Greater Posttraumatic Stress Disorder Symptoms Research Articles

Multiple perpetrator sexual assault: correlates of PTSD and depressive symptoms in a sample of adult women

ABSTRACT While most sexual assaults are committed by a sole perpetrator, multiple-perpetrator assaults (MPSAs) still occur. However, less is known about their post-assault impacts. This study examined demographic, assault, and post-assault characteristics as correlates of post-traumatic stress disorder (PTSD) and depressive symptoms in a community sample of adult sexual assault survivors who experienced MPSA (N = 350) in the Chicago area. This study also included demographic and assault characteristics of perpetrators as reported by survivors. Backward regression analysis showed that stressful life events, more violent assaults, post-assault maladaptive coping and characterological self-blame, and receiving acknowledgement without support (e.g. acknowledging the assault happened, but giving inadequate support) reactions were related to greater PTSD symptoms. Older age and greater perceived control over recovery were associated with fewer PTSD symptoms. Greater violence, maladaptive coping, and characterological self-blame were related to greater depressive symptoms, whereas more education and greater perceived control over recovery correlated with fewer depressive symptoms. This study adds to research on MPSA and findings have implications for clinical treatment, intervention, and prevention with survivors.

Cardiovascular risk as a moderator of associations among anxiety sensitivity, distress tolerance, PTSD and depression symptoms among trauma-exposed firefighters

BackgroundFirefighters experience frequent and severe trauma exposure, which places them at elevated risk for posttraumatic stress disorder (PTSD) and major depression. Cardiovascular issues may exacerbate the effects of mental health risk factors, such as anxiety sensitivity (AS) and distress tolerance (DT), on PTSD and depression. The current study investigated cardiovascular risk as a moderator of associations between risk factors (AS and DT) and psychiatric symptoms (PTSD and depression) among firefighters. MethodsParticipants were 836 trauma-exposed active duty firefighters (93.90% men; with mean age 38 years, [SD = 9]). Participants endorsing at least one of three cardiovascular risk items—experiencing current high blood pressure, history of heart problems, and experiencing chest pains in the past 2 years—were considered high in cardiovascular risk. ResultsA structural equation model indicated that higher AS was associated with greater PTSD (β = 0.38, p < .01) and depression symptoms (β = 0.32, p < .01); lower DT was associated with greater PTSD (β = −0.18, p < .01) and depression symptoms (β = −0.31, p < .01). Multigroup analyses showed that cardiovascular risk moderated the association between 1) AS and PTSD symptoms, but not 2) AS and depression symptoms, 3) DT and PTSD symptoms, or 4) DT and depression symptoms. For those high in cardiovascular risk, higher AS was associated more strongly with greater PTSD symptoms (high cardiovascular risk group: β = 0.46, p < .01]; low cardiovascular risk group: β = 0.33, p < .01). ConclusionsHigh cardiovascular risk may contribute to PTSD symptoms among trauma-exposed firefighters with high AS. These results highlight the importance of considering physical and mental health vulnerabilities in first responder populations.

A-107 Historyt of Remote Mild TBI Predicts Poor Health-Related Quality of Life Outcomes in Military Veterans

Abstract Objective We examined health-related quality of life (QOL) in military Veterans with and without a history of mild traumatic brain injury (mTBI). Additionally, we investigated how mTBI injury characteristics modify health-related QOL. Method Veterans with a history of remote mTBI (n = 81) and military controls (MCs) without a history of mTBI (n = 62) completed self-report questionnaires measuring combat exposure, posttraumatic stress disorder (PTSD) and neurobehavioral symptoms, and health-related QOL. Primary outcomes included the eight subscales of the 36-Item Short-Form Survey (SF-36). Results ANCOVAs adjusting for combat exposure and PTSD symptoms found that the mTBI group demonstrated significantly more health-related QOL symptoms when compared to MCs across the following SF-36 subscales: General Health, Vitality, Bodily Pain, Physical Role Functioning, and Social Functioning (p = .001–.045, ηp2 = 0.03–0.07). Within the mTBI sample, repetitive mTBI, combat exposure, and PTSD and neurobehavioral symptoms collectively significantly predicted all five QOL subscales (all p’s &amp;lt; .001), accounting for roughly 33–53% of the total variance. Greater neurobehavioral symptoms were associated with lower Physical Role Functioning, Vitality, and Social Functioning scores; repetitive TBI was associated with higher Bodily Pain scores; greater PTSD symptoms were associated with lower Social Functioning scores; and greater combat exposure was associated with lower General Health scores. Conclusions Results suggest that, over and above PTSD and combat exposure, mTBI status independently contributes to health-related QOL. Moreover, specific dimensions of health-related QOL are influenced by different factors, with affective and vestibular-related neurobehavioral symptoms showing the strongest negative associations with health-related QOL. Findings highlight the need for comprehensive assessment and multimodal treatment within this vulnerable population.

