The relationship between distress tolerance regulation,counterfactual rumination,and PTSD symptom clusters

BackgroundDistress tolerance (DT) and rumination both influence the development and maintenance of posttraumatic stress disorder (PTSD). However, few studies have investigated these constructs simultaneously. We investigated whether the regulation dimension of DT was associated with PTSD symptom clusters (intrusions, avoidance, negative alternations in cognitions and mood, alterations in arousal and reactivity), and whether counterfactual rumination (CFT) mediated these relationships.MethodsThis cross-sectional study sampled trauma-exposed adults (N = 119) seeking mental health services at a community mental health center. Participants completed self-report measures of DT, rumination, and PTSD. Mediation analyses were conducted using the SPSS PROCESS Macro.ResultsLower scores on the DT regulation dimension were associated with higher PTSD symptom severity for all four symptom clusters, controlling for depression and number of traumas. CFT significantly mediated this relationship between DT's regulation and PTSD's intrusions and avoidance symptoms.LimitationsLimitations included use of self-report data and the cross-sectional nature of this data.ConclusionsClinically, this study highlights that difficulties with regulating negative emotions can result in the use of maladaptive cognitive strategies, such as CFT. This, in turn, may exacerbate PTSD symptom severity, particularly intrusions and avoidance. This study highlights the importance of understanding specific dimensions of DT, rumination, and PTSD symptom clusters to develop precise and efficient psychological interventions.     

Event-based prospective memory among veterans: The role of posttraumatic stress disorder symptom severity in executing intentions

Objective: Posttraumatic stress disorder (PTSD) has been linked with neuropsychological deficits in several areas, including attention, learning and memory, and cognitive inhibition. Although memory dysfunction is among the most commonly documented deficits associated with PTSD, our existing knowledge pertains only to retrospective memory. The current study investigated the relationship between PTSD symptom severity and event-based prospective memory (PM). Method: Forty veterans completed a computerized event-based PM task, a self-report measure of PTSD, and measures of retrospective memory. Results: Hierarchical regression analysis results revealed that PTSD symptom severity accounted for 16% of the variance in PM performance, F(3, 36) = 3.47, p < .05, after controlling for age and retrospective memory. Additionally, each of the three PTSD symptom clusters was related, to varying degrees, with PM performance. Conclusions: Results suggest that elevated PTSD symptoms may be associated with more difficulties completing tasks requiring PM. Further examination of PM in PTSD is warranted, especially in regard to its impact on everyday functioning.     

Investigating the specific domains of the cognitive attentional syndrome that predict posttraumatic stress symptoms: The moderating effect of attentional control

The metacognitive model of posttraumatic stress disorder (PTSD) suggests that persistent use of the maladaptive self-regulation strategies that comprise the cognitive attentional syndrome (CAS) increases the likelihood of developing PTSD symptoms following trauma exposure. The metacognitive model also suggests that flexible regulation of attention might be protective against developing maladaptive outcomes that are associated with the CAS. The aims of this study were to (1) examine associations between all seven domains of the CAS and PTSD symptoms using a recently developed, multidimensional measure of the CAS, and (2) examine the moderating effect of self-reported attentional control on associations between the CAS and PTSD symptoms. Participants were trauma-exposed community adults (N = 237) who completed a battery of self-report measures. Results from linear regression analyses showed that worry, substance use, and internal threat monitoring accounted for unique variance in PTSD symptoms when all seven CAS domains were entered into the same model. Moderation analyses showed that attentional control dampened the effect of the CAS, specifically external threat monitoring, on PTSD symptoms. Study results support attentional control as a protective factor against the maladaptive effects of the CAS on PTSD symptoms.     

Emotion regulation,physiological arousal and PTSD symptoms in trauma-exposed individuals

Objectives

Retrospective studies suggest a link between PTSD and difficulty regulating negative emotions. This study investigated the relationship between PTSD symptoms and the ability to regulate negative emotions in real-time using a computerised task to assess emotion regulation.

