C. Alex Brake’s research while affiliated with Brown University and other places

Trauma-related mental contamination (MC) is a distressing sense of dirtiness that arises absent a contaminant following a traumatic event. Existing work has linked MC to more severe posttraumatic stress disorder symptoms among individuals with sexual trauma histories and has begun to characterize some aspects of the experience of trauma-related MC. However, a more nuanced understanding of how individuals experience and respond to trauma-related MC is lacking. The present study explored lived experiences of trauma-related MC among a sample of 34 women with sexual trauma histories using semi-structured qualitative interviews. Women were asked about MC across several domains, including somatic locations where trauma-related MC is experienced; triggers for trauma-related MC; and engagement in MC-related coping strategies, including washing behaviors. Women reported experiencing trauma-related MC in various bodily locations (internal, external, and both). Both overtly trauma-related triggers (e.g., trauma-relevant people or words, sexual contact) and non-trauma-related triggers (e.g., sweating, being around other people) were mentioned. Women also reported experiencing a variety of emotions alongside trauma-related MC (e.g., disgust, shame, anger) and using a range of strategies to cope with trauma-related MC, including washing behaviors, distraction, and substance use. Findings suggest that triggers for and responses to trauma-related MC are heterogeneous. Future work should explore the role of context in individuals’ experiences of and responses to trauma-related MC, as well as whether experiences of trauma-related MC may differ by gender or across settings. Increased understanding of trauma-related MC may inform efforts to more readily and effectively identify and target MC in clinical practice.

Mental contamination refers to feelings of dirtiness in response to thoughts, images, or memories. Mental contamination is frequently reported after sexual trauma and is associated with symptoms of posttraumatic stress disorder (PTSD). Differences in individuals' views about morality and purity may influence the severity of mental contamination, though this has been studied primarily outside of samples assessed for trauma and/or PTSD. The present study addressed this gap by investigating scrupulosity as a prospective predictor of daily sexual trauma-related mental contamination and PTSD symptoms. Participants included 40 adult women with a history of sexual trauma and current sexual trauma-related mental contamination who completed baseline diagnostic interviews and questionnaires followed by two assessments every day for 2 weeks. The results indicate that scrupulosity was positively correlated with PTSD symptom severity and sexual trauma-related mental contamination at baseline. Scrupulosity was also a prospective predictor of increased daily sexual trauma-related mental contamination, B = 0.19, SE = 0.07, p = .010, but not daily PTSD symptoms, B = -0.10, SE = .08, p = .198. The findings indicate that scrupulosity may be an important factor in understanding recovery from sexual assault.

Mental contamination (MC), the experience of dirtiness in the absence of a physical contaminant, has established links with posttraumatic stress disorder (PTSD). Shame and guilt have well-documented relationships with symptoms of PTSD and may play a role in the development and maintenance of MC. The present study examined whether trauma-related shame and guilt prospectively predicted daily MC and symptoms of PTSD among 41 women with a history of sexual trauma. Women completed baseline and twice-daily assessments of MC and symptoms of PTSD over a 2-week period and baseline measures of trauma-related shame and guilt. Two sets of hierarchical mixed linear regression models examined individual and combined fixed effects of baseline trauma-related guilt (guilt cognitions and global guilt) and shame in predicting daily trauma-related MC and symptoms of PTSD. Trauma-related shame positively predicted both daily MC and PTSD. This association remained robust even when accounting for the experience of trauma-related guilt. Neither trauma-related guilt cognitions nor global guilt predicted daily MC or PTSD. While other studies have addressed shame related to sexual assault, this is the first study to demonstrate a positive prospective relationship between shame and trauma-related MC. Findings regarding PTSD and shame are consistent with a growing literature. Further research is needed to better understand the temporal relationships between trauma-related shame, MC, and symptoms of PTSD, including how these variables interact and change over the course of PTSD treatment. A better understanding of the factors influencing the development and maintenance of MC can inform efforts to more easily target and improve MC, and subsequently PTSD.

