Within-patient association between emotion regulation and outcome in prolonged exposure for posttraumatic stress disorder.

OBJECTIVE: Difficulties with emotion regulation (ER) are a risk factor for the development and maintenance of posttraumatic stress disorder (PTSD). Less is known about temporal relations between ER and PTSD symptom change during treatment, including whether ER may represent a more potent change ingredient for some patients relative to others. This study examined the association between within-patient changes in ER and next-session PTSD symptom change and whether this association was more pronounced for patients with poorer baseline ER, more severe depression, or higher borderline personality disorder symptoms. METHOD: Data derived from a randomized controlled trial (NCT01600456) in which 149 adults with PTSD received up to 10 sessions of prolonged exposure (PE) or PE + sertraline. Patients rated difficulties with ER and PTSD symptoms repeatedly during treatment. Moderators were assessed at baseline. RESULTS: Cross-lagged, dynamic structural equation models revealed that ER improvements were associated with next-session reductions in PTSD (standardized effect = 0.13). PTSD symptom reduction was also associated with next-session ER improvement (standardized effect = 0.34). Moderator analyses revealed that the within-person ER-PTSD symptoms association was stronger for patients with higher baseline depression (standardized effect = 0.39). CONCLUSIONS: Reductions in PTSD symptoms may facilitate ER improvements during PE and PE augmented with sertraline rather than improvements in ER producing changes in PTSD symptoms. For patients with higher severity co-occurring depression, ER may represent a more active change ingredient. PE therapists could therefore consider placing particular emphasis on improving ER capabilities when working with this subgroup of patients. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The role of posttraumatic stress symptoms on memory complaints and performance in active-duty service members.

OBJECTIVE: Memory complaints are the most common form of cognitive limitation reported by military service members, but prior research suggests that posttraumatic stress symptoms (PTSS) may account for the link between subjective cognitive complaints and objective cognitive performance. The mechanisms underlying this relationship are largely unknown, including whether the finding applies to memory complaints and performance, which clinical dimensions are involved, and how the association varies when memory complaints are non-credible. METHOD: Using a sample of 196 US military service members, the present study aims to address these gaps by modeling the relationship between objective memory performance and plausible/implausible subjective memory complaints, then evaluating how the association is influenced by PTSS and clinical traits commonly found within PTSS (e.g. depression, anxiety, and somatic concerns). RESULTS: Overall memory complaints were associated with immediate and delayed recall, but both associations were fully mediated by PTSS (95% CI -0.14, -0.01; 95% CI -0.14, -0.02, respectively). Implausible memory complaints, however, were inconsistently linked to memory performance, and no PTSS mediation was observed. Of the clinical traits, only depression moderated the impact of PTSS, specifically by influencing the link between PTSS and overall memory complaints (ß = -0.02, SE = 0.004, p < .001). CONCLUSIONS: These results corroborate the importance of assessment for PTSS and depression in service members who report subjective memory complaints and highlight how targeted intervention for these conditions may play a key role in the management of memory complaints.

The impact of PTSD and mTBI on the relationship between subjective and objective cognitive deficits in combat-exposed veterans.

OBJECTIVE: Cognitive complaints, such as attentional or memory concerns, are commonly reported by veterans diagnosed with posttraumatic stress disorder (PTSD) or a history of mild traumatic brain injury (mTBI). The degree to which those complaints actually map onto measurable cognitive deficits is unclear and is likely complicated by the severity of trauma-related sequelae. In the present study we sought to characterize the degree to which PTSD symptoms and mTBI accounted for the relationship of subjective cognitive complaints to objective cognitive performance, with the goal of facilitating the accurate assessment of trauma-exposed veterans complaining of cognitive decline. METHOD: A sample of 203 U.S. military veterans previously deployed to Iraq and/or Afghanistan were assessed for PTSD severity, history of blast and impact mTBI, objective cognitive function, and subjective cognitive complaints. Separate mediation analyses were conducted to explore the degree that PTSD severity, blast mTBI severity, and impact mTBI severity influenced the association between subjective cognitive complaints and objective cognitive performance. Models reflecting significant mediation were followed by post hoc moderated mediation analyses. RESULTS: Subjective cognitive complaints and objective cognitive performance were significantly associated (ß = -6.49, SE = 2.85, p = .03), but this relationship was mediated by PTSD severity (ß= -2.95, SE = 2.86, p = .30). PTSD mediation was not moderated by either blast or impact mTBI. CONCLUSION: The present results delineate the prominent impact of PTSD symptoms, relative to blast and impact mTBI, on cognition following combat. These findings highlight the importance of assessing for trauma-related psychopathology in those seeking neuropsychological assessment or rehabilitative care for cognitive complaints. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Personality Factors and Their Impact on PTSD and Post-traumatic Growth is Mediated by Coping Style Among OIF/OEF Veterans.

INTRODUCTION: Traumatic experiences can trigger negative effects such as post-traumatic stress disorder (PTSD). However, some individuals may also experience positive changes following trauma exposure. These changes are known as post-traumatic growth (PTG). Dispositional and situational factors are likely at play in determining both severity of PTSD symptoms and whether and to what degree an individual experiences PTG. This study examined how coping style and personality traits interact to influence PTSD and PTG. MATERIALS AND METHODS: Two hundred and seventy-one Operation Iraqi Freedom/Operation Enduring Freedom veterans not engaged in mental health treatment completed self-report measures of trauma exposure, personality traits, coping styles, PTSD symptoms, and PTG. The study was approved by the Minneapolis VAHCS Institutional Review Board. RESULTS: Adaptive coping and positive personality traits such as openness were positively correlated with PTG. Maladaptive coping and neuroticism were positively correlated with PTSD symptoms. Regression analyses indicated that an inverted-U (quadratic) curve characterized the relationship between PTSD symptoms and PTG; veterans who reported moderate PTSD levels reported the most PTG. Mediation analyses revealed that adaptive coping partially mediated the relationship between openness and PTG. Maladaptive coping partially mediated the relationship between neuroticism and PTSD symptoms. CONCLUSION: This study demonstrated that coping style mediated relationships between personality traits and post-trauma outcomes. Our findings are subject to the limitations of the self-report and cross-sectional nature of the data. Longitudinal studies, preferably incorporating coping-oriented interventions, could convincingly demonstrate the impact of coping style on PTSD and PTG. As coping styles can be modified, our findings nