Distinct Trauma Types in Military Service Members Seeking Treatment for Posttraumatic Stress Disorder.

We examined the frequency of trauma types reported in a cohort of service members seeking treatment for posttraumatic stress disorder (PTSD) and compared symptom profiles between types. In this observational study, 999 service members (9.2% women; Mage = 32.91 years; 55.6% White) were evaluated using a standardized assessment procedure to determine eligibility for clinical trials. Participants were evaluated for DSM-IV-TR-defined PTSD using the PTSD Symptom Scale-Interview; all participants reported a Criterion A event. Independent evaluators rated descriptions of Criterion A events as belonging to trauma types at a high degree of reliability, κ = 0.80. Aggregated non-life-threat primary trauma types were more frequently endorsed than aggregated life-threat types, 95% CI [17.10%, 29.20%]. Participants who endorsed moral injury-self traumas had a higher level of reexperiencing (d = 0.39), guilt (hindsight bias, d = 1.06; wrongdoing, d = 0.93), and self-blame (d = 0.58) symptoms, relative to those who reported life threat-self. Participants who experienced traumatic loss had greater reexperiencing (d = 0.39), avoidance (d = 0.22), guilt (responsibility, d = 0.39), and greater peri- and posttraumatic sadness (d = 0.84 and d = 0.70, respectively) symptoms, relative to those who endorsed life threat-self. Relative to life threat-self, moral injury-others was associated with greater peri- (d = 0.36) and posttraumatic (d = 0.33) betrayal/humiliation symptoms, and endorsement of aftermath of violence was associated with greater peri- (d = 0.84) and posttraumatic sadness (d = 0.57) symptoms. War zone traumas were heterogeneous, and non-life-threat traumas were associated with distinct symptoms and problems.

The Upside to Feeling Worse Than Average (WTA): A Conceptual Framework to Understand When, How, and for Whom WTA Beliefs Have Long-Term Benefits.

Our thoughts, feelings, and behaviors are shaped in critical ways by our beliefs about how we compare to other people. Prior research has predominately focused on the consequences of believing oneself to be better than average (BTA). Research on the consequences of worse-than-average (WTA) beliefs has been far more limited, focusing mostly on the downsides of WTA beliefs. In this paper, we argue for the systematic investigation of the possible long-term benefits of WTA beliefs in domains including motivation, task performance, and subjective well-being. We develop a conceptual framework for examining these possible benefits, we explore the usefulness of this framework to generate novel insights in an important psychological domain (skill learning), and we conclude with broader recommendations for research in other domains such as friendship formation, moral, and political decision making.

Are ADHD Screeners Safe to Use?

Objective: To investigate whether administration of a common ADHD screener followed by generic feedback would affect college students' subsequent symptom reports and cognitive performance. Method: Participants were 157 college students randomly assigned to an experimental group-which completed the World Health Organization Adult ADHD Self-Report Scale screener and received standard generic feedback-or a control group. All participants then completed a battery of cognitive tasks and a long-form symptom rating scale. Results: The experimental and control groups did not differ significantly in terms of their subsequent symptom reports or their performance on any cognitive tasks. These null results remained after considering possibilities such as unequal group variances and interactions between screening effects and gender. Conclusion: When administered judiciously alongside generic feedback in a group setting, this common ADHD screener does not appear to affect college students' self-perceptions or cognitive abilities.

Common Data Elements in the Assessment of Military-Related PTSD Research Applied in the Consortium to Alleviate PTSD.

INTRODUCTION: Driven by the need to share data, sufficiently power studies, and allow for cross-study comparisons of medical and psychiatric diseases, the President's National Research Action Plan issued in 2013 called for the use of state-of-the-art common data elements (CDEs) for research studies. CDEs are variables measured across independent studies that facilitate methodologically sound data aggregation and study replication. Researchers in the field of military-related post-traumatic stress disorder (PTSD) have suggested applicable CDEs; however, to date, these recommendations have been conceptual and not field-tested. The Consortium to Alleviate PTSD (CAP) - an interdisciplinary and multi-institutional, military-related PTSD research consortium funded by the Departments of Defense and Veterans Affairs - generated and applied CDEs that can be used to combine data from disparate studies to improve the methodological and statistical capabilities of study findings. We provide a description and rationale for the CAP CDEs and details about administration with two main goals: (1) to encourage military-related PTSD researchers to use these measures in future studies and (2) to facilitate comparison, replication, and data aggregation. MATERIALS AND METHODS: The CAP compiled mandated (core) and optional CDEs based on the following criteria: (1) construct applicability to military-related PTSD; (2) precedence (use) in prior, related research; (3) published and strong psychometric evidence; (4) no cost (public domain); and (5) brevity, to limit participant burden. We provided descriptive statistics and internal consistency reliabilities for mandated measures from an initial cohort of around 400 participants enrolled in CAP studies. RESULTS: Mandated CDEs in the CAP were found to have very good internal consistency reliability. CONCLUSION: Although further research is needed to determine the incremental validity of these CDEs, preliminary analyses indicated that each mandated measure has very good internal consistency reliability. Investigators designing military-related PTSD research should consider using these field-tested CDEs to facilitate future data aggregation. Feedback based on empirical evidence or practical concerns to improve these CDEs is welcome.

