Pupil Response to Threat in Trauma‐Exposed Individuals With or Without PTSD

An infrequently studied and potentially promising physiological marker for posttraumatic stress disorder (PTSD) is pupil response. This study tested the hypothesis that pupil responses to threat would be significantly larger in trauma‐exposed individuals with PTSD compared to those without PTSD. Eye‐tracking technology was used to evaluate pupil response to threatening and neutral images. Recruited for participation were 40 trauma‐exposed individuals; 40.0% (n = 16) met diagnostic criteria for PTSD. Individuals with PTSD showed significantly more pupil dilation to threat‐relevant stimuli compared to the neutral elements (Cohen's d = 0.76), and to trauma‐exposed controls (Cohen's d = 0.75). Pupil dilation significantly accounted for 12% of variability in PTSD after time elapsed since most recent trauma, cumulative violence exposure, and trait anxiety were statistically adjusted. The final logistic regression model was associated with 85% of variability in PTSD status and correctly classified 93.8% of individuals with PTSD and 95.8% of those without. Pupil reactivity showed promise as a physiological marker for PTSD.     

Emotional Reactivity,Emotion Regulation Capacity,and Posttraumatic Stress Disorder in Traumatized Refugees: An Experimental Investigation

Refugees who suffer from posttraumatic stress disorder (PTSD) often react with strong emotions when confronted with trauma reminders. In this study, we aimed to investigate the associations between low emotion regulation capacity (as indexed by low heart rate variability [HRV]), probable PTSD diagnosis, and fear and anger reaction and recovery to trauma‐related stimuli. Participants were 81 trauma‐exposed refugees (probable PTSD, n = 23; trauma‐exposed controls, n = 58). The experiment comprised three 5‐min phases: a resting phase (baseline); an exposition phase, during which participants were exposed to trauma‐related images (stimulus); and another resting phase (recovery). We assessed HRV at baseline, and fear and anger were rated at the end of each phase. Linear mixed model analyses were used to investigate the associations between baseline HRV and probable DSM‐5 PTSD diagnosis in influencing anger and fear responses both immediately after viewing trauma‐related stimuli and at the end of the recovery phase. Compared to controls, participants with probable PTSD showed a greater increase in fear from baseline to stimulus presentation, d = 0.606. Compared to participants with low emotion regulation capacity, participants with high emotion regulation capacity showed a smaller reduction in anger from stimulus presentation to recovery, d = 0.548. Our findings indicated that following exposure to trauma‐related stimuli, probable PTSD diagnosis predicted increased fear reactivity, and low emotion regulation capacity predicted decreased anger recovery. Impaired anger recovery following trauma reminders in the context of low emotion regulation capacity might contribute to the increased levels of anger found in postconflict samples.     

Associations Among Hair Cortisol Concentrations,Posttraumatic Stress Disorder Status,and Amygdala Reactivity to Negative Affective Stimuli in Female Police Officers

Posttraumatic stress disorder (PTSD) is associated with altered hypothalamic‐pituitary‐adrenal (HPA) axis function. Measurement of hair cortisol concentrations (HCC) allows retrospective assessment of HPA axis regulation over prolonged periods of time. Currently, research investigating HCC in PTSD remains sparse. Previous cross‐sectional studies have included only civilian populations, although it is known that trauma type moderates associations between PTSD status and HPA axis function. We investigated differences in HCC between trauma‐exposed female police officers with current PTSD (n = 13) and without current and lifetime PTSD (n = 15). To investigate whether HCC was associated with neural correlates of PTSD, we additionally performed exploratory correlational analyses between HCC and amygdala reactivity to negative affective stimuli. We observed significantly lower HCC in participants with PTSD than in participants without PTSD, d = 0.89. Additionally, within participants with PTSD, we observed positive correlations between HCC and right amygdala reactivity to negative affective (vs. happy/neutral) faces, r = .806 (n = 11) and left amygdala reactivity to negative affective (vs. neutral) pictures, r = .663 (n = 10). Additionally, left amygdala reactivity to negative faces was positively correlated with HCC in trauma‐exposed controls, r = .582 (n = 13). This indicates that lower HCC is associated with diminished amygdala differentiation between negative affective and neutral stimuli. Thus, we observed lower HCC in trauma‐exposed noncivilian women with PTSD compared to those without PTSD, which likely reflects prolonged HPA axis dysregulation. Additionally, HCC was associated with hallmark neurobiological correlates of PTSD, providing additional insights into pathophysiological processes in PTSD.     

