Emotion dysregulation mediates the association between acute sleep disturbance and later posttraumatic stress symptoms in trauma exposed adults

Introduction Trauma-exposed individuals are at risk of developing symptoms of posttraumatic stress disorder (PTSD), which has been linked to both sleep disturbances and sleep-related daytime impairment. A growing body of literature suggests affective processes, such as negative and positive emotion regulation, may influence associations between PTSD and sleep. Therefore, our study aimed to examine if there was a direct effect of negative and positive emotion dysregulation on sleep disturbances and sleep-related impairment above the influence of PTSD symptoms. Methods Participants were 460 trauma-exposed college students (69.8% female; 62.0% White; Mage = 20.13 ± 2.94) recruited from the University of North Texas. Trauma exposure was assessed with the Life Events Checklist for DSM-5. Participants completed demographic questionnaires, the PTSD Checklist for DSM-5 (excluding sleep-related questions), the Difficulties in Emotion Regulation Scale (DERS-16), the Difficulties in Emotion Regulation – Positive (DERS-P), the PROMIS Sleep Disturbance (PROMIS-SD), and Sleep-Related Impairment (PROMIS-SRI) Short Forms. Multiple regression models with robust standard errors were conducted to examine associations between both positive and negative emotion dysregulation on sleep disturbances and sleep-related impairment, covarying for PTSD symptoms, age, gender, race, and ethnicity. Results Greater negative emotion dysregulation was associated with greater sleep disturbances (b = 0.06, SE = 0.03, p = .015, ηp2 = 0.01) above the influence of positive emotion dysregulation, PTSD symptoms, age, gender, race, and ethnicity (R2 = 0.28). Greater negative emotion dysregulation was also associated with greater sleep-related impairments (b = 0.20, SE = 0.03, p < .001, ηp2 = 0.08) above the influence of the same covariates (R2 = 0.31). Positive emotion dysregulation was not associated with sleep disturbances or sleep-related impairments. Conclusion Results suggest that more difficulty regulating negative emotions is linked to disturbed sleep among trauma-exposed individuals. Additional experimental work is needed to understand if regulating negative emotions via cognitive-behavioral strategies (e.g., mindfulness, cognitive restructuring) can lead to downstream improvements in sleep. Support (if any)

Effective treatment options are needed for veterans who do not participate in trauma-focused psychotherapy. Research has yet to examine the effectiveness of transdiagnostic psychotherapy in veterans with posttraumatic stress disorder (PTSD) and co-occurring psychological disorders. This pilot study examined the effectiveness of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) delivered in a 16-week group format. We examined treatment outcomes in male and female veterans ( n = 52) in an outpatient specialty PTSD clinic at a large Veterans Affairs (VA) medical center. We hypothesized significant decreases in emotion regulation difficulty (Difficulties in Emotion Regulation Scale), PTSD symptom severity (PTSD Checklist for DSM-5), and depressive symptom severity (Patient Health Questionnaire-9). In addition, we hypothesized that reductions in emotion regulation difficulty across treatment would negatively predict PTSD and depressive symptoms at posttreatment. PTSD symptoms, depressive symptoms, and emotion regulation difficulty all evidenced significant improvements at the end of treatment relative to baseline ( ps < .001). In addition, reductions in emotion regulation across treatment were associated with lower PTSD and depressive symptoms at posttreatment ( ps < .001). This pilot study provides preliminary evidence supporting use of UP among veterans with PTSD and co-occurring disorders. Well-designed clinical trials evaluating efficacy of UP among veterans are needed.

Prior research has shown that difficulties in emotion regulation is associated with overall levels of posttraumatic stress symptoms (PTSS). However, it is currently unclear which facets of difficulties in emotion regulation (e.g., lack of emotion regulation strategies, impulse control problems, non-acceptance of emotional responses) are associated with specific PTSS clusters. This information may be valuable in refining treatment approaches in PTSS. The aim of the current study was to use structural equation modeling to test the relationships between Difficulties in Emotion Regulation Scale (DERS) subfactors and PTSS in a trauma-exposed community sample (N = 746). Results indicated that impulse control difficulties were most consistently associated across PTSS clusters (i.e., re-experiencing, avoidance, and hyperarousal), while lack of emotion regulation strategies and emotional clarity were uniquely associated with numbing symptoms, after covarying for neuroticism. However, other facets of difficulties in emotion regulation (i.e., non-acceptance of emotional responses and difficulties engaging in goal-directed behavior while upset) were not associated with PTSS. These findings provide further support for the role of difficulties in emotion regulation in specific PTSS clusters. Additionally, they suggest that impulse control problems may be important in the development of most PTSS and thus most beneficial to target clinically, while lack of emotional clarity and effective emotion regulation strategies may be specific to numbing symptoms.

