Fear of sin and fear of God: Scrupulosity predicts women's daily experiences of mental contamination following sexual trauma.

Mental contamination refers to feelings of dirtiness in response to thoughts, images, or memories. Mental contamination is frequently reported after sexual trauma and is associated with symptoms of posttraumatic stress disorder (PTSD). Differences in individuals' views about morality and purity may influence the severity of mental contamination, though this has been studied primarily outside of samples assessed for trauma and/or PTSD. The present study addressed this gap by investigating scrupulosity as a prospective predictor of daily sexual trauma-related mental contamination and PTSD symptoms. Participants included 40 adult women with a history of sexual trauma and current sexual trauma-related mental contamination who completed baseline diagnostic interviews and questionnaires followed by two assessments every day for 2 weeks. The results indicate that scrupulosity was positively correlated with PTSD symptom severity and sexual trauma-related mental contamination at baseline. Scrupulosity was also a prospective predictor of increased daily sexual trauma-related mental contamination, B = 0.19, SE = 0.07, p = .010, but not daily PTSD symptoms, B = -0.10, SE = .08, p = .198. The findings indicate that scrupulosity may be an important factor in understanding recovery from sexual assault.

"I Felt Dirty in a Way a Shower Wouldn't Fix": A Qualitative Examination of Sexual Trauma-Related Mental Contamination.

Trauma-related mental contamination (MC) is a distressing sense of dirtiness that arises absent a contaminant following a traumatic event. Existing work has linked MC to more severe posttraumatic stress disorder symptoms among individuals with sexual trauma histories and has begun to characterize some aspects of the experience of trauma-related MC. However, a more nuanced understanding of how individuals experience and respond to trauma-related MC is lacking. The present study explored lived experiences of trauma-related MC among a sample of 34 women with sexual trauma histories using semi-structured qualitative interviews. Women were asked about MC across several domains, including somatic locations where trauma-related MC is experienced; triggers for trauma-related MC; and engagement in MC-related coping strategies, including washing behaviors. Women reported experiencing trauma-related MC in various bodily locations (internal, external, and both). Both overtly trauma-related triggers (e.g., trauma-relevant people or words, sexual contact) and non-trauma-related triggers (e.g., sweating, being around other people) were mentioned. Women also reported experiencing a variety of emotions alongside trauma-related MC (e.g., disgust, shame, anger) and using a range of strategies to cope with trauma-related MC, including washing behaviors, distraction, and substance use. Findings suggest that triggers for and responses to trauma-related MC are heterogeneous. Future work should explore the role of context in individuals' experiences of and responses to trauma-related MC, as well as whether experiences of trauma-related MC may differ by gender or across settings. Increased understanding of trauma-related MC may inform efforts to more readily and effectively identify and target MC in clinical practice.

Trauma-Related Shame and Guilt as Prospective Predictors of Daily Mental Contamination and PTSD Symptoms in Survivors of Sexual Trauma.

Mental contamination (MC), the experience of dirtiness in the absence of a physical contaminant, has established links with posttraumatic stress disorder (PTSD). Shame and guilt have well-documented relationships with symptoms of PTSD and may play a role in the development and maintenance of MC. The present study examined whether trauma-related shame and guilt prospectively predicted daily MC and symptoms of PTSD among 41 women with a history of sexual trauma. Women completed baseline and twice-daily assessments of MC and symptoms of PTSD over a 2-week period and baseline measures of trauma-related shame and guilt. Two sets of hierarchical mixed linear regression models examined individual and combined fixed effects of baseline trauma-related guilt (guilt cognitions and global guilt) and shame in predicting daily trauma-related MC and symptoms of PTSD. Trauma-related shame positively predicted both daily MC and PTSD. This association remained robust even when accounting for the experience of trauma-related guilt. Neither trauma-related guilt cognitions nor global guilt predicted daily MC or PTSD. While other studies have addressed shame related to sexual assault, this is the first study to demonstrate a positive prospective relationship between shame and trauma-related MC. Findings regarding PTSD and shame are consistent with a growing literature. Further research is needed to better understand the temporal relationships between trauma-related shame, MC, and symptoms of PTSD, including how these variables interact and change over the course of PTSD treatment. A better understanding of the factors influencing the development and maintenance of MC can inform efforts to more easily target and improve MC, and subsequently PTSD.

Daily Associations Between Trauma-Related Mental Contamination and Use of Specific Coping Strategies: Results of a Daily Monitoring Study.