Testosterone and Resting State Connectivity of the Parahippocampal Gyrus in Men With History of Deployment-Related Mild Traumatic Brain Injury.

The purpose of this study was to explore the effect of low testosterone level on whole-brain resting state (RS) connectivity in male veterans with symptoms such as sleep disturbance, fatiguability, pain, anxiety, irritability, or aggressiveness persisting after mild traumatic brain injury (mTBI). Follow-up analyses were performed to determine if sleep scores affected the results. In our cross-sectional design study, RS magnetic resonance imaging scans on 28 veterans were performed, and testosterone, sleep quality, mood, and post-traumatic stress symptoms were measured. For each participant, we computed the average correlation of each voxel's time-series with the rest of the voxels in the brain, then used AFNI's 3dttest++ on the group data to determine whether the effects of testosterone level on whole-brain connectivity were significant. We then performed follow-up region of interest-based RS analyses of testosterone, with and without sleep quality as a covariate. The study protocol was approved by the National Institute of Health's Combined Neuroscience Institutional Review Board. Sixteen participants reported repeated blast exposure in theater, leading to symptoms; the rest reported exposure to a single blast or a nonblast TBI. Thirty-three percent had testosterone levels <300ng/dL. Testosterone level was lower in participants who screened positive for post-traumatic stress disorder compared to those who screened negative, but it did not reach statistical significance. Whole-brain connectivity and testosterone level were positively correlated in the left parahippocampal gyrus (LPhG), especially in its connectivity with frontal areas, the lingual gyrus, cingulate, insula, caudate, and right parahippocampal gyrus. Further analysis revealed that the effect of testosterone on LPhG connectivity is only partially mediated by sleep quality. Sleep quality by itself had an effect on connectivity of the thalamus, cerebellum, precuneus, and posterior cingulate. Lower testosterone levels were correlated with lower connectivity of the LPhG. Weaknesses of this study include a retrospective design based on self-report of mTBI and the lack of a control group without TBI. Without a control group or pre-injury testosterone measures, we were not able to attribute the rate of low testosterone in our participants to TBI per se. Also testosterone levels were checked only once. The high rate of low testosterone level that we found suggests there may be an association between low testosterone level and greater post-traumatic stress disorder symptoms following deployment, but the causality of the relationships between TBI and deployment stress, testosterone level, behavioral symptomatology, and LPhG connectivity remains to be determined. Our study on men with persistent symptoms postdeployment and post-mTBI may help us understand the role of low testosterone and sleep quality in persistent symptoms and may be important in developing therapeutic interventions. Our results highlight the role of the LPhG, as we found that whole-brain connectivity in that region was positively associated with testosterone level, with only a limited portion of that effect attributable to sleep quality.

PTSD Symptoms, Suicidal Ideation, and Suicide Risk in University Students: The Role of Distress Tolerance

ABSTRACT Posttraumatic stress disorder (PTSD) is associated with suicidal ideation and suicide attempts. Distress tolerance, or the perceived capacity to tolerate negative emotional states, is a cognitive-affective factor with clinical relevance to PTSD-suicide relations. No studies to date have examined the associations of PTSD symptoms, distress tolerance, and suicidal ideation or suicide risk among university students, a population at risk for suicidal ideation and behavior. It was hypothesized that greater PTSD symptom severity and lower perceived distress tolerance, respectively, would be associated with greater suicidal ideation and suicide risk; and that PTSD symptom severity would exert an indirect effect on suicidal ideation and risk through perceived distress tolerance. Covariates included trauma load, negative affectivity, and gender. Participants were comprised of 819 trauma-exposed university students (78.0% female; Mage = 22.0), who completed a battery of questionnaires. Mediation analyses were conducted, and results indicated that greater PTSD symptom severity and lower distress tolerance, respectively, were significantly associated with greater suicidal ideation and suicide risk. PTSD symptom severity exerted an indirect effect on suicidal ideation and suicide risk through perceived distress tolerance. Effects were demonstrated after controlling for theoretically relevant covariates. Clinical and research implications are discussed.

