Shame Proneness, Negative Cognitions, and Posttraumatic Stress Among Women with a History Sexual Trauma.

While fear and anger have been extensively studied as emotions involved in posttraumatic stress disorder, shame is an important emotion to examine in those who have experienced a traumatic event, as it is often associated with treatment avoidance and treatment resistance. Compared to guilt, which is associated with having participated in something that violates social/cultural norms or expectations, shame is associated with a negative perception of the self. The current paper sought to examine the role of shame proneness and guilt proneness, as it relates to posttraumatic cognitions and posttraumatic stress symptoms (PTSS) among women reporting a history of sexual trauma. Seventy-two community-recruited women with a history of sexual trauma completed self-report measures of shame and guilt proneness and negative posttraumatic cognitions as well as a semi-structured interview assessing PTSS. There was an indirect effect of shame proneness on PTSS, through its positive association with negative cognitions about the self but not others or the world. Guilt proneness was not significantly related to PTSS or negative posttraumatic cognitions. The current paper outlines the importance of these findings and future directions for continuing to better understand the relations between shame and posttraumatic stress disorder symptoms and treatment.

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.

Affective lability predicts decreased habituation in posttraumatic stress symptom responding during a single laboratory session of imaginal exposure.

Affective lability, or the instability of emotional states, is associated with heightened levels of trauma-related emotional responding and posttraumatic stress disorder (PTSD) symptoms. However, the impact of affective lability, specifically on habituation to idiographic trauma cues, has yet to be examined among trauma-exposed individuals. The current study examined differential response trajectories to trauma-related imaginal exposure as a function of affective lability. Specifically, 72 women with a history of sexual victimization participated in a laboratory-based study involving a single session of repeated imaginal exposures to idiographic traumatic event cues. As hypothesized, participants higher in affective lability reported less reduction in trauma-cue elicited posttraumatic stress symptoms across exposure trials. Given these results, it will be important to continue to extend these laboratory findings to better understand how elevated affective lability is related to response to trauma-focused exposure therapy among individuals with PTSD or other trauma-related psychopathology (e.g., borderline personality disorder).

Posttraumatic Stress Disorder and Suicidal Behavior: Indirect Effects of Impaired Social Functioning.

Social functioning is negatively impacted by the presence of PTSD, while increasing risk of suicidal behavior among individuals with PTSD. However, little research has examined the specific role of social functioning in the association between PTSD and suicidal behavior. Parallel multiple indirect effects analyses were performed to understand the unique indirect effects of four aspects of social functioning. Indirect effects of PTSD on suicidal ideation were significant through three pathways: interpersonal conflict, perceived family support, and interpersonal apprehension. Perceived family support was the only indirect pathway significantly associated with suicide attempt. Findings suggest that social functioning should be assessed and potentially targeted during treatment to help modify the risk for suicidal behavior among individuals with PTSD.

Alleviation of moral disgust, shame, and guilt in posttraumatic stress reactions: an evaluation of comprehensive distancing.

Research suggests that moral disgust, shame, and guilt are present in posttraumatic psychopathology. However, it is unclear that these emotional states are responsive to empirically supported interventions for posttraumatic stress symptoms (PTSS). This study explored the relations among moral disgust, shame, guilt, and PTSS, and examined comprehensive distancing (CD) as a novel intervention for these emotional states in undergraduates with elevated PTSS. Participants were randomly assigned to use a CD or a cognitive challenge task in response to personalized scripts of a traumatic event. Both interventions were associated with decreases in disgust, moral disgust, shame, and guilt. Contrary to predictions, there were no significant differences between the exercises in the reduction of negative emotions. In addition, PTSS severity was correlated with trauma-related guilt as well as state guilt and shame, but not trait or state measures of disgust or moral disgust. This proof of concept project sets the stage for further research examining CD as an alternative or adjunctive intervention for posttraumatic stress reactions with strong features of moral disgust, shame, and guilt.

Understanding PTSD comorbidity and suicidal behavior: associations among histories of alcohol dependence, major depressive disorder, and suicidal ideation and attempts.

Individuals with posttraumatic stress disorder (PTSD) are at an elevated risk for experiencing suicidal thoughts and actions. However, a relative dearth of research has examined factors that may impact this relation, such as common co-occurring disorders. Utilizing the National Comorbidity Survey-Replication data, the current study examined comparisons between comorbid PTSD and major depressive disorder (MDD) and comorbid PTSD and alcohol dependence (AD) in relation to suicidal ideation and suicide attempts. It was hypothesized that comorbid MDD would be associated with an elevated likelihood of suicidal ideation, while comorbid AD would be associated with an elevated likelihood of suicide attempt history. Results indicated that only PTSD-AD was significantly associated with an elevated likelihood of endorsing histories of both suicidal ideation and suicide attempts. These findings suggest that AD may be a critical risk factor for acquiring the capability for suicide attempts.

Posttraumatic stress disorder and alcohol dependence: individual and combined associations with social network problems.

