Baseline Posttraumatic Stress Disorder Symptoms Research Articles

Protocol for individual participant data meta-analysis of interventions for post-traumatic stress

IntroductionSeveral evidence-based treatments are effective for post-traumatic stress disorder (PTSD), yet a substantial proportion of patients do not respond or dropout of treatment. We describe the protocol for a systematic...

Distress tolerance: prospective associations with cognitive-behavioral therapy outcomes in adults with posttraumatic stress and substance use disorders

ABSTRACT 74Distress tolerance (DT; perceived or actual ability to tolerate aversive physical or emotional states) is related to both posttraumatic stress disorder (PTSD) symptoms and substance use disorders (SUD). This investigation evaluates self-report and behavioral measures of DT as potential predictors of PTSD and SUD cognitive-behavioral therapy outcomes. Participants included 41 treatment-seeking adults (53.7% women; 73.2% African American; M age = 44.90, SD = 9.68) who met at least four symptoms of DSM-5 PTSD and DSM-IV substance dependence, assessed via structured interviews. At baseline (pre-treatment), participants completed the Distress Tolerance Scale (DTS), Mirror-Tracing Persistence Task (MTPT), Breath Holding task, and Paced Auditory Serial Addition Task. The Clinician-Administered PTSD Scale for DSM-5 severity scores and percent days of primary substance use, measured via Timeline Follow-back, were used as indicators of PTSD symptoms and substance use, respectively. Covariates included treatment condition, baseline PTSD symptom severity, and baseline substance use. Lower perceived DT at baseline (DTS total score) was associated with higher PTSD symptom severity at end-of-treatment. Lower behavioral DT at baseline (MTPT duration) was associated with higher substance use at the conclusion of treatment (i.e. proportion of number of use days to total number of days between two final treatment sessions).

Longitudinal associations between hair cortisol, PTSD symptoms, and sleep disturbances in a sample of firefighters with duty-related trauma exposure

Several studies have found evidence of altered cortisol levels in patients with posttraumatic stress disorder (PTSD). Based on these findings, it is assumed that these patients may show signs of cortisol dysregulation after trauma. Posttrauma cortisol levels are thus considered a potential biomarker of PTSD. However, longitudinal studies using indicators of long-term cortisol secretion such as hair cortisol concentrations (HCC) are scarce. The current study investigated prospective associations between HCC and PTSD symptoms in a sample of Dutch firefighters taking into account varying levels of work-related trauma severity. In addition, we assessed posttraumatic sleep disturbances as a secondary outcome measure to investigate whether effects generalize to this frequent comorbidity of PTSD. Three hundred seventy-one Dutch firefighters with a mean of 14.01 years of work experience were included in the analyses. Baseline assessment included the collection of hair samples and the measurement of work-related trauma severity, PTSD symptoms, and sleep disturbances. PTSD symptoms and sleep disturbance were re-assessed after six and twelve months. Multilevel analyses indicate a significant positive correlation between HCC and baseline PTSD symptoms in those with average or above-average work-related trauma severity. A similar pattern was evident for posttraumatic sleep disturbances at baseline. Moreover, higher HCC predicted more posttraumatic sleep disturbances after 6 months in participants with above-average work-related trauma severity. No other associations emerged for PTSD symptoms or posttraumatic sleep disturbances at six or twelve months. As such, our study supports the existence of a cross-sectional association between HCC and trauma symptoms, which may vary for different levels of subjective trauma severity. The longitudinal stability of this association should be reinvestigated by future research.

Personalization of Treatment for Patients with Childhood-Abuse-Related Posttraumatic Stress Disorder.