Emotional Nonacceptance, Distraction Coping and PTSD Symptoms in a Trauma-Exposed Adolescent Inpatient Sample

Emotional nonacceptance is associated with greater posttraumatic stress disorder (PTSD) symptoms among trauma-exposed youth. Similarly, the use of distraction as a coping strategy is associated with greater PTSD symptoms, yet synergistic relations between emotional nonacceptance and distraction coping among trauma-exposed youth have not been examined. The present study examined associations and interactive effects of emotional nonacceptance and distraction coping in relation to PTSD symptoms among trauma-exposed inpatient adolescents. Participants included 50 adolescents (52.0% female; Mage = 15.1 years, SD = .51; 44% White) receiving acute psychiatric care at an inpatient hospital. All participants reported experiencing at least one traumatic event and completed measures of emotion dysregulation, coping strategies, and PTSD symptoms. Analyses revealed a significant interaction between emotional nonacceptance and distraction coping in relation to PTSD symptoms (∆R2 = 0.05; B = 0.60, SE = 0.29; t = 2.06, p = 0.045; 95% CI [0.12, 1.18]). PTSD symptoms were most severe among youth who reported higher levels of emotional nonacceptance and greater use of distraction as a coping strategy. Difficulties accepting negative emotions, coupled with greater use of distraction as a coping mechanism, were associated with more severe PTSD symptoms. The importance of teaching adaptive coping mechanisms to trauma-exposed youth who experience difficulties accepting negative emotions is discussed.

Trauma exposure, mental health and tobacco use among vulnerable Syrian refugee youth in Jordan.

Little is known about tobacco use among youth exposed to armed conflicts, or the influence of trauma on tobacco use in this context. This study examined patterns of smoking by tobacco product and gender among Syrian refugee youth living in host communities in Jordan and assessed the associations of post-traumatic stress disorder (PTSD) and depression symptoms, trauma exposure and social support with current smoking status in boys and girls. Syrian refugee students (mean [standard deviation] age=14.9 [1.33] years) were identified through the public school system. Data were collected using an online Arabic questionnaire that included questions about demographics, trauma exposure, current smoking (cigarette and waterpipe), PTSD, depression and perceived social support. Logistic regression was used to assess the adjusted effects of independent variables on current smoking status. One in 7 boys and one in 14 girls were current smokers, with boys reporting greater tobacco use than girls. Among boys, current smokers reported significantly higher family member loss and lower perceived family social support than nonsmokers; among girls, current smokers also reported significantly higher family member loss as well as greater PTSD symptoms and lower perceived significant other/special person social support. Tobacco use is established among this vulnerable group. The findings highlight the potential role of psychosocial support for tobacco prevention and cessation strategies.

Posttraumatic stress disorder symptoms, relationship quality, and risky alcohol use among trauma-exposed students

Individuals with posttraumatic stress disorder (PTSD) are at increased risk for alcohol use disorder (AUD), in part due to the use of alcohol as a coping strategy. High quality romantic relationships can buffer individuals against risk for psychopathology; however, no studies have evaluated romantic relationship quality in risk for PTSD-AUD in non-clinical samples. The current study examined the main and interactive effects of PTSD symptoms and romantic relationship quality on alcohol consumption (i.e., past 30-day alcohol use quantity, frequency, and binge frequency) and alcohol-related consequences in a sample of 101 college students (78.2% women) with a history of interpersonal trauma (i.e., physical/sexual assault, excluding intimate partner violence) who reported being in a romantic relationship. Relationship quality significantly moderated the association between PTSD symptom severity and alcohol use quantity (B = −0.972, p = .016) and alcohol-related consequences (B = −0.973, p = .009), such that greater PTSD symptoms were associated with greater alcohol use quantity and consequences among those low, but not high, in relationship quality. The interaction between PTSD symptom severity and relationship quality in relation to binge drinking was marginally significant (B = −0.762, p = .063), and relationship quality did not significantly moderate the association between PTSD symptom severity and alcohol use frequency. The main effect of PTSD symptom severity was significantly associated with alcohol-related consequences, but no other alcohol outcomes; the main effect of relationship quality was not associated with alcohol use outcomes or consequences. High quality romantic relationships may serve as a buffer for young adults at risk for alcohol problems.

