Latent Difference Score Research Articles

Associations among child temperament, parenting, and young children's moral and conventional understanding: The moderating role of self‐regulation

AbstractThe current study examined the role of child temperament, parenting, and their interactions in 2‐ to 6‐year‐olds’ (n = 112; Mage = 3.82 years, SD = 1.01) moral and social‐conventional understanding. Children's judgments regarding hypothetical moral and conventional transgressions were assessed in a semi‐structured interview administered on an iPad. Parents reported on their child's temperamental self‐regulation (i.e., effortful control) and negative affect, as well as their own parenting practices (hostility and positive affect); children's self‐regulatory behavior was assessed during a snack delay task. Parent‐rated child effortful control was associated with greater distinctions between moral and conventional judgments, as estimated using latent difference score modeling, but only when parents were high in positive affect. Parental hostility was associated negatively with moral‐conventional domain distinctions, but only for children with poorer behavioral self‐regulation. Finally, children high in negative affect differentiated moral and social‐conventional transgressions more only when they were rated as high in effortful control by parents. The results demonstrated that an interplay between child temperament and parenting was associated with the development of young children's moral and social‐conventional understanding.

Longitudinal associations between racial discrimination and brain aging among black older adults

AbstractBackgroundNon‐Hispanic Black older adults exhibit worse brain and cognitive health than non‐Hispanic Whites. Emerging research points to racially‐patterned social stress (e.g., discrimination) as a contributor to racial inequalities independent of socioeconomic and health status. While comparative studies show that non‐Hispanic Blacks face more discrimination than non‐Hispanic Whites, few studies focus exclusively on non‐Hispanic Black older adults in order to examine within‐group heterogeneity and clarify how the unique experiences of discrimination among Black older adults link to their brain aging.Method221 non‐Hispanic Black participants in the Washington Heights‐Inwood Columbia Aging Project completed psychosocial measures and structural magnetic resonance imaging (MRI). Experiences of discrimination were operationalized using the Everyday Discrimination and Major Experiences of Lifetime Discrimination scales. After reporting the frequency of discrimination, participants reported the attribution(s) of these experiences (e.g., race). Latent difference score models examined associations between discrimination and brain aging, operationalized as hippocampal and white matter hyperintensity (WMH) volumes measured over an average of four years. Initial models considered general discrimination (i.e., regardless of attribution), and subsequent models considered racial discrimination per sé. All models controlled for age, sex/gender, education, income, total intracranial volume, and length of follow‐up.ResultGeneral discrimination was not associated with brain aging. Lifetime racial discrimination was associated with lower initial hippocampal volume. Everyday racial discrimination was associated with faster accumulation of WMH over time.ConclusionThis longitudinal MRI study suggests that racial discrimination may be detrimental for brain aging among non‐Hispanic Black older adults, which could contribute to their disproportionate dementia burden. Disaggregating discrimination by attribution can clarify research on psychosocial contributors to racial inequalities in brain and cognitive aging, as racial discrimination appears to be particularly toxic. Future research should examine both distal (e.g., environmental exposures, life course opportunities) and proximal (e.g., physiological stress pathways, inflammation) mechanisms linking racial discrimination to worse brain aging, which may differ for institutional versus interpersonal forms of racism.

Cognition and the development of temperament from late childhood to early adolescence

Temperament is related to cognition, but it is unclear whether reciprocal associations exist with early developmental trajectories. Children from the Longitudinal Study of Australian Children (N = 8,677) were assessed over four waves on verbal ability at ages 8/9, nonverbal ability at ages 8/9 and 10/11, and parent-rated temperament every two years from ages 8/9 to 14/15. Latent difference score analyses indicated correlated changes between ages 8/9 and 10/11.Increasednonverbal ability over the first two years wasassociated with declinedreactivity and increasedpersistence. Latent growth curve models further indicated that nonverbal and verbalability at baseline were associated with declined reactivity and increasedpersistence over the six years. These findings suggest bidirectional associations between childhood cognitive ability and temperament development.