A prospective assessment of auditory startle alterations in rape and physical assault survivors

This study used a prospective design to investigate startle reactivity following trauma exposure. Startle response was evaluated using loud tones during which measures of eyeblink electromyogram (EMG) and heart rate (HR) were collected. Participants were 40 female sexual or physical assault survivors assessed at 1 month and 6 months postassault. There were no significant differences in startle reactivity between posttraumatic stress disorder (PTSD) and non-PTSD groups at the initial assessment. However, at 6 months postassault there was a significantly greater EMG and HR response in the PTSD group as well as a significant increase in startle reactivity from 1 month to 6 months postassault. The findings lend support to a sensitization model of trauma reactivity in which startle response develops over time along with PTSD symptoms.     

Gender Differences in Threat Biases: Trauma Type Matters in Posttraumatic Stress Disorder

Women are diagnosed with posttraumatic stress disorder (PTSD) at twice the rate of men. This gender difference may be related to differences in PTSD experiences (e.g., more hypervigilance in women) or types of trauma experienced (e.g., interpersonal trauma). We examined whether attentional threat biases were associated with gender, PTSD diagnosis, and/or trauma type. Participants were 70 civilians and veterans (38 women, 32 men; 41 with PTSD, 29 without PTSD) assessed with the Clinician Administered PTSD Scale for DSM‐IV who completed a facial dot‐probe attention bias task and self‐report measures of psychiatric symptoms and trauma history. Factorial ANOVA and regression models examined associations between gender, PTSD diagnosis, index trauma type, lifetime traumatic experiences, and attentional threat biases. Results revealed that compared to women without PTSD and men both with and without PTSD, women with PTSD demonstrated attentional biases toward threatening facial expressions, d = 1.19, particularly fearful expressions, d = 0.74. Psychiatric symptoms or early/lifetime trauma did not account for these attentional biases. Biases were related to interpersonal assault index traumas, η_p² = .13, especially sexual assault, d = 1.19. Trauma type may be an important factor in the development of attentional threat biases, which theoretically interfere with trauma recovery. Women may be more likely to demonstrate attentional threat biases due to higher likelihood of interpersonal trauma victimization rather than due to gender‐specific psychobiological pathways. Future research is necessary to clarify if sexual assault alone or in combination with gender puts individuals at higher risk of developing PTSD.     

Punishment Learning in U.S. Veterans With Posttraumatic Stress Disorder

Learning processes have been implicated in the development and course of posttraumatic stress disorder (PTSD); however, little is currently known about punishment‐based learning in PTSD. The current study investigated impairments in punishment‐based learning in U.S. veterans. We expected that veterans with PTSD would demonstrate greater punishment‐based learning compared to a non‐PTSD control group. We compared a PTSD group with and without co‐occurring depression (n = 27) to a control group (with and without trauma exposure) without PTSD or depression (n = 29). Participants completed a computerized probabilistic punishment‐based learning task. Compared to the non‐PTSD control group, veterans with PTSD showed significantly greater punishment‐based learning. Specifically, there was a significant Block × Group interaction, F(1, 54) = 4.12, p = .047, η² = .07. Veterans with PTSD demonstrated greater change in response bias for responding toward a less frequently punished stimulus across blocks. The observed hypersensitivity to punishment in individuals with PTSD may contribute to avoidant responses that are not specific to trauma cues.     

