Shame as a Mediator in the Association Between Emotion Dysregulation and Posttraumatic Stress Disorder Symptom Reductions Among Combat Veterans in a Residential Treatment Program.

Emotion dysregulation (ED) can be defined as one's inability to effectively respond to and manage internal experiences and the expression of emotion. ED has been linked to the development and maintenance of posttraumatic stress disorder (PTSD), with recent research suggesting that reductions in ED may predict improved treatment outcomes among both civilian and veteran populations. However, few studies have examined how changes in ED may predict treatment outcomes among veterans with PTSD and whether certain core features of PTSD, such as shame, may act as potential mediators in the association between ED and PTSD symptom reductions. The present study sought to explore facets of ED, feelings of shame, and PTSD symptoms among 43 combat veterans upon their admission and discharge to a residential PTSD program. The results demonstrated that all variables of interest significantly decreased from admission to discharge, ds = 0.75-1.84. Correlations indicated that reductions in ED, R2 = .184, and shame, R2 = .228, were associated with reductions in PTSD symptoms. However, the association between reductions in ED and PTSD was significantly mediated by reductions in shame. Overall, these results suggest that higher levels of emotion regulation may partially affect PTSD symptoms through reductions in shame. This may explain the efficacy of frontline PTSD treatments, as they explicitly focus on the processing of one's traumatic experience by reducing PTSD symptoms through regulation techniques that target emotional-behavioral cycles, which may include the shame-withdraw cycle.

Prevalence of eating disorders and comorbid psychopathology in a US sample of treatment-seeking veterans.

OBJECTIVE: Eating disorders (EDs) are a well-studied public health issue in the general population. Less is known, however, about the prevalence of such conditions and levels of comorbid psychopathology among military and veteran populations. The current study sought to describe the probable prevalence of EDs and levels of comorbid psychopathology using a racially diverse treatment-seeking sample of US veteran men and women. METHOD: Veterans (N =254) presenting for routine clinical care completed self-report questionnaires assessing EDs, posttraumatic stress disorder, depression, and shame. RESULTS: Thirty-one percent of the sample met probable criteria for either bulimia nervosa (BN), binge-eating disorder, or purging disorder. Although overall ED prevalence estimates were similar across men and women, estimates of BN were higher among Black veterans compared to White veterans or veterans who identified as a race other than Black or White. Further, mean levels of psychopathology were significantly higher in veterans with a probable ED compared to those without. DISCUSSION: This study extends previous research and highlights the importance of establishing dedicated ED screening programs within the Veterans Health Administration.

Shame as a Moderator between Emotion Dysregulation and Posttraumatic Stress Disorder Severity among Combat Veterans Seeking Residential Treatment.

BACKGROUND: Growing evidence suggests that emotion dysregulation may be predictive of posttraumatic stress disorder (PTSD) severity, with emotional non-acceptance, lack of counter strategies, impulse control deficits, and lack of emotional awareness all being positive predictors. However, findings have been mixed. This may be due to no previous study examining the association between emotion dysregulation and PTSD severity with shame, a maintaining factor of PTSD, as a potential moderator. METHODS: The present study examined the relationship between emotion dysregulation, shame, and PTSD severity among 78 male combat veterans (mean age = 42.19) upon their admission to a residential combat PTSD program. RESULTS: Results demonstrated that shame and all facets of emotion dysregulation (except lack of emotional awareness & clarity) were positively associated with PTSD severity. Shame moderated the relationship between lack of emotional awareness and strategies. Among those at or below the sample mean on shame, lack of access to strategies was a positive predictor of PTSD severity. Comparatively, among those with high levels of shame, emotional awareness predicted greater PTSD severity, while among those with low levels of shame, emotional awareness predicted lower PTSD severity. LIMITATIONS: Limitations included reliance on self-report questionnaires and an all-male sample. CONCLUSIONS: Thus, emotion dysregulation may only predict PTSD severity among those reporting lower levels of shame, suggesting the importance of addressing shame as well as emotion dysregulation deficits among those with PTSD. Moreover, emotional awareness may be either a risk or protective factor depending on levels of shame.

Examining potential overlap of DSM-5 PTSD criteria D and E.

The Diagnostic and Statistical Manual, Fifth Edition-5 (DSM-5) has adopted a four-factor symptom model for Posttraumatic Stress Disorder (PTSD) that includes new symptom additions in criterion D (D2, D3, D4), negative alterations in cognition and mood. This article examines potential overlapping endorsement of these symptoms amongst one another and with the behavioral symptoms within PTSD criterion E (E1 and E3; alterations in arousal and reactivity), through the lenses of cognitive-behavioral theory. Responses of veteran participants (N=320) completing the PTSD Checklist-5 were used to determine overlap in symptom reporting. We conducted a series of direct logistic regressions to determine the predictive ability of meeting the criterion D or E symptoms based on endorsement of the target D symptoms (D2, D3, D4). Results suggest that the new cognitive and emotional symptoms of criterion D have significant overlapping content, and that thought-related symptoms are often endorsed in conjunction with their behavioral counterpoint (D2/E3; D4/E1). Our results suggest that DSM-5 criterion D symptoms may not be central to the diagnostic structure of PTSD. These symptoms add complexity and difficulty to diagnosing PTSD without adding much unique content.