Measuring ICD shock anxiety: Status update on the Florida Shock Anxiety Scale after over a decade of use

Approximately 44% of patients with implantable cardioverter defibrillators (ICDs) experience some form of shock anxiety, associated with cardiac fear, physical inactivity, and increased morbidity and mortality. The Florida Shock Anxiety Scale (FSAS) was created to measure ICD-specific fears for a more precise target of patient psychologic distress and potential need for intervention. The current paper describes results from a focused literature review of studies using FSAS over the past 15 years, with the aim of summarizing its current reliability and validity, associated outcomes, and potential future directions for its clinical and research implementation. In this review, 26 peer-reviewed articles were analyzed and selected from an in-depth literature search of two electronic databases. The reliability and validity of FSAS has been upheld since its initial validation and remain positive. The majority of studies used FSAS as an assessment tool to evaluate a clinical need for psychologic support or psychoeducation. The most frequently reported predictors of FSAS shock anxiety include experience of shock, appropriate and inappropriate, and number of shocks experienced. Common correlates of higher FSAS scores include lower device-related knowledge, lower perceived support from healthcare providers, greater posttraumatic stress disorder symptoms, and negative attitudes about device dependency. Younger age and female gender are also associated with increased shock anxiety. Since 2006, FSAS has been widely represented as a valid and reliable assessment tool for quantifying device-related anxiety in ICD recipients in diverse populations. Future directions for FSAS should explore its potential role in support of measurement-based care.

Understanding pathways between PTSD, homelessness, and substance use among adolescents.

Youth experiencing homelessness have been shown to experience high levels of both trauma and substance use. However, prior work has yet to consider how substance use, posttraumatic stress disorder (PTSD) symptoms, and homelessness are temporally, or reciprocally, associated over time. The current study uses symptom-driven and experience-driven models to examine the reciprocal relationships between substance use, PTSD symptoms, and homelessness among a large sample of adolescents receiving substance use treatment in the United States. Adolescents (n = 20,069; Mage = 15.6; 74% male) completed baseline, 3-, 6-, and 12-month assessments. Autoregressive latent trajectory with structured residual (ALT-SR) models were used to examine within- and between-person relationships. We found continued support for prior work at the between-person level of analysis. At the within-person level, during the treatment phase, PTSD emerged as a key mechanism predicting both return to use and increased days of homelessness posttreatment. Further, greater substance use at treatment completion was associated with greater PTSD symptoms and homelessness, prospectively. The current study extends the previous work to consider individual level processes in conjunction with overarching event level predictors of homelessness. We found that PTSD symptomology is a driving factor that influences, both directly and indirectly, experiences of homelessness posttreatment. Interventions may wish to incorporate trauma informed approaches for youth entering treatment as this may mitigate long-term experiences of homelessness and return to substance use. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Post-traumatic Stress Disorder, Cocaine Use, and HIV Persistence.

Post-traumatic stress disorder (PTSD) and stimulant use disorders are highly prevalent, commonly co-occur, and predict faster clinical HIV progression. However, scant research has examined if PTSD and cocaine use are associated with the HIV reservoir that persists in immune cells, lymphoid tissue, and organs of people living with HIV that are receiving effective treatment. This cross-sectional study enrolled 48 HIV-positive persons with sustained undetectable viral load (< 20 copies/mL) in the past year to examine the associations of PTSD and recent cocaine use with two measures of HIV persistence in immune cells: (1) proviral HIV DNA and (2) cell-associated (CA)-HIV RNA. Greater PTSD symptoms were significantly associated with lower proviral HIV DNA (r= - 0.30, p= 0.041) but not with CA-HIV RNA. Greater severity of PTSD symptom clusters for intrusions (Standardized Beta = - 0.30, p= 0.038) and hyperarousal (Standardized Beta = - 0.30, p= 0.047) were independently associated with lower proviral HIV DNA. Although participants with recent cocaine use had a significantly shorter duration of sustained undetectable HIV viral load (19.9 versus 26.9months; p= 0.047), cocaine use was not significantly associated with proviral HIV DNA or CA-HIV RNA. Further research is needed to examine the potentially bi-directional pathways linking PTSD symptom severity and HIV persistence.