Mental contamination (MC)-a sense of dirtiness experienced without contacting an identifiable pollutant-is a distressing and enduring experience among many survivors of sexual trauma. MC has been linked to more frequent use of avoidant coping behaviors (e.g., washing behavior, substance use, binge eating) and approach coping. However, it is unclear if specific approach and avoidant coping strategies are more consistently related to perseverative experiences of trauma-related MC, if the use of certain strategies predicts changes in MC, and if fluctuations in MC predict the use of certain strategies. The present study evaluated contemporaneous and prospective relationships between sexual trauma-related MC and use of 11 specific coping strategies among 41 women with a history of sexual trauma using an experience sampling design. Women completed twice-daily assessments of coping strategy use and MC for 14 days. Between-persons, women reporting more intense MC on average reported more frequent use of distraction, denial, giving up, self-blame, thought suppression, washing behavior, emotional processing, and emotional expression than those experiencing less intense MC. Within-person increases in MC were associated with more frequent concurrent use of all coping strategies except seeking support. Lastly, within-person increases in MC predicted more frequent use of giving up, substance use, and seeking support at the next assessment and within-person increases in substance use predicted less severe MC at the next assessment. Future work should aim to identify factors influencing the selection and/or quality of use of these specific coping strategies among individuals experiencing MC.

Concurrent and proximal associations among PTSD symptoms, prescription opioid use, and co-use of other substances: Results from a daily monitoring study.

OBJECTIVE: Posttraumatic stress disorder (PTSD) and nonmedical prescription opioid use (NMPOU) are linked. Much of the research documenting this association uses cross-sectional or longitudinal designs that describe patterns of use over extended intervals. The present study used a daily monitoring design to examine how daily fluctuations in PTSD symptoms predicted patterns of prescription opioid use (both medical and nonmedical) and co-use of other substances. This approach has distinct advantages for understanding proximal temporal relations between PTSD symptom variation and substance use patterns. METHOD: Forty adults with clinical or subclinical PTSD and past-month NMPOU completed daily measures of PTSD symptoms, physical pain, prescription opioid use, and other substance use for 28 days using a smartphone application. RESULTS: Same day co-use of prescription opioids and at least one other substance was common. Higher-than-typical PTSD symptoms on a given day (within-person) was associated with an increased likelihood of reporting NMPOU (overall and with co-use of one or more additional substances) on the same day. This association was specific to PTSD alterations in arousal and reactivity symptoms (Criteria E). Neither total PTSD symptoms nor individual PTSD symptom clusters prospectively predicted next-day prescription opioid use (overall or with co-use). Use of prescription opioids also did not predict next-day PTSD symptom severity. CONCLUSION: This is the first study to demonstrate positive associations between day-to-day fluctuations in PTSD symptoms and NMPOU. Results from the current study also highlight the importance of examining polysubstance use patterns among individuals with PTSD who use prescription opioids. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Obsessive-Compulsive Symptoms and Daily Experiences of Posttraumatic Stress and Mental Contamination Following Sexual Trauma.

Although cross-sectional research highlights similarities between symptoms of obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) among individuals exposed to sexual trauma, little is known about how these disorders relate over time. The goal of the present study was to examine whether 1) OCD symptoms prospectively predicted daily symptoms of PTSD, and 2) OCD and PTSD symptoms prospectively predicted daily experiences of sexual trauma-related mental contamination (i.e., dirtiness in the absence of a physical pollutant). Forty-one women with a sexual trauma history completed baseline measures of OCD and PTSD, as well as twice-daily assessments of PTSD symptoms and mental contamination over a two-week period. Total OCD symptoms and the unacceptable thoughts dimension significantly predicted daily PTSD symptoms after accounting for other OCD dimensions. Only total OCD symptoms significantly predicted daily mental contamination when examined together with total PTSD symptoms. No individual PTSD or OCD clusters/dimensions significantly predicted daily mental contamination when examined simultaneously. Findings from this study highlight the nuanced associations among OCD symptoms, PTSD symptoms, and experiences of mental contamination. Future research is needed to further understand the development of PTSD, OCD, and mental contamination over time to inform targets for intervention.

Posttraumatic stress and risky sex in trauma-exposed college students: the role of personality dispositions toward impulsive behavior.