This study examined trauma frequency, alcohol use, and posttraumatic stress disorder (PTSD) symptoms as predictors of emotion regulation (ER) difficulties among post-9/11 Veterans. Seventy-four Veterans (95.5% male; mean age = 40; 45.9% Caucasian) completed questionnaires on demographics, PTSD symptoms, ER, trauma frequency, and drinking. Positive correlations were observed between PTSD symptom severity and ER difficulties (r = .6, p < .001) and drinking behavior and emotion dysregulation (r = .25, p < .05). PTSD symptoms above the clinical cutoff resulted in significantly higher ER difficulties than subclinical symptoms, t(66) = -2.975, p < .01). Linear regressions revealed that PTSD accounted for 37% of the variance in ER difficulties, F(1, 66) = 37.34, p < .05. Cluster C was the only significant predictor of Difficulties in Emotion Regulation Scale (DERS) total scores (B = 1.40, p < .05). Regression analyses on DERS subscales were also examined. Both PTSD Checklist-Specific (PCL-S) total and Cluster C significantly predicted the subscales of nonacceptance (PCL-S total, B = .30, p < .001; Cluster C, B = .45, p < .05) and clarity (PCL-S total, B = .12, p < .05; Cluster C, B = .31, p < .05). PCL-S total predicted strategies (PCL-S total, B = .43, p < .01). PCL-S total was the only significant predictor of the DERS subscales of goals (B = .21, p < .001) and impulse (B = .27, p < .001). There were no significant predictors for the subscale of awareness. The findings will aid the development of targeted intervention strategies in Veterans. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Theoretical and empirical evidence has begun to delineate posttraumatic stress disorder (PTSD) and racial trauma, but the degree to which individual psychological processes differ in the development of these two outcomes remains limited. Despite key distinctions in etiology and phenotypic presentations, prominent PTSD risk factors such as difficulties in emotion regulation and experiential avoidance (EA) may also contribute to the development of racial trauma. The goal of the present cross-sectional study was to investigate how difficulties in emotion regulation and EA differ in their associations with PTSD and racial trauma. For this study, racial and ethnic minority undergraduate students completed a battery of questionnaires including the Everyday Discrimination Scale, Brief Experiential Avoidance Questionnaire, Difficulties in Emotion Regulation Scale, Trauma Symptoms of Discrimination Scale, and the PTSD checklist for DSM-5. A path model suggested emotion regulation difficulties and EA significantly mediated the relationship between perceived discrimination and PTSD symptoms. However, only emotion regulation difficulties mediated the relationship between perceived discrimination and racial trauma symptoms. Compared to racial trauma, pairwise comparisons suggested that emotion regulation difficulties and EA indirect effects were significantly greater when predicting PTSD symptoms. Additionally, the effects of emotion regulation difficulties were greater than EA when predicting PTSD symptoms and racial trauma. Findings of the present study suggest individual psychological factors may play a lesser role in the development of racial trauma compared to PTSD symptoms. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: Dissociative Disorder is a complex phenomenon related to stress which started from period of adolescence marks the shift from childhood to adulthood and marked by physical, psychological, social, and emotional changes. Emotional regulation issues are fundamental to mental health, the emergence and maintenance of psychiatric illness, and the origin and maintenance of maladaptive behaviours. The emotion (dys) regulation represents a core feature, involved in the dissociative symptoms as highlighted in several empirical contributions. The inability to regulate extreme intense emotions may results to a state of mental and bodily disconnection. At the same time, the activation of dissociative mechanisms alters the emotion regulation functioning, interfering with the coherent coding of salient events and facilitating the onset of intense and automatic responses that manifest themselves incoherently. The high prevalence rate of emotional dysregulation has been found among patients experiencing dissociative symptoms. Aim: (1) To assess the severity of emotional dysregulation, (2) To assess the relationship between dissociative experience and difficulty in emotional regulation of the participants. Methodology: The study was a hospital based cross-sectional explorative study, conducted at Department of Psychiatry, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Instituteof Medical Sciences and Dr. RamManohar Lohia Hospital, New Delhi among individuals with dissociative disorder (DD). Ninety participants were selected with exclusion of intellectual disabilities, significant co-morbidities of other psychiatric disorders, and chronic physical illnesses. Participants were diagnosed as per criteria of ICD-10 and assessed using the Socio-demographic and clinical datasheet, Dissociative Experience Scale-II and Difficulties in Emotional Regulation scale (Hindi version). Results: The result shows that the majority of participants were between the age group of 18-28 years (67.6%) and 29-38 years (22.5%). The participant average age was 25.88 ± 7. 045. The results are more applicable to female (88.9%) patients than male patients as the percentage of male were very low (11.9). The findings of the study showed moderate level of dysfunction in all domains. Positive correlation was found between dissociative disorders and domains of difficulties in emotional regulation scale. The highest correlations with dissociative derealization, emotional restraint, and memory impairment were found in total emotion dysregulation. Conclusion: Dissociative disorder is a stress related disorder presented with physical, psychological, social, and emotional changes. In adolescence and the early stages of adulthood, dissociative disorder was found more common in women than in men. Females with dissociative disorder have more difficulty to regulate, modulate, control and adapt adequate strategies to express their emotions. The study finds high rates of emotional dysregulation in this population, with specific deficits in emotional acceptance, clarity, goal settings, impulse control, and emotion regulation strategies.