Background: Differences in effectiveness among treatments for posttraumatic stress disorder (PTSD) are typically small. Given the variation between patients in treatment response, personalization offers a new way to improve treatment outcomes. The aim of this study was to identify predictors of psychotherapy outcome in PTSD and to combine these into a personalized advantage index (PAI). Methods: We used data from a recent randomized controlled trial comparing prolonged exposure (PE; n = 48), intensified PE (iPE; n = 51), and skills training (STAIR), followed by PE (n = 50) in 149 patients with childhood-abuse-related PTSD (CA-PTSD). Outcome measures were clinician-assessed and self-reported PTSD symptoms. Predictors were identified in the exposure therapies (PE and iPE) and STAIR+PE separately using random forests and subsequent bootstrap procedures. Next, these predictors were used to calculate PAI and to retrospectively determine optimal and suboptimal treatment in a leave-one-out cross-validation approach. Results: More depressive symptoms, less social support, more axis-1 diagnoses, and higher severity of childhood sexual abuse were predictors of worse treatment outcomes in PE and iPE. More emotion regulation difficulties, lower general health status, and higher baseline PTSD symptoms were predictors of worse treatment outcomes in STAIR+PE. Randomization to optimal treatment based on these predictors resulted in more improvement than suboptimal treatment in clinician assessed (Cohens’ d = 0.55) and self-reported PTSD symptoms (Cohens’ d = 0.47). Conclusion: Personalization based on PAI is a promising tool to improve therapy outcomes in patients with CA-PTSD. Further studies are needed to replicate findings in prospective studies.

Predictors of Attrition and Response in Cognitive Processing Therapy for Interpersonal Trauma Survivors with PTSD.

With the establishment of empirically validated treatments for posttraumatic stress disorder (PTSD), concerns remain regarding the effectiveness of such treatments in real-world clinical settings. Specifically, premature termination and treatment response limit the effectiveness of these interventions. The current study investigated factors potentially related to premature termination and treatment response in Cognitive Processing Therapy with Account (CPT-A). Participants in this study included 42 women (Mage = 30.70 SDage = 9.40) with PTSD from exposure to interpersonal trauma. Demographic characteristics, pre-treatment symptoms of PTSD and depression, and transdiagnostic factors were examined as predictors of attrition and treatment response. Hierarchical regression and logistic regression models were analyzed to test the variance explained and predictive value of these factors. The present study revealed that age was a significant factor related to dropout from CPT-A whereas baseline PTSD symptom severity was significantly related to treatment response. Results of this study suggest the importance of the interrelationships among pre-treatment predictors as well as the consideration of attrition and treatment response as distinct metrics of treatment outcome. Further, these results inform the application of CPT-A for PTSD in survivors of interpersonal trauma, as consideration of the identified predictors of dropout and non-response at intake may contribute to treatment retention and response.

Perceived resilience and social connection as predictors of adjustment following occupational adversity.

The present research examined social connection as a mediator through which perceived resilience prior to a combat deployment predicts fewer posttraumatic stress disorder (PTSD) symptoms for soldiers exposed to high levels of combat. Soldiers (N = 1,222) completed the Brief Resilience Scale (BRS) and a measure of PTSD symptoms prior to deploying to Afghanistan (Time 1) and measures of combat exposure and social connection immediately after the deployment (Time 2). Soldiers then completed measures of PTSD symptoms at 3 months (Time 3) and 10-12 months (Time 4) following the deployment. Within the context of the Conservation of Resources (COR) model, perceived resilience and social connection represented personal and social resources that allow military personnel to demonstrate better mental health when confronted with the traumatic stressor of combat exposure. Perceived resilience prior to the deployment interacted with combat exposure to predict PTSD symptoms at Time 3 and Time 4 after controlling for baseline PTSD symptoms. Perceived resilience was more strongly related to PTSD symptoms under higher levels of combat exposure. Moderated mediation models provided support for social connection as a mediator of the relationship between perceived resilience at baseline and PTSD symptoms at Time 3 and 4 under higher levels of combat exposure. The results provide some of the first empirical evidence regarding the predictive value of perceived resilience prior to potentially traumatic exposure and document social connection as an important resource linking perceived resilience to positive adaptation after adversity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Predicting response to Cognitive Processing Therapy for PTSD: A machine-learning approach

Cognitive Processing Therapy (CPT) is an effective treatment for posttraumatic stress disorder (PTSD); however, not every client achieves optimal outcomes. Data were pooled from four randomized trials in which female interpersonal trauma survivors completed CPT (N = 179). Random forests of classification trees were used to investigate the role of both baseline (e.g., demographics, trauma history, comorbid disorders) and session PTSD and depressive symptom scores on predicting trajectory and outcome. Of particular focus was whether those on track for poor outcome (e.g., non-response, partial treatment response) could be identified early in therapy. Results demonstrated inconsistent findings for discrimination between delayed responders (no early change but full response after 12 weeks of therapy) and those who either showed a partial response to treatment or did not respond at all; level of discrimination depended on the assessment point under study and the chosen comparison group. Those defined as clear and early responders, however, could be reliably differentiated from the other groups by session 4. Although it is possible to identify clients who will recover from PTSD by the middle of the CPT protocol, further work is needed to accurately identify those who will ultimately not recover from PTSD during a course of CPT.