Equine‐Assisted Therapy for Anxiety and Posttraumatic Stress Symptoms

We tested the efficacy of the Equine Partnering Naturally^© approach to equine‐assisted therapy for treating anxiety and posttraumatic stress disorder (PTSD) symptoms. Participants were 16 volunteers who had experienced a Criterion A traumatic event, such as a rape or serious accident, and had current PTSD symptoms above 31 on the PTSD Checklist (PCL‐S; Weathers, Litz, Herman, Huska, & Keane, 1993). Participants engaged in tasks with horses for 6 weekly 2‐hour sessions. Immediately following the final session, participants reported significantly reduced posttraumatic stress symptoms, d = 1.21, less severe emotional responses to trauma, d = 0.60, less generalized anxiety, d = 1.01, and fewer symptoms of depression, d = 0.54. As well, participants significantly increased mindfulness strategies, d = 1.28, and decreased alcohol use, d = 0.58. There was no significant effect of the treatment on physical health, proactive coping, self‐efficacy, social support, or life satisfaction. Thus, we found evidence that the Equine Partnering Naturally^© approach to equine‐assisted therapy may be an effective treatment for anxiety and posttraumatic stress symptoms. Future research should include larger groups, random assignment, and longer term follow‐up.     

The Impact of Posttraumatic Stress Disorder on Blood Pressure and Heart Rate in a Veteran Population

Hyperarousal is a hallmark of posttraumatic stress disorder (PTSD). PTSD has been associated with increased blood pressure (BP) and heart rate (HR) in veteran populations. We retrospectively identified male patients consulted to outpatient psychiatry at the Iowa City Veterans Affairs Healthcare System. Patients were divided into PTSD (n = 88) and non‐PTSD (n = 98) groups. All PTSD patients and a subset of non‐PTSD patients had documented blast exposure during service. The study investigated whether patients with PTSD had higher systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) than patients without PTSD. The effect of trauma exposure on BP was also examined. Mean SBP (133.8 vs. 122.3 mm Hg; p < .001), DBP (87.6 vs. 78.6 mm Hg; p < .001), and HR (78.9 vs. 73.1 bpm; p < .001) were all significantly higher in the PTSD group. Trauma‐exposed patients without PTSD had significantly higher BP than nonexposed patients. The prevalence of hypertension (HTN) was 34.1% (diagnosed and undiagnosed) among PTSD patients. Patients with PTSD had higher BP and HR compared to patients without PTSD. Trauma exposure may increase BP in this population. These findings will increase awareness about the cardiovascular implications of PTSD.     

Acute Psychophysiological Arousal and Posttraumatic Stress Disorder: A Two-Year Prospective Study

This study investigated the role of acute arousal in the development of posttraumatic stress disorder (PTSD). Hospitalized motor vehicle accident survivors (n = 146) were assessed for acute stress disorder (ASD) within 1 month of the trauma, 6 months later, and reassessed for PTSD 2 years posttrauma (n = 87). Heart rates (HR) were assessed on the day of hospital discharge. Participants who had PTSD 2 years posttrauma had higher HR at hospital discharge than those without PTSD. A diagnosis of ASD or a resting HR of 95 beats per minute had moderate sensitivity (74%) and specificity (91%) in predicting PTSD. These findings suggest that caution is required in using acute HR as a predictor of longer-term PTSD following trauma.     

Guilt in the Treatment of Posttraumatic Stress Disorder Among Active Duty Military Personnel

The current study examined the role of trauma‐related guilt on posttraumatic stress disorder (PTSD) symptom change during prolonged exposure therapy (PE) as well as the efficacy of PE in reducing three dimensions of guilt (responsibility, wrongdoing, and lack of justification) during treatment. Participants were 331 active duty U.S. military personnel seeking treatment for PTSD who were randomized to one of four groups: massed PE (10 sessions delivered over 2 weeks), spaced PE (10 sessions delivered over 8 weeks), present‐centered therapy (PCT; 10 sessions delivered over 8 weeks), or minimal contact control (MCC; weekly therapist phone check‐in for 4 weeks). The results showed that baseline guilt did not predict reductions in PTSD symptoms for spaced PE or for PCT, ps = .178–.387, ds = ?0.02–0.07. Treatment condition (massed PE vs. MCC; spaced PE vs. PCT) did not moderate reductions in guilt for spaced PE versus PCT. Guilt decreased significantly over treatment in all groups, p < .001 to p = .038, ds = ?0.19 to –0.42, except concerning justification in the spaced PE and PCT groups, p = .140, d = ?0.10. The findings suggest that guilt may be reduced significantly following active PTSD treatment and attention control and that PTSD recovery is not impacted by baseline levels of trauma‐related guilt in military personnel with PTSD, although reported levels of guilt were low to moderate in this sample.     