Maternal and paternal insensitivity, adaptive engagement, and school readiness skills among economically disadvantaged children: A dynamic approach

The transition to kindergarten is considered as one of the most significant developmental milestones in childhood. Although the significance of parental caregiving for child school readiness is well documented, it remains relatively unknown how dynamic interplay of maternal and paternal caregiving unfolds over time to promote school readiness, mediated by child characteristics. The present study used observed parent-child interactions to examine how maternal and paternal insensitivity across 24 to 36 months were similarly or differentially manifested in shaping school readiness in language and self-regulation skills among children from low-income families. Further, we tested whether children's adaptive engagement mediated the relations between parental insensitivity and school readiness. To these ends, this study used extant data from the Early Head Start Research and Evaluation Study (N = 453 families of mothers, fathers, and children; 51% girls). Latent difference score model revealed commonality in the similar effects of mothers and fathers on child early language, linking both maternal and paternal insensitivity at 24 months to poorer vocabulary skills in children at age 5. Additional findings showed specificity in the differential effects of maternal and paternal insensitivity on child functioning, such that maternal insensitivity predicted deficits in children's vocabulary and self-regulation skills indirectly through poorer child engagement, whereas paternal insensitivity directly predicted children's poorer self-regulation skills. The findings highlight the longitudinal processes of early maternal and paternal insensitivity with common and differential implications for school readiness.

Interoception Underlies Therapeutic Effects of Mindfulness Meditation for Posttraumatic Stress Disorder: A Randomized Clinical Trial

BackgroundMindfulness-based interventions have proven efficacy in treating posttraumatic stress disorder (PTSD), but the neurobiological mechanism underlying the therapeutic effects is unknown. As mindfulness meditation cultivates attention to the present moment and bodily sensations, neural functions related to interoception (i.e., central processes of bodily signals) might be such a mechanism. MethodsWe conducted a clinical trial in which veterans with PTSD were randomly assigned to receive an 8-week mindfulness-based stress reduction (MBSR) intervention (n = 47) or an active control intervention (present-centered group therapy; n = 51). We assessed pre- and postintervention PTSD symptoms and electroencephalography measures of neural outcomes, including spontaneous brain activity, cognitive task–related brain responses, and interoceptive brain responses (heartbeat-evoked brain responses). We conducted statistical causal mediation analyses using treatment type as a predictor, pre- and postintervention measures of symptom severity as treatment response, and the neural outcomes as mediators. ResultsCompared with the control group, the MBSR group had greater improvements in PTSD symptoms and increases in spontaneous alpha power (8–13 Hz), task-related frontal theta power (4–7 Hz in 140–220 ms after stimulus), and frontal theta heartbeat-evoked brain responses (3–5 Hz and 265–336 ms after R peak). The mediation analysis using latent difference score modeling revealed that only changes in frontal theta heartbeat-evoked brain responses mediated the MBSR treatment effect. ConclusionsMindfulness meditation improves brain functions of attentional control and resting brain states reflective of internally oriented relaxation. However, interoceptive neural functions enhanced by MBSR seem to be a primary cerebral mechanism that improves symptoms of PTSD.

Longitudinal associations between interpersonal relationship functioning and posttraumatic stress disorder (PTSD) in recently traumatized individuals: differential findings by assessment method.

The role of interpersonal relationship functioning in trauma recovery is well-established. However, much of this research has been done with cross-sectional samples, often years after trauma exposure, using self-report methodology only, and is focused on intimate relationship adjustment. The current study investigated the longitudinal associations between interpersonal (intimate and non-intimate) relationship functioning and clinician- and self-reported posttraumatic stress disorder (PTSD) symptoms in 151 recently (within the past 6 months) traumatized individuals. Participants were assessed at four time points over 1 year. Approximately 53% of the sample was diagnosed with PTSD at initial assessment, with declining rates of diagnostic status over time to 16%. Latent difference score (LDS) modeling revealed nonlinear declines in both clinician-assessed and self-reported PTSD symptom severity, with faster declines in earlier periods. Likewise, LDS models revealed nonlinear declines in negative (conflict) aspects of interpersonal relationship functioning, but linear declines in positive (support, depth) aspects. The relationship between PTSD and relationship functioning differed for clinician- and self-reported PTSD. Bivariate LDS modeling revealed significant cross-lagged effects from relationship conflict to clinician-assessed PTSD, and significant cross-lagged effects from self-reported PTSD to relationship conflict over time. These results highlight that the variability in prior results may be related to the method of assessing PTSD symptomatology and different relational constructs. Implications for theory and early intervention are discussed.

