Extinction retention and the menstrual cycle: Different associations for women with posttraumatic stress disorder.

The propensity to acquire and retain conditioned fear responses may contribute to the risk of developing and maintaining posttraumatic stress disorder (PTSD) following a traumatic event. There is growing evidence that the gonadal hormones estrogen and progesterone are associated with how well women retain extinction of previously conditioned fear responses. Thus, sex steroid effects may contribute to the increased prevalence of PTSD in women. For the current study, 32 nonmedicated female trauma survivors with and without PTSD completed a differential fear conditioning task both during the early follicular phase of the menstrual cycle when estradiol and progesterone levels are low, and during the midluteal phase when estradiol and progesterone levels are high. Skin conductance served as the measure of conditioned fear. Women with PTSD, compared to those without, showed impaired retention of extinction learning in the midluteal phase of the menstrual cycle. Therefore, the impact of menstrual phase on extinction retention may differ between women with and without PTSD. These findings raise potential considerations regarding the coordination of psychopharmacologic and trauma exposure-based treatments for PTSD with specific phases of the menstrual cycle.

Adverse childhood experiences, health perception, and the role of shared familial factors in adult twins.

To examine the relationship between adverse childhood experiences (ACE) and health perception in adulthood, and to explore the contribution of shared familial factors to these associations. Data were collected from 180 female twins (90 pairs) from the community-based University of Washington Twin Registry. Participants completed questionnaires including the modified ACE Questionnaire, Traumatic Life Events Questionnaire, McGill Pain Questionnaire-Short Form, and the SF-36. Mixed effects linear regression modeling investigated the effects of ACE on indices of health perception controlling for correlated twin data. Additional models examined the associations while controlling for the experience of physical and/or sexual abuse in childhood; within-twin pair models that inherently adjust for familial factors explored shared familial influences. After controlling for relevant demographic variables, more ACE was associated with worse perceptions of general health (p=.01) and vitality (p=.05) on the SF-36. After controlling for childhood physical and/or sexual abuse, the relationship between ACE and general health remained significant (p=.01) while vitality was no longer significant. None of the associations remained significant after accounting for the influence of familial factors. These results support previous findings on the negative link between ACE and perceived health in adulthood. The detrimental effects of ACE on vitality may be accounted for by the experience of childhood physical and/or sexual abuse. Shared familial factors might play a partial role in the relationship between ACE and health perception. Future research should further investigate the genetic and environmental mechanisms that may explain this relationship.

Health and distress predictors of heart rate variability in fibromyalgia and other forms of chronic pain.

OBJECTIVE: To examine health, psychological, and autonomic impairment differences between individuals with fibromyalgia and those with other chronic benign pain in these conditions. The possible role of the autonomic nervous system in the maintenance of chronic benign pain can be examined using heart rate variability (HRV), which measures the interplay between the excitatory sympathetic and the inhibitory parasympathetic nervous system. Predictors of HRV will also be examined. METHODS: This study examined resting HRV in a sample of 84 patients with chronic benign pain, a subgroup of whom had fibromyalgia. Participants completed a battery of self-report measures and underwent measurements of resting HRV. RESULTS: Individuals with fibromyalgia experienced higher levels of depression (t (82)=-2.27, p<.05) and significantly greater difficulty with physical functioning (t (75.8)=2.65, p<.01) than did those with other chronic benign pain, there were no significant differences in any of the HRV indices. Across all pain conditions, we found that age, gender, physical health functioning, pain anxiety, and pain sensations were all significant predictors of HRV, suggesting that each are involved in the relationship between chronic benign pain and autonomic function. CONCLUSIONS: These findings emphasize the importance of addressing psychological distress and physical functioning in chronic pain populations and specifically fibromyalgia. Future research can further examine the role of physical health functioning, psychological distress, and pain severity in the relationship between chronic pain and autonomic abnormalities.

Trauma reactivity, avoidant coping, and PTSD symptoms: a moderating relationship?

In the immediate aftermath of a traumatic event, many individuals experience physiological reactivity in response to reminders of the traumatic event that typically lessens over time. However, an overreliance on avoidant coping strategies may interfere with the natural recovery process, particularly for those who are highly reactive to trauma reminders. In the current investigation, we examined avoidant coping as a moderator of the association between heart rate reactivity to a trauma monologue measured shortly after a traumatic event and severity of posttraumatic stress disorder (PTSD) symptoms measured several months later. Fifty-five female survivors of assault completed PTSD diagnostic interviews and a self-report coping measure and participated in a trauma monologue procedure that included continuous heart rate measurement. These procedures were completed within 1 month of the assault and again 3 months postassault. After we controlled for the effect of initial symptom levels, the interaction of heart rate reactivity to the trauma monologue and avoidant coping measured at Time 1 was associated with PTSD symptom severity at Time 2. Individuals who are relatively highly reliant on avoidant coping strategies and relatively highly reactive to trauma reminders may be at greatest risk of maintaining or potentially increasing their PTSD symptoms within the first few months following the trauma. These findings may help inform early intervention efforts for survivors of traumatic events.

Attentional biases in PTSD: More evidence for interference.

Attentional biases to trauma-related stimuli have been widely demonstrated in individuals with posttraumatic stress disorder (PTSD). However, the majority of these studies used methods not suited to differentiating difficulty disengaging attention from threatening stimuli (interference) from facilitated detection of threat. In the current study, a visual search task (VST) with a lexical decision component was used to differentiate between attentional interference and facilitation. Forty-six sexual assault survivors with High PTSD or Low PTSD symptoms completed the VST with three types of stimuli (trauma-related, general threat-related, and semantically-related neutral words), to examine the specificity of attentional biases associated with PTSD symptoms. High PTSD participants showed increased interference to trauma-related words relative to Low PTSD participants. Furthermore, the increased attentional interference in High PTSD participants was specific to trauma-related stimuli. No evidence was found for facilitated detection of threatening stimuli in PTSD. These results provide additional support for attentional biases in PTSD relating to attentional interference with trauma-related cues rather than facilitated detection of threat. The implications for this pattern of results are discussed in relation to anxiety disorders that are characterized by rumination and/or intrusions (e.g., PTSD, GAD) rather than those more circumscribed to fight or flight response (e.g., phobias).