From sucker to saint: moralization in response to self-threat.

When people's rationality and agency are implicitly called into question by the more expedient behavior of others, they sometimes respond by feeling morally superior; this is referred to as the sucker-to-saint effect. In Experiment 1, participants who completed a tedious task and then saw a confederate quit the same task elevated their own morality over that of the confederate, whereas participants who simply completed the task or simply saw the confederate quit did not. In Experiment 2, this effect was eliminated by having participants contemplate a valued personal quality before encountering the rebellious confederate, a result suggesting a role for self-threat in producing moralization. These studies demonstrate that moral judgments can be more deeply embedded in judges' immediate social contexts-and driven more by motivations to maintain self-image-than is typically appreciated in contemporary moral-psychology research. Rather than uphold abstract principles of justice, moral judgment may sometimes just help people feel a little less foolish.

Disgust as embodied moral judgment.

How, and for whom, does disgust influence moral judgment? In four experiments participants made moral judgments while experiencing extraneous feelings of disgust. Disgust was induced in Experiment 1 by exposure to a bad smell, in Experiment 2 by working in a disgusting room, in Experiment 3 by recalling a physically disgusting experience, and in Experiment 4 through a video induction. In each case, the results showed that disgust can increase the severity of moral judgments relative to controls. Experiment 4 found that disgust had a different effect on moral judgment than did sadness. In addition, Experiments 2-4 showed that the role of disgust in severity of moral judgments depends on participants' sensitivity to their own bodily sensations. Taken together, these data indicate the importance-and specificity-of gut feelings in moral judgments.

From Misperception to Social Connection: Correlates and Consequences of Overestimating Others' Social Connectedness.

Two studies document the existence and correlates of a widespread social belief, wherein individuals who have recently moved to a new social environment see their peers as more socially connected than they themselves are. In Study 1, the prevalence of this belief was documented in a large sample of first-year students ( N = 1,099). In Study 2, the prevalence of this social belief was replicated in a targeted sample of university students ( N = 389). Study 2 also documented both positive and negative implications of this belief. Specifically, at any given time, students who believed that their peers were more socially connected reported lower well-being and belonging. Over time, however, the belief that one's peers are moderately more socially connected than oneself was associated with more friendship formation.

Distinguishing war-related PTSD resulting from perpetration- and betrayal-based morally injurious events.

OBJECTIVE: We investigated whether potentially morally injurious events (PMIEs) during a combat deployment may lead to PTSD through distinct pathways from danger-based events. We also examined the prevalence of perpetration-based PMIEs, during which service members behaved in ways that violated their own moral values, and betrayal-based PMIEs, during which personal moral expectations were violated by trusted others. METHOD: Using a sample of 867 active duty Marines from a single infantry battalion that engaged in heavy ground combat while deployed to Afghanistan, a structural equation model was built to examine the relationships between perpetration- and betrayal-based PMIEs, combat experiences, and peritraumatic dissociation reported at 1 month postdeployment, and guilt/shame, anger, and PTSD symptoms reported at 8 months postdeployment. RESULTS: The relationship between betrayal-based PMIEs and PTSD was mediated by anger (ß = .14). There was marginal evidence of mediation of the relationship between perpetration-based PMIEs and PTSD by shame and guilt (ß = .09), and of the relationship between danger-based combat events and PTSD by peritraumatic dissociation (ß = .08). No significant direct relationships were found between any of these 3 types of events and subsequent PTSD. Perceived perpetration and betrayal accounted for PTSD symptoms above and beyond combat exposure. Over a third of the sample reported experiencing perpetration- or betrayal-based PMIEs. CONCLUSIONS: The associations of perpetration and betrayal with PTSD, controlling for danger-based combat events, highlight the limitations of conceptualizations and treatments of PTSD based on fear or helplessness as sole etiologic factors. (PsycINFO Database Record

Psychometric analysis of the PTSD Checklist-5 (PCL-5) among treatment-seeking military service members.

