Solitude can be good-If you see it as such: Reappraisal helps lonely people experience solitude more positively.

OBJECTIVE: Solitude is a common experience that can elicit both positive (e.g., relaxation) and negative (e.g., loneliness) emotions. But can changing the way we think about solitude improve its emotional effects? In a previous study, our team found that positively reframing solitude buffers against a reduction in positive affect when alone. Yet, it is unknown whether people who are lonely-and thus more likely to experience solitude negatively-benefit from modifying their beliefs about being alone. METHOD: Here, we test whether reframing solitude as a beneficial experience or de-stigmatizing loneliness helps people experiencing moderate-to-severe loneliness (N = 224) feel more positive emotion and less negative emotion during solitude. We randomly assigned participants to read about either the benefits of solitude, the high prevalence of loneliness, or a control topic. Then, participants spent 10 min alone in the laboratory. State affect was assessed before and after the solitude period. RESULTS: Across conditions, the solitude period reduced high-arousal positive (e.g., excited) and high-arousal negative (e.g., anxious) affect. Notably, people who read about the benefits of solitude experienced a significantly larger increase in low-arousal positive affect compared with the control condition. CONCLUSION: Our findings indicate that lonely individuals can more readily reap the emotional benefits of solitude when they reframe solitude as an experience that can enhance their well-being.

Is avoidance the only issue? A case study of "self-triggering" in combat-related posttraumatic stress disorder.

OBJECTIVE: We explore the emerging concept of "self-triggering" through a case illustration of a Vietnam veteran with posttraumatic stress disorder (PTSD) who engaged in self-triggering for 50 years after his index trauma. He reduced the frequency of self-triggering upon receiving a combination of cognitive processing therapy and behavioral exposure treatment. METHOD: This article provides a brief overview of the emerging literature on self-triggering, proposes theory for its function, and discusses how self-triggering affected the treatment of this veteran's chronic PTSD. RESULTS: Through clinical intervention that focused on what to approach (i.e., real-world experiences) and what to avoid (i.e., online triggering videos), the veteran stopped one kind of self-triggering but not another. The veteran attributed much of his positive behavior change to desire to honor the life of a young boy whose likely death he witnessed in Vietnam. CONCLUSIONS: Though people with PTSD often go to great lengths to avoid reminders of their trauma, there is a subset who seek reminders that trigger distressing reexperiencing symptoms. Such puzzling self-triggering behavior in those with PTSD is seldom studied and poorly understood. The details of this veteran's experience present a compelling case for self-triggering as an attempt to search for meaning in one's trauma, gain control of symptoms, and punish oneself. Implications for research and clinical practice are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Self-triggering: Does function determine pathogenesis?

OBJECTIVE: Research suggests six motives for exposing oneself to painful reminders of a trauma outside of a therapeutic context (self-triggering). These include provoking arousal, escaping emotional numbness, self-punishment, controlling symptoms of posttraumatic stress disorder (PTSD), making meaning of one's trauma, and generating an experience that matches one's emotions. The goal of the current study is to examine if these motives subserve broader functions of self-triggering behavior that differentially relate to PTSD symptoms. METHOD: We conducted an exploratory factor analysis on the self-reported reasons for self-triggering collected from 360 adults who endorsed lifetime self-triggering. We then theorized higher-order factors and tested both their fit to the data with a confirmatory factor analysis and whether they moderated the relationship between self-triggering and PTSD symptoms. RESULTS: We found that five factors best described the reasons for self-triggering. We theorized one higher-order factor (function) of "emotional modification" that encompasses sensation-seeking, antinumbing, self-punishment, and affect-matching. The "meaning-making" function consists of efforts to make meaning of one's trauma. This structure fit the data well in a confirmatory factor analysis. Self-triggering frequency no longer predicted symptom severity when meaning-making was highly endorsed as a function of self-triggering. Emotional modification did not affect this relationship. CONCLUSIONS: Generalizability may be limited by the sample's high symptom levels, limited demographic diversity, and high proportion of interpersonal trauma. These findings suggest that the degree to which individuals self-trigger to make meaning of trauma may affect how pathogenic the behavior is, underscoring the clinical importance of identifying the function of patients' self-triggering. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Exposure to descriptions of traumatic events narrows one's concept of trauma.