Method

Trauma-exposed ambulance workers (N = 45) completed self-report measures of trauma exposure, PTSD symptoms and depression. Participants then completed a computer task requiring them to enhance, decrease or maintain their negative emotions in response to unpleasant images. Skin conductance responses (SCR) were recorded and participants also made ratings of emotion intensity. Immediately after the computer task, participants were asked to describe the strategies they had used to regulate their negative emotions during the task and recorded spontaneous intrusions for the unpleasant images they had seen throughout the following week.

Results

PTSD symptoms were associated with difficulty regulating (specifically, enhancing) negative emotions, greater use of response modulation (i.e., suppression) and less use of cognitive change (i.e., reappraisal) strategies to down-regulate their negative emotions during the task. More intrusions developed in participants who had greater reductions in physiological arousal whilst decreasing their negative emotions.

Limitations

PTSD was measured by self-report rather than by a clinician administered interview. The results suggest a relationship between emotion regulation ability and PTSD symptoms rather than emotion regulation and PTSD.

Conclusions

Difficulty regulating negative emotions may be a feature of trauma-exposed individuals with PTSD symptoms, which may be linked to the types of strategies they employ to regulate negative emotions.     

The relationship between cognitive control and posttraumatic stress symptoms

Background and objectivesRecently researchers have theorized that individual differences in cognitive control (i.e., the ability to complete goal-directed behavior by actively maintaining information while inhibiting irrelevant information) may elucidate processes involved in disorders characterized by intrusive thoughts and memories. By this account, the relationship between cognitive control and emotional disorders would be specific to symptoms associated with intrusive cognitions, such as re-experiencing symptoms of posttraumatic stress disorder (PTSD).MethodsIn the present study, 77 undergraduate participants with a self-reported history of trauma exposure were administered assessments of cognitive control (working memory capacity; WMC), PTSD symptoms, trait anxiety, and depression. PTSD symptoms from each of the three symptom clusters (re-experiencing, avoidance, and hyperarousal) were predicted from trait anxiety, depression, and WMC performance scores using separate regression models.ResultsAfter controlling for trait anxiety and depression, there was a negative, statistically significant relationship between cognitive control and re-experiencing symptoms but not avoidance or hyperarousal symptoms.LimitationsThe study was completed cross-sectionally and did not include a diagnostic assessment of PTSD.ConclusionsFindings add to extant literature suggesting a relationship between cognitive control and intrusive cognitions. Moreover, the present study expands the current literature by demonstrating the specificity of this relationship within individuals with varying degrees of PTSD symptom severity.     

Negative appraisals and cognitive avoidance of intrusive memories in depression: a replication and extension

Recent research has demonstrated that intrusive negative autobiographical memories represent a shared phenomenological feature of posttraumatic stress disorder (PTSD) and depression. A preliminary investigation (Starr and Moulds, 2006) successfully applied a cognitive appraisal model of PTSD to the maintenance of intrusive memories in depression. The current investigation sought to replicate and extend these findings. Two hundred and fifty first-year undergraduate students were interviewed to assess for the presence of a negative autobiographical memory that had spontaneously intruded in the past week. Participants completed self-report inventories assessing trait and situational employment of cognitive avoidance mechanisms in response to these memories. Consistent with Starr and Moulds, intrusion-related distress correlated with dysphoria, irrespective of intrusion frequency. Assigning negative appraisals to one's intrusive memory and attempts to control the memory were positively associated with intrusion-related distress, level of depression, and cognitive avoidance mechanisms. Additionally, negative appraisals and control influenced the employment rumination as an avoidant response to a greater degree than the corresponding trait tendency. Finally, negative appraisals and the use of cognitive mechanisms were predictive of depression concurrently. The results support the validity of borrowing from PTSD models to elucidate the cognitive mechanisms that maintain intrusive memories in depressed samples.     