In Trauma-Exposed Individuals, Self-reported Hyperarousal and Sleep Architecture Predict Resting-State Functional Connectivity in Frontocortical and Paralimbic Regions

BackgroundSymptoms of posttraumatic stress disorder (PTSD) reflect abnormalities in large-scale brain networks. In individuals with recent trauma exposure, we examined associations of seed-based resting-state functional connectivity (rs-FC) with posttraumatic symptoms and sleep. We hypothesized that more severe PTSD symptoms and poorer sleep quality would predict 1) greater rs-FC between fear-related seeds and other fear-related regions and 2) lesser rs-FC between fear-related seeds and emotion-regulatory regions. MethodsSeventy-four participants who had experienced a DSM-5 criterion A stressor within the past 2 years and ranged from asymptomatic to fully meeting criteria for PTSD diagnosis underwent 14 days of actigraphy and sleep diaries, a night of ambulatory polysomnography, and a functional magnetic resonance imaging resting-state scan at 3T. rs-FC measures of 5 fear-related seeds and 1 emotion regulatory seed with regions of the anterior cerebrum were correlated with PTSD symptoms, objective and subjective habitual sleep quality, and sleep architecture. ResultsLonger objective habitual sleep onset latency was associated with greater connectivity between fear-related seeds and other regions of the salience network. Greater PTSD symptoms were associated with less connectivity between fear-related seeds and anterior emotion regulatory regions, whereas greater percent slow wave sleep was associated with more connectivity between these regions. However, other objective and subjective measures reflecting better habitual sleep quality were associated with less rs-FC between these regions. ConclusionsLonger sleep onset latency predicted greater rs-FC among fear-related areas. More severe PTSD symptoms predicted less rs-FC between fear and fear regulatory regions reflecting putatively reduced top-down fear regulation. Some (e.g., percent slow wave sleep), but not all sleep indices predicted greater top-down fear regulation.

Anxiety Sensitivity Moderates the Effect of Posttraumatic Stress Disorder Symptoms on Emotion Dysregulation among Trauma-Exposed Firefighters

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.

Predictors of Dropout From Residential Treatment for Posttraumatic Stress Disorder Among Military Veterans.

Background: Successful psychotherapy for posttraumatic stress disorder (PTSD) necessitates initial and sustained engagement. However, treatment dropout is common, with rates of 50–70% depending on the setting, type of treatment and how dropout is calculated. Dropout from residential treatment is less understood and could be impacted by participation of more symptomatic patient populations and reduced day-to-day barriers to engagement. Gaining insight into predictors of treatment dropout is critical given that individuals with greater symptoms are the most in need of successful treatments but also at higher risk of unsuccessful psychotherapy episodes.Aim: The aim of the current study was to examine predictors of treatment dropout among veterans receiving residential treatment for PTSD.Methods: The study included 3,965 veterans who initiated residential PTSD treatment within a Department of Veterans Affairs program during Fiscal Year 2015 and completed self-report measures of demographics and psychiatric symptoms at admission.Results: In our sample (N = 3,965, 86.5% male, mean age = 45.5), 27.5% did not complete the residential program (n = 1,091). Controlling for age, marital status, combat/non-combat trauma, and facility, generalized estimating equation modeling analysis indicated greater PTSD symptoms and physical functioning at admission were associated with reduced likelihood of completing the residential program. There were significant differences in trauma-focused psychotherapy received by individuals who dropped out of residential treatment and those who did not. Among veterans who dropped out, 43.6% did not get any trauma-focused psychotherapy; 22.3% got some, but less than 8 sessions; and 34.1% got at least 8 sessions; compared to 37.3%, 4.8%, and 57.9%, respectively, among program completers.Conclusion: Dropout rates from residential PTSD programs indicate that at least one in four veterans do not complete residential treatment, with more symptomatic individuals and those who do not receive trauma-focused therapy being less likely to complete.

