Civilian moral injury: associations with trauma type and high-frequency heart rate variability in two trauma-exposed community-based samples.

BACKGROUND: Moral injury exposure (MIE) and distress (MID) may indirectly affect the relationship between trauma exposure and alterations in autonomic regulation [assessed via high-frequency heart rate variability (hfHRV)] in civilians, but this has not been tested in prior research. We conducted two exploratory studies to examine trauma types' associations with MIE and MID among civilian medical patients (Study 1) and explore how these facets may indirectly affect the relationship between trauma type and hfHRV among civilians seeking mental health services (Study 2). METHODS: Participants recruited from a public hospital and/or community advertisements (Study 1, n = 72, 87.5% Black, 83.3% women; Study 2, n = 46, 71.7% Black, 97.8% women) completed measures assessing trauma type, MIE, and MID. In Study 1, trauma types that emerged as significant correlates of MIE and MID were entered into separate linear regression analyses. Trauma types identified were included as predictors in indirect effects models with MIE or MID as the mediator and resting hfHRV (assayed via electrocardiography) as the outcome. RESULTS: Childhood sexual abuse emerged as the only significant predictor of MIE, b = 0.38, p < 0.001; childhood sexual abuse, b = 0.26, p < 0.05, and adulthood sexual assault, b = 0.23, p < 0.05 were significant predictors of MID. Participants with greater MIE and MID demonstrated lower hfHRV. Adulthood sexual assault showed an indirect effect on hfHRV through MID, B = -0.10, s.e. = 0.06, 95%CI (-0.232 to -0.005). CONCLUSIONS: Moral injury was uniquely associated with sexual violence and lower hfHRV in civilians. Data highlight moral injury as a pathway through which autonomic dysregulation may emerge and its salience for trauma treatment selection.

Neurophysiological changes associated with vibroacoustically-augmented breath-focused mindfulness for dissociation: targeting interoception and attention.

BACKGROUND: Dissociative symptoms can emerge after trauma and interfere with attentional control and interoception; disruptions to these processes are barriers to mind-body interventions such as breath-focused mindfulness (BFM). To overcome these barriers, we tested the use of an exteroceptive augmentation to BFM, using vibrations equivalent to the amplitude of the auditory waveform of the actual breath, delivered via a wearable subwoofer in real time (VBFM). We tested whether this device enhanced interoceptive processes, attentional control and autonomic regulation in trauma-exposed women with dissociative symptoms. METHODS: 65 women, majority (82%) Black American, aged 18-65 completed self-report measures of interoception and 6 BFM sessions, during which electrocardiographic recordings were taken to derive high-frequency heart rate variability (HRV) estimates. A subset (n = 31) of participants completed functional MRI at pre- and post-intervention, during which they were administered an affective attentional control task. RESULTS: Compared to those who received BFM only, women who received VBFM demonstrated greater increases in interoception, particularly their ability to trust body signals, increased sustained attention, as well as increased connectivity between nodes of emotion processing and interoceptive networks. Intervention condition moderated the relationship between interoception change and dissociation change, as well as the relationship between dissociation and HRV change. CONCLUSIONS: Vibration feedback during breath focus yielded greater improvements in interoception, sustained attention and increased connectivity of emotion processing and interoceptive networks. Augmenting BFM with vibration appears to have considerable effects on interoception, attention and autonomic regulation; it could be used as a monotherapy or to address trauma treatment barriers.

The impact of PTSD on associations between sex hormones and cardiovascular disease symptoms.

Background: Women have twice the lifetime prevalence of posttraumatic stress disorder (PTSD) relative to men, and PTSD is a known risk factor for cardiovascular disease (CVD). Two sex hormones - estradiol and progesterone - have been found to impact both PTSD and CVD symptomatology, but the way in which sex hormones influence cardiovascular physiology among individuals with PTSD is not well understood.Objective: This study sought to clarify the association between sex hormones, PTSD, and CVD among trauma-exposed women.Method: Sixty-six trauma-exposed women (M age = 31.45, SD = 8.92) completed a clinical interview for PTSD and self-reported CVD symptoms; estradiol and progesterone were assayed from blood samples. The association between each sex hormone and CVD symptoms was analyzed, controlling for age, systolic blood pressure (BP), and diastolic BP.Results: Neither estradiol nor the PTSD-by-estradiol interaction was significantly associated with CVD symptoms. Higher progesterone and, relatedly, progesterone-to-estradiol ratio (PE ratio) were each significantly associated with greater CVD symptom severity, but only for individuals with lower relative PTSD severity.Conclusions: The findings indicate that PTSD moderates the relationship between progesterone and CVD symptoms, and further research is warranted to reconcile findings in existing literature regarding the direction of and mechanisms behind this relationship.

Posttraumatic stress disorder (PTSD) is a risk factor for cardiovascular disease (CVD) and sex hormones have been implicated in their link.The current study examined associations between sex hormones, PTSD, and CVD symptoms among 66 trauma-exposed women.Estradiol was not significantly associated with CVD symptoms, but higher progesterone was significantly associated with greater CVD symptom severity, but only for individuals with lower relative PTSD severity.

Emotionally intelligent school leadership predicts educator well-being before and during a crisis.

We examined the role of educator perceptions of school leader emotion regulation (ER) and emotional support (ES) in educator well-being during a typical year and during the COVID-19 pandemic. Based on emotion contagion theory, leaders' (in)ability to regulate their own emotions may trigger ripple effects of positive or negative emotions throughout their organizations, impacting staff well-being. Additionally, based on conservation of resources theory, when experiencing psychologically taxing events, skillful emotional support provided by leaders may help to replenish staff's depleted psychological resources, promoting staff well-being. In two national studies, a cross-sectional (NStudy 1 = 4,847) and a two-wave study (NStudy 2 = 2,749), we tested the association between United States preK-12 educator perceptions of school leaders' ER and ES with educator well-being before and during the COVID-19 pandemic, employing structural equation modeling and multilevel modeling. In Studies 1 and 2, educator reports of their leaders' ER and ES skills predicted greater educator well-being, including higher positive affect and job satisfaction and lower emotional exhaustion and turnover intentions. In moderation analyses, perceived leader ER predicted well-being about equally among educators facing severe versus mild health impacts from COVID-19. In contrast, perceived leader ES was more strongly associated with educator well-being for some outcomes in those severely versus mildly impacted by COVID-19 illness and death. Leader ER played a role in the well-being of everyone, whereas leader ES was more predictive of well-being for those severely impacted by a crisis. Regarding implications for policy and practice, efforts to promote well-being among educators may be enhanced when combined with efforts to develop school leaders' ER and ES skills, especially in times of crisis. Accordingly, school districts should consider the value of investing in systematic, evidence-based emotion skills training for their leaders.

Moral injury in civilians: associations with trauma exposure, PTSD, and suicide behavior.

Background: Moral injury (MI) describes emotional, spiritual, and social suffering that can arise following psychological trauma. Prior research in military pop ulations indicates the relevance of MI to adverse psychological outcomes, such as post-traumatic stress disorder (PTSD) and suicidal behaviours, and shows evidence for MI as a unique construct. Minimal studies of MI have been implemented in civilians, usually restricted to small samples with a specific set of traumatic experiences, despite the conceptual relevance of MI to non-military trauma reactions more broadly (e.g. feelings of betrayal towards a perpetrator of sexual abuse). Objective: To address this problem, we assessed MI in trauma-exposed civilians to examine ways in which this construct was related to and distinct from trauma and traumatic stress-related problems, including PTSD and depression. Method: We adapted an existing MI scale, Moral Injury Events Scale (MIES) and administered this measure to 81 men and women along with measures of trauma exposure, PTSD and depression, and also asked participants about past suicide attempts. Results: We observed that both greater exposure and distress related to potentially morally injurious events were associated with higher trauma exposure, particularly childhood maltreatment, as well as post-traumatic and depressive psychopathology. However, even after accounting for current PTSD and depression symptoms, MI exposure (F = 6.05, p = .017) was significantly higher among participants who had previously attempted suicide. Conclusions: These pilot data reveal the ways in which MI is associated with trauma exposure, PTSD and depression and highlight the salience of MI in civilians. Similarly, these data demonstrate the unique relevance of MI to suicide behaviours, independent of post-traumatic psychopathology, indicating that this construct may be an understudied contributor to suicide risk in civilians.