The link between emotion regulation,social functioning,and depression in boys with ASD

PurposeSymptoms of depression are common in children and adolescents with an autism spectrum disorder (ASD), but information about underlying developmental factors is limited. Depression is often linked to aspects of emotional functioning such as coping strategies, but in children with ASD difficulties with social interactions are also a likely contributor to depressive symptoms.MethodologyWe examined several aspects of emotional coping (approach, avoidant, maladaptive) and social functioning (victimization, negative friendship interactions) and their relation to depression symptoms in children with ASD (N = 63) and typically developing (TD) peers (N = 57). Children completed a battery of self-report questionnaires.ResultsLess approach and avoidant, but more maladaptive coping strategies, and poor social functioning were uniquely associated with more symptoms of depression in children with ASD. Only less approach and more maladaptive coping were uniquely associated with depression severity in TD boys.ConclusionsUnlike TD boys, boys with ASD who report using avoidant strategies to deal with stressful situations report fewer symptoms of depression, suggesting that this may be an adaptive emotion regulation strategy. However, understanding the role of over-arousal in this process, inferences about long-term effects of this strategy, its causality and direction of effects will require additional research.     

Memory amplification for trauma: Investigating the role of analogue PTSD symptoms in the laboratory

Victims of trauma often remember their experience as being more traumatic later, compared to immediately after, the event took place. This finding—the “memory amplification effect”—is associated with increased re-experiencing symptoms. However, the effect has been found almost exclusively in field-based studies. We examined whether the effect could be replicated in the laboratory. In two studies, we exposed participants to negative photographs and assessed their memory for the photographs and analogue PTSD symptoms on two occasions. In Study 1, analogue symptoms at follow-up were positively associated with remembering more negative photos over time. In Study 2, we focused on “memory amplifiers”: people whose memory of the photos amplified over time. Consistent with field research, analogue re-experiencing symptoms were associated with memory amplification. Overall, our findings confirm that analogue PTSD symptoms are also associated with an amplified memory for a trauma analogue.     

Do prolonged grief disorder symptoms predict post-traumatic stress disorder symptoms following bereavement? A cross-lagged analysis

BackgroundBereavement can precipitate different forms of psychopathology, including prolonged grief disorder (PGD) and posttraumatic stress disorder (PTSD) symptoms. How these symptoms influence each other is unclear. The aim of this study was to examine the temporal relationship of symptoms of PGD and PTSD following bereavement.MethodsWe included 204 individuals, confronted with the loss of a loved one within the past year, who completed self-report measures of PGD and PTSD and again completed these measures one year later. We conducted a cross-lagged analysis to explore cross-lagged and autoregressive relationships.ResultsA significant cross-lagged relationship was found between PGD symptoms at time point 1 (T1) and PTSD symptoms at time point 2 (T2) (β − = 0.270, p < 0.001). Furthermore, PGD symptoms at T1 predicted PGD symptoms at T2 and PTSD symptoms at predicted PTSD symptoms at T2 (β − = 0.617 and β − = 0.458, ps < 0.001, respectively). In addition, PGD and PTSD symptoms were significantly correlated on both time points.ConclusionsWe found that PGD symptoms predict PTSD symptoms after a loss. Potentially, this could help to design new strategies and interventions for bereaved individuals. Additionally, PGD symptom levels predicted PGD symptom levels one year later, independently of the PTSD levels. This finding adds to the accumulating evidence that PGD is a distinct disorder.     

Post-traumatic stress disorder is associated with altered modulation of prefrontal alpha band oscillations during working memory

ObjectiveTo investigate the relationship between the severity of PTSD symptoms, modulation of alpha band oscillations, and behavioral performance in a working memory task.MethodsMagnetoencephalography data were recorded in 35 participants with combat exposure and various degrees of PTSD symptom severity while they performed a modified Sternberg working memory task: briefly presented sets of two or six letters had to be held in memory and participants indicated whether subsequent probe letters were present or absent from these sets.ResultsPTSD scores were positively correlated with the false positive rate in the high memory load condition. Higher rates of false recognition were associated with negative probes that were seen in recent previous trials (negative probe recency effect) or were physically similar with the list letters. The relative alpha band power in the left middle frontal gyrus was negatively correlated with both PTSD scores and false positive rates.ConclusionsReduced task specific modulation of alpha band oscillations in left middle frontal cortex may reflect alterations in the functions of pattern separation and suppression of memory traces for irrelevant or no longer relevant information in PTSD.SignificanceThe lower amplitude of prefrontal alpha band oscillations may represent an important physiological basis for core PTSD symptoms and can provide a target for interventions to augment response to treatment.     

