Social problem-solving in intimate partner violence victims: Exploring the relative contributions of shame and PTSD symptoms.

OBJECTIVE: This study examined the contributions of shame and posttraumatic stress disorder (PTSD) symptoms to two dimensions of social problem-solving. METHOD: A sample of 426 women who were seeking mental health assistance following experiences of intimate partner violence completed self-report and clinician measures. Separate path analyses were conducted for problem orientation and problem-solving styles. RESULTS: In the model examining problem orientation, higher levels of shame were significantly associated with lower levels of positive problem orientation (f2 = 0.32) and higher levels of negative problem orientation (f2 = 0.92), with large effects noted. PTSD symptoms were significantly, positively associated with negative problem orientation (f2 = 0.3, large effect). When examining problem-solving styles, shame showed a significant negative association with rational style (f2 = 0.08, small effect) and significant positive associations with impulsive style (f2 = 0.45, large effect) and avoidant style (f2 = 0.48, large effect). PTSD symptoms did not return significant associations with any of the three problem-solving styles. CONCLUSION: Results indicate that shame holds notable associations with both dimensions of social problem-solving, relative to PTSD symptoms, and are discussed in light of current models of post-trauma functioning. Implications for clinical care and early intervention efforts are highlighted.

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.

Examining the Content Validity of the Measure of Psychologically Abusive Behaviors: A Qualitative Approach.

The content validity of the Measure of Psychologically Abusive Behaviors (MPAB) was examined via qualitative content analysis of interviews conducted with 262 women who experienced intimate partner violence. Data were coded using MPAB categories and items. Approximately 73.4% of the data were represented by the MPAB at both the category and severity levels; half of the data mapped onto "severe" items. At the category level, 12.3% of the data did not map onto the MPAB; 15.5% of the data mapped onto a category but did not match a severity level. Results support the content validity of the MPAB.

Alcohol Use and Mental Health Symptoms in Nurses during the Early Months of COVID-19.

OBJECTIVE: The current study examined associations of symptoms of posttraumatic stress disorder [PTSD], depression, and generalized anxiety disorder [GAD] with alcohol consumption and drinking to cope in a sample of 310 nurses during the first six months of the COVID-19 pandemic. METHOD: Using a cross-sectional design, nurses completed online surveys. RESULTS: Over 50% of the sample reported alcohol misuse and 12.2% reported drinking to cope. Further, 38.7% reported elevated symptoms of PTSD, 29.7% moderate-to-high symptoms of depression, and 56.8% elevated symptoms of GAD symptoms. Hierarchical regression analyses were conducted to examine how mental health symptoms were associated with alcohol outcomes, controlling for age, gender pronouns, education, and race. No significant predictors emerged for alcohol consumption. Significant associations of symptoms of PTSD and depression were found for drinking to cope, such that higher levels of mental health symptoms were associated with greater endorsement of drinking to cope. CONCLUSION: Results are discussed in light of increasing prevention and support services for nurses.

Understanding the role of COVID-19-related workplace stress and institutional betrayal on mental health in nurses: Some heroes wear scrubs.

This study examined the association of three specific COVID-19-related workplace stressors (percentage of nursing work with COVID-positive [COVID+] patients, number of COVID-19-related patient deaths witnessed, and living separately from family for safety) and their associations with posttraumatic stress symptoms (PTSS) and symptoms of major depressive disorder (MDD) and generalized anxiety disorder (GAD) among 391 nurses (93.6% White, 93.4% utilize she/her pronouns). Cross-sectional data were collected via an online survey. Institutional betrayal (i.e., the perception that an institution failed to protect a member who depends on and trusts it) was examined as a moderator of these associations. Although institutional betrayal was not a significant moderator in the three individual models, it held small-to-medium-sized positive main effects with PTSS and symptoms of GAD and MDD in both the individual and combined models. In the individual models, the percentage of nursing work with COVID+ patients was significantly positively associated with all three mental health conditions, f2 = .019-.195, whereas it only showed a significant effect with PTSS in the combined model, f2 = .138. Living separately from family was significantly positively associated with PTSS and MDD symptoms in both the individual, f2 = .037 and .015, respectively, and combined models, f2 = .025 and .013, respectively. Number of patient deaths held a significant positive association with PTSS alone, f2 = .022, in the individual model only. The findings are discussed in light of ways in which health care settings can better support and prioritize mental health among nursing staff.