The concept of "trauma" was originally used by psychiatrists to describe horrific events such as rape and torture that characteristically provoke extreme emotional distress. Both colloquially and clinically, the concept of psychological trauma has broadened considerably. Although many clinical scientists have expressed concern about the broadening of the concept of trauma, it remains unclear how this concept expansion occurs. We present two experiments in which American adults (N = 276 and N = 267) sequentially classified descriptions of events (e.g., "broke a leg in a bicycle accident") as either "trauma" or "not trauma." In the first experiment, we manipulated the frequency of severe events (i.e., severe events became less and less common). In the second experiment, we manipulated the range of events (i.e., participants viewed only severe or only nonsevere events). Together, the findings suggest that an individual's frame of reference for the severity of events plays a role in narrowing or broadening the concept of trauma. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Does the network structure of obsessive-compulsive symptoms at treatment admission identify patients at risk for non-response?

Exposure and response prevention is the gold-standard treatment for obsessive compulsive disorder (OCD), yet up to half of patients do not adequately respond. Thus, different approaches to identifying and intervening with non-responders are badly needed. One approach would be to better understand the functional connections among aspects of OCD symptoms and, ultimately, how to target those associations in treatment. In a large sample of patients who completed intensive treatment for OCD and related disorders (N = 1343), we examined whether differences in network structure of OCD symptom aspects existed at baseline between treatment responders versus non-responders. A network comparison test indicated a significant difference between OCD network structure for responders versus non-responders (M = 0.19, p = .02). Consistent differences emerged between responders and non-responders in how they responded to emotional distress. This pattern of associations suggests that non-responders may have been more reactive to their distress by performing compulsions, thereby worsening their functioning. By examining the association between baseline distress intolerance with other symptom aspects that presumably maintain the disorder (e.g., ritualizing), clinicians can more effectively target those associations in treatment.

Loneliness in Kenyan adolescents: Socio-cultural factors and network association with depression and anxiety symptoms.

Loneliness is associated with negative mental health outcomes and is particularly common among adolescents. Yet, little is known about the dynamics of adolescent loneliness in non-Western, low-income nations. Accordingly, we estimated the severity of loneliness in a sample of Kenyan adolescents and used mixed-effects regression modelling to determine the socio-cultural factors associated with loneliness. We also used network analysis to examine the associations between loneliness, depression, and anxiety at the symptom level. We analyzed data from a large sample (N = 2,192) of school-attending Kenyan adolescents aged 12-19 (58.3% female, 41.7% male). Standardized measures of loneliness (ULS-8), depression (PHQ-8), and anxiety (GAD-7) were used. Our mixed-effects model revealed that female and lower-income adolescents felt lonelier. The perception of feeling alone emerged as the aspect of loneliness most strongly linked to depression and anxiety symptoms. Our findings establish an estimate of loneliness levels in Kenyan adolescents, and identify possible socio-cultural factors associated with loneliness. We found that perceptions of isolation more strongly linked loneliness to psychopathology than did objective measures of isolation or preferences for social contact. Finally, we identify specific aspects of loneliness that could prove to be treatment targets for youth psychopathology; however, further research is needed. Limitations, future directions, and clinical implications are discussed.

Resolving the paradox of posttraumatic growth and event centrality in trauma survivors.

When a traumatic experience is central to an individual's identity and worldview, it can result in either severe posttraumatic stress disorder (PTSD) symptoms, perceived posttraumatic growth (PTG), or, paradoxically, both. To resolve this apparent paradox, we used network analytic methods to estimate the relations among components of event centrality (EC), PTSD symptoms, and PTG in 1,136 undergraduates who had experienced trauma. Participants completed surveys on their experiences with traumatic events as well as the degree to which they experienced PTSD symptoms, components of EC, and components of PTG. We performed network analysis to examine EC, PTSD, and PTG and identify which components of EC were most conducive to its associations with PTSD versus those with PTG. We found that the components of EC most associated with PTSD, the extent to which trauma serves as a script for the future, were markedly distinct from the components associated with PTG, the extent to which trauma is seen as a turning point in one's life. The combined findings suggest that EC may be a catalyst for subsequent positive or negative effects contingent upon how an individual interprets the centrality of their traumatic experience.

A Network Analysis of DSM-5 Posttraumatic Stress Disorder Symptoms and Event Centrality.