Using Clinicians' Ideal Social Climate Ratings in Group Therapy Training: Staff Development, Supervision, and Teaching.

A group's norms are reflected in the group's social climate, and social climate dimensions have been associated with treatment outcomes in group therapy. However, novice group therapists are often not clear about which norms to develop in a given group. We describe a procedure in which clinicians specify their ideal social climate for a therapy group or a treatment setting on the Group Environment Scale (Moos, 2002) or the Community-Oriented Program Environment Scale (Moos, 1988) and compare their ideals with various reference groups and with one another. Discrepancies in ideal social climate ratings between co-therapists or among clinical staff can be explored in order to enhance coordinated interventions. This procedure has been used with experienced clinicians, trainees, and graduate students in group therapy courses.

Efficacy of structured approach therapy in reducing PTSD in returning veterans: A randomized clinical trial.

The U.S. military deployed in support to Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) show high rates of posttraumatic stress disorder (PTSD) and relationship, partner, and parenting distress. Given the pervasive effect of combat-related PTSD on returning veterans and its effect on their loved ones, the investigators have developed a couples-based treatment, structured approach therapy (SAT), to reduce PTSD while simultaneously decreasing relationship and partner distress. This study presents treatment outcome data measuring PTSD and relationship outcomes from a randomized clinical trial (RCT) comparing SAT, a manualized 12-session novel couples-based PTSD treatment, to a manualized 12-session couples-based educational intervention (PTSD Family Education [PFE]). Data were collected from 57 returning veterans meeting Diagnostic and Statistical Manual of Mental Disorders (fourth edition, text revision; DSM-IV-TR) criteria for PTSD and their cohabiting partners; data collection was scheduled for pretreatment, posttreatment, and 3-month follow-up. Findings from an intent-to-treat analysis revealed that veterans receiving SAT showed significantly greater reductions in self-rated (PTSD Checklist; p < .0006) and Clinician-Administered PTSD Scale (CAPS)-rated PTSD (p < .0001) through the 3-month follow-up compared with veterans receiving PFE; 15 of 29 (52%) veterans receiving SAT and 2 of 28 (7%) receiving PFE no longer met DSM-IV-TR criteria for PTSD. Furthermore, SAT was associated with significant improvements in veteran relationship adjustment, attachment avoidance, and state anxiety. Partners showed significant reductions in attachment anxiety. This couples-based treatment for combat-related PTSD appears to have a strong therapeutic effect on combat-related PTSD in recently returned veterans.

Changes in psychopathology and symptom severity in bulimia nervosa between 1993 and 2003.

OBJECTIVE: This study investigated changes in symptom severity and the psychopathology of patients with bulimia nervosa between 1993 and 2003. METHOD: Pretreatment data of patients diagnosed with bulimia nervosa, collected between 1993 and 1997 from two multisite studies (N = 263), and from 2001 to 2003 from a third multisite study (N = 233) were compared for differences in psychopathology, eating disorder symptoms, and demographic characteristics. RESULTS: There was a significant increase in baseline age between the cohorts (1993M = 28.7 +/- 7.9, 2001M = 30.3 +/- 8.7, p = 0.036) together with a decrease in personality disorders and in several aspects of eating disorder psychopathology. After controlling for age however, significant pretreatment differences were found only in the restraint subscale on the EDE. CONCLUSION: Results suggest that the presentation of individuals with bulimia nervosa has changed between 1993 and 2003, in that participants were older and demonstrated less dietary restraint. Hence, comparisons between samples and treatment trials over time must be made with caution.

Reactivity of the B-H Bond in tris(pyrazolyl)hydroborato zinc complexes: unexpected example of zinc hydride formation in a protic solvent and its relevance towards hydrogen transfer to NAD(+) mimics by tris(pyrazolyl)hydroborato zinc complexes in alcoholic media.

Solutions of the zinc hydroxide complex [Tp(Bu(t),Me)]ZnOH in alcohols (ROH; R = Me, Et, Pr(i)) achieve hydride transfer to the NAD(+) model, 10-methylacridinium perchlorate. Deuterium labeling studies, however, demonstrate that the source of the hydride is not the alcohol but, rather, the B [bond] H group of the [Tp(Bu(t),Me)] ligand. A further example in which a [Tp(Bu(t),Me)] ligand acts as a hydride donor is provided by the reaction of the aqua complex [[Tp(Bu(t),Me)]Zn(OH(2))][HOB(C(6)F(5))(3)] with MeOH to generate the zinc hydride complex [Tp(Bu(t),Me)]ZnH. The present study therefore provides a caveat for the often assumed inertness of the B [bond] H group in tris(pyrazolyl)hydroborato ligands, especially in the presence of reactive cationic species.