Does Social Support Moderate the Association between Adverse Childhood Experiences and Substance-Related Problems?

Background: More than half of individuals in the United States have had adverse childhood experiences (ACEs), which can result in physical and mental distress. ACEs has been linked with greater likelihood of harmful alcohol and drug use. Research has found that protective factors, such as social support, may potentially buffer against harmful substance use engagement among those who have experienced ACEs. The purpose of this study was to examine associations between perceived social support, ACEs, and alcohol and cannabis-related problems. Moreover, this study aimed to examine if specific domains of perceived social support (family, friends, and significant other) moderated the relationship between ACEs and alcohol and cannabis-related problems. Method: Validated measures of ACEs, perceived social support, and alcohol and cannabis problems were collected in a sample of 401 emerging adults via Prolific Academic (an online data collection platform). Results: Overall perceived social support and domains such as perceived family and friend social support moderated the relationship between ACEs and alcohol-related problems but not ACEs and cannabis-related problems. The association between ACEs and alcohol-related problems was strongest at low levels of perceived family and friend social support. Perceived social support was not associated with cannabis-related problems. Conclusions: Lack of social support is a potential risk factor for alcohol-related problems among emerging adults. Bolstering perceived social support from family and friends among those who have experienced ACEs may be beneficial in intervention and treatment efforts aiming to reduce harmful substance use in this population.

Cannabis use in civilian college students and college student service members/veterans: the moderating effect of anxiety.

Background: Cannabis is the most commonly used illicit drug on college campuses. Research suggests that Student Service Members/Veterans (SSM/V) may be more likely to use alcohol than civilian students, but little research has focused on cannabis use in these two samples. Objectives: The purpose of the current study was to compare cannabis use frequency, cannabis use disorder (CUD) symptoms, and cannabis-related problems between civilian students and SSM/V. A second aim was to determine if group differences in these outcomes were moderated by symptoms of depression, stress, or anxiety. Methods: The sample included 164 college SSM/V (80.4% female, 19.6% male) and 456 civilian (78% female, 22% male) college students. Participants completed an online survey assessing demographics, number of days of past month cannabis use, cannabis-related problems, CUD symptoms, and a measure of anxiety, depression, and stress. Results: Negative binomial regressions indicated no significant differences in number of days of past-month cannabis use or past-year cannabis-related problems between civilian students and SSM/V, although SSM/V reported more past-year CUD symptoms. Moderation analyses revealed that at elevated levels of anxiety, SSM/V students used cannabis more frequently than civilian students. Conclusion: These findings indicate that when experiencing elevated levels of anxiety, SSM/V use cannabis more frequently than civilian students, suggesting that anxiety may be a more prominent risk factor for frequency of cannabis use for SSM/V compared to civilian students. Education, prevention, and intervention efforts specifically addressing anxiety in this demographic are needed.

Does a history of childhood abuse moderate the association between symptoms of posttraumatic stress disorder and borderline personality disorder in survivors of intimate partner violence?

OBJECTIVE: This study examined whether a history of childhood abuse (CA) strengthened the association between borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) in the aftermath of intimate partner violence (IPV). This hypothesis arises from clinical literature but has not been examined empirically. We predicted that a history of CA would enhance associations between BPD features and PTSD symptoms. METHOD: Dimensional assessment of both PTSD and BPD was made in a sample of 211 women who sought mental health services following IPV. Two analyses were conducted using clinician-assessed DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed.) PTSD symptoms: (a) total score and (b) symptom clusters. RESULTS: Using path analysis, results indicated significant associations between BPD features and PTSD symptoms, but no significant interaction between BPD and CA in either analysis. CONCLUSIONS: Results are discussed given current understanding of comorbidities involving PTSD, with particular attention to potential implications for clinical practice. Areas for future research are proposed.

Do latent profiles of self-reported anxiety, depression, and PTSD map onto clinician ratings? An examination with intimate partner violence survivors.

OBJECTIVE: Studies exploring latent profiles of mental health in trauma survivors have largely relied on self-report, making it unclear whether these patterns correspond with clinician-assessed psychopathology. The purpose of the current study was to examine latent profiles of self-reported PTSD, depression, and anxiety in a sample of 387 women who had experienced intimate partner violence (IPV) and investigate whether profiles mapped onto clinician-rated measures of the same outcomes. METHOD: Participants completed a series of semi-structured interviews and self-report measures assessing PTSD, depression, and anxiety. RESULTS: Latent profile analyses revealed a 3-profile solution characterized by Low (22.48 %), Moderate (37.98 %), and High (39.53 %) self-reported symptomology. Clinician ratings were significant predictors of membership in the low vs. moderate vs. high symptomology profiles. However, normalized means showed discrepancies between self-report and clinician assessment regarding which issue was rated most severe. CONCLUSIONS: Results suggest that while latent modeling approaches relying on self-report may adequately approximate common underlying patterns of psychopathology, they have limitations in identifying which disorders are most salient for clinical intervention.