Corrigendum to “Do prolonged grief disorder symptoms predict post-traumatic stress disorder symptoms following bereavement? A cross-lagged analysis” [Compr Psychiatry 80 (2018) 65–71]

Background: Bereavement can precipitate different forms of psychopathology, including prolonged grief disorder (PGD) and posttraumatic-stress disorder (PTSD) symptoms. How these symptoms influence each other is unclear. The aim of this study was to examine the temporal relationship of symptoms of PGD and PTSD following bereavement.Methods: We included 204 individuals, confronted with the loss of a loved one within the past year, who completed self-report measures of PGD and PTSD and again completed these measures one year later. We conducted a cross-lagged analysis to explore cross-lagged and autoregressive relationships.Results: A significant cross-lagged relationship was found between PGD symptoms at time point 1 (T1) and PTSD symptoms at time point 2 (T2) (β = 0.270, p < 0.001). Furthermore, PGD symptoms at T1 predicted PGD symptoms at T2 and PTSD symptoms at T1 predicted PTSD symptoms at T2 (β = 0.617 and β = 0.458, ps < 0.001, respectively). In addition, PGD and PTSD symptoms were significantly correlated on both time points.Conclusions: We found that PGD symptoms predict PTSD symptoms after a loss. Potentially, this could help to design new strategies and interventions for bereaved individuals. Additionally, PGD symptom levels predicted PGD symptom levels one year later, independently of the PTSD levels. This finding adds to the accumulating evidence that PGD is a distinct disorder.The authors would like to apologize for any inconvenience caused.     

Blushing in rosacea sufferers

ObjectiveRosacea is characterized by extremely sensitive skin and persistent facial flushing, perhaps initiated or exacerbated by frequent or intense blushing. To investigate this, blushing was assessed in rosacea sufferers and controls during embarrassing laboratory tasks.MethodsChanges in forehead blood flow were monitored with laser Doppler fluxmetry in 31 rosacea sufferers (12 with severe symptoms and 19 with mild symptoms) and 86 controls while singing, giving an impromptu speech, and listening to recordings of these activities.ResultsChanges in forehead blood flow were similar in rosacea sufferers and controls, and were similar in subgroups with mild and severe rosacea. Even so, rosacea sufferers thought that that they blushed more intensely and were more embarrassed than controls during most of the tasks. Likewise, changes in forehead blood flow were similar in participants with mild and severe rosacea. Nevertheless, ratings of embarrassment and blushing were greater in those with severe than mild symptoms. Within the rosacea group, increases in blood flow while singing were greatest in participants with the highest blushing ratings, whereas increases in blood flow while listening to the speech were greatest in the most embarrassed participants.ConclusionsThese findings do not support the hypothesis that blushing is abnormal in rosacea but, nevertheless, suggest that rosacea sufferers are more aware of and embarrassed by blushing than controls. This might contribute to social anxiety in rosacea sufferers.     

Prospective and retrospective episodic metamemory in posttraumatic stress disorder

Objectives: Posttraumatic stress disorder (PTSD) has been consistently associated with episodic memory deficits. To some extent, these deficits could be related to an impairment of metamemory in individuals with PTSD. This research consequently aims at investigating prospective (feeling-of-knowing, FOK) and retrospective (confidence) metamemory judgments for episodic information in PTSD.

Method: Twenty participants with PTSD and without depression were compared to 30 healthy comparison participants on metamemory judgments during an episodic memory task. The concordance between metamemory judgments and recognition performance was then assessed by gamma correlations.

