Emotional experiencing in women with posttraumatic stress disorder: congruence between facial expressivity and self-report

The congruence between facial expressivity and self-report of emotion was examined among 11 women with sexual assault-related PTSD and 8 women without PTSD, under both a neutral and a sexual assault prime condition. The PTSD group demonstrated some incongruities in emotional responding. Although the PTSD group was as facially expressive as the control group, they reported more arousal to the emotional stimuli. Further, an inverse relationship between negative facial expressivity and self-report to negative stimuli was found for some variables for the PTSD group only, such that the less expressions they showed facially, the more negative they reported feeling. However, the overall pattern of results suggests fewer significant relationships between expression and experience than predicted.     

An experimental examination of emotional experience, expression, and disclosure in women reporting a history of childhood sexual abuse

Researchers have suggested that childhood sexual abuse (CSA) is a distal risk factor for the development of emotion regulation difficulties in adulthood. The present study examined 20 females with and without a history of CSA on the dimensions of subjective emotional experience (positive and negative activation), facial expressivity, and disclosure (positive and negative emotion words) in response to positively and negatively valenced film stimuli. The CSA group reported experiencing reduced positive activation while no group differences were found for negative activation. The CSA group disclosed fewer negative emotion words to express their experience and exhibited a trend towards less facial expressivity. The results are interpreted within the context of CSA survivors' emotional responding difficulties, and their implications are discussed.     

Numbing of Positive,Negative, and General Emotions: Associations With Trauma Exposure,Posttraumatic Stress,and Depressive Symptoms Among Justice‐Involved Youth

Increasing attention has been drawn to the symptom of emotional numbing in the phenomenology of posttraumatic stress disorder (PTSD), particularly regarding its implications for maladaptive outcomes in adolescence such as delinquent behavior. One change in the definition of emotional numbing according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM‐5; American Psychiatric Association, 2013) was the limitation to the numbing of positive emotions. Previous research with youth, however, has implicated general numbing or numbing of negative emotions in PTSD, whereas numbing of positive emotions may overlap with other disorders, particularly depression. Consequently, the goal of this study was to investigate whether numbing of positive emotions was associated with PTSD symptoms above and beyond numbing of negative emotions, general emotional numbing, or depressive symptoms among at‐risk adolescents. In a sample of 221 detained youth (mean age = 15.98 years, SD = 1.25; 50.7% ethnic minority), results of hierarchical multiple regressions indicated that only general emotional numbing and numbing of anger accounted for significant variance in PTSD symptoms (total R² = .37). In contrast, numbing of sadness and positive emotions were statistical correlates of depressive symptoms (total R² = .24). Further tests using Hayes’ Process macro showed that general numbing, 95% CI [.02, .45], and numbing of anger, 95% CI [.01, .42], demonstrated indirect effects on the association between trauma exposure and PTSD symptoms.     

Exploring the Roles of Emotional Numbing, Depression, and Dissociation in PTSD

Some researchers consider emotional numbing a cardinal feature of posttraumatic stress disorder (PTSD). Others view numbing symptoms as representing an overlap between PTSD, depression, and dissociation. In this study, we examined the ability of early emotional numbing, depression, and dissociation symptoms to predict PTSD. One-hundred sixty-one women who were recent victims of sexual or nonsexual assault were assessed prospectively for 12 weeks. Emotional numbing, depression, and dissociation were each associated with initial PTSD severity. Notably, regression analyses revealed that after depression and dissociation were accounted for, early numbing contributed to the prediction of later PTSD.     

The relationship between PTSD symptom factors and emotion

The relationship between posttraumatic stress disorder (PTSD) symptom factors and two facets of emotion were examined. Emotional congruence effects were examined using an affective priming word pronunciation (naming) task, and negative affect was measured using self-report. Current PTSD symptoms were assessed using the Clinician-Administered PTSD Scale in 95 adults with trauma histories. Two alternative PTSD symptom factor structures were examined, one of which included an emotional numbing factor, and one of which included a dysphoria factor. Emotional congruence effects were significantly associated with an emotional numbing factor, but not with any other PTSD factors. Negative affect was significantly associated with a dysphoria factor, but not with any other PTSD factors.     

Male war-zone veterans' perceived relationships with their children: the importance of emotional numbing

Despite growing recognition of substantial interpersonal impairment among many war-zone veterans with posttraumatic stress disorder (PTSD), little is known about the association between PTSD symptomatology and veterans' relationships with their children. This study examined the differential pattern of associations between the symptom clusters of PTSD and the perceived father–child relationships of 66 male Vietnam veterans. Analyses revealed that only the emotional numbing cluster was significantly related to perceived quality of all relationship domains. The association between emotional numbing and perceived relationship quality remained significant in regression analyses even after controlling for fathers' family-of-origin stressors, combat exposure, depression, and substance abuse. Findings suggest that emotional numbing may be the component of PTSD most closely linked to interpersonal impairment in war-zone veterans.     