Predictors of treatment completion in group psychotherapy for male veterans with posttraumatic stress disorder.

Group therapy is a frequently used therapy format for posttraumatic stress disorder (PTSD). However, factors contributing to treatment completion remain understudied. The current study examined predictors of treatment completion, defined as having completed 10 out of 14 sessions within 16 weeks, in veterans with PTSD who engaged in a hybrid efficacy-effectiveness randomized controlled trial of group psychotherapy for PTSD. Veterans (N = 198) were randomly assigned to 14 sessions of either group cognitive behavioral treatment (GBCT; n = 98) or group present-centered treatment (GPCT; n = 100). Four primary domains of predictors were examined, encompassing sociodemographic factors, the severity of PTSD and comorbid conditions, modifiable predictors, and treatment condition. Multilevel binomial logistic regression models following the Fournier analysis approach were used to examine significant predictors within domains, which were then included in a final model. Overall, 70.7% of participants completed treatment (GCBT = 61.6%, GPCT = 79.8%). Participants in the GPCT condition were 2.389 times, 95% CI [1.394, 4.092], more likely to complete treatment than those in the GCBT condition. Older age, a higher income and level of educational attainment, more lifetime and current mental health diagnoses, and higher use of positive reappraisal ER skills predicted treatment completion. Higher levels of depressive symptoms, cumulative trauma burden, and use of positive refocusing ER skills predicted treatment noncompletion. These findings are discussed in the context of current clinical and research practices for examining treatment noncompletion, with attention to the inclusion of translational predictors.

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).

Sexual Functioning and Satisfaction Among College Survivors of Sexual Violence: Examining PTSD Symptoms and Sexual Schemas.

Decreased sexual functioning is prevalent among female survivors of sexual violence yet psychological factors that contribute to sexual impairments in this population are understudied. To extend research in this area, the current study examined two psychological factors as they relate to sexual functioning concerns among 148 female survivors of sexual violence: severity of posttraumatic stress symptoms (PTSSs) and sexual self-schemas. Four domains of sexual functioning were examined: sexual desire, sexual arousal, sexual satisfaction, and orgasm functioning. It was predicted that PTSSs would be associated with a more negative sexual schema, which in turn, would be associated with decreased sexual functioning across the four domains. Using path analysis, PTSSs were found to be indirectly associated with decreased sexual satisfaction (b = -.08, SEb = .04, p = .035), sexual arousal (b = -.01, SEb = .001, p = .02), and reduced orgasm functioning (b = -.01, SEb = .001, p = .002). Results also supported significant direct paths from PTSS to all sexual functioning variables. These results support that negative sexual self-schemas may be relevant to the co-association of PTSSs and reductions in sexual functioning and satisfaction.

Using a Person-Centered Approach to Identify Patterns of Exposure to Intimate Partner Violence and Child Abuse in Women: Associations With Mental Health.

Patterns of exposure to intimate partner violence (IPV) and child abuse (CA) were explored in 467 women seeking psychological assistance following IPV. Using latent class analysis, three classes were obtained: women who had experienced physical, sexual, and psychological IPV, along with childhood physical and sexual abuse (IPV + CA; 38.5%); women who had experienced physical, sexual, and psychological IPV only (IPV/no CA; 52.9%); and women who had experienced psychological IPV only (Psych IPV only; 8.6%). Associations of class membership with severity of specific mental health conditions were examined, along with the number of diagnosed conditions. Significant between-class differences were noted on severity of IPV-related posttraumatic stress disorder, depressive disorders, alcohol and substance use disorders, and social phobia. Classes also differed significantly on the number of mental health conditions. Understanding patterns of betrayal-based trauma (e.g., IPV and CA) can inform care within agencies that serve IPV survivors by highlighting individuals at-risk for mental health conditions.