Dynamics of risk: Recent changes in psychological inflexibility precede subsequent changes in returning US veterans' posttraumatic stress.

As a malleable risk-factor, psychological inflexibility is implicated in the development and maintenance of posttraumatic stress symptoms (PTS). Unfortunately, limited research has addressed whether changes in psychological inflexibility are antecedent to changes in PTS severity over time, or whether such changes are mutually dependent. Utilizing bivariate latent difference score modeling, this longitudinal study sequenced intraindividual changes in psychological inflexibility and PTS severity within a sample of 305 returning US veterans. Veterans' self-reported psychological inflexibility and PTS severity were assessed quarterly over 1 year. Results indicated that early reductions in psychological inflexibility potentiated later declines in veterans' PTS severity, accounting for veterans' prior levels of psychological inflexibility and PTS severity. These findings underscore the unique role of changes in psychological inflexibility as an important mechanism of change in PTS severity and provide empirical support for an antecedent model of the role of psychological inflexibility in PTS recovery.

Investment in Emotional Labor: Daily Resource Spirals and Recovery

Service workers perform emotional labor with customers by surface acting (modifying expressions) or deep acting (modifying mood). Surface acting clearly has more costs and fewer gains than deep acting, but it is less clear how those daily costs and gains contribute to the performance of emotional labor over time. Based on emotional labor theorizing and conservation of resources (COR) theory, daily investment of resources (i.e., emotional and cognitive) are needed for surface and deep acting, which result in that day’s net resource loss or gain, respectively. We argue that over time, this creates accumulating resource losses or gain (i.e., spirals) that predict future strategy use, unless one recovers those resources after work. We conduct a novel and rigorous test of this idea, using two experience sampling methodology (ESM) studies of service workers, and applying latent difference score models to capture resource accumulation over time. Across both studies, results supported resource gain and loss spirals: Deep acting required an investment of emotional resources that created increasingly greater resource gains, while surface acting had accumulating losses to emotional resources each day, making it harder and harder to invest in deep acting in future days. Importantly, recovery after work, specifically low-effort activities, mitigated resource loss spirals from surface acting and enhanced resource gain spirals via deep acting. Results offer new evidence for untested theoretical assumptions about emotional labor and COR, while providing recommendations for how to replenish and protect service workers’ emotional resources over time.

While a shy child waits: Autonomic and affective responses during the anticipation and delivery of a speech.

Shyness is a temperament characterized by wariness to social novelty and perceived social evaluation. However, we know relatively little about temperamentally shy children's psychophysiological and affective responses during different phases of social stressors. We examined whether children's temperamental shyness was related to distinct patterns of autonomic and affective responses across three conditions: baseline, speech anticipation, and speech delivery. Participants included 152 children (Mage = 7.82 years, SD = 0.44) who had their autonomic nervous system activity [respiratory sinus arrhythmia (RSA) and heart rate (HR)] and subjective nervousness assessed across each experimental condition. Children's temperamental shyness was assessed according to parent- and child-report. Using a latent difference score framework to model dynamic changes across task phases, we found that higher levels of parent-reported shyness was related to decreases in RSA from baseline to speech anticipation followed by increases in RSA from speech anticipation to delivery. Further, higher levels of parent-reported shyness were related to increases in HR from baseline to speech anticipation, and higher levels of child-reported shyness was related to increases in subjective nervousness from baseline to speech anticipation. These findings illustrate that children with higher levels of temperamental shyness may experience autonomic and emotion dysregulation particularly during the anticipation of social stressors, which may reflect their tendency to react to perceived impending social threat on both physiological and affective levels. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Fit gets better: A longitudinal study of changes in interest fit in educational and work environments

Theories of person–environment fit describe a dynamic process in which fit should improve over time due to changes in a person’s attributes, the environment, or both. Although these ideas are central in several theoretical perspectives, they have largely gone untested. Here, we report a longitudinal examination of interest congruence (i.e. interest fit) across 12 years during the transition from education to the workforce. The study uses four methods to capture interest congruence and the drivers of fit change: growth models, latent congruence models, person and environment latent difference scores, and piecewise growth models based on environmental transitions. Each method uses a different lens to understand interest congruence in educational and work domains. Across methods, three results were typically found: (1) interest congruence improved over time in school and at work, (2) participants’ interests often predicted educational and work changes, and (3) participants’ interests rarely changed in response to their environment. These results support a dynamic conceptualization of fit and suggest that selection—rather than socialization—is the main mechanism through which individuals achieve better interest fit during young adulthood. Other implications are discussed for theory development and the applied use of interest assessments.