People with either posttraumatic stress disorder (PTSD) or alcohol dependence (AD) are apt to report problems in their social networks, including low perceived support and elevated conflict. However, little research has examined social networks among people with comorbid PTSD/AD despite evidence suggesting these two conditions commonly co-occur and are linked to particularly severe problems. To test the hypothesis that people with comorbid PTSD/AD experience particularly elevated social network problems, individuals with lifetime diagnoses of PTSD, AD, comorbid PTSD/AD, or no lifetime history of Axis I psychopathology in the National Comorbidity Survey-Replication were compared on four dimensions of social networks: (1) Closeness, (2) Conflict, (3) Family Support, and (4) Apprehension. Persons with PTSD, AD, or comorbid PTSD/AD endorsed more problems with the Conflict, Family Support, and Apprehension factors compared to people with no history of Axis I psychopathology. Moreover, individuals with comorbid PTSD/AD endorsed greater Apprehension and significantly less Family Support compared to the other three groups. Results suggest people with comorbid PTSD/AD experience increased problems with their family as well as greater concerns about enlisting social support than even people with PTSD or AD alone. Treatments for people suffering from comorbid PTSD/AD should consider assessing for and possibly targeting family support and apprehension about being close to others.

Disgust, mental contamination, and posttraumatic stress: unique relations following sexual versus non-sexual assault.

Disgust and mental contamination (or feelings of dirtiness and urges to wash in the absence of a physical contaminant) are increasingly being linked to traumatic event exposure and posttraumatic stress (PTS) symptomatology. Evidence suggests disgust and mental contamination are particularly relevant to sexual assault experiences; however, there has been relatively little direct examination of these relations. The primary aim of the current study was to assess disgust and mental contamination-based reactivity to an individualized interpersonal assault-related script-driven imagery procedure. Participants included 22 women with a history of traumatic sexual assault and 19 women with a history of traumatic non-sexual assault. Sexual assault and PTS symptom severity predicted greater increases in disgust, feelings of dirtiness, and urges to wash in response to the traumatic event script. Finally, assault type affected the association between PTS symptom severity and increases in feelings of dirtiness and urges to wash in response to the traumatic event script such that these associations were only significant among sexually assaulted individuals. These findings highlight the need for future research focused on elucidating the nature of the relation between disgust and mental contamination and PTS reactions following various traumatic events.

The influence of depressive symptoms on suicidal ideation among U.S. Vietnam-era and Afghanistan/Iraq-era veterans with posttraumatic stress disorder.

Major depressive disorder (MDD) co-occurs frequently with posttraumatic stress disorder (PTSD), and both disorders are linked to suicidal ideation. An emergent literature examines suicidal ideation in U.S. Afghanistan/Iraq-era veterans. Little research, however, has studied the role of PTSD and comorbid MDD on suicidal ideation across service eras. Therefore, this study aimed to examine the impact of depression on suicidal ideation in Afghanistan/Iraq-era and Vietnam-era veterans with PTSD. The sample included 164 Vietnam and 98 Afghanistan/Iraq veterans diagnosed with PTSD at a VA outpatient PTSD Clinic. Using structured interviews, 63% of the Vietnam sample and 45% of the Afghanistan/Iraq sample were diagnosed with comorbid current MDD. Measures included self-report assessments of PTSD and depressive symptoms and the Personality Assessment Inventory. Results of analyses suggested that in veterans of both eras, PTSD, MDD, and their interaction were significantly related to suicidal ideation (PTSD: η(2) = .01; MDD: η(2) = .10; PTSD × MDD: η(2) = .02). For veterans reporting greater depressive symptoms, there was a stronger relationship between PTSD symptoms and suicidal ideation. These results suggest that veterans from both eras display a similar clinical presentation and highlight the need to consider depressive symptoms when assessing veterans with PTSD. Future research should examine suicidal ideation and behaviors as they change over time in these two cohorts.

Smoking withdrawal in smokers with and without posttraumatic stress disorder.

INTRODUCTION: Previous research on smoking withdrawal in posttraumatic stress disorder (PTSD) has been limited by the use of retrospective and observational methods and has lacked repeated assessments on the first day of abstinence and evaluation of the conditioned effects of smoking. METHODS: Smokers with (n = 17; 59% female) and without (n = 30; 17% female) PTSD completed 3 randomly ordered experimental sessions using a 2 (group: PTSD vs. non-PTSD) × 3 (smoking condition: usual brand vs. nicotine free vs. no smoking) design. Before the smoking manipulation, participants completed self-report measures of smoking urges and withdrawal, followed by withdrawal assessment after the smoking manipulation. RESULTS: Compared with smokers without PTSD, smokers with PTSD exhibited higher craving (χ1² = 16.60, p < .001) and habit withdrawal (χ1² = 10.38, p = .001) following overnight abstinence. PTSD smokers also exhibited worsening negative affect throughout the morning when not smoking a cigarette (χ1² = 11.30, p = .004). After smoking, smokers with PTSD reported diminished relief from craving (χ1² = 6.49, p = .011), negative affect (χ1² = 4.51, p = .034), arousal (χ1² = 6.46, p = .011), and habit withdrawal (χ1² = 7.22, p = .007), relative to smokers without PTSD. CONCLUSIONS: Results of this preliminary investigation suggested that after overnight abstinence, PTSD smokers experienced worse withdrawal symptoms and greater urges to smoke for both positive and negative reinforcement. Research on smoking withdrawal early in the course of smoking abstinence in PTSD could inform interventions targeting abstinence early in the quit attempt.