Interacting with a friend after a trauma film reduces anxiety and intrusive memories.

OBJECTIVE: Interpersonal factors have been linked with psychological adjustment to trauma, but how interpersonal factors influence trauma response is still unclear. Experimental paradigms such as the trauma film paradigm offer a valuable approach for studying this complex dynamic. However, few studies have used the trauma film paradigm to examine the interpersonal context of trauma response, and no studies have incorporated friends into the trauma film paradigm. The purpose of the current study was to examine how inclusion of a friend influenced reactions to a trauma analog. METHOD: One hundred young adult females were randomized to watch a brief stressful film of a sexual assault either with or without a friend and the Friend Present condition was given an opportunity to interact following the film. Participants were evaluated on distress during the film, skin conductance, anxiety and negative affect immediately postfilm (preinteraction) and 5 minutes later (postinteraction), and intrusive memories over a three-day period. RESULTS: No differences were found between conditions on skin conductance or subjective distress during the film. However, the Friend Present condition experienced a greater reduction in state anxiety from preinteraction to postinteraction and greater decreases in intrusive memories over the three-day period. CONCLUSIONS: Findings show the inclusion of a friend mitigated trauma-related stress reactions and suggest that interacting with a friend aided in adaptive processing of the stressor. Findings indicate that additional work is needed to examine how platonic relationships can be targeted to improve prevention and intervention efforts in trauma-related outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The effects of shame on subsequent reactions to a trauma analog.

The current study examined the effects of experimentally-induced shame on subsequent reactions to a trauma analog. Participants were 88 college-aged women randomly assigned to a shame prime condition or to a control (neutral) condition. Participants then were presented with an analog trauma audiotape depicting dating violence. Participants reported intrusive thoughts relating to the trauma analog in the two days following the procedure. Negative (shame, guilt) and positive (pride, positive affect) emotions were monitored throughout the procedure. Results indicated that the shame prime successfully increased shame in the Shame condition alone. After the trauma analog, increases in shame were noted in both conditions. In contrast, guilt reduced in the Shame condition, while this emotion increased in the Control condition, contrary to hypothesis. Shame and guilt were somewhat volatile for participants in the Shame condition in the two days following the lab procedure, while individuals in the Control condition reported steadily decreasing levels of these emotions. No between-condition differences were noted in the frequency of intrusions in the two days following the laboratory procedure, contrary to hypothesis. Results are discussed in light of our current understanding of shame and its role in PTSD, with suggestions to guide future research.

A Cross-Lagged Panel Approach to Understanding Social Support and Chronic Posttraumatic Stress Disorder Symptoms in Veterans: Assessment Modality Matters.

Although there is a strong and consistent association between social support and posttraumatic stress disorder (PTSD), the directionality of this association has been debated, with some research indicating that social support protects against PTSD symptoms, whereas other research suggests that PTSD symptoms erode social support. The majority of studies in the literature have been cross-sectional, rendering directionality impossible to determine. Cross-lagged panel models overcome many previous limitations; however, findings from the few studies employing these designs have been mixed, possibly due to methodological differences including self-report versus clinician-administered assessment. The current study used a cross-lagged panel structural equation model to explore the relationship between social support and chronic PTSD symptoms over a 1-year period in a sample of 264 Iraq and Afghanistan veterans assessed several years after trauma exposure. Approximately a third of the sample met criteria for PTSD at the baseline assessment, with veterans' trauma occurring an average of 6 years prior to baseline. Two separate models were run, with one using PTSD symptoms assessed via self-report and the other using clinician-assessed PTSD symptoms. Excellent model fit was found for both models. Results indicated that the relationship between social support and PTSD symptoms was affected by assessment modality. Whereas the self-report model indicated a bidirectional relationship between social support and PTSD symptoms over time, the clinician-assessed model indicated only that baseline PTSD symptoms predicted social support 1 year later. Results highlight that assessment modality is one factor that likely impacts disparate findings across previous studies. Theoretical and clinical implications of these findings are discussed, with suggestions for the growing body of literature utilizing these designs to dismantle this complex association.

Using the trauma film paradigm to explore interpersonal processes after trauma exposure.

OBJECTIVE: The present study sought to examine ways in which social support might influence trauma symptoms using a variation of the trauma film paradigm. METHOD: Sixty-seven undergraduate female students in romantic relationships were randomized to watch a stressful film clip depicting a sexual assault, either in the presence (PP) or absence (PA) of their romantic partner. RESULTS: Analyses showed that the PP condition experienced more intrusive memories of the film than the PA condition. In addition, participants in the PP condition whose romantic partner reported low relationship trust had higher film-related distress than participants in the PP condition whose romantic partner reported high relationship trust. Observational coding of partner behaviors after viewing the film clip found that greater expression of negative emotion from partners predicted participants' negative affect and intrusive memories over time. Positive emotional support did not have any effect upon participants' distress. CONCLUSIONS: Findings identify possible ways in which interpersonal processes influence trauma adjustment and suggest that the trauma film paradigm can be adapted to examine the role of interpersonal processes in post-trauma adjustment. (PsycINFO Database Record

Demand/withdraw communication in the context of intimate partner violence: Implications for psychological outcomes.

Intimate partner violence (IPV) is associated with symptoms of posttraumatic stress disorder (PTSD) and generalized anxiety disorder (GAD). To clarify the influence of a dyadic conflict pattern that has previously been shown to accompany violence in romantic relationships (partner demand/self withdraw) on these mental health outcomes, we examined the associations between three forms of IPV (physical, emotional-verbal, dominance-isolation), partner demand/self withdraw, and PTSD and GAD symptoms, in a sample of 284 IPV-exposed women. Using structural equation modeling, we found significant associations between dominance-isolation IPV, partner demand/self withdraw, and clinician-assessed GAD symptoms. Associations between emotional-verbal IPV and partner demand/self withdraw were also significant. Associations for physical IPV, partner demand/self withdraw, and clinician-assessed PTSD symptoms were not statistically significant. These results underscore the need for research on the mental health outcomes associated with specific forms of IPV and the long-term psychological consequences of the conflict patterns that uniquely characterize violent relationships.

Correspondence Between Self-Report Measures and Clinician Assessments of Psychopathology in Female Intimate Partner Violence Survivors.

Intimate partner violence (IPV) has potentially severe and long-lasting mental health consequences for survivors, including elevated symptoms and diagnoses of posttraumatic stress disorder (PTSD), depression, and generalized anxiety disorder (GAD). The current study examined the relationship between three self-report measures of psychological distress and ratings obtained from the corresponding clinician-administered measures in women seeking assessment for mental health problems following IPV ( N = 185). PTSD symptoms were assessed using the self-report Impact of Event Scale-Revised (IES-R) and the interview-based Clinician-Administered PTSD Scale (CAPS). Depression symptoms were assessed using the self-report Beck Depression Inventory-II (BDI-II) and the depressive disorders sections from the clinician-administered Anxiety Disorders Interview Schedule-IV (ADIS-IV). Anxiety symptoms were assessed using the self-report Beck Anxiety Inventory (BAI) and the clinician-administered GAD section from the ADIS-IV. Results indicated that psychological distress was prevalent in the sample, with 27% receiving a PTSD diagnosis, 40% diagnosed with a depressive disorder, and 55% meeting criteria for GAD. Although each self-report measure was significantly and positively correlated with its corresponding clinician-administered measure, rates of diagnostic concordance were mixed. The BDI-II showed a high degree of agreement with the ADIS-IV depression section, but the IES-R and the CAPS were discordant at classifying PTSD. The BAI had acceptable sensitivity but poor specificity in relation to the ADIS-IV GAD section. These findings suggest that multiple assessment modalities should be considered when rating symptoms and estimating the prevalence of diagnoses among survivors of IPV.

Understanding the role of dysfunctional post-trauma cognitions in the co-occurrence of Posttraumatic Stress Disorder and Generalized Anxiety Disorder: Two trauma samples.

This report focuses on the co-occurrence of PTSD-GAD and examines a factor that could operate to maintain both conditions, specifically negative post-trauma cognitions about the self, the world, and self-blame. Two separate help-seeking samples were examined: (a) a mixed gender sample of 301 individuals who had experienced a serious motor vehicle accident (MVA), a single incident, non-interpersonal trauma; and (b) a sample of 157 women who had experienced intimate partner violence (IPV), a recurrent, interpersonal trauma. When examined at the diagnostic level, posttraumatic cognitions for one diagnosis did not vary as a function of whether the other diagnosis was present. In the MVA sample, both diagnosed PTSD and GAD were associated with elevations in negative thoughts about the self. Diagnosed GAD was also significantly associated with negative thoughts about the world. In the IPV sample, diagnosed PTSD was associated with elevations in negative thoughts about the self only. When continuously measured PTSD and GAD were examined, results indicated that negative thoughts about the self showed significant simultaneous associations with PTSD and GAD in both samples. In the MVA sample, negative thoughts about the world and self-blame showed significant associations with PTSD but not with GAD. In the IPV sample, negative thoughts about the world and self-blame were not significantly associated with either PTSD or GAD. Results are discussed in light of current treatment models for these conditions, with emphasis on the potential for addressing transdiagnostic processes as a more effective approach to treating comorbid conditions following trauma.

Social support, posttraumatic cognitions, and PTSD: The influence of family, friends, and a close other in an interpersonal and non-interpersonal trauma group.

Research has suggested that social support can shape posttraumatic cognitions and PTSD. However, research has yet to compare the influence of separate domains of support on posttraumatic cognitions. Multiple-group path analysis was used to examine a model in a sample of 170 victims of intimate partner violence and 208 motor vehicle accident victims in which support from friends, family, and a close other were each predicted to influence posttraumatic cognitions, which were in turn predicted to influence PTSD. Analyses revealed that support from family and friends were each negatively correlated with posttraumatic cognitions, which in turn were positively associated with PTSD. Social support from a close other was not associated with posttraumatic cognitions. No significant differences in the model were found between trauma groups. Findings identify which relationships are likely to influence posttraumatic cognitions and are discussed with regard to interpersonal processes in the development and maintenance of PTSD.

How do negative emotions relate to dysfunctional posttrauma cognitions? An examination of interpersonal trauma survivors.

In order to broaden theoretical models of adaptation following trauma and inform current diagnostic practices, the goal of the current study was to examine associations between negative emotions and dysfunctional trauma-related cognitions. In a sample of 109 women who were seeking mental health assistance after intimate partner violence (IPV), anxiety, depression, shame, and guilt were explored in association with negative thoughts about the self, negative thoughts about the world, and self-blame. Higher levels of shame and depression were significantly associated with higher levels of negative thoughts about the self. An increased level of guilt was the only significant finding in the analysis involving negative thoughts about the world. Lower levels of depression and higher levels of shame and guilt were significantly associated with increased levels of self-blame. Anxiety did not emerge as a significant predictor in any of these analyses. Implications for current models of posttraumatic stress disorder (PTSD), revisions to diagnostic practices, and treatment of individuals who have experienced interpersonal trauma are discussed.

Does self-blame moderate psychological adjustment following intimate partner violence?

This study explored whether self-blame moderates the relationship between exposure to specific types of abuse and both poor general psychological adjustment (i.e., self-esteem) and specific symptomatology (i.e., posttraumatic stress disorder [PTSD]) among women who had experienced intimate partner violence (IPV). Eighty female IPV survivors were involved in this study. Results indicated that self-blame was negatively associated with self-esteem for physical, psychological, and sexual abuse. Self-blame moderated physical abuse, such that high levels of physical abuse interacted with high levels of self-blame in their association with PTSD. Nonsignificant models were noted for psychological and sexual abuse in association with self-blame and PTSD. These findings support the conceptualization that self-blame is associated with both general and specific psychological outcomes in the aftermath of IPV. Future research examining different forms of blame associated with IPV might further untangle inconsistencies in the self-blame literature.

Expressive inhibition following interpersonal trauma: an analysis of reported function.

Existing research indicates veterans with posttraumatic stress disorder (PTSD) may deliberately inhibit the expression of emotion. However, the degree to which inhibition generalizes to other trauma populations and the specific reasons survivors with PTSD inhibit expression remains unclear. The present study looked to evaluate expressive inhibition among survivors of intimate partner violence (N = 74), to determine reasons for inhibition in this population, and to examine whether any justifications for inhibition are unique to individuals with PTSD. The frequency and intensity of inhibition scores were similar to those noted in previous research although no differences were observed across women with and without PTSD. Self-reported justifications for inhibition indicated five general themes: Concern for others, Mistrust/fear of exploitation, Perception of others as indifferent/uncaring, Control/Experiential avoidance, and Situation-specific inhibition. Only mistrust/exploitation motives were uniquely associated with PTSD. Whereas expressive inhibition may be elevated within help-seeking samples, individuals who develop PTSD appear to hold unique reasons for restricting emotional expression.

How do attachment style and social support contribute to women's psychopathology following intimate partner violence? Examining clinician ratings versus self-report.

Concurrent associations between attachment style and social support in posttraumatic stress disorder, depression, and generalized anxiety disorder were explored using regression analyses in a sample of 108 victims of intimate partner violence. To examine whether assessment modality influenced findings, self-report and clinician ratings of psychopathology were compared. Both lower perceived social support and higher attachment anxiety were significantly associated with higher self-reported PTSD; however, only lower social support was significantly associated with clinician assessed PTSD. Lower social support, higher attachment anxiety, and lower attachment closeness were related with higher self-reported depression; however, only lower social support was related to clinician assessed depression. Lastly, only higher attachment anxiety was associated with self-reported GAD, whereas lower attachment dependency showed the only significant association in clinician assessed GAD. Possible explanations for discrepancies between assessment modalities are discussed, with emphasis on application to intimate partner violence and suggestions for future research.