Positive Emotion Dysregulation Among Community Individuals: The Role of Trauma Exposure and Posttraumatic Stress Disorder

Existing literature has provided support for an association between posttraumatic stress disorder (PTSD) and emotion dysregulation. However, few studies have examined the relation between PTSD and emotion dysregulation that stems from positive emotions. Moreover, the role of trauma exposure, per se, on positive emotion dysregulation is unknown. Addressing these limitations, the current study compared levels of positive emotion dysregulation among (a) individuals without trauma exposure, (b) trauma-exposed individuals without probable PTSD, and (c) trauma-exposed individuals with probable PTSD. Participants were 400 community-dwelling individuals (M age = 43.76 years, 68.6% female; 24.2% Asian, 23.7% Black, 24.5% Hispanic, 27.6% White). Lower levels of positive emotion dysregulation were found among trauma-exposed participants without probable PTSD compared to trauma-exposed participants with probable PTSD, ds = 0.66–0.73, and unexposed participants, ds = 0.58–0.64. The present findings suggest the potential protective role of low levels of positive emotion dysregulation following trauma exposure. If replicated in longitudinal studies, these results may indicate the utility of enhancing skills for regulating positive emotions among individuals at risk for trauma exposure.     

The Cycle of Violence: Associations Between Exposure to Violence,Trauma‐Related Symptoms and Aggression—Findings from Congolese Refugees in Uganda

War‐related trauma exposure has been linked to aggression and enhanced levels of community and family violence, suggesting a cycle of violence. Reactive aggression—an aggressive reaction to a perceived threat—has been associated with posttraumatic stress disorder (PTSD). In contrast, appetitive aggression—a hedonic, intrinsically motivated form of aggression—seems to be negatively related to PTSD in offender and military populations. This study examined the associations between exposure to violence, trauma‐related symptoms and aggression in a civilian population. In semistructured interviews, 290 Congolese refugees were questioned about trauma exposure, PTSD symptoms, and aggression. War‐related trauma exposure correlated positively with exposure to family and community violence in the past month (r = .31, p < .001), and appetitive (r = .18, p = .002) and reactive aggression (r = .29, p < .001). The relationship between war‐related trauma exposure and reactive aggressive behavior was mediated by PTSD symptoms and appetitive aggression. In a multiple sequential regression analysis, trauma exposure (β = .43, p < .001) and reactive aggression (β = .36, p < .001) were positively associated with PTSD symptoms, whereas appetitive aggression was negatively associated (β = ?.13, p = .007) with PTSD symptoms. Our findings were congruent with the cycle of violence hypothesis and indicate a differential relation between distinct subtypes of aggression and PTSD.     

Women's Sexual Desire,Trauma Exposure,and Posttraumatic Stress Disorder

Research suggests that posttraumatic stress disorder (PTSD) is associated with sexual dysfunction; however, there is a paucity of research examining the relations among trauma exposure, PTSD, and low sexual desire, specifically. Thus, the goal of the present study was to investigate whether women with hypoactive sexual desire disorder (HSDD; n = 132) were more likely to meet criteria for a diagnosis of current or lifetime PTSD relative to women with no sexual desire concerns (n = 137). We also sought to compare the type, frequency, and intensity of PTSD symptoms between the two groups. Finally, we examined whether women in the two groups were exposed to more, or different types of, potentially traumatic events. Compared to women with no sexual health concerns, women with HSDD were more likely to meet criteria for current PTSD, odds ratio (OR) = 5.50, 95% CI [1.18, 25.61]; and lifetime PTSD, OR = 2.78, 95% CI [1.56, 4.94]. Women in the HSDD group also had higher odds of meeting criteria for avoidance (5.10 times) and hyperarousal symptoms (4.48 times) and scored higher on measures of past-month PTSD symptom frequency, d = 0.62, and intensity, d = 0.57. No group differences were observed regarding reexperiencing symptoms, the associated features of PTSD, or type or frequency of exposure to potentially traumatic events. The findings indicate PTSD symptomatology may be a predisposing or perpetuating contributor to low sexual desire, and low sexual desire and PTSD may be related through an alteration in stress adaptability.     