PTSD, emotion dysregulation, and dissociative symptoms in a highly traumatized sample

In response to the high rates of comorbidity as well as the severe social impairment among refugees, the examination of transdiagnostic factors such as emotion regulation appears particularly promising in this group. This study investigates the contribution of difficulties in emotion regulation to the self-reported symptom levels of posttraumatic stress disorder (PTSD), depression, and anxiety/insomnia, which are highly prevalent symptoms among refugees. In addition, the link between emotion regulation and social impairment is examined. Participants were 74 male Afghan refugees exposed to trauma. They completed measures of trauma exposure, difficulties in emotion regulation (Difficulties in Emotion Regulation Scale), PTSD (PTSD Checklist for DSM-5), depression, anxiety/insomnia, and social impairment (General Health Questionnaire-28). Higher symptom severities of PTSD, depression, and anxiety/insomnia were related to the Difficulties in Emotion Regulation Scale subscales nonacceptance, goals, impulse, strategies, and clarity, but none of our outcomes was related to lack of emotional awareness. Difficulties in emotion regulation accounted for significant variance in PTSD, depression, and anxiety/insomnia beyond demographics and trauma exposure. When predicting social impairment, difficulties in emotion regulation accounted for significant variance beyond PTSD and anxiety/insomnia but not beyond depression. The findings indicate that emotion regulation may be a transdiagnostic key factor contributing to symptoms of different mental disorders as well as social impairment in trauma-exposed refugees. It highlights the need and potential directions for transdiagnostic interventions that target these difficulties. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Posttraumatic stress disorder (PTSD) symptoms are associated with significant emotion dysregulation, which in turn marks risk for greater symptom-related difficulties and psychiatric comorbidity. Individuals with PTSD symptoms who are high in anxiety sensitivity (AS; fear of anxiety and related sensations) may have particular difficulty managing negative affect, as they tend to perceive their trauma-related symptoms to be more threatening. The present study investigated the main and interactive effects of PTSD symptoms (PTSD Checklist for DSM-5) and AS (Anxiety Sensitivity Index-3) on emotion dysregulation (Difficulties in Emotion Regulation Scale-16) in a sample of 836 trauma-exposed firefighters (94.6% men; Mage = 38.5 years, SD = 8.5). Results of hierarchical linear regression models indicated that the main effects of PTSD symptom severity (β = .353, p < .001) and AS (β = .273, p < .001) were significantly positively associated with emotion dysregulation, accounting for 28.0% of variance. The interaction term accounted for an additional 2.0% of variance (β = .157, p < .001). Post hoc probing of simple slopes revealed that the strength of the association between PTSD symptom severity and emotion regulation was more than twice as strong for individuals high, compared to low, in AS. Exploratory analyses regarding subscales of the Difficulties in Emotion Regulation Scale-16 (i.e., Clarity, Goals, Impulse, Strategies, and Non-Acceptance) were also conducted. PTSD symptoms were associated with greater emotion dysregulation for all DERS-16 subscales; AS was associated with greater emotion dysregulation for all subscales with the exception of DERS-16 Impulse. AS moderated the association between PTSD symptoms and DERS-16 Strategies and DERS-16 Non-acceptance. Specifically, greater PTSD symptoms were associated with less access to emotion regulation strategies and greater non-acceptance of emotions for those high, compared to low, in AS. These findings provide novel information regarding the ways in which PTSD symptoms, AS, and emotion dysregulation are interrelated in trauma-exposed, active-duty firefighters.

