Clarity sub-scale accounted for further variance in life satisfaction not accounted for by positive and negative affect. This finding provides further evidence that components of the EI construct account for variance in this important human value not accounted for by personality. Implications and directions for further research are discussed.