The centrality of a traumatic event to one's autobiographical memory has been associated with posttraumatic stress disorder (PTSD) symptom severity. In the present study, we investigated the associations between specific features of event centrality (EC), as measured using the Centrality of Event Scale, and specific symptoms of PTSD. We computed a cross-sectional graphical lasso network of PTSD symptoms and specific features of EC in a sample of trauma-exposed individuals (n = 451), many of whom met the clinical threshold for a PTSD diagnosis. The graphical lasso revealed intrusive memories, negative trauma-related feelings, and the perception that the traumatic event was central to one's identity to be influential nodes. Viewing the future through the lens of one's trauma exposure was the EC feature most strongly linked to PTSD. Among all PTSD symptoms, blaming oneself or others for the traumatic event showed the strongest link to EC. The network was stable, allowing for reliable interpretations. Future longitudinal research is needed to clarify the associations among EC features and PTSD symptoms over time.

Posttraumatic stress or posttraumatic growth? Using network analysis to explore the relationships between coping styles and trauma outcomes.

Trauma can produce posttraumatic stress disorder (PTSD), but may also foster positive outcomes, such as posttraumatic growth. Individual differences in coping styles may contribute to both positive and negative sequelae of trauma. Using network analytic methods, we investigated the structure of PTSD symptoms, elements of growth, and coping styles in bereaved survivors of a major earthquake in China. Hypervigilance and difficulty concentrating were identified as the most central symptoms in the PTSD network, whereas establishing a new path in life, feeling closer to others, and doing better things with life ranked highest on centrality in the posttraumatic growth network. Direct connections between PTSD symptoms and elements of growth were low in magnitude in our sample. Our final network, which included PTSD symptoms, growth elements, and coping styles, suggests that adaptive and active coping styles, such as positive reframing, are positively related to elements of growth, but not appreciably negatively related to PTSD symptoms. Conversely, maladaptive coping styles are positively related to PTSD symptoms, but are not negatively associated with growth. Future longitudinal studies could shed light on the direction of causality in these relationships and their clinical utility.

Reframing Time Spent Alone: Reappraisal Buffers the Emotional Effects of Isolation.

BACKGROUND: Loneliness, a transdiagnostic feature of psychopathology, is an experience of perceived isolation only weakly linked to the amount of time spent alone. Although traditional loneliness interventions aim to increase social contact, targeting maladaptive cognition about time alone may be an effective way to reduce loneliness. We investigated whether a brief reappraisal manipulation enables individuals to experience their time alone more positively. We also tested the impact of trait loneliness, compulsive social media use, and trait reappraisal on experiences of time alone. METHODS: College students and community members (N = 220) were randomly assigned to read a passage about the benefits of solitude (n = 74), the true prevalence of loneliness (n = 72), or a control topic (n = 74). Participants then sat alone for 10 min. RESULTS: Across conditions, positive and negative mood significantly decreased after sitting alone. Participants who read about the benefits of solitude experienced a smaller reduction in positive mood than those in the control condition. Participants who less frequently used reappraisal in their everyday lives benefited most from the manipulation. CONCLUSIONS: Our results provide preliminary evidence that reappraising time alone as solitude may boost resilience to the decrements in positive mood associated with time alone. Limitations, clinical implications, and directions for future research are discussed.

"Identity confusion in complicated grief: A closer look": Correction.

Reports an error in "Identity confusion in complicated grief: A closer look" by Benjamin W. Bellet, Nicole J. LeBlanc, Marie-Christine Nizzi, Mikaela L. Carter, Florentine H. S. van der Does, Jacqueline Peters, Donald J. Robinaugh and Richard J. McNally (Journal of Abnormal Psychology, 2020[May], Vol 129[4], 397-407). In the original article, the following acknowledgment of funding was missing from the author note: "Donald J. Robinaugh's work on this article was supported by federal funding from the National Institute of Mental Health (Grant 1K23MH113805-01A1; principal investigator: Donald J. Robinaugh)." The online version of this article has been corrected. (The following abstract of the original article appeared in record 2020-23551-001). Complicated grief (CG) is characterized by a wide range of symptoms, including identity confusion or a sense that a part of oneself has died with the decedent. Although identity confusion is a commonly reported feature of CG, little is known about which specific aspects of self-concept are compromised. In the current study, we used qualitative coding methods to investigate which aspects of the sense of self differed between those with and without CG in a sample of 77 bereaved adults. Relative to individuals without CG, those with CG provided fewer descriptors of their self-concept overall (lower self-fluency), provided sets of descriptors that consisted of fewer categories (lower self-diversity), and had lower proportions of self-relevant preferences and activities. However, group differences were not observed for proportions of any other categories of self-concept descriptors, including references to the loss, the past, or distress-related self-statements. Directions for future research and clinical implications are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Trigger warnings and resilience in college students: A preregistered replication and extension.