A study examining whether social cognitive abilities impact on recovery from PTSD

AimsDeficits in social cognition (the ability to recognise and understand emotions, intentions and actions in oneself and in others) have been found in people with post-traumatic stress disorder (PTSD). Few studies so far have examined whether social cognitive ability impacts on PTSD recovery. Here we present a protocol and preliminary data for a study that aims to evaluate whether pre-treatment social cognitive deficits are associated with treatment outcomes following trauma-focused therapy for PTSD.MethodThe protocol was developed after discussion with Patient and Public Involvement (PPI) groups, and a battery of social cognitive tasks was trialled on 20 participants without PTSD. The final protocol was then developed using information and feedback from these preliminary studies. We aim to recruit 60 individuals who are about to start a trauma-focused therapy for PTSD within the two tertiary PTSD services. Social cognition (measured using a variety of tasks including Reading the Mind in the Eyes Task and the Reflective Functioning Questionnaire) and potential confounders (including severity of trauma history, attachment and verbal IQ) are assessed at baseline, prior to the start of therapy. PTSD symptom severity (measured using the PCL-5) and daily functioning (measured using the WSAS) are assessed pre and post-treatment. The primary aim of the study is to examine whether baseline social cognition is associated with the degree of improvement in the PCL-5.ResultSo far 29 participants have been recruited and consented. 6 participants have completed follow-up assessments. The study has been adapted for the COVID-19 pandemic so participants can complete the tasks remotely. Preliminary results show a moderate negative correlation between baseline social cognitive abilities and baseline PTSD symptom severity (Spearman's correlation -0.30) and functional abilities (Spearman's correlation -0.42).ConclusionDevelopment of our study in collaboration with PPI and preliminary testing of measures suggests it is likely that it will be feasible for us to conduct this study in this patient group. Baseline preliminary results show/suggest a moderate correlation between PTSD symptom severity and social cognitive impairment. Our main analyses, when completed, will help to determine whether social cognitive ability is associated with recovery from PTSD.

729 Daily stress and nightmares are bidirectionally associated among nurses

Abstract Introduction Nurses may experience frequent nightmares due to stressful work environments. Some studies estimate that 35% of nurses experience nightmares related to experiences at work. Nightmares may also exacerbate stress among nurses, although this has yet to be tested empirically. We examined daily bidirectional associations between stress severity and nightmare occurrence and severity, and whether posttraumatic stress disorder (PTSD) symptoms moderated those relationships. Methods 392 nurses (mean age = 39.54 years; SD = 11.15; 92% female; 78% White) were recruited for a larger study on sleep and vaccine response. For 14 days, upon awakening, nurses completed daily sleep diaries to assess previous-day stress severity (0 = not at all, 4 = extremely), as well as nightmare occurrence (0 = no nightmare, 1 = nightmare occurred) and nightmare severity (0 = not at all, 3 = very). PTSD symptoms were assessed at baseline using the PTSD Checklist of DSM-5 (PCL-5). Multilevel models were used to examine bidirectional, within-person associations between daily stress and nightmares, and cross-level moderation by baseline PTSD symptoms. Results Approximately 10.5% of nurses met criteria for PTSD based on PCL-5 scores. 47.2% of nurses reported at least one nightmare across the two weeks. Days with greater stress severity were associated with higher odds of experiencing a nightmare (OR = 1.22, p = 0.001), as well as greater nightmare severity that night (b = 0.09, p = 0.033). Nightmare occurrence (b = 0.15, p < 0.001) was associated with greater next-day stress severity. PTSD symptoms did not moderate daily stress and nightmare associations. Conclusion Nurses face intense occupational demands and frequent exposure to potentially traumatic events. Our results indicated nightmares and stress may occur in a bidirectional fashion among nurses. Results were similar regardless of nurses’ PTSD status. Future studies should explore whether targeting nightmares and stress may improve nurses’ health and well-being. Given the essential role that nurses play in maintaining patient health and safety, it is critical to understand the causes and consequences of their sleep-related disturbances. Support (if any):