Trauma-related mental contamination, or a sense of dirtiness occurring without recent contact with a contaminant, is a distressing and often persistent phenomenon after sexual trauma. Following sexual trauma, cross-sectional work has demonstrated separate positive associations between mental contamination and (a) negative posttraumatic cognitions about oneself, the world, and/or self-blame and (b) disgust sensitivity, defined as the extent to which one is prone to distress when experiencing disgust. However, existing work has been primarily restricted to cross-sectional designs and has yet to consider the potential moderating role of disgust sensitivity in associations between negative posttraumatic cognitions and persistent mental contamination. The present study used a daily monitoring design to evaluate main and interactive effects of negative posttraumatic cognitions (about the self, world, and self-blame) and disgust sensitivity in predicting daily experiences of mental contamination among a sample of 39 women with a history of sexual trauma. Results revealed a significant main effect of posttraumatic cognitions about the self in predicting subsequent mental contamination. An unexpected interaction also emerged for posttraumatic cognitions about the world, wherein such cognitions only significantly predicted daily mental contamination among women high in disgust sensitivity. Findings offer preliminary understanding regarding the role of cognitions about the self in contributing to ongoing mental contamination as well as the potential contributing role of cognitions about the world among women more vulnerable to distress when experiencing disgust. Future work should consider the potential for bidirectional relationships between negative posttraumatic cognitions and trauma-related mental contamination.

Although cross-sectional research highlights similarities between symptoms of obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) among individuals exposed to sexual trauma, little is known about how these disorders relate over time. The goal of the present study was to examine whether 1) OCD symptoms prospectively predicted daily symptoms of PTSD, and 2) OCD and PTSD symptoms prospectively predicted daily experiences of sexual trauma-related mental contamination (i.e., dirtiness in the absence of a physical pollutant). Forty-one women with a sexual trauma history completed baseline measures of OCD and PTSD, as well as twice-daily assessments of PTSD symptoms and mental contamination over a two-week period. Total OCD symptoms and the unacceptable thoughts dimension significantly predicted daily PTSD symptoms after accounting for other OCD dimensions. Only total OCD symptoms significantly predicted daily mental contamination when examined together with total PTSD symptoms. No individual PTSD or OCD clusters/dimensions significantly predicted daily mental contamination when examined simultaneously. Findings from this study highlight the nuanced associations among OCD symptoms, PTSD symptoms, and experiences of mental contamination. Future research is needed to further understand the development of PTSD, OCD, and mental contamination over time to inform targets for intervention.

Mental contamination (MC)—a sense of dirtiness experienced without contacting an identifiable pollutant—is a distressing and enduring experience among many survivors of sexual trauma. MC has been linked to more frequent use of avoidant coping behaviors (e.g., washing behavior, substance use, binge eating) and approach coping. However, it is unclear if specific approach and avoidant coping strategies are more consistently related to perseverative experiences of trauma-related MC, if the use of certain strategies predicts changes in MC, and if fluctuations in MC predict the use of certain strategies. The present study evaluated contemporaneous and prospective relationships between sexual trauma-related MC and use of 11 specific coping strategies among 41 women with a history of sexual trauma using an experience sampling design. Women completed twice-daily assessments of coping strategy use and MC for 14 days. Between-persons, women reporting more intense MC on average reported more frequent use of distraction, denial, giving up, self-blame, thought suppression, washing behavior, emotional processing, and emotional expression than those experiencing less intense MC. Within-person increases in MC were associated with more frequent concurrent use of all coping strategies except seeking support. Lastly, within-person increases in MC predicted more frequent use of giving up, substance use, and seeking support at the next assessment and within-person increases in substance use predicted less severe MC at the next assessment. Future work should aim to identify factors influencing the selection and/or quality of use of these specific coping strategies among individuals experiencing MC.