Results: The results confirmed that PTSD is associated with episodic memory impairment. Regarding metamemory, gamma correlations indicated that participants with PTSD failed to accurately predict their future memory performance as compared to the comparison group (mean FOK gamma correlations: .23 vs. .42, respectively). Furthermore, participants with PTSD made less accurate confidence judgments than comparison participants (mean confidence gamma correlations: .62 vs. .74, respectively).

Conclusion: Our results demonstrate an alteration of both prospective and retrospective metamemory processes in PTSD, which could be of particular relevance to future therapeutic interventions focusing on metacognitive strategies.     

Cognitive-behavioral coping strategies associated with combat-related PTSD in treatment-seeking OEF-OIF Veterans

Posttraumatic stress disorder (PTSD) is associated with intrusive trauma-related thoughts and avoidance behaviors that contribute to its severity and chronicity. This study examined thought control and avoidance coping strategies associated with both a probable diagnosis and symptom severity of combat-related PTSD in a sample of 167 treatment-seeking Operations Enduring Freedom and Iraqi Freedom (OEF-OIF) Veterans. Within one year of returning from deployment, Veterans completed a survey containing measures of combat exposure, coping strategies, psychopathology, and postdeployment social support. Veterans with a positive screen for PTSD scored higher than Veterans without a positive screen for PTSD on measures of worry, self-punishment, social control, behavioral distraction, and avoidance coping strategies. Worry and social avoidance coping were positively related to PTSD symptoms, and greater perceptions of understanding from others were negatively related to these symptoms. A structural equation model revealed that scores on a measure of postdeployment social support were negatively associated with scores on measures of maladaptive cognitive coping (i.e., worry, self-punishment) and avoidance coping (social and non-social avoidance coping) strategies, which were positively associated with combat-related PTSD symptoms. These results suggest that maladaptive thought control and avoidance coping may partially mediate the relation between postdeployment social support and combat-related PTSD symptoms in treatment-seeking OEF-OIF Veterans. Consistent with cognitive therapy models, these findings suggest that interventions that target maladaptive coping strategies such as worry, self-punishment, and social avoidance, and that bolster social support, most notably understanding from others, may help reduce combat-related PTSD symptoms in this population.     

Reducing suicidal ideation through evidence-based treatment for posttraumatic stress disorder

BackgroundSuicide is a major public health concern in military and civilian contexts. Veteran populations are at increased risk for suicide, especially veterans with mental health disorders such as Posttraumatic Stress Disorder (PTSD). Suicidal ideation (SI) is a primary risk factor for suicide.MethodsWe investigated changes in SI in a multi-site sample of treatment seeking veterans from three separate Veterans Health Administration (VA) medical centers (n = 289) who received Prolonged Exposure (PE) therapy, an evidence-based treatment (EBT) for PTSD. SI and PTSD symptoms were assessed, using self-report instruments, throughout routine clinical care.ResultsBoth PTSD and SI symptoms reduced over the course of treatment (d-type effect sizes of 1.47 and 0.27, respectively). While SI was associated with PTSD symptoms at all time points, appropriately specified, time lagged models indicated that changes in PTSD symptoms were predictive of future declines in SI, while the converse was not true.ConclusionsResults indicate that treating PTSD symptoms with an EBT for PTSD can be an effective way to reduce SI, at least partially, and for some patients. These data are significant in light of the resources and programming devoted to addressing SI in the VA relative to available empirical evidence regarding the effectiveness of developed strategies. The findings demonstrate the importance of facilitating EBT referrals for specific disorders as a component of broad-based suicide outreach and preventions strategies.     