Hippocampal activation during contextual fear inhibition related to resilience in the early aftermath of trauma

BackgroundImpaired contextual fear inhibition is often associated with posttraumatic stress disorder (PTSD). Our previous work has demonstrated that more hippocampal activation during a response inhibition task after trauma exposure was related to greater resilience and fewer future PTSD symptoms. In the current study, we sought to extend our previous findings by employing a contextual fear conditioning and extinction paradigm to further determine the role of the hippocampus in resilience and PTSD in the early aftermath of trauma. MethodsParticipants (N = 28) were recruited in the Emergency Department shortly after experiencing a traumatic event. A contextual fear inhibition task was conducted in a 3 T MRI scanner approximately two months post-trauma. Measures of resilience (CD-RISC) at time of scan and PTSD symptoms three months post-trauma were collected. The associations between hippocampal activation during fear conditioning and during the effect of context during extinction, and post-trauma resilience and PTSD symptoms at three-months were assessed. ResultsDuring fear conditioning, activation of the bilateral hippocampal region of interest (ROI) correlated positively with resilience (r = 0.48, p = 0.01). During the effect of context during extinction, greater bilateral hippocampal activation correlated with lower PTSD symptoms three months post-trauma after controlling for baseline PTSD symptoms, age and gender (r=-0.59, p=0.009). ConclusionsGreater hippocampal activation was related to post-trauma resilience and lower PTSD symptoms three months post-trauma. The current study supports and strengthens prior findings suggesting the importance of hippocampus-dependent context processing as a mechanism for resilience versus PTSD risk, which could be a potential mechanistic target for novel early interventions.

What goes around comes around: Nightmares and daily stress are bidirectionally associated in nurses.

Nurses may experience frequent nightmares due to stressful work environments. Nightmares may also exacerbate stress among nurses, although this has yet to be tested empirically. We examined daily bidirectional associations between stress severity and nightmares, and moderation by post-traumatic stress disorder (PTSD) symptoms. 392 nurses (92% female; 78% White) completed 14 days of sleep diaries to assess previous-day stress severity and nightmare occurrence and severity. PTSD symptoms were assessed at baseline. Multilevel models were used to examine bidirectional, within-person associations between daily stress and nightmares, and cross-level moderation by baseline PTSD symptoms. 47.2% of nurses reported at least one nightmare across the two weeks. Days with greater stress were associated with higher odds of experiencing a nightmare (OR=1.22, p=0.001), as well as greater nightmare severity (b=0.09, p=0.033). Nightmare occurrence was associated with greater next-day stress severity (b = 0.15, p < 0.001). Daily stress and nightmare associations were similar for those with and without PTSD symptoms. Nightmares and stress may occur in a bidirectional fashion. Nurses face intense occupational demands and frequent exposure to potentially traumatic events. Studies should explore whether targeting nightmares and stress may improve nurses' health and well-being.

Emotion regulation and the association between PTSD, diet, and exercise: a longitudinal evaluation among US military veterans

ABSTRACT Background: Posttraumatic stress disorder (PTSD) is associated with premature onset of chronic health conditions such as cardiovascular disease. Diet and exercise are behavioural contributors to physical health, and research suggests they are influenced by psychiatric symptoms, including PTSD. Objectives: The aim of this study was to examine longitudinal associations between PTSD and exercise and diet quality and to test if emotion regulation strategies contribute to the link between PTSD and these health behaviours. Method: A representative sample of US military veterans (n = 860 at Time 1, n = 503 at Time 2, mean age = 63 years, 91.5% male) were assessed twice over the course of approximately three years. Results: Mediation models revealed that the association between baseline PTSD symptom severity and subsequent diet quality was mediated by emotion suppression (measured at Time 2; indirect B = −.03; 95% CI: −.059 to −.002). Trauma exposure also directly predicted diet quality (B = −.31; p = .003). There were no significant direct or indirect associations between PTSD severity or trauma exposure and exercise engagement. Conclusions: These results suggest that PTSD symptoms are associated with worse diet quality and that the consumption of unhealthy food may be driven by efforts to suppress emotion. This carries implications for understanding and treating medical comorbidities among those with traumatic stress.