Associations of developmental imbalance between sensation seeking and premeditation in adolescence and heavy episodic drinking in emerging adulthood.

Dual systems theories suggest that greater imbalance between higher reward sensitivity and lower cognitive control across adolescence conveys risk for behaviors such as heavy episodic drinking (HED). Prior research demonstrated that psychological analogues of these systems, sensation seeking and premeditation, change from childhood through emerging adulthood, and each has been independently linked with HED. However, few studies have assessed whether change over time in these developing analogues is prospectively associated with HED. Moreover, we know of no research that has shown whether within-person differences between higher sensation seeking and relatively lower premeditation across the adolescent period predict HED in emerging adulthood. Prospective data from the National Consortium on Alcohol and NeuroDevelopment in Adolescence study (n=715) were used to examine the association of sensation seeking and premeditation with HED among adolescents ages 16 to 20years. We used novel applications of latent difference score modeling and growth curve analysis to test whether increasing sensation seeking, premeditation, and their imbalance over time are associated with HED across the study period, and whether these associations differed by sex. Whereas premeditation increased linearly from adolescence through emerging adulthood across sexes, males reported growth and females reported decline in sensation seeking. Sensation seeking in adolescence (and not premeditation) was associated with higher levels of HED by emerging adulthood. Importantly, greater imbalance between sensation seeking and premeditation was associated with higher levels of HED by emerging adulthood though we note that variability capturing this imbalance correlated highly (r=0.86) with baseline levels of sensation seeking. Developmental imbalance between higher sensation seeking and lower premeditation in late adolescence may be a risk factor for greater HED in emerging adulthood.

Is Delinquency Associated With Subsequent Victimization by Community Violence in Adolescents? A Test of the Risky Behavior Model in a Primarily African American Sample.

Victimization is common in adolescence and is associated with negative outcomes, including school failure, and poor emotional, behavioral, and physical health. A deeper understanding of the risk of victimization can inform prevention and intervention efforts. This study tests the risky behavior model in adolescents, examining prospective associations between mean levels of and changes in delinquency and risk for victimization over four annual data collections. Low-income adolescent (53.6% female; M age = 12.13 years, SD = 1.62 years; 91.9% African American) and maternal caregiver dyads (N = 358) residing in urban neighborhoods in the mid-Atlantic region of the United States that had moderate-to-high levels of violence and/or poverty completed separate annual home interviews for 4 years. Maternal caregivers reported on adolescents' delinquent behavior; adolescents reported on their victimization by community violence experiences. Using a latent difference score model, results supported the risky behavior model for the first 2 years, but not the final data collection period. That is, levels of and changes in delinquent behavior were associated with more victimization by community violence at the subsequent time point for the first 2 study years. In contrast, there was no evidence for the opposite, specifically that victimization by community violence predicted delinquency. Knowing that both levels of delinquency and increases in delinquency place youth at heightened risk for victimization by community violence provides impetus to intervene. Screening for increases in delinquency among youth may be one way to target youth at high risk for victimization by community violence for fast-tracked intervention.

Technology supported mindfulness for obsessive compulsive disorder: The role of obsessive beliefs

The current study examined the association of OCD symptoms and OCD belief domains, for individuals engaged in Technology Supported Mindfulness training (TSM) using an EEG-based biofeedback device (called “Muse”) that permits individuals to engage in home based mindfulness meditation practices. In this randomized controlled study, treatment-seeking participants with a principal DSM-5 diagnosis of OCD (N = 71) were randomly assigned to eight weeks of: 1) a meditation program involving daily use of the “Muse” device, or 2) wait list control. At weeks 1, 4, and 8, participants completed self-report measures of OCD symptoms (YBOCS: Yale-Brown Obsessive Compulsive Scale) and OCD beliefs (OBQ; OCCWG, 2005). Latent Difference Score (LDS) models indicated that there was no significant longitudinal relationship between OBQ “Responsibility/Threat” (OBQ R/T) scores and OCD symptoms. The analysis of OBQ “Perfectionism/Certainty” (OBQ P/C) and OCD symptoms demonstrated a significant reciprocal relationship between these two variables, in which OCD symptoms predicted subsequent increases in OBQ P/C and vice versa. The analysis of OBQ “Importance/Control of Thoughts” (OBQ I/C) and OCD symptoms demonstrated a significant reciprocal relationship between these two variables, in which OCD symptoms predicted subsequent increases in OBQ I/C and vice versa. The analysis of OBQ domains and EEG derived attentional changes demonstrated a significant association between OBQ P/C and Alpha band frequencies. These results clarify the association of OBQ belief domains, OCD symptom change and EEG derived indicators of attention during TSM.