Introduction: Cardiovascular disease (CVD) remains the leading cause of death among women in the United States. Although premenopausal women are thought to be protected from CVD, trauma exposure increases their CVD risk. Poor sleep – a CVD risk factor – is common after trauma exposure. Further, accumulating evidence suggests that vascular dysfunction is independently associated with CVD. However, the link between sleep and vascular function in otherwise healthy, trauma-exposed young women is not known. Therefore, the purpose of the present study was to investigate the individual and combined effects of sleep quality and post-traumatic stress disorder (PTSD) symptom severity on endothelial function and arterial stiffness. Methods: We recruited 42 otherwise healthy women (18 –­ 40 years) from diverse backgrounds who had been exposed to trauma. We successfully collected data on sleep, vascular function, depression and PTSD symptom severity in 35 women, across two visits. Sleep efficiency (SE) was objectively measured as the relative time (%) spent asleep while in bed, using wrist actigraphy. Participants wore the ActiWatch for seven days between visits. During visit one, PTSD symptom severity was assessed using the PTSD checklist for DSM 5 (PCL5) and depressive symptom severity with the Beck Depression Inventory (BDI). At visit two, we assessed endothelial function via reactive hyperemia index (RHI) using peripheral arterial tone and arterial stiffness via pulse wave velocity (PWV) using applanation tonometry. Results: Participants’ mean age and body mass index (BMI) were 27±7 years and 27±6 kg/m2 respectively. Mean systolic and diastolic blood pressures were 103±9 and 67±8 mmHg respectively, and heart rate was 74±12 bpm. SE was positively correlated with RHI (r=0.35, p=0.019), and negatively correlated with PWV (r=-0.46, p=0.004). PCL5 score was negatively correlated with RHI (r=-0.52, p&lt;0.001), and not PWV (r=0.12, p=0.253). Additionally, a positive association was observed between age and PWV (r=0.50, p=0.001). BDI score was only correlated with PCL5 (r=0.60, p&lt;0.001). Next, to explore the predictive value of SE and PCL5 on RHI and PWV, we conducted separate multiple linear regression models with SE, PCL5 scores and age as predictors. The model predicting RHI was significant (R2=0.48, p&lt;0.001), with PCL5 emerging as the strongest predictor (β=-0.56, p&lt;0.001). Similarly, the model predicting PWV was significant (R2=0.45, p&lt;0.001), with both SE and age as the strongest predictors (β=-0.44, p=0.004 and β=0.49, p=0.001, respectively). Conclusion: Our results suggest that poor sleep may contribute to increased arterial stiffness after trauma exposure, while endothelial dysfunction could be driven by PTSD symptom severity. These findings could serve to distinguish trauma-exposed women at risk of CVD and identify specific interventions (i.e., targeting sleep efficiency or PTSD symptoms) to prevent or delay vascular dysfunction. UL1TR002494, NIH K01HL161027 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

To investigate emotion regulation difficulties in association with self-reported insomnia symptoms, nightmares, and depression symptoms in a sample of current and retired firefighters. A total of 880 current and retired United States firefighters completed a web-based survey of firefighter behavioral health. Self-report measures included the Center for Epidemiologic Studies Depression Scale, Insomnia Severity Index, PTSD Checklist, and Difficulties in Emotion Regulation Scale. A notable portion of participants reported clinically significant depression symptoms (39.6%) and insomnia symptoms (52.7%), as well as nightmare problems (19.2%), each of which demonstrated a strong association with emotion regulation difficulties (rs = 0.56-0.80). Bootstrapped mediation analyses revealed that the indirect effects of overall emotion regulation difficulties were significant both for the relationship between insomnia and depression (95% CI: 0.385-0.566) and nightmares and depression (95% CI: 1.445-2.365). Limited access to emotion regulation strategies emerged as the strongest, significant indirect effect for both relationships (insomnia 95% CI: 0.136-0.335; nightmares 95% CI: 0.887-1.931). Findings extend previous affective neuroscience research by providing evidence that insomnia and nightmares may influence depression symptoms specifically through the pathway of explicit emotion regulation difficulties. Sleep disturbances may impair the ability to access and leverage emotion regulation strategies effectively, thus conferring risk for negative affect and depression.