Objective: Posttraumatic stress disorder (PTSD) and nonmedical prescription opioid use (NMPOU) are linked. Much of the research documenting this association uses cross-sectional or longitudinal designs that describe patterns of use over extended intervals. The present study used a daily monitoring design to examine how daily fluctuations in PTSD symptoms predicted patterns of prescription opioid use (both medical and nonmedical) and co-use of other substances. This approach has distinct advantages for understanding proximal temporal relations between PTSD symptom variation and substance use patterns. Method: Forty adults with clinical or subclinical PTSD and past-month NMPOU completed daily measures of PTSD symptoms, physical pain, prescription opioid use, and other substance use for 28 days using a smartphone application. Results: Same day co-use of prescription opioids and at least one other substance was common. Higher-than-typical PTSD symptoms on a given day (within-person) was associated with an increased likelihood of reporting NMPOU (overall and with co-use of one or more additional substances) on the same day. This association was specific to PTSD alterations in arousal and reactivity symptoms (Criteria E). Neither total PTSD symptoms nor individual PTSD symptom clusters prospectively predicted next-day prescription opioid use (overall or with co-use). Use of prescription opioids also did not predict next-day PTSD symptom severity. Conclusion: This is the first study to demonstrate positive associations between day-to-day fluctuations in PTSD symptoms and NMPOU. Results from the current study also highlight the importance of examining polysubstance use patterns among individuals with PTSD who use prescription opioids. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Mental contamination (MC) – dirtiness experienced in the absence of contact with a physical contaminant – has been linked to PTSD symptoms following sexual trauma. However, there is limited understanding regarding the temporal nature of this association. The present study utilized experience sampling to examine associations between baseline and daily experiences of MC and PTSD symptoms and the mediating role of avoidance and approach coping among a sample of 41 adult women with a history of sexual trauma and current MC. Participants completed baseline measures and 14 days of twice-daily assessments. Results indicated that daily MC and PTSD symptoms were bidirectionally related. The tendency to engage in avoidance coping positively mediated relations between 1) baseline MC and daily PTSD symptoms and 2) baseline PTSD symptoms and daily MC. Further, daily avoidance coping (T-1) positively mediated associations between daily MC (T-2) and subsequent daily PTSD symptoms (T). Approach coping was not a mediator (between- or within-) in any models. Findings lend support to a mutual maintenance model of PTSD symptoms and trauma-related MC mediated by avoidance coping. Future research over a more extended period is warranted to clarify whether PTSD symptoms and MC indeed mutually maintain or exacerbate one another over time.

Obsessive-compulsive and related disorders (OCRDs) represent a newly defined category of disorders that include obsessive-compulsive disorder (OCD), hoarding disorder, body dysmorphic disorder, trichotillomania, and skin-picking disorder. Many environmental factors can influence the etiology and expression of obsessive-compulsive symptoms and OCD, such as exposure to environmental stressors, including traumatic and other life stressors. Stressors include incidents and experiences that disrupt a person’s homeostatic state and can range from mild acute stressors to traumatic stressors. Although all stressors are inherently stressful, most of them are not traumatic in nature. Although multiple researchers have reviewed the contributions of stress and trauma on OCD, currently no reviews exist that consider the associations among stress, trauma, and the other putative OCRDs. This chapter reviews the extant literature on the associations among OCRDs and stress, trauma, and posttraumatic stress disorder and discusses how these factors may influence the incidence, etiology, expression, and treatment of OCRDs.

Mental contamination (MC)—feelings of dirtiness triggered by internal sources—is a potentially important yet understudied factor for survivors of sexual trauma. MC has been linked to disgust and other negative emotions (e.g., shame, guilt) cross-sectionally and in lab-based paradigms but not yet examined in ecological contexts. Additionally, links between MC and distinct negative emotions have not been studied systematically. The present study thus modeled relationships between MC and specific emotions both across and within days over a daily monitoring period. Forty-one females with sexual trauma history and associated MC completed twice-daily assessments of MC and seven emotions (disgust, shame, guilt, anger, hopelessness, sadness, anxiety) over two weeks via a smartphone app. Baseline MC and average daily MC were largely associated with higher daily averages of negative emotions. Concurrently, within-person changes in MC and negative emotions were also positively linked. Unexpectedly, intraindividual changes in MC were largely not associated with later negative emotions, whereas several emotions were negatively associated with later MC. Notably, MC among screened sexual trauma survivors was much more prevalent compared to prior research. Clinical relevance and future recommendations for ecological research in trauma-related mental contamination are discussed.