The Impact of Interpersonal and Noninterpersonal Trauma on Psychological Symptoms in Refugees: The Moderating Role of Gender and Trauma Type

Research findings have documented a relationship between the number of types of traumatic events to which refugees were exposed and psychological disorders. It is unclear, however, if gender moderates the impact of trauma on refugee mental health. The participants in this study were 60 male and 31 female refugees and asylum‐seekers resettled in Australia. Participants had a mean age of 34.54 years (SD = 9.70), and were from a variety of countries including Iraq, Iran, and Sri Lanka. We conducted a multigroup path analysis to test if the relationship between psychological outcomes of exposure to trauma (posttraumatic stress disorder [PTSD] symptoms, symptoms of anxiety, and symptoms of depression) was different as a function of the type of traumatic exposure (interpersonal vs. noninterpersonal) or as a function of gender. We found a significant relationship between interpersonal trauma exposure and PTSD symptoms (β = .77) and anxiety symptoms (β = .32) in women, and a significant association between noninterpersonal trauma exposure and PTSD symptoms (β = .59), anxiety (β =.49), and depression symptoms (β = .32) in men. For men, the effect sizes of the relationship between exposure to specific types of noninterpersonal trauma and psychological symptoms ranged from d = 0.14 to 1.01; for exposure to interpersonal trauma, they ranged from d = ?0.53 to 0.43. For women, the effect sizes of the relationship between exposure to specific types of noninterpersonal trauma and psychological symptoms ranged from d = ?0.79 to 0.67; for exposure to interpersonal trauma, they ranged from d = ?0.09 to 1.46. These results suggested supporting refugees in their efforts to overcome the psychological impact of trauma, including the allocation of resources in clinical services to support the psychological recovery of refugees.     

Cumulative Trauma Exposure,Emotion Regulation,and Posttraumatic Stress Disorder Among Incarcerated Women

Incarcerated women report high rates of trauma exposure and posttraumatic stress disorder (PTSD). Emotion regulation has been identified as a potential mechanism that contributes to the association between trauma exposure and PTSD severity. The present study examined associations among cumulative trauma exposure, emotion regulation difficulties, and current (30‐day) PTSD in 152 randomly selected women in prison. Utilizing structural equation modeling (SEM), results indicated cumulative trauma was significantly associated with emotion regulation difficulties, β = .31, SE = .13, p  = .005; and PTSD symptom severity, β = .41, SE = .14, p  = .005. We identified a significant indirect effect, 0.11, z = 2.37, p = .018, of emotion regulation on the association between cumulative trauma exposure and severity of current PTSD symptoms. These findings are consistent with previous longitudinal research suggesting that emotion regulation is significantly affected by trauma exposure, and they support previously identified associations between emotion regulation difficulties and severity of PTSD. Further, these findings have the potential to inform current efforts to identify and implement effective PTSD‐focused interventions with incarcerated women. In particular, it appears that emotion regulation skills may be an important component of effective PTSD focused interventions for this population.     

Trauma Exposure and Health: The Role of Depressive and Hyperarousal Symptoms

Posttraumatic stress disorder (PTSD) and depressive symptoms have been theorized to mediate the relationship between trauma exposure and physical health symptoms. Although empirical evidence supports this premise, studies conducted to date have employed statistical mediation analyses that are now broadly criticized. Furthermore, the mediating roles of both PTSD and depressive symptoms have seldom been examined concurrently, and it remains unclear which PTSD symptom clusters uniquely mediate this relationship. The aim of the present study was to examine the mediating role of reexperiencing, avoidance/numbing, hyperarousal, and depressive symptoms in the relationship between trauma exposure and physical health symptoms. Participants were 516 Spanish female undergraduate students. Physical health symptoms were compared between those who reported trauma exposure (n = 266) and those who did not (n = 250). Data from trauma‐exposed participants were analyzed using regression models with bootstrapping to test mediation. Results of the analyses showed that the trauma‐exposed group reported significantly more physical health symptoms (r² = .035). Hyperarousal and depressive symptoms uniquely mediated the relationship between trauma exposure and physical health symptoms. Our findings clarify some of the mechanisms by which negative health consequences occur subsequent to trauma exposure.     