Neighborhood disadvantage is associated with stable deficits in neurocognitive functioning in traumatically-injured adults.

In trauma-exposed adults, the relationship between an individual's socioeconomic position (SEP) and post-traumatic stress disorder (PTSD) has been well demonstrated. One potential mechanism by which the stress associated with lower SEPs may impact trauma outcomes is through changes in neurocognition. In both healthy and clinical samples, area-level factors also appear to be independently related to neurocognition. Far less is known about how neighborhood socioeconomic disadvantage, may impact cognition in traumatically-injured adults. The current study employed hierarchical linear modeling to longitudinally investigate whether neighborhood disadvantage was associated with neurocognitive functioning in five domains: processing speed, sustained attention, controlled attention, cognitive flexibility, and response inhibition. One-hundred and ninety-five socioeconomically diverse traumatically-injured subjects (mean age=32.8, 52.8% female) were recruited from an Emergency Department. Two-weeks, three-months, and six-months post-trauma, participants completed self-report measures and a computerized test battery to evaluate neurocognition. An Area Deprivation Index (ADI) score, a measure of a neighborhood's socioeconomic disadvantage, was derived from each participants' home address. Greater neighborhood disadvantage was significantly related to lower scores in all domains. Results of hierarchical linear models revealed neighborhood disadvantage was significantly associated with processing speed, controlled attention, cognitive flexibility, and response inhibition across time, even after adjusting for individual annual household income, baseline PTSD symptoms, and previous adverse life experiences. This relationship was stable for all domains except sustained attention, which varied across time. These findings indicate neighborhood disadvantage contributes uniquely to neurocognitive functioning and, for the majority of domains, these contributions are stable across time. The relationship between area-level variables and cognitive function may underlie individual vulnerability to developing psychiatric disorders. Future work should continue to examine the interaction between socioenvironmental stressors and PTSD symptoms longitudinally.

Impact of disaster exposure severity: Cascading effects across parental distress, adolescent PTSD symptoms, as well as parent-child conflict and communication.

Natural disasters are common and have potentially deleterious impacts on individuals, as well as on the relationships among family members (Adams et al., 2015; Paul, 2015). Additionally, caregiver-, offspring-, and family-level outcomes are often correlated following disaster. Thus, longitudinal work is needed to clarify the prospective associations among such constructs following severe disasters. The current study included 1,271 adolescents and investigated whether disaster exposure impacted adolescent posttraumatic stress disorder (PTSD) symptoms, parent distress, and family parent-child conflict and communication, as well as whether/how these factors influenced one another over time. This study used a dynamic cascade model and included adolescents (ages 12-17) and caregivers present for tornadoes in Missouri and Alabama in 2011. These participants were part of a larger study involving a web-based intervention. Over and above covariates (i.e., adolescent age, gender, race, treatment, prior trauma, adolescent alcohol use and depressive symptoms, and household income), families who experienced greater severity of disaster exposure had adolescents who reported more baseline PTSD symptoms and caregivers who reported more distress at baseline. Providing tangible resources (e.g., housing, food, transportation, essential possessions) to families post-disaster may reduce parent distress and adolescent PTSD symptoms. Additionally, reducing adolescent PTSD symptoms may prospectively improve relationships between parents and adolescents.

Exposure-related cortisol predicts outcome of psychotherapy in veterans with treatment-resistant posttraumatic stress disorder