Temporal Associations Among Chronic PTSD Symptoms in U.S. Combat Veterans

The present study examined fluctuation over time in symptoms of posttraumatic stress disorder (PTSD) among 34 combat veterans (28 with diagnosed PTSD, 6 with subclinical symptoms) assessed every 2 weeks for up to 2 years (range of assessments = 13–52). Temporal relationships were examined among four PTSD symptom clusters (reexperiencing, avoidance, emotional numbing, and hyperarousal) with particular attention to the influence of hyperarousal. Multilevel cross‐lagged random coefficients autoregression for intensive time series data analyses were used to model symptom fluctuation decades after combat experiences. As anticipated, hyperarousal predicted subsequent fluctuations in the 3 other PTSD symptom clusters (reexperiencing, avoidance, emotional numbing) at subsequent 2‐week intervals (rs = .45, .36, and .40, respectively). Additionally, emotional numbing influenced later reexperiencing and avoidance, and reexperiencing influenced later hyperarousal (rs = .44, .40, and .34, respectively). These findings underscore the important influence of hyperarousal. Furthermore, results indicate a bidirectional relationship between hyperarousal and reexperiencing as well as a possible chaining of symptoms (hyperarousal → emotional numbing → reexperiencing → hyperarousal) and establish potential internal, intrapersonal mechanisms for the maintenance of persistent PTSD symptoms. Results suggested that clinical interventions targeting hyperarousal and emotional numbing symptoms may hold promise for PTSD of long duration.     

Posttraumatic Stress Disorder Symptoms and Parenting Satisfaction Among a National Sample of Male Vietnam Veterans

This study examined relationships between posttraumatic stress disorder (PTSD) symptoms and parenting satisfaction. Total PTSD severity scores and avoidance and emotional numbing symptoms were significantly associated with parenting satisfaction. These associations remained significant even after controlling for partner violence, major depression, and alcohol abuse/dependence. Results suggest that higher levels of PTSD symptoms and avoidance and emotional numbing symptoms in particular may have a deleterious effect on parent-child relationship satisfaction.     

PTSD symptom clusters are differentially related to substance use among community women exposed to intimate partner violence

Women who experience intimate partner violence (IPV) have higher rates of posttraumatic stress disorder (PTSD) and substance abuse compared to women who do not experience IPV. However, the extent to which IPV-related PTSD symptoms are related to women's substance use involvement largely has been unexplored. The current study investigated PTSD symptomatology and substance use in a community sample of 212 IPV-exposed women. Drug-using women reported higher PTSD severity scores compared to women who reported no substance use or alcohol use only. Moreover, the reexperiencing, avoidance and numbing, and arousal clusters demonstrated unique associations with substance use involvement. Findings not only elucidate the associations among IPV-related PTSD symptoms and substance use, but they also can inform community-based preventive interventions.     

Emotional Deficits in Military-Related PTSD: An Investigation of Content and Process Disturbances

To expound on the nature of emotional deficits in PTSD, the current study investigated the relationships among emotion content and process variables and PTSD symptomatology in a sample of 85 veterans with military-related trauma. Alexithymic externally oriented thinking and negative affectivity emerged as the most consistent predictors of PTSD symptoms; however, depression was the only variable associated with emotional numbing. Theoretical and clinical implications of these findings are discussed, as well as future research directions including the collateral and clinician assessment of emotional functioning, use of other process measures, and inclusion of various control groups.     

Neural Correlates of Trait Rumination During an Emotion Interference Task in Women With PTSD

Rumination, defined as repetitive, negative, self‐focused thinking, is hypothesized to be a transdiagnostic factor that is associated with depression, anxiety, and posttraumatic stress disorder (PTSD). Theory has suggested that in individuals with PTSD, rumination serves as a cognitive avoidance factor that contributes to the maintenance of symptoms by inhibiting the cognitive and emotional processing of the traumatic event, subsequently interfering with treatment engagement and outcome. Little is known about the neural correlates of rumination in women with PTSD. The current study utilized functional magnetic resonance imaging (fMRI) to examine neural correlates during an emotion interference task of self‐reported rumination in women with PTSD. Women with PTSD (39 participants) were recruited at a university‐based trauma clinic and completed a clinical evaluation that included measures of PTSD symptoms, rumination, and depressive symptoms, as well as a neuroimaging session in which the participants were administered an emotion interference task. There was a significant relationship between self‐reported rumination and activity in the right orbital frontal cortex, BA 11; t(37) = 5.62, p = .004, k = 46 during the task. This finding suggested that women with PTSD, who had higher levels of rumination, may experience greater difficulty inhibiting negative emotional stimuli compared to women with lower levels of rumination.     