Prazosin Use During Prolonged Exposure Therapy with Veterans: An Examination of Treatment Effectiveness

Prazosin is being used to treat sleep symptoms for individuals with posttraumatic stress disorder (PTSD). Prescription of prazosin for veterans with PTSD has increased every year in the Veteran’s Healthcare Administration (VHA) since 2000; however, a recent trial found prazosin was no more effective than placebo. Little is known about the effectiveness of prazosin in combination with first-line psychosocial treatments for PTSD (e.g., prolonged exposure; PE). This effectiveness study investigated the relationship between prazosin and PTSD symptom change in a VHA PTSD clinic among 120 veterans [86% male, 49% Black, 47% White, mean age = 45.5 years (SD = 12.02)]. Hierarchical linear modeling examined PTSD symptom change between veterans who were and were not prescribed prazosin during PE. Nearly half of the veterans (52%) had an active prazosin prescription at the start of PE, and there were no between group differences between groups with respect to baseline PTSD or nightmare symptoms. Veterans who were not prescribed prazosin experienced greater PTSD symptom reduction after completing PE compared to veterans who were prescribed prazosin. Results support the need for continued examination of the efficacy and effectiveness of prazosin on PTSD symptoms when prescribed alone and/or in combination with evidence-based psychotherapy.

Examining the impact of behavioral health encounter dose and frequency on posttraumatic stress symptoms among active duty service members.

Several factors may influence the standardized delivery and frequency of behavioral health encounters for posttraumatic stress disorder (PTSD) in active duty military settings, potentially impacting the effectiveness of care. This retrospective analysis evaluated the course of treatment among 884 active duty Army service members in routine outpatient care. Patients were included in the analysis based on a screening score of 50 or higher on the PTSD Checklist (PCL-C) at intake. Patients subsequently completed the PCL-C at periodic intervals during behavioral health encounters. A multilevel model predicting PCL-C score was constructed with the number of encounters and days between encounters as predictor variables, controlling for intake PCL-C scores. A higher number of total encounters during the entire study period predicted lower scores on the PCL-C. Quadratic effects showed that encounter frequency of less than 3 weeks and treatment during the first 8 encounters was associated with lower symptoms. A curvilinear effect showed that long breaks in care are associated with greater PTSD symptoms, but also that very-frequent care (e.g., twice weekly) would be associated with greater symptoms. These results suggest the need to carefully monitor the frequency and overall dose of behavioral health encounters for PTSD among active duty military patients, suggesting that the greatest treatment gains occur early in treatment and that there is a need for idiographic treatment planning that addresses both the needs of the patient and the mission needs of the military command. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Childhood Adversity and Pain Facilitation.

This study investigated whether childhood adversity would be associated with hypersensitivity on two measures of central pain facilitation: area of secondary allodynia and temporal summation of second pain (TSSP), and whether pain facilitation would be explained by adult posttraumatic stress disorder (PTSD) symptoms. Participants endorsing high (n = 31) and low (n = 31) childhood adversity underwent capsaicin-induced secondary allodynia and TSSP testing. The tests were conducted a week apart with test order counterbalanced. Larger areas of secondary allodynia were observed in the high adversity group compared with the low adversity group (F(1,60) = 4.81, p = .032). This group difference was largely (62%) explained by greater PTSD symptoms in the high adversity group. Although no overall difference was found in TSSP slopes (p = .886), this was attributed to an order by group interaction (F(1,58) = 5.07, p = .028) and low power. Subsequent analyses revealed positive TSSP slopes in the high adversity group when TSSP testing was performed first, and this order effect was associated with blunted sympathetic responses to TSSP on the first visit. The two facilitation measures were unrelated (p = .631). Larger areas of secondary allodynia were observed in the high adversity group, which was explained largely by PTSD symptoms. This suggests that adversity-related changes in pain facilitation may underlie the association between childhood adversity and generalized widespread pain. Although TSSP was affected by previous testing, adversity-related pain facilitation was observed when TSSP testing occurred first. Finally, adversity was not associated with a consistent pattern of hypersensitivity across the two measures of central pain facilitation.

Cognitive reappraisal moderates the relationship between PTSD symptoms and alcohol use over time in post-9/11 U.S. military veterans

BackgroundRates of comorbid alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD) are increasing among post-9/11 veterans, and emotion regulation problems have been identified as a feature of both disorders. However, no studies to date have explored how individual differences in emotion regulation may moderate the relationship between PTSD symptoms and alcohol use. We evaluated how two core emotion regulation strategies – one adaptive (i.e., cognitive reappraisal) and one maladaptive (i.e., expressive suppression) are related to PTSD symptoms and alcohol use over one-year. MethodsA total of 71 post-9/11 veterans (12 female, 59 male) completed a baseline screening and at least two follow-up assessments over the course of 12 months which included measures of emotion regulation, PTSD symptoms, and alcohol use. A mixed growth model was utilized to determine if changes in PTSD symptoms covaried with alcohol use over time and whether this relation was moderated by frequency of use of emotion regulation strategies. ResultsIn general, higher PTSD symptoms were significantly associated with greater alcohol use, but cognitive reappraisal moderated this relationship. Specifically, at low cognitive reappraisal, greater PTSD symptoms were associated with greater alcohol use. At high cognitive reappraisal, there was no significant association between PTSD symptoms and alcohol use. ConclusionsFindings from the present study suggest that baseline individual differences in cognitive reappraisal influence the relation between PTSD symptoms and alcohol use. For post-9/11 veterans, high levels of cognitive reappraisal may serve as a protective factor against ongoing alcohol use.