Social Anhedonia is Associated with Low Social Network Diversity in Trauma‐Exposed Adults

Social anhedonia has been proposed to contribute to social isolation in several psychiatric disorders, but it has not been examined in relation to deficits in social connection that also characterize posttraumatic stress disorder (PTSD). A growing body of evidence emphasizes the health importance of structural features of social networks, including their size and complexity. The current study examined the association between social anhedonia and social network features in a sample of trauma‐exposed participants with and without PTSD as well as in non–trauma‐exposed controls. Participants (N = 101; n = 37 healthy controls, n = 23 trauma‐exposed without PTSD; n = 41 lifetime PTSD) completed self‐report measures of social anhedonia (Revised Social Anhedonia Scale) and structural social network features, including social network size, diversity, and the number of embedded networks (Social Network Index). Relative to healthy controls, participants with PTSD reported significantly lower social network sizes and fewer embedded networks. In the combined trauma‐exposed sample, higher ratings of social anhedonia were associated with lower social network diversity, r(62) = ?.43, p < .001, an effect that remained statistically significant after controlling for PTSD and depression symptom severity. These results suggest that elevated social anhedonia in trauma‐exposed individuals may contribute to disruptions in social network structure consistent with social isolation.     

Psychobiological Responses to Aerobic Exercise in Individuals With Posttraumatic Stress Disorder

Previous reports have shown improvements in mood and increases in endocannabinoids in healthy adults following a session of aerobic exercise, but it is unclear whether adults with posttraumatic stress disorder (PTSD) experience similar responses. The purpose of this study was to examine psychobiological responses (plasma endocannabinoids [eCBs], mood, and pain) to aerobic exercise in a sample of adults with a diagnosis of PTSD (n = 12) and healthy controls (n = 12). Participants engaged in an aerobic exercise session in which they ran on a treadmill for 30 min at a moderate intensity (70 to 75% maximum heart rate [MHR]). Results indicated improvements in mood states and reductions in pain for both groups following exercise, ds = 0.19 to 1.53. Circulating concentrations of N‐arachidonylethanolamine (AEA), 2‐arachidonoylglycerol (2‐AG), and oleoylethanolamide (OEA) significantly increased (ps = .000 to .050) following the aerobic exercise session for both groups. There were no significant time, group, or interaction effects (ps = .062 to .846) for palmitoylethanolamide (PEA) and 2‐oleoylglycerol (2‐OG). Although eCBs increased significantly for both groups, within‐group effect size calculations indicated the healthy controls experienced a greater magnitude of change for AEA when compared with adults with PTSD, d = 1.21 and d = 0.45, respectively; as well as for 2‐AG, d = 0.43 and d = 0.21, respectively. The findings from this study indicated that adults with and without PTSD reported significant mood improvements following 30 min of moderate‐intensity aerobic exercise. In addition, the endocannabinoid system was activated in adults with and without PTSD, although effect sizes suggest that adults with PTSD may have a blunted endocannabinoid response to exercise.     

Group Trauma‐Informed Treatment for Adolescent Psychiatric Inpatients: A Preliminary Uncontrolled Trial

Despite high rates of trauma exposure (46%‐96%) and significant posttraumatic stress disorder (PTSD; 21%–29%) symptoms in adolescent psychiatric inpatients, there is a dearth of research on effective interventions delivered in inpatient settings. The current report describes the development of Brief STAIR‐A, a repeatable 3‐module version of skills training in affective and interpersonal regulation (STAIR) developed for adolescents in inpatient care. An uncontrolled design was used to conduct a preliminary examination of the group intervention's effectiveness. Adolescent psychiatric inpatients (N = 38; ages 12 years–17 years) admitted to a public hospital participated in Brief STAIR‐A and attended a median of 6 sessions (range 3–36). They completed measures of PTSD and depressive symptom severity, coping skill use, and coping efficacy upon admission and again prior to discharge. Participants reported significant reductions in symptom severity (d = 0.65–0.67), no change in the absolute level of coping skills used (d = 0.16), but greater coping efficacy when discharged from care (d = 0.75). Results from this pilot study suggest that this brief group treatment shows promise for treating adolescents’ trauma‐related difficulties in inpatient psychiatry settings, but additional research examining its effectiveness is essential.