BackgroundHypothalamic-pituitary-adrenal axis functioning has been related to treatment outcome in posttraumatic stress disorder (PTSD). Previous studies have primarily focused on cortisol levels before and after a course of therapy and findings have not been fully consistent. This study investigated session-related cortisol levels in veterans with treatment-resistant PTSD over the course of a novel motion-assisted virtual reality exposure therapy and aimed to determine whether cortisol levels were related to changes in PTSD symptom severity. MethodsVeterans (N = 22) received six exposure sessions during which salivary cortisol samples were collected pre-session, post-session and in the late afternoon following sessions. PTSD symptom severity was assessed by structured clinical interviews at pre- and post-treatment. Average cortisol levels were compared between responders and non-responders. Linear regression analyses were conducted with PTSD symptom change as criterion variable, average cortisol levels as predictor, and timing of sampling and baseline PTSD symptoms as covariates. ResultsResponders to treatment tended to have higher average cortisol levels at pre-session (p = 0.064) and post-session (p = 0.050) compared to non-responders. Higher average pre-session and post-session cortisol levels predicted greater PTSD symptom improvement (pre: b = −1.83, p = 0.009; post: b = −3.57, p = 0.004). ConclusionThis study provides preliminary evidence for session-related cortisol as biomarker of response to exposure-based therapies for PTSD. Higher cortisol levels may have facilitated fear extinction and reconsolidation, and may indicate increased physiological stress activation necessary for appropriate treatment engagement. Further work involving comparable methodology is encouraged to establish session-related cortisol as biomarker and to determine the mechanisms through which it interacts with treatment outcome.

A Randomized Trial of Modified Prolonged Exposure to Prevent the Development of Posttraumatic Stress Disorder in Patients Hospitalized With Traumatic Injuries.

Individuals who require hospitalization after traumatic injuries are at increased risk for developing posttraumatic stress disorder (PTSD); however, few early behavioral interventions have been effective at preventing PTSD within this population. The aim of this pilot study was to assess the feasibility and effectiveness of modified prolonged exposure therapy (mPE) to prevent PTSD and depression symptoms among patients hospitalized after a DSM-5 single-incident trauma. Hospitalized patients were eligible if they screened positive for PTSD risk. Participants (N = 74) were randomly assigned in a parallel-groups design to receive mPE (n = 38) or standard of care treatment (SoC; n = 36) while admitted to the hospital after a traumatic injury. Individuals randomized to the intervention condition received one (42.1%), two (36.8%), or three sessions (15.8%) of mPE, mainly depending on length of stay. There were no significant differences between groups regarding PTSD or depression severity at 1- or 3-months posttrauma, except for more PTSD diagnoses in the intervention group after 1 month, ϕ = -.326. Intervention differences were nonsignificant when we took baseline PTSD symptoms and the nonindependence of the repeated measurements within the data into account. No adverse events were reported. Overall, mPE was no more effective than SoC for hospitalized, traumatic injury survivors with a high PTSD risk. The results may point to a need for a stepped-care approach, where intervention protocols focus on first briefly treating individuals who are actively exhibiting acute stress reactions, then extensively treating those whose symptoms do not decrease over time.

A Preliminary Examination of Endogenous Peripheral Oxytocin in a Pilot Randomized Clinical Trial of Oxytocin-Enhanced Psychotherapy for Posttraumatic Stress Disorder.

Preclinical and clinical research suggests that the oxytocin system is implicated in the development and maintenance of stress and anxiety-related psychiatric conditions, such as posttraumatic stress disorder (PTSD). Recent research also suggests that intranasal oxytocin holds promise as a treatment for PTSD. However, little is known about the relationship between levels of peripheral oxytocin and PTSD symptom severity, PTSD treatment response, and repeated intranasal oxytocin administration. In the current study, we examined associations between PTSD symptom severity and peripheral oxytocin levels measured in plasma before and after a course of prolonged exposure (PE) for PTSD (n = 13); participants were randomized to adjunctive intranasal oxytocin (n = 6) or placebo (n = 7). Baseline peripheral oxytocin levels were not associated with baseline PTSD symptom severity. Change in peripheral oxytocin levels did not differ by treatment condition and did not correspond to change in PTSD symptoms. This proof-of-concept study illustrates the acceptability and feasibility of measuring peripheral oxytocin among individuals engaged in psychotherapy for PTSD and informs the utilization of these procedures in future adequately powered studies.

Emotion Dysregulation Prospectively Predicts Posttraumatic Stress Disorder Symptom Severity 3 Months After Trauma Exposure.