The complex link between forgiveness, PTSD symptoms and well-being in female victims of intimate partner stalking

PurposeThe purpose of this paper is to examine the relationship between posttraumatic stress disorder (PTSD) symptoms and poor general health reported by female victims of intimate partner stalking (IPS) and victims’ forgiveness or lack of forgiveness towards their perpetrators, controlling for escalation of stalking, age of victims and dispositional forgiveness.Design/methodology/approachA total of 120 Italian female victims of IPS, who had obtained an administrative protective order (PO) issued by police in stalking cases (Ammonimento), took part in a retrospective study that examined the relationship between the presence or absence of victims’ forgiveness of perpetrators and victims’ PTSD symptoms and general well-being. Interviews took place after one, two or three years following the PO.FindingsAll participants reported some level of direct or indirect stalking, and up to 98 per cent had suffered both. In half of all cases, a PO had been breached within a year of its issuance. Positive forgiveness was not associated with lower PTSD symptoms and was marginally associated with well-being. Negative forgiveness (e.g. holding a grudge, desiring revenge) was associated with greater PTSD symptoms; holding a grudge was significantly associated with poorer general health.Research limitations/implicationsVictims of IPS experience a state of fear and anxiety due to the constant risk of being attacked, followed and controlled. Compared to studies about the protective role of forgiveness in community couples, this study found that among couples where stalking is present not only positive forgiveness does not take place at the same rate, but it is also not associated with the increased well-being. On the contrary, lack of forgiveness by stalked victims was related to PTSD symptoms and poorer health. Harbouring negative feelings, such a desire for revenge and holding a grudge towards a perpetrator, worsened woman’s mental health. These findings are novel and may assist the criminal justice system, law enforcement and service providers in their efforts to help women who are victims of IPS.Originality/valueThis study addresses the relationship between forgiveness and lack of forgiveness among victims of IPS and PTSD symptoms and victims’ poor health. Although longitudinal studies are needed to establish any causal relationship between stalking and mental health and the possibly mediating effects of forgiveness, this study is a first contribution to this important field of inquiry.

Role of Islamic appraisals, trauma-related appraisals, and religious coping in the posttraumatic adjustment of Muslim trauma survivors.

This research investigated the role of Islamic appraisals, trauma-related appraisals, and religious coping in Muslim trauma survivors. We report 2 studies of Muslim trauma survivors with and without posttraumatic stress disorder (PTSD) living in the United Kingdom (Study 1) and a sample of Muslim trauma survivors living in Northern Iraq (Study 2). In both studies participants completed the Posttraumatic Stress Diagnostic Scale, Brief Religious Coping Scale, Islamic Appraisal Questionnaire, and Posttraumatic Cognitions Inventory in Arabic. First, it was found that negative religious coping differentiated between trauma survivors with and without PTSD (Study 1) and was significantly correlated with PTSD symptoms (Study 2). Second, negative Islamic appraisals were significantly associated with greater PTSD symptoms whereas positive Islamic appraisals were significantly associated with fewer PTSD symptoms (Study 2). Third, negative trauma-related appraisals correlated significantly with, and uniquely predicted, PTSD symptoms (Study 2). Finally, trauma-related appraisals were found to mediate the relationship between negative Islamic appraisals and negative religious coping and PTSD symptoms. These findings suggest that the theoretical emphasis on trauma-related cognitions may also be applicable to our understanding of PTSD in Muslim trauma survivors. However, for this population, trauma-related appraisals and subsequent coping strategies may be influenced by Islamic beliefs and values. Clinically, our findings suggest that addressing PTSD symptoms in Muslim trauma survivors may require clinicians to consider the impact of trauma on the survivor's religious appraisals and relationship with God. (PsycINFO Database Record