A Preliminary Investigation of the Role of Strategic Withholding of Emotions in PTSD

Individuals with posttraumatic stress disorder (PTSD) experience deficits in emotional responding, yet to date these deficits have been poorly understood. This study is an initial investigation of the role of strategic, intentional withholding of emotional responses among individuals with PTSD. In a sample of 61 combat veterans, veterans with PTSD reported significantly more frequent and intense withholding of their emotional responses than did combat veterans without PTSD. The tendency to withhold emotional responses was associated with PTSD, beyond measures of comorbid distress. The implications of these findings for future research and interventions aimed at deficits in emotional responding are discussed.     

Gender Differences in the Associations of PTSD Symptom Clusters With Relationship Distress in U.S. Vietnam Veterans and Their Partners

Research has consistently linked symptoms of posttraumatic stress disorder (PTSD) with relationship distress in combat veterans and their partners. Studies of specific clusters of PTSD symptoms indicate that symptoms of emotional numbing/withdrawal (now referred to as negative alterations in cognition and mood) are more strongly linked with relationship distress than other symptom clusters. These findings, however, are based predominantly on samples of male veterans. Given the increasing numbers of female veterans, research on potential gender differences in these associations is needed. The present study examined gender differences in the multivariate associations of PTSD symptom clusters with relationship distress in 465 opposite‐sex couples (375 with male veterans and 90 with female veterans) from the National Vietnam Veterans Readjustment Study. Comparisons of nested path models revealed that emotional numbing/withdrawal symptoms were associated with relationship distress in both types of couples. The strength of this association, however, was stronger for female veterans (b = .46) and female partners (b = .28), compared to male veterans (b = .38) and male partners (b = .26). Results suggest that couples‐based interventions (e.g., psychoeducation regarding emotional numbing symptoms as part of PTSD) are particularly important for both female partners of male veterans and female veterans themselves.     

Confirmatory factor analysis of posttraumatic stress symptoms in sexually harassed women

Posttraumatic stress disorder (PTSD) factor analytic research to date has not provided a clear consensus on the structure of posttraumatic stress symptoms. Seven hypothesized factor structures were evaluated using confirmatory factor analysis of the Posttraumatic Stress Disorder Checklist, a paper-and-pencil measure of posttraumatic stress symptom severity, in a sample of 1,218 women who experienced a broad range of workplace sexual harassment. The model specifying correlated re-experiencing, effortful avoidance, emotional numbing, and hyperarousal factors provided the best fit to the data. Virtually no support was obtained for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV; American Psychiatric Association, 1994) three-factor model of re-experiencing, avoidance, and hyperarousal factors. Different patterns of correlations with external variables were found for the avoidance and emotional numbing factors, providing further validation of the supported model.     

Posttraumatic stress disorder instrument wording content is associated with differences in factor structure

The authors examined posttraumatic stress disorder (PTSD) item wording differences on the factor structure of PTSD. Nonclinical, trauma-exposed participants were randomly assigned to complete a PTSD measure using item wording content from the PTSD Checklist (n = 182) or PTSD Symptom Scale (n = 203). Compared to the 4-factor emotional numbing PTSD model, the 4-factor dysphoria PTSD model fit best across groups based on smaller Bayesian information criterion (BIC) values. For PTSD Checklist participants, the numbing model's BIC was 6238.54 compared to the dysphoria model's BIC of 6156.03. For the PTSD Symptom Scale, the numbing model's BIC was 6161.38 compared to the dysphoria model's BIC of 6102.87. Groups differed on variable intercepts and residual variances. Instrument and construct implications are discussed.     

Role of distinct PTSD symptoms in intimate partner reabuse: a prospective study

This prospective study examines the impact of four posttraumatic stress disorder (PTSD) symptom clusters (hyperarousal, reexperiencing, numbing, and avoidance) on reabuse over 1 year among women exposed to intimate partner violence (IPV). The covariates include severity of IPV, a history of childhood violence, and characteristics of the abusive relationship. Although both hyperarousal and numbing symptoms were higher at baseline among women subsequently reabused, only numbing symptoms increased the odds of reabuse after controlling for the covariates. Greater IPV severity and shorter relationship duration also increased the risk of reabuse. Results indicate that specific symptoms of PTSD, especially numbing, need to be addressed to increase the safety of women seeking services for IPV.     