Antecedentes: El daño moral (DM) describe el sufrimiento emocional, espiritual y social que puede surgir después de un trauma psicológico. Investigaciones previas en poblaciones militares indican la relevancia del DM para los desenlaces psicológicos adversos, como trastorno de estrés postraumático (TEPT) y las conductas suicidas, y muestran evidencia de que el DM es un constructo único. Se han implementado mínimos estudios de DM en civiles, usualmente restringidos a pequeñas muestras con un conjunto específico de experiencias traumáticas, a pesar de la relevancia conceptual de DM para las reacciones de trauma no militares más amplias (p.Ej., Sentimientos de traición hacia un perpetrador de abuso sexual).Objetivo: Para abordar este problema, evaluamos el DM en civiles expuestos a trauma para examinar las formas en que este constructo se relacionaba y se diferenciaba de los problemas relacionados con el trauma y el estrés traumático, incluidos el trastorno de estrés postraumático y la depresión.Método: Adaptamos una escala de DM existente, la Escala de eventos de daños morales y administramos esta medida a 81 hombres y mujeres junto con medidas de exposición al trauma, TEPT y depresión, y también preguntamos a los participantes sobre intentos suicidas pasados.Resultados: Observamos que tanto una exposición mayor como la angustia relacionada con eventos de potencial daño moral se asociaron con mayor exposición a trauma, particularmente al maltrato infantil, así como a psicopatología postraumática y depresiva. Sin embargo, incluso después de tener en cuenta los síntomasde TEPT actuales y depresión, la exposición a DM (F = 6.05, p = .017) fue significativamente mayor entre los participantes que habían intentado suicidio previamente.Conclusiones: Estos datos piloto revelan las formas en que el DM se asocia con la exposición al trauma, TEPT y depresión y resaltan la importancia del DM en la población civil. De manera similar, estos datos demuestran la relevancia única del DM para los comportamientos suicidas, independientemente de la psicopatología postraumática, lo que indica que este constructo puede ser un contribuyente subestudiado del riesgo de suicidio en la población civil.

Maternal influences on binge eating behaviors in children.

Binge eating in childhood has been linked to adverse future health outcomes. Parental factors, such as parents' emotion regulation and executive functioning, are likely to influence children's self-regulatory behaviors, including eating. Executive functioning describes a range of higher-order cognitive functions such as planning, abstraction, inhibitory control and working memory, which involves the ability to learn, update and manipulate new information while managing distractions. No studies have examined associations between maternal emotion regulation and executive functioning and the child's maladaptive eating patterns, which was the goal of the present study. Forty-eight mother and child pairs completed self-report clinical measures of emotion dysregulation and attentional control, and mothers completed a brief neuropsychological battery, which included executive functioning measures. Child's disordered eating was measured with the Child Binge Eating Disorder Scale. Linear regression results indicated that mother's performance on a working memory task and child's emotion dysregulation was significantly associated with child's binge eating symptoms (R 2 = 0.34). These data, which reveal that maternal executive functioning is associated with self-regulatory behaviors in children, indicate a possible mechanism through which maladaptive eating behaviors may emerge early in development. This relationship merits further exploration in larger-scale prospective intergenerational studies.

Post-trauma anhedonia is associated with increased substance use in a recently-traumatized population.

Recreational substance use (SU) can emerge or worsen in the aftermath of psychological trauma. Anhedonia is one reason for this problematic SU. Symptoms of posttraumatic stress disorder (PTSD) that represent anhedonia (post-trauma anhedonia; PTA) have been consistently linked to SU disorders. However, no prospective studies have examined whether changes in PTA over time are associated with problematic SU in recently-traumatized people, which was the goal of this study. 165 men and women were recruited as part of a prospective PTSD study in the emergency department of a Level 1 trauma center. Clinical assessments of PTSD and SU were administered at three and six months post-trauma. Compared to participants with minimal SU at six months post-trauma, high substance users at six months post-trauma showed significant increases in PTA during the three to six month time period. This relationship was significant even after accounting for variance associated with other factors, including PTSD symptoms such as re-experiencing and hyperarousal. Participants who demonstrated increases in SU during this time also showed significant increases in PTA, unlike those who demonstrated consistently minimal/no SU during this time. These findings indicate that PTA may be a mechanism through which SU problems emerge in recently-traumatized individuals.