Objectives: Posttraumatic stress disorder (PTSD) has been linked to risky sexual behavior (RSB). However, little is known regarding the role of impulsivity in this relation among college students. Participants: The present study examined the moderating role of impulsivity dispositions on the relation between PTSD symptoms and past-year RSB in a sample of 221 trauma-exposed undergraduate students (77.4% female). Results: Two separate negative binomial regression models examined each impulsivity disposition's unique moderating effect on the association between PTSD symptoms and high risk/casual sex. In the high risk model, significant interactions were found for the urgency dispositions, (lack of) premeditation and (lack of) perseverance, though the pattern of these relations differed across these dispositions. Only positive main effects for negative urgency and (lack of) premeditation emerged in the casual sex model. Conclusions: The present study expands on the limited literature on the role of impulsivity in the relation between PTSD and RSB in trauma-exposed college students.

Mental contamination, PTSD symptoms, and coping following sexual trauma: Results from a daily monitoring study.

Mental contamination (MC) - dirtiness experienced in the absence of contact with a physical contaminant - has been linked to PTSD symptoms following sexual trauma. However, there is limited understanding regarding the temporal nature of this association. The present study utilized experience sampling to examine associations between baseline and daily experiences of MC and PTSD symptoms and the mediating role of avoidance and approach coping among a sample of 41 adult women with a history of sexual trauma and current MC. Participants completed baseline measures and 14 days of twice-daily assessments. Results indicated that daily MC and PTSD symptoms were bidirectionally related. The tendency to engage in avoidance coping positively mediated relations between 1) baseline MC and daily PTSD symptoms and 2) baseline PTSD symptoms and daily MC. Further, daily avoidance coping (T-1) positively mediated associations between daily MC (T-2) and subsequent daily PTSD symptoms (T). Approach coping was not a mediator (between- or within-) in any models. Findings lend support to a mutual maintenance model of PTSD symptoms and trauma-related MC mediated by avoidance coping. Future research over a more extended period is warranted to clarify whether PTSD symptoms and MC indeed mutually maintain or exacerbate one another over time.

Mental contamination, disgust, and other negative emotions among survivors of sexual trauma: Results from a daily monitoring study.

Mental contamination (MC)-feelings of dirtiness triggered by internal sources-is a potentially important yet understudied factor for survivors of sexual trauma. MC has been linked to disgust and other negative emotions (e.g., shame, guilt) cross-sectionally and in lab-based paradigms but not yet examined in ecological contexts. Additionally, links between MC and distinct negative emotions have not been studied systematically. The present study thus modeled relationships between MC and specific emotions both across and within days over a daily monitoring period. Forty-one females with sexual trauma history and associated MC completed twice-daily assessments of MC and seven emotions (disgust, shame, guilt, anger, hopelessness, sadness, anxiety) over 2 weeks via a smartphone app. Baseline MC and average daily MC were largely associated with higher daily averages of negative emotions. Concurrently, within-person changes in MC and negative emotions were also positively linked. Unexpectedly, intraindividual changes in MC were largely not associated with later negative emotions, whereas several emotions were negatively associated with later MC. Notably, MC among screened sexual trauma survivors was much more prevalent compared to prior research. Clinical relevance and future recommendations for ecological research in trauma-related mental contamination are discussed.

Moral injury as a unique predictor of suicidal ideation in a veteran sample with a substance use disorder.

OBJECTIVE: Suicide among military veterans accounts for 22.2% of all suicide deaths in the United States per year, and veterans with a substance use disorder (SUD) are at an even higher risk for death by suicide. This prevalence has led to increased efforts to identify and investigate both potential risks and protective factors for veterans. This study examines relationships between depression symptomology, exposure to potentially morally injurious events, posttraumatic stress disorder (PTSD) diagnosis, and suicidal ideation, with the primary aim of examining exposure to moral injurious events as a risk factor for suicide in veterans with SUD. METHOD: An inpatient sample of 40 veterans with an active SUD admitted for suicidal ideation was evaluated to examine differences in suicidal ideation, depression symptomology, and exposure to morally injurious events in participants with and without a PTSD diagnosis. Further, exposure to morally injurious events and depression symptomology were examined as predictors of suicidal ideation. RESULTS: Analyses revealed that exposure to morally injurious events (d = 1.72) and depression symptomology (d = 0.72) were higher in participants with a PTSD diagnosis compared to those without a diagnosis, though no significant differences emerged between the two groups on suicidality. A hierarchical regression analysis indicated that only exposure to morally injurious events significantly accounted for variance in suicidality (ß = .31, p = .04, 95% confidence interval [.01, .37]). CONCLUSIONS: These results suggest that although PTSD may be associated with exposure to morally injurious events and depression symptoms, exposure to morally injurious events may potentially lead to higher suicide risk among veterans above and beyond PTSD and depressive symptoms. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Affective Lability Moderates the Associations between Negative and Positive Urgency and Posttraumatic Stress.