Posttraumatic growth in exposure therapy for PTSD

This study aims to increase our understanding of trauma positive outcomes by (a) exploring associations between posttraumatic growth and posttraumatic stress disorder (PTSD), and (b) investigating posttraumatic growth course and its impact on exposure treatment. In 80 mixed trauma PTSD patients, growth was negatively related to PTSD symptoms, especially emotional numbing. Sixty‐five PTSD patients also completed Prolonged Exposure therapy with pretreatment and posttreatment assessments. Posttraumatic growth—New Possibilities and Personal Strength—increased during exposure therapy, and these increases were associated to decreases of PTSD symptoms. Pretreatment posttraumatic growth, more specifically the Appreciation of Life subscale, predicted better treatment outcome after controlling for pretreatment PTSD. The results indicate that posttraumatic growth may be a valuable new concept in trauma therapy.     

Post‐traumatic stress disorder's relation with positive and negative emotional avoidance: The moderating role of gender

Post‐traumatic stress disorder (PTSD) is characterized by avoidance of trauma‐related emotions. Research indicates that this avoidance may extend to any emotional experience that elicits distress, including those that are unrelated to the trauma. Literature in this area has been limited in its exclusive focus on negative emotions. Despite evidence of gender differences in PTSD and emotional avoidance separately, no studies to date have examined gender as a moderator of their association. The goal of the current study was to extend research by exploring the moderating role of gender in the relation between PTSD symptom severity and positive and negative emotional avoidance. Participants were 276 trauma‐exposed individuals (65.9% female, 65.6% White, M_age = 19.24) from a university in the north‐eastern United States. Moderation results indicated a main effect for PTSD symptom severity on both positive (b = 0.07, p < .001) and negative (b = 0.04, p = .03) emotional avoidance. The interaction of gender and PTSD symptom severity was significant for positive emotion avoidance (b = 0.97, p = .01). Analysis of simple slopes revealed that PTSD symptom severity was significantly associated with positive emotional avoidance for males (b = 0.13, p < .001) but not females (b = 0.03, p = .08). Results suggest the importance of gender‐sensitive recommendations for assessment and treatment of emotional avoidance in PTSD.     

Smoking intensity and severity of specific symptom clusters in posttraumatic stress disorder

Smoking prevalence among patients with posttraumatic stress disorder (PTSD) is over 40%. Baseline data from the VA Cooperative Studies Program trial of integrated versus usual care for smoking cessation in veterans with PTSD (N = 863) were used in multivariate analyses of PTSD and depression severity, and 4 measures of smoking intensity: cigarettes per day (CPD), Fagerström Test for Nicotine Dependence (FTND), time to first cigarette, and expired carbon monoxide. Multivariate regression analysis showed the following significant associations: CPD with race (B = ?7.16), age (B = 0.11), and emotional numbing (B =0 .16); FTND with race (B = ?0.94), education (B = ?0.34), emotional numbing (B = 0.04), significant distress (B = ?0.12), and PHQ‐9 (B = 0.04); time to first cigarette with education (B = 0.41), emotional numbing (B = ?0.03), significant distress (B = 0.09), and PHQ‐9 (B = ?0.03); and expired carbon monoxide with race (B = ?9.40). Findings suggest that among veterans with PTSD, White race and emotional numbing were most consistently related to increased smoking intensity and had more explanatory power than total PTSD symptom score. Results suggest specific PTSD symptom clusters are important to understanding smoking behavior in patients with PTSD.     

Changes in Social Adjustment With Cognitive Processing Therapy: Effects of Treatment and Association With PTSD Symptom Change

The current study sought to determine if different spheres of social adjustment, social and leisure, family, and work and income improved immediately following a course of cognitive processing therapy (CPT) when compared with those on a waiting list in a sample of 46 U.S. veterans diagnosed with posttraumatic stress disorder (PTSD). We also sought to determine whether changes in different PTSD symptom clusters were associated with changes in these spheres of social adjustment. Overall social adjustment, extended family relationships, and housework completion significantly improved in the CPT versus waiting‐list condition, η² = .08 to .11. Hierarchical multiple regression analyses revealed that improvements in total clinician‐rated PTSD symptoms were associated with improvements in overall social and housework adjustment. When changes in reexperiencing, avoidance, emotional numbing, and hyperarousal were all in the model accounting for changes in total social adjustment, improvements in emotional numbing symptoms were associated with improvements in overall social, extended family, and housework adjustment (β = .38 to .55). In addition, improvements in avoidance symptoms were associated with improvements in housework adjustment (β = .30), but associated with declines in extended family adjustment (β = ?.34). Results suggest that it is important to consider the extent to which PTSD treatments effectively reduce specific types of symptoms, particularly emotional numbing and avoidance, to generally improve social adjustment.