Trigger warnings notify people that content they are about to engage with may result in adverse emotional consequences. An experiment by Bellet, Jones, and McNally (2018) indicated that trigger warnings increased the extent to which trauma-naïve crowd-sourced participants see themselves and others as emotionally vulnerable to potential future traumas but did not have a significant main effect on anxiety responses to distressing literature passages. However, they did increase anxiety responses for participants who strongly believed that words can harm. In this article, we present a preregistered replication of this study in a college student sample, using Bayesian statistics to estimate the success of each effect's replication. We found strong evidence that none of the previously significant effects replicated. However, we found substantial evidence that trigger warnings' previously nonsignificant main effect of increasing anxiety responses to distressing content was genuine, albeit small. Interpretation of the findings, implications, and future directions are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Identity confusion in complicated grief: A closer look.

Complicated grief (CG) is characterized by a wide range of symptoms, including identity confusion or a sense that a part of oneself has died with the decedent. Although identity confusion is a commonly reported feature of CG, little is known about which specific aspects of self-concept are compromised. In the current study, we used qualitative coding methods to investigate which aspects of the sense of self differed between those with and without CG in a sample of 77 bereaved adults. Relative to individuals without CG, those with CG provided fewer descriptors of their self-concept overall (lower self-fluency), provided sets of descriptors that consisted of fewer categories (lower self-diversity), and had lower proportions of self-relevant preferences and activities. However, group differences were not observed for proportions of any other categories of self-concept descriptors, including references to the loss, the past, or distress-related self-statements. Directions for future research and clinical implications are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The Social Meaning in Life Events Scale (SMILES): A preliminary psychometric evaluation in a bereaved sample.

A mourner's success in making meaning of a loss has proven key in predicting a wide array of bereavement outcomes. However, much of this meaning-making process takes place in an interpersonal framework that is hypothesized to either aid or obstruct this process. To date, a psychometrically validated measure of the degree to which a mourner successfully makes meaning of a loss in a social context has yet to be developed. The present study examines the factor structure, reliability, and validity of a new measure called the Social Meaning in Life Events Scale (SMILES) in a sample of bereaved college students (N = 590). The SMILES displayed a two-factor structure, with one factor assessing the extent to which a mourner's efforts at making meaning were invalidated (Social Invalidation subscale), and the other assessing the extent to which a mourner's meaning-making process was validated (Social Validation subscale). The subscales displayed good reliability and construct validity in reference to several outcome variables of interest (complicated grief, general health, and post-loss growth), as well as related but different variables (social support and meaning made). The subscales also demonstrated group differences according to two demographic variables associated with complications in the mourning process (age and mode of loss), as well as incremental validity in predicting adverse bereavement outcomes over and above general social support. Clinical and research implications involving the use of this new measure are discussed.

Posttraumatic stress disorder symptoms improve after an integrated brief alcohol intervention for OEF/OIF/OND veterans.

OBJECTIVE: Although brief alcohol interventions (BAIs) that incorporate personalized feedback demonstrate efficacy for reducing the frequency and quantity of alcohol consumption in veteran samples, little research has explored the influence of BAIs in reducing symptoms of posttraumatic stress disorder (PTSD). The goal of this investigation was to understand whether PTSD symptom severity and diagnostic status changed after exposure to an intervention that targeted alcohol misuse and integrated feedback on PTSD. METHOD: Sixty-eight combat veterans (8.8% female; 27.9% African American) who screened positive for hazardous drinking were recruited from a Veterans Affairs Medical Center. Participants received a 1-session brief intervention that primarily targeted alcohol misuse but also included personalized feedback and psychoeducation on PTSD symptoms and coping. Participants were randomized to receive personalized written feedback either with or without a motivational interview. RESULTS: A mixed-model repeated measures analysis revealed that PTSD symptom severity was significantly lower at the 6-week (M = 41.47, SD = 28.94) and 6-month (M = 35.56 SD = 26.99) follow-up appointments relative to baseline (M = 51.22, SD = 26.67), F(2, 127.24) = 38.32, p < .001. Regression analyses demonstrate that the percent change in alcohol use was related to the change in PTSD severity. Further, results indicated that a motivational-interviewing-style counseling session accompanying the feedback was not significantly more efficacious than receiving feedback only. CONCLUSION: A brief alcohol intervention that integrates information on PTSD has the potential to reduce PTSD severity. Personalized alcohol and PTSD feedback may be useful as an opportunistic intervention for OEF/OIF veterans. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Distinguishing the meaning making processes of survivors of suicide loss: An expansion of the meaning of loss codebook.