Exploring ambivalent rape acknowledgment and posttraumatic stress symptoms among college women who have experienced rape: What's in a name?

The present study explored rape acknowledgment among 131 college women survivors of rape utilizing three subgroups: acknowledged rape, unacknowledged rape, and ambivalent acknowledgment. Posttraumatic stress disorder (PTSD) symptom clusters and parameters of victimization and were compared between the subgroups. Of the participants, 28.2 % were classified as ambivalent rape acknowledgment, 49.6 % as acknowledged rape, and 22.1 % as unacknowledged rape. Across all four PTSD symptom clusters, the ambivalent acknowledgment group had significantly higher PTSD symptoms than the unacknowledged group. With the exception of hyperarousal symptoms, PTSD symptoms did not differ between the acknowledged and ambivalent acknowledgment groups. With regard to potential group differences in exposure to various rape tactics (i.e., physical force, threat, incapacitation), the acknowledged group indicated (a) exposure to a greater number of rape tactics relative to the other groups, (b) higher likelihood of endorsing rape via threat than the ambivalent acknowledgment group, and (c) more frequent endorsement of forcible rape than the unacknowledged group. Results are discussed in light of screening methods to assess for PTSD symptoms among rape survivors, as well as the recent changes to the Title IX law regarding sexual misconduct reports on college campuses.

Moderators of PTSD symptom change in group cognitive behavioral therapy and group present centered therapy.

To examine moderators of change during group-based intervention for Posttraumatic Stress Disorder (PTSD), multilevel models were used to assess trajectories of symptom clusters in male veterans receiving trauma focused Group Cognitive Behavioral Treatment (gCBT; N = 84) or non-trauma focused Group Present Centered Therapy (gPCT; N = 91; Sloan et al., 2018). Separate models were conducted for symptom clusters in each intervention, examining pre-treatment PTSD symptoms, pre-treatment depression severity, age, index trauma, and outcome expectancies as potential moderators. Unconditioned growth models for both gCBT and gPCT showed reductions in intrusions, avoidance, negative cognitions/mood, and arousal/reactivity (all p < .001). Distinct moderators of recovery emerged for each treatment. Reductions in avoidance during gCBT were strongest at high levels of pre-treatment PTSD symptoms (low PTSD: p = .964, d = .05; high PTSD: p < .001, d = 1.31) whereas positive outcome expectancies enhanced reductions in cognitions/mood (low Expectancy: p = .120, d = .50; high Expectancy: p < .001, d = 1.13). For gPCT, high levels of pre-treatment depression symptoms negatively impacted change in both intrusion (low depression: p < .001, d = .96; high depression: p = .376, d = .22) and arousal/reactivity (low depression: p < .001, d = .95; high depression: p = .092, d = .39) symptoms. Results support the importance of examining trajectories of change and their moderators for specific treatments, particularly when contrasting trauma focused and non-trauma focused treatments.

Can the Behavioral Model of Health Care Utilization Be Used to Predict Completion of a Mental Health Assessment Following Intimate Partner Violence?

Survivors of intimate partner violence (IPV) may experience mental health problems. Although some survivors access mental health resources to address these concerns, many discontinue prematurely. One model of health care utilization that has recently gained attention in the trauma literature is the behavioral model of health care utilization (BMHU). This model considers three groups of variables in predicting health care utilization: immutable predisposing variables (e.g., age), enabling resources (e.g., income), and measures of need (e.g., symptom severity). The current study tested the BMHU's ability to predict completion of a free, multisession mental health evaluation for female survivors of IPV (N = 214). Two models were tested, each assessing a separate need-based predictor: The first model assessed symptoms of depression and the second model assessed symptoms of posttraumatic stress disorder (PTSD). Results were consistent across both models and suggested that younger age and receiving public assistance were both associated with a lower likelihood of completing the evaluation. Contrary to the BMHU's assumed positive relation between symptom severity and health care utilization, greater severity of depression and PTSD symptoms were both associated with a lower likelihood of completing the evaluation. It is possible that following IPV, experiencing psychological distress may engender help-seeking but too much distress may serve as a barrier to continued utilization. Future research should seek to better understand the complex relation between need and access, in the context of mental health care, and develop strategies for retaining IPV survivors who access mental health resources.