Urgency and affective lability are two vulnerabilities that have been linked to posttraumatic stress disorder (PTSD). Urgency refers to rash action when experiencing intense positive or negative affect, whereas affective lability is the tendency to shift rapidly between emotion states. Although individuals high in urgency and affective lability may be more likely to engage in behaviors often exhibited by individuals with PTSD (e.g., substance use, risky behaviors), the extent to which urgency and affective lability interact to impact PTSD symptoms has yet to be examined. The current study hypothesized that the association between urgency (negative and positive) and PTSD symptoms would be stronger among those reporting elevated affective lability. Participants included 232 trauma-exposed college students who completed a series of questionnaires. Among individuals low in affective lability, both positive and negative urgency were positively associated with PTSD symptoms. Contrary to hypotheses, among those high in affective lability, positive and negative urgency were not associated with PTSD symptoms. Models with dimensions of affective lability were also examined. Findings suggest that the association between urgency and PTSD symptoms may only emerge among individuals who do not already possess the vulnerability associated with higher affective lability.

Posttraumatic Mental Contamination and the Interpersonal Psychological Theory of Suicide: Effects via DSM-5 PTSD Symptom Clusters.

Research has yet to establish a relationship between posttraumatic mental contamination and suicide risk, despite theoretical overlap. The present study examined relationships between posttraumatic mental contamination and suicide risk via posttraumatic stress symptom clusters and appraisals of perceived burdensomeness and thwarted belongingness. Trauma-exposed participants (N=183) completed measures of posttraumatic mental contamination, posttraumatic stress symptoms, thwarted belongingness, perceived burdensomeness, and suicide risk. Findings revealed significant indirect effects of posttraumatic mental contamination on suicide risk via all posttraumatic stress symptom clusters. Significant serial indirect effects of posttraumatic mental contamination on suicide risk were observed via posttraumatic avoidance and arousal/reactivity and, subsequently, via thwarted belongingness and perceived burdensomeness. Serial models via posttraumatic re-experiencing and negative cognitions/mood symptoms were nonsignificant. Results suggest that posttraumatic mental contamination may increase suicide risk via posttraumatic stress symptom severity, and maladaptive interpersonal appraisals may explain these links through distinct symptom pathways. Implications for posttraumatic suicide risk are discussed.

Self-disgust as a potential mechanism underlying the association between PTSD and suicide risk.

Suicide risk is highly prevalent among individuals with posttraumatic stress disorder (PTSD). Self-disgust, defined as disgust directed internally and comprised of disgust with oneself (disgusting self) and with one's behaviors (disgusting ways), may impact this increased risk. The present study examined self-disgust as a putative mechanism linking PTSD symptoms with suicide risk. A sample of 347 trauma-exposed undergraduates completed measures of PTSD symptoms, suicide risk, self-disgust, and depressive symptoms. Controlling for depressive symptoms, a process model indicated PTSD symptoms were positively linked to suicide risk via increased disgusting self but not disgusting ways. Process models examining individual PTSD symptom clusters revealed positive, indirect links between all PTSD symptom clusters except alterations in arousal and reactivity and suicide risk via disgusting self. These findings expand on growing literature documenting the importance of self-disgust in trauma-related pathology by identifying connections with suicide risk. Future directions and clinical considerations are discussed.

Origins and outlook of interoceptive exposure.