Delayed reward discounting and increased risk for suicide attempts among U.S. adults with probable PTSD

BackgroundPTSD is an established risk factor for suicide attempts and suicide death, but the mechanisms underlying this association remain unknown. The present study examined associations among delayed reward discounting—the balance between smaller immediate available rewards versus larger delayed rewards—self-reported PTSD symptoms, and recent suicide attempts among individuals reporting suicide ideation within the past year.MethodsA cross-sectional survey of U.S. adults completed the Primary Care PTSD Screen for DSM-5, the 21-item Monetary Choice Questionnaire, and the Self-Injurious Thoughts and Behaviors Interview-Revised. Analyses of variance and multinomial regression models were used to test associations among variables.ResultsAmong participants reporting suicide ideation within the past year, discount rates were significantly higher among those reporting more PTSD symptoms and a past-year suicide attempt, suggesting these participants expressed a preference for immediately available rewards.ConclusionsChoice behavior among individuals reporting many PTSD symptoms and a recent suicide attempt is influenced to a greater degree by immediately available rewards. Sensitivity to immediate rewards at the expense of larger delayed rewards may reflect a vulnerability for suicidal behavior among individuals screening positive for PTSD.     

Memory representation of aversive social experiences in Social Anxiety Disorder

Aversive social experiences are proposed to be a risk factor for developing Social Anxiety Disorder (SAD). Many patients with SAD report associated daily life symptoms, such as intrusive re-experiencing (e.g., negatively distorted images of oneself), avoidance, alterations in cognitions and mood, as well as hyperarousal, resembling symptom dimensions of Posttraumatic Stress Disorder (PTSD). These PTSD-like symptoms may result from maladaptive processing and representation of the aversive social experiences in memory. Emotional hyperreactivity during memory retrieval of aversive social experiences is another feature of SAD which was found in previous studies. This study aimed to further investigate PTSD-like symptoms and emotional reactivity associated with etiologically relevant aversive social experiences and shed more light on a potential relationship between both. Eighty-five patients with SAD and 85 healthy controls (HC) participated in this cross-sectional study. It comprised an imagination task with self-report and physiological measures to assess emotional reactivity during the cued recall of the aversive social experience and clinical interviews to assess PTSD-like symptoms. We expected increased emotional reactivity and more severe PTSD-like symptoms in response to the aversive social experience in patients with SAD compared to HC, as well as a positive correlation between emotional reactivity and PTSD-like symptoms in patients with SAD. Indeed, patients with SAD showed emotional hyperreactivity (self-report, physiology) during the cued recall of the aversive social experiences, also when compared to two control memory conditions (neutral, negative non-social) and HC. Patients with SAD furthermore reported more severe PTSD-like symptoms compared to HC and intrusive re-experiencing symptoms were positively correlated with distress during imagery of the social aversive event in patients with SAD. These results might point toward a maladaptive representation of aversive social experiences in memory. Similar to PTSD, this maladaptive memory representation might promote the development of PTSD-like symptoms such as intrusive re-experiencing (e.g., in the form of intrusive self-images in patients with SAD), which might finally lead to and maintain symptoms of SAD.     

Executive dysfunction and autobiographical memory retrieval in recovered depressed women

Background and objectivesDepressed individuals have difficulty remembering specific autobiographical events. These deficits often persist after recovery of mood symptoms, but the mechanisms underlying impaired memory specificity in recovered depressed individuals remain unclear. Here, we sought to examine whether performance on two cognitive measures might be related to deficits in autobiographical memory retrieval in individuals with a history of depression.MethodsTwenty-four recovered depressed women (12 with more than one previous episode) and 24 never depressed women completed two cognitive measures (Digit Span and a Number Generation Task) and tests of autobiographical memory recall.ResultsOverall, the recovered depressed women did not show deficits in autobiographical retrieval. However, those with more than one previous episode had impaired retrieval of categorical autobiographical memories. Moreover, depression history moderated the relationship between Digit Span and retrieval of categoric autobiographical memories such that within the whole recovered depressed group (but not the never depressed group), those with lower Digit Span also had poorer retrieval of categorical autobiographical memories.LimitationsOur sample size was small and included only women. Moreover, order effects may have been a significant factor.ConclusionsThese findings support the notion that working memory is an important factor in impairing autobiographical memory in those who have recovered from depression, but suggest a complex relationship with autobiographical recall.