Despite growing evidence in support of emotion dysregulation as a risk factor for the development of posttraumatic stress disorder (PTSD) following trauma exposure, few studies have examined temporal relations between emotion dysregulation and the onset and/or worsening of PTSD symptoms over time. The aim of the present study was to extend research on temporal associations between emotion dysregulation and PTSD in a sample of individuals recruited from hospital emergency departments soon after a traumatic event. Adult participants (N = 85; 62.4% female) completed self-report measures of emotion dysregulation and PTSD symptoms within 2 weeks of experiencing a traumatic event. Symptoms of PTSD were assessed approximately 3 months posttrauma. The results of a hierarchical linear regression analysis demonstrated that the inclusion of emotion dysregulation accounted for a significant amount of unique variance, β = .23, ΔR2 = .04, p = .042, in 3-month PTSD symptom severity over and above other risk factors and baseline PTSD symptoms. No specific facet of emotion dysregulation emerged as a significant predictor of 3-month PTSD symptoms when all facets were included on the same step of the model, βs = -.04-.33, ps = .133-.954. These results demonstrate that posttraumatic emotion dysregulation may predict PTSD symptoms 3 months after trauma exposure. These findings are consistent with a growing body of literature that speaks to the relevance of emotional processes to the onset and maintenance of PTSD following exposure to a traumatic event.

Sleep disturbance underlies the co-occurrence of trauma and pediatric chronic pain: a longitudinal examination.

Epidemiological and cross-sectional studies have shown that post-traumatic stress disorder symptoms (PTSS) are common and impairing in youth with chronic pain. Yet, the co-occurrence of PTSS and pediatric chronic pain has not been examined longitudinally, which has limited understanding of theoretically proposed mechanisms (eg, sleep disturbance) underlying the PTSS-pain relationship over time. This longitudinal study aimed to fill this gap. Participants included 138 youth (Mage = 14.29, 75% girls) referred to a tertiary-level outpatient chronic pain program and one of their parents. At baseline, youth reported their pain intensity and interference, PTSS, and subjective sleep disturbances (ie, sleep quality and insomnia). Youth and parents completed semistructured diagnostic interviews to determine the child's post-traumatic stress disorder diagnostic status, and youth completed an objective assessment of sleep patterns for 7 days using actigraphy. At 3-month follow-up, youth once again completed the diagnostic interview and reported their pain intensity, pain interference, and PTSS. Partially latent cross-lagged structural equation panel models revealed that, controlling for pain intensity, pain interference and PTSS co-occurred at baseline, but not at follow-up (while controlling for baseline levels). Higher levels of baseline PTSS were predictive of increases in pain interference at follow-up. Furthermore, subjective sleep disturbances mediated the relationship between baseline PTSS and follow-up pain interference. These findings lend support to conceptual models of PTSS-pain co-occurrence and highlight a critical need to assess and address trauma and sleep disturbances in youth with chronic pain.

Reciprocal processes in trauma and coping: Bidirectional effects over a four-year period.

Both trauma exposure and coping are strong predictors of mental health outcomes. There is evidence that trauma and coping are linked, with cross-sectional work suggesting that individuals with more trauma exposure show poorer coping ability (i.e., more avoidance coping, less approach coping). To date, no study has examined the temporal directionality of this association, a question with important clinical implications. Using a longitudinal data set over 4 years of college (N = 787), we examined bidirectional associations between trauma exposure and 3 coping styles (approach, avoidance, social support seeking). Our data analytic approach allowed us to examine both within-person and between-person effects, to better determine how change occurs at the individual level. Coping was assessed using the Brief Cope (Carver, 1997), and trauma exposure was assessed using the Traumatic Life Experiences Questionnaire (Kubany et al., 2000). Gender, baseline posttraumatic stress disorder symptoms, and precollege trauma were included as statistical control variables. The between-person effects were consistent with the cross-sectional literature. Interestingly, rather than an increase in avoidance coping and trauma exposure over time, the within-person findings suggested an adaptive cycle over time, in which increased trauma exposure marginally predicted an increase in approach coping (B = .05, p = .07), and approach coping predicted decreased trauma exposure (B = -.07, p = .04). Our study sheds new light on how coping and stressful events may impact one another across time. Findings suggest that a focus on approach-based coping skills may be an important direction for prevention efforts. (PsycINFO Database Record (c) 2020 APA, all rights reserved).