Using Social Support Matter in the Association of Post-Traumatic Cognitions and Perceived Social Support? Comparison of Female Survivors of Intimate Partner Violence With and Without a History of Child Abuse.

The association between high levels of post-traumatic stress disorder (PTSD) symptoms and low levels of perceived social support is well-documented in the trauma literature; research on processes that may underlie this association is less common. The current study examined negative attitudes about using social support as a potential link between negative post-traumatic cognitions about the world and self, one aspect of PTSD, and perceived social support in two groups of female survivors of intimate partner violence: those who had a history of child abuse (n = 153; IPV/CA+) and those who did not (n = 96; IPV/CA-). Negative attitudes about using social support were found to be an important link between negative post-traumatic cognitions and social support for both groups. IPV survivors with a history of child abuse had higher levels of negative post-traumatic cognitions about the world (d = .32) and self (d = .33), greater negative attitudes about using social support (d = .35), and lower perceived social support from family (d = .48), compared with IPV survivors without a history of child abuse. These results support the relevance of negative attitudes about using social support as one important factor in the relationship between PTSD symptoms and social support in interpersonal trauma survivors and highlight the impact that negative attitudes about using social support can have on the trauma survivor's functioning.

Factor Structure of the Communication Patterns Questionnaire in Violence-Exposed Women.

Understanding and addressing violence among intimate partners requires sound assessment of their communication patterns. In prior research, the 35-item, self-report Communication Patterns Questionnaire (CPQ) has been used to assess communication patterns in violent relationships. To date, psychometric analysis of the CPQ has been examined only among nonviolent couples; no studies have examined the psychometric properties of this measure in a sample of survivors of intimate partner violence (IPV). Using confirmatory factor analysis, the present study evaluated the factor structure of the CPQ in a sample of women survivors of IPV who sought mental health assessments at a university research clinic. Analyses suggested that a modified three-factor solution (constructive communication [CC], self-demand/partner withdraw [SDPW], partner demand/self-withdraw [PDSW]) provided good fit in our sample. Internal consistency estimates for each of the modified scales were acceptable and exceeded reported coefficients in prior IPV studies. Significant bivariate correlations among modified scales, and between communication patterns and aggressive behaviors, provided initial validity evidence for the CPQ scales in our sample. We found CC to be negatively associated with partner psychological aggression, PDSW to be positively associated with all forms of partner aggression and respondent psychological aggression, and SDPW to be positively associated with respondent physical and psychological aggression. The results of this study indicate that the CPQ may be an appropriate measure for assessing communication patterns in violent relationships; however, modified scoring procedures should be used. We contextualize our results within existing models of IPV and address clinical, cultural, and contextual issues in communication patterns assessment.

The role of negative cognitions in co-occurring posttraumatic stress disorder and depression: Examination of interpersonal and noninterpersonal trauma survivors.

OBJECTIVE: To examine negative cognitions underlying both posttraumatic stress disorder (PTSD) and depression following trauma. METHOD: A mixed-gender motor vehicle accident (N = 297, Mage = 43.49 years) sample and a female intimate partner violence (N = 242, Mage = 36.95 years) sample was cross-sectionally studied at research clinics of two universities. RESULTS: When diagnostic groups (PTSD+/-, depression+/-) were studied, no significant interactions were noted for any of the three forms of negative cognitions (negative thoughts about the self, negative thoughts about the world, and self-blame) in either sample. When continuous ratings of PTSD and depression were studied, the results showed that negative thoughts about the self were linked to both PTSD and depression. CONCLUSION: Findings suggest that it may be beneficial to target negative thoughts about the self when treating PTSD and depression together.