BACKGROUND AND OBJECTIVES: Interoceptive exposure (IE) is a behavioral intervention that reduces anxiety sensitivity and distress associated with somatic sensations. In this discussion, we describe the history, current applications and additional clinical potential of IE. METHOD: We review the origins of IE and its historical application to panic disorder, as well as the accumulating evidence for transdiagnostic application to other disorders including post-traumatic stress disorder, social anxiety disorder, specific phobias and physical disorders. Then, we discuss ways in which IE could contribute to the treatment of additional disorders. RESULTS: IE is well-established in the treatment of panic disorder and increasingly used to target anxiety-provoking physical sensations in other disorders. Research and clinical evidence suggests that anxiety sensitivity is present across a range of disorders, and may actually be one variation on a broader phenomenon of interoceptive sensitivity, or anxiety focused on physical sensations that have been conditioned to unpleasant emotional states. Moreover, somatic symptoms are central to the experience of most emotions and may contribute to avoidant coping, a maintenance factor for disorders of emotion. IE has potential as a transdiagnostic intervention targeting interoceptive sensitivity in disorders such as depression and eating disorders. Nevertheless, IE is underutilized by clinicians in practice. Recent research in inhibitory learning and extinction suggests strategies for maximizing the effectiveness of IE. LIMITATIONS: This review is not exhaustive in nature, and systematic research on transdiagnostic applications of IE remains scarce. CONCLUSIONS: IE is a potentially powerful yet understudied transdiagnostic intervention.

Mindfulness-Based Exposure Strategies as a Transdiagnostic Mechanism of Change: An Exploratory Alternating Treatment Design.

The present study explored whether distress reduction in response to strong negative emotions, a putative transdiagnostic mechanism of action, is facilitated by mindfulness strategies. Seven patients (mean age=31.14years, SD=12.28, range 19-48 years, 43% female, 86% Caucasian) with heterogeneous anxiety disorders (i.e., panic disorder with or without agoraphobia, social anxiety, generalized anxiety) were assigned a randomized order of weeklong blocks utilizing either mindfulness- or avoidance-based strategies while ascending a 6-week emotion exposure hierarchy. Participants completed three exposures per block and provided distress and avoidance use ratings following each exposure. Anxiety severity, distress aversion, and distraction/suppression tendencies were also assessed at baseline and the conclusion of each block. Visual, descriptive, and effect size results showing exposures utilizing mindfulness were associated with higher overall distress levels, compared with those utilizing avoidance. Within blocks, the majority of participants exhibited declining distress levels when employing mindfulness strategies, as opposed to more static distress levels in the avoidance condition. Systematic changes in anxiety severity, distress aversion, and distraction/suppression were not observed. These results suggest mindfulness strategies may be effective in facilitating emotion exposure; however, a minimum dosage may be necessary to overcome initial distress elevation. Potential transdiagnostic change mechanisms and clinical implications are discussed.

Mindfulness-Based Interventions for Older Adults: A Review of the Effects on Physical and Emotional Well-being.

This comprehensive review examined the effects of mindfulness-based interventions on the physical and emotional wellbeing of older adults, a rapidly growing segment of the general population. Search procedures yielded 15 treatment outcome studies meeting inclusion criteria. Support was found for the feasibility and acceptability of mindfulness-based interventions with older adults. Physical and emotional wellbeing outcome variables offered mixed support for the use of mindfulness-based interventions with older adults. Potential explanations of mixed findings may include methodological flaws, study limitations, and inconsistent modifications of protocols. These are discussed in detail and future avenues of research are discussed, emphasizing the need to incorporate geriatric populations into future mindfulness-based empirical research.

Relationships among adaptive and maladaptive emotion regulation strategies and psychopathology during the treatment of comorbid anxiety and alcohol use disorders.

Both maladaptive and adaptive emotion regulation strategies have been linked with psychopathology. However, previous studies have largely examined them separately, and little research has examined the interplay of these strategies cross-sectionally or longitudinally in patients undergoing psychological treatment. This study examined the use and interplay of adaptive and maladaptive emotion regulation strategies in 81 patients receiving cognitive-behavioral interventions for comorbid alcohol use and anxiety disorders. Patients completed measures of emotion regulation strategy use and symptoms of psychopathology pre- and post-treatment. Cross-sectionally, higher use of maladaptive strategies (e.g., denial) was significantly related to higher psychopathology pre- and post-treatment, whereas higher use of adaptive strategies (e.g., acceptance) only significantly related to lower psychopathology post-treatment. Prospectively, changes in maladaptive strategies, but not changes in adaptive strategies, were significantly associated with post-treatment psychopathology. However, for patients with higher pre-treatment maladaptive strategy use, gains in adaptive strategies were significantly associated with lower post-treatment psychopathology. These findings suggest that psychological treatments may maximize efficacy by considering patient skill use at treatment outset. By better understanding a patient's initial emotion regulation skills, clinicians may be better able to optimize treatment outcomes by emphasizing maladaptive strategy use reduction predominately, or in conjunction with increasing adaptive skill use.