Supplemental Material for Uniting the Unit: Trivariate Latent Difference Score Modeling of the Parent–Child Triad

Supplemental Material for Uniting the Unit: Trivariate Latent Difference Score Modeling of the Parent–Child Triad

Externalizing behavior and stress system functioning in infants exposed to early adversity: A multi-system exploration.

Children who experience early adversity often show alterations across multiple stress response systems, including the hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system (ANS). Changes in the diurnal rhythm of salivary cortisol (a marker of HPA axis functioning) and alpha-amylase (a marker of ANS functioning) may increase their probability of developing behavior problems. The goal of this study is to examine how these analytes may interact to predict externalizing behavior in infants exposed to early stress. Participants included 179 parents and their 6- to 20-month old infants recruited from a low-income neighborhood. Parents reported on their infants' externalizing behaviors and collected saliva samples from their children at wake-up and bedtime over three days. Diurnal cortisol and alpha-amylase were modeled using latent difference scores. Four models were tested examining the effects of cortisol and alpha-amylase morning values and slopes, as well as their interactions, on externalizing behavior. Results showed a significant interaction effect of cortisol and alpha-amylase morning values, such that low morning cortisol was associated with decreased externalizing behavior when morning alpha-amylase was high but not low. These findings highlight the importance of examining multiple systems when characterizing the physiological correlates of externalizing behavior among infants experiencing adversity.

Is only one cognitive technique also effective? Results from a randomized controlled trial of two different versions of an internet-based cognitive behavioural intervention for post-traumatic stress disorder in Arabic-speaking countries

ABSTRACT Background: Internet-based cognitive-behavioural interventions seem to be effective for the treatment of posttraumatic stress disorder (PTSD) in Arabic-speaking countries in the MENA region. However, due to high prevalence rates of trauma-related mental disorders in this region, it is important to scale up existing Internet-based interventions in order to increase the number of clients. Objective: The aim of the study was to examine whether a brief Internet-based intervention with one cognitive technique (TF-short, 6 assignments) results in the same PTSD symptom change and lower dropouts compared to a longer intervention with two cognitive techniques (TF-reg, 10 assignments). Method: A total of 224 Arab participants (67.4% female; M = 25.3 years old) with PTSD were randomly assigned to Internet-based CBT with either a TF-reg protocol (n = 110) or a TF-short protocol (n = 114). Symptoms of PTSD and secondary outcomes (anxiety, depression, somatic complaints, quality of life) were self-assessed online at baseline and post-treatment. Treatment-associated changes were estimated using multigroup latent difference score models. Results: The overall PTSD score assessed with the PDS decreased by about 15 points in both conditions. The between-group differences (TF-reg vs. TF-short) at post-assessment were non-significant, Δ = 0.29, p = .896, d = 0.02, 95% CI [-0.30, 0.34]. Like the primary outcome, all within-group changes for the secondary outcomes throughout the intervention were statistically significant and all between-group effects were non-significant. Overall, the dropout rates did not differ between the two conditions, χ2 (1/N = 175) = 0.83, p = .364. Conclusions: The findings suggest that the shorter condition results in the same symptom change and dropout rate as the longer condition. This highlights the potential of shorter, more scalable Internet-based interventions in socially restricted and (post-)conflict societies. ClinicalTrials.gov ID: NCT01508377

Using informant discrepancies in report of parent-adolescent conflict to predict hopelessness in adolescent depression.