Suicide loss represents particularly a difficult form of bereavement due to the challenges that volitional death poses to survivors. Understanding these challenges requires recognition of the idiosyncratic processes of meaning reconstruction for this specific group of grievers. The current study investigates such processes in survivors of suicide loss (SOSL) by utilizing the Meaning of Loss Codebook (MLC) to analyze the narratives of eight SOSL. The findings contribute to a broader understanding of meaning making following suicide, strengthen the validity of the MLC by demonstrating its appropriateness for SOSL, and illuminate unique challenges faced by SOSL, resulting in the proposal of supplemental MLC codes. Research and clinical implications are discussed.

Event Centrality and Bereavement Symptomatology: The Moderating Role of Meaning Made.

The centrality of a loss to a bereaved individual's identity is associated with greater symptomatology, whereas meaning made of a loss is associated with positive outcomes. This article examines meaning made as a moderator of the relationship between event centrality and symptomatology. Our sample consisted of 204 bereaved undergraduate university students. Centrality was assessed using the Centrality of Events Scale, meaning made was assessed using the Integration of Stressful Life Experiences Scale, and symptomatology was assessed using the posttraumatic stress disorder Checklist-Civilian and Inventory of Complicated Grief-Revised. Meaning made had a significant moderating effect on the relationship between centrality and both measures of symptomatology. At lower levels of meaning made, centrality had a strong and positive association with symptomatology; at higher levels of meaning made, this association became weaker. These results suggest that meaning made is the key to understanding how centrality affects bereavement outcomes.

Trigger warning: Empirical evidence ahead.

BACKGROUND AND OBJECTIVES: Trigger warnings notify people of the distress that written, audiovisual, or other material may evoke, and were initially used to provide for the needs of those with posttraumatic stress disorder (PTSD). Since their inception, trigger warnings have become more widely applied throughout contemporary culture, sparking intense controversy in academia and beyond. Some argue that they empower vulnerable individuals by allowing them to psychologically prepare for or avoid disturbing content, whereas others argue that such warnings undermine resilience to stress and increase vulnerability to psychopathology while constraining academic freedom. The objective of our experiment was to investigate the psychological effects of issuing trigger warnings. METHODS: We randomly assigned online participants to receive (n = 133) or not receive (n = 137) trigger warnings prior to reading literary passages that varied in potentially disturbing content. RESULTS: Participants in the trigger warning group believed themselves and people in general to be more emotionally vulnerable if they were to experience trauma. Participants receiving warnings reported greater anxiety in response to reading potentially distressing passages, but only if they believed that words can cause harm. Warnings did not affect participants' implicit self-identification as vulnerable, or subsequent anxiety response to less distressing content. LIMITATIONS: The sample included only non-traumatized participants; the observed effects may differ for a traumatized population. CONCLUSIONS: Trigger warnings may inadvertently undermine some aspects of emotional resilience. Further research is needed on the generalizability of our findings, especially to collegiate populations and to those with trauma histories.

The Utility of the Personality Assessment Inventory in the Assessment of Posttraumatic Stress Disorder in OEF/OIF/OND Veterans.

We examined the use of the Personality Assessment Inventory (PAI) in a small sample of 47 U.S. military veterans of the conflicts in Iraq and Afghanistan. Approximately half of the sample met criteria for posttraumatic stress disorder (PTSD) based on the Clinician-Administered PTSD Scale. PAI profiles were compared between the PTSD and non-PTSD groups. The PTSD group had clinically significant scores (≥ 70 T) on the PAI for 5 clinical scales (anxiety, anxiety-related disorders, depression, paranoia, and schizophrenia) and 10 clinical subscales consistent with the typical symptom picture for PTSD. Effect size correlations ( r) between scales and diagnosis group membership were large ( r ≥ .5) for several scales that reflect PTSD symptoms and for the PTSD LOGIT function. In a receiver operating characteristics curve analysis, the PTSD LOGIT function and the Traumatic Stress Subscale both demonstrated good diagnostic utility (areas under the curve > .80).