BackgroundPatients with depression struggle with significant emotion regulation difficulties, which adversely affect their psychological well-being and hinder recovery. Traditional therapeutic approaches often fail to adequately address these challenges, leading to a persistent gap in effective mental health care. This research seeks to address this gap by investigating the impact of emotion regulation skills training on patients with depression.AimTo assess the difficulties in emotion regulation among patients with depression and evaluate the impact of an emotion regulation skills training intervention on those with higher levels of emotion regulation difficulties, specifically focusing on increasing the use of adaptive emotion regulation strategies and reducing the use of maladaptive emotion regulation strategies.MethodA quasi-experimental research design was utilized, using three tools: a socio-demographic and Clinical Data structured interview schedule, Difficulties in Emotional Regulation Scale, and Cognitive Emotion Regulation Questionnaire. Eighty patients with depression were recruited to assess those with higher levels of emotion regulation difficulties; out of those with greater difficulties, 30 patients were chosen to participate in the emotion regulation skills training intervention.ResultThe 80 studied subjects' emotion regulation difficulties scores ranged from 158 to 169 (164.5 ± 3.21), and they indicated less use of adaptive cognitive emotion regulation strategies and more use of maladaptive cognitive emotion regulation strategies (56.07 ± 2.67). Regarding the intervention group, the overall mean score of the 30 patients’ emotion regulation difficulties decreased from 167.35 ± 2.21 pre-intervention to 105.85 ± 3.33 post-intervention (p < 0.0001). Cognitive emotion regulation total scores improved markedly from 54.07 ± 1.66 to 35.2 ± 3.46 (p < 0.01).ImplicationHealthcare providers should routinely assess emotion regulation difficulties in patients with depression and integrate personalized treatment plans that target individual emotion regulation difficulties.ConclusionThe findings suggest that the emotion regulation intervention has the potential to improve emotion regulation difficulties and cognitive emotion regulation strategies among patients with depression.

Evidence describing the association between sleep quality and trauma-focused therapy is mixed. This secondary analysis of a primary care sample examined whether (a) baseline sleep quality moderated posttraumatic stress disorder (PTSD) symptom severity over time across groups receiving different doses of cognitive processing therapy (CPT) and (b) sleep quality improved over time with CPT. Participants were 227 adults who screened positive for PTSD and were participating in a clinical trial comparing two models of PTSD treatment delivery in primary care. The Pittsburgh Sleep Quality Index (PSQI) and PTSD Checklist for DSM-5 (PCL-5) were used to assess sleep disturbance and PTSD symptom severity, respectively. Multiple linear regression was used to assess whether baseline PSQI scores moderated 12-month PCL-5 scores across CPT dosage groups (0 sessions: 51.1%, 1-7 sessions: 31.7%; ≥ 8 sessions [adequate dose]: 17.2%) and whether PSQI scores differed by group at 12-month follow-up. Post hoc analyses examined changes in PCL-5 sleep disturbance items. Baseline sleep disturbance did not moderate the effect of CPT on PTSD severity among participants with an adequate CPT dose, p>.112.Sleep quality improved with adequate dose, B = -2.63, SE = 0.75,p<.001. Differences in change scores across groups for PCL-5 Item 2,F(2, 435) = 11.34,and Item 20,H(2) = 32.04, indicated that participants with an adequate CPT dose had greater reductions in trauma-related sleep symptoms than those who received 0-7 sessions, ps <.001. Residual post-CPT sleep impairment despite adequate PTSD improvement warrants further interventions.

Frédéric Fanget Toujours mieux! Psychologie du perfectionnisme 2006 Éditions Odile Jacob Paris 11-14

Évaluation multidimensionnelle de la régulation des émotions : propriétés psychométriques d’une version francophone du Difficulties in Emotion Regulation Scale