The Speaker's Experience of Stuttering: Measuring Spontaneity.

Purpose This study measures the experience of spontaneous speech in everyday speaking situations. Spontaneity of speech is a novel concept developed to account for the subjective experience of speaking. Spontaneous speech is characterized by little premeditation and effortless production, and it is enjoyable and meaningful. Attention is not directed on the physical production of speech. Spontaneity is intended to be distinct from fluency so that it can be used to describe both stuttered and fluent speech. This is the first study to attempt to measure the concept of spontaneity of speech. Method The experience sampling method was used with 44 people who stutter. They were surveyed five times a day for 1 week through their cell phones. They reported on their perceived spontaneity, fluency, and speaking context. Results Results indicate that spontaneity and fluency are independent, though correlated, constructs that vary with context. Importantly, an increase in spontaneity significantly decreases the adverse impact of stuttering on people's lives. Fluency did not significantly affect adverse life impact of stuttering. Conclusion Findings support a theoretical construct of spontaneity that is distinct from speech fluency and that can inform our views of stuttering and approaches to stuttering treatment.

Latent Factor Structure and Construct Validity of the Cognitive Emotion Regulation Questionnaire-Short Form Among Two PTSD Samples.

The Cognitive Emotion Regulation Questionnaire-Short form (CERQ-Short; Garnefski & Kraaij, 2006) was developed to assess nine theoretically derived factors of emotion regulation. However, the psychometric properties of this measure have never been studied in a clinical sample. The present study examined the latent factor structure and construct validity of the CERQ-Short in two samples presenting for posttraumatic stress disorder treatment (N = 480). Results indicated that a six-factor solution, rather than the proposed nine factors, was the best-fitting measurement model. The original CERQ-Short factors of acceptance, positive refocusing, other-blame, and self-blame were retained. A novel perseveration factor incorporated both the original rumination and catastrophizing factors and a novel reappraisal factor incorporated items from the original positive reappraisal and putting into perspective factors. The revised six-factor measurement model provided good fit and demonstrated strong construct validity in a second clinical sample. Results support a more parsimonious six-factor CERQ-Short measurement model.

If we build it, will they come? And will they stay? Commentary on Holmes et al. "Examining patterns of dose response for clients who do and do not complete Cognitive Processing Therapy".

Although evidence-based practice is becoming more widely accepted, the issue of patient preference has been relatively ignored. As noted by Holmes and colleagues (2019), when delivered in a community setting, Cognitive Processing Therapy (CPT) can have a relatively high dropout rate (42 % in the Holmes et al., 2019). In this commentary, issues about the conceptualization of treatment dropout as one index of patient preference are discussed. Dropout can be conceptualized as a potential reflection of poor fit between the patient and a specific empirically-supported treatment. Consideration of ways in which an empirically-supported treatment can be personalized, while remaining true to its underlying principles, are discussed using CPT as an example.

Problematic driving in former service members: An evaluation of the Driving Behavior Survey in veterans with posttraumatic stress disorder.

Despite high levels of traffic-related mortality, injury, and impairment among former service members, measures validated to assess problematic driving in this population remain limited. The current study examined characteristics of the Driving Behavior Survey (DBS) in male veterans (76.3% White; age: M = 56.4, SD = 12.3) meeting criteria for PTSD. Confirmatory factor analyses indicated acceptable fit of a 3-factor model specifying dimensions of anxiety-based performance deficits, exaggerated safety/caution, and hostile/aggressive driving behavior. Concurrent associations with indices of anxiety, depression, trauma history, and clinician-rated PTSD were consistent with small (r = .10-.29) to medium (r = .30-.49) effects. Discriminative validity was noted through elevations in performance deficit (d = .26), safety/caution (d = .50), and hostile/aggressive (d = .39) scales relative to published data from student drivers. Scores comparable to civilian motorists with accident-related PTSD help to qualify the severity of problematic driving behavior in trauma-exposed veterans.

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.