Hopelessness is an important symptom of adolescent depression, being associated with both risk of suicide and poor treatment response, but predictors of hopelessness are understudied. Conflict with parents is common in adolescent depression, but parents and adolescents often disagree when reporting conflict severity. Discrepancy in reporting may be an indicator of the parent–adolescent dyad lacking a shared representation of the state of their relationship. This could make conflicts seem unresolvable to the adolescent, leading to expectations of persistent stress and lack of support, increasing hopelessness. This study employed latent difference scores, ordinal regression and cross-validation to evaluate the hypothesis that discrepancy in report of parent–adolescent conflict would predict hopelessness among depressed adolescents. Parents reporting less conflict than the adolescent was associated with increased adolescent hopelessness, giving preliminary support to the hypothesis.

Does divorce change your personality? Examining the effect of divorce occurrence on the Big Five personality traits using panel surveys from three countries

Experiencing a divorce can be challenging and have a lasting impact on people's lives, but does it change your personality? By making use of large panel surveys from Australia, Germany, and the United Kingdom, intra-individual change in the Big Five personality traits of those who separated during a four-year observation, was compared to that of those who remained married. We tested the replicability of divorce-induced personality change across the three country samples, while also examining gender differences and separation duration. Latent difference score models mostly indicated that divorce is not a consistent predictor of personality change, as only isolated effects were found, and these could not be replicated across samples. Aside from the overall lack of replicable effects a few isolated effects were detected that offer some support for a modified version of the social investment principle. Nonetheless, the overall finding of this study suggests that experiencing a divorce is unlikely to lead to permanent personality change.

Technology supported mindfulness for obsessive compulsive disorder: Self-reported mindfulness and EEG correlates of mind wandering

Cognitive Behavior Therapy (CBT) incorporating Exposure with Response Prevention (ERP) is the most efficacious treatment intervention for Obsessive Compulsive Disorder (OCD); however, there is a growing literature indicating that mindfulness based approaches can be beneficial in terms of managing OCD symptoms. The current study examined the potential benefits of using a consumer grade EEG-based biofeedback device (called “Muse”) that permits individuals to engage in mindfulness meditation practices while at home. In this randomized controlled study, participants with a principal DSM-5 diagnosis of OCD (N = 71) were randomly assigned to eight weeks of: 1) a meditation program involving daily use of the “Muse” device, or 2) waitlist control. At weeks 1, 4, and 8, participants completed a five minute “open monitoring” practice while EEG data was recorded, and they completed self-report measures of mindfulness (FFMQ: Five Factor Mindfulness Questionnaire) and OCD symptoms (YBOCS: Yale-Brown Obsessive Compulsive Scale). Latent Difference Score (LDS) models demonstrated that the FFMQ “Non-Reactivity” facet and EEG-derived correlates of “Mind Wandering” (i.e., alpha, beta, but not delta or theta band power) were temporally associated with subsequent changes in YBOCS symptom scores. Participants in the Muse group (in comparison to the control group) experienced increased FFMQ “Non-Reactivity” and decreased mind wandering (increased alpha and beta band power), and in each case, these variables were associated with subsequent OCD symptom improvement. These results suggest that technology supported mindfulness training for OCD is associated with improvements in OCD symptoms, mindfulness and decreased mind wandering.

Test of the dynamic interplay between DSM-5 PTSD symptom clusters in children and adolescents

BackgroundRevealing the dynamic interplay between posttraumatic stress disorder (PTSD) symptom clusters has always been an important topic in traumatic stress studies. Based on longitudinal studies, different hypotheses have been proposed to explain PTSD symptom dynamics. But currently, no study have been conducted to test these hypotheses in children and adolescents. MethodsData were derived from a longitudinal study of child and adolescent traumatic event survivors of an explosion accident (N = 659). DSM-5 PTSD symptoms was measured by the PTSD Checklist-5 (PCL-5) at 4, 8, and 13 months after the disaster. Latent difference score (LDS) modeling was used to evaluate the dynamic interplay between clusters. ResultsThe results of LDS model indicated that intrusion level positively predicted subsequent rate of increase for hyperarousal (p = .008) and negative changes in cognitions and mood symptoms (p = .036). Also, intrusion level trended to positively predict subsequent increase rate of avoidance symptoms (p = .059). ConclusionsThis study expands previous knowledge of dynamic relations between symptom clusters during the maintenance and fluctuation of child and adolescent PTSD symptoms. By using new methodology, this study provided novel evidence for the hypothesis that intrusion symptom plays an important role in maintaining other PTSD symptoms.