The Posttraumatic Stress Disorder Checklist (PCL-5; Weathers et al., 2013) was recently revised to reflect the changed diagnostic criteria for posttraumatic stress disorder (PTSD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013). We investigated the psychometric properties of PCL-5 scores in a large cohort (N = 912) of military service members seeking PTSD treatment while stationed in garrison. We examined the internal consistency, convergent and discriminant validity, and DSM-5 factor structure of PCL-5 scores, their sensitivity to clinical change relative to PTSD Symptom Scale-Interview (PSS-I; Foa, Riggs, Dancu, & Rothbaum, 1993) scores, and their diagnostic utility for predicting a PTSD diagnosis based on various measures and scoring rules. PCL-5 scores exhibited high internal consistency. There was strong agreement between the order of hypothesized and observed correlations among PCL-5 and criterion measure scores. The best-fitting structural model was a 7-factor hybrid model (Armour et al., 2015), which demonstrated closer fit than all other models evaluated, including the DSM-5 model. The PCL-5's sensitivity to clinical change, pre- to posttreatment, was comparable with that of the PSS-I. Optimally efficient cut scores for predicting PTSD diagnosis were consistent with prior research with service members (Hoge, Riviere, Wilk, Herrell, & Weathers, 2014). The results indicate that the PCL-5 is a psychometrically sound measure of DSM-5 PTSD symptoms that is useful for identifying provisional PTSD diagnostic status, quantifying PTSD symptom severity, and detecting clinical change over time in PTSD symptoms among service members seeking treatment. (PsycINFO Database Record

The influence of social networking photos on social norms and sexual health behaviors.

Two studies tested whether online social networking technologies influence health behavioral social norms, and in turn, personal health behavioral intentions. In Study 1, experimental participants browsed peers' Facebook photos on a college network with a low prevalence of sexually suggestive content. Participants estimated the percentage of their peers who have sex without condoms, and rated their own future intentions to use condoms. Experimental participants, compared to controls who did not view photos, estimated that a larger percentage of their peers use condoms, and indicated a greater intention to use condoms themselves in the future. In Study 2, participants were randomly assigned to view sexually suggestive or nonsexually suggestive Facebook photos, and responded to sexual risk behavioral questions. Compared to participants viewing nonsuggestive photos, those who viewed sexually suggestive Facebook photos estimated that a larger percentage of their peers have unprotected sexual intercourse and sex with strangers and were more likely to report that they themselves would engage in these behaviors. Thus, online social networks can influence perceptions of the peer prevalence of sexual risk behaviors, and can influence users' own intentions with regard to such behaviors. These studies suggest the potential power of social networks to affect health behaviors by altering perceptions of peer norms.

Misery has more company than people think: underestimating the prevalence of others' negative emotions.

Four studies document underestimations of the prevalence of others' negative emotions and suggest causes and correlates of these erroneous perceptions. In Study 1a, participants reported that their negative emotions were more private or hidden than were their positive emotions; in Study 1b, participants underestimated the peer prevalence of common negative, but not positive, experiences described in Study 1a. In Study 2, people underestimated negative emotions and overestimated positive emotions even for well-known peers, and this effect was partially mediated by the degree to which those peers reported suppression of negative (vs. positive) emotions. Study 3 showed that lower estimations of the prevalence of negative emotional experiences predicted greater loneliness and rumination and lower life satisfaction and that higher estimations for positive emotional experiences predicted lower life satisfaction. Taken together, these studies suggest that people may think they are more alone in their emotional difficulties than they really are.

Victim entitlement to behave selfishly.

Three experiments demonstrated that feeling wronged leads to a sense of entitlement and to selfish behavior. In Experiment 1, participants instructed to recall a time when their lives were unfair were more likely to refuse to help the experimenter with a supplementary task than were participants who recalled a time when they were bored. In Experiment 2, the same manipulation increased intentions to engage in a number of selfish behaviors, and this effect was mediated by self-reported entitlement to obtain positive (and avoid negative) outcomes. In Experiment 3, participants who lost at a computer game for an unfair reason (a glitch in the program) requested a more selfish money allocation for a future task than did participants who lost the game for a fair reason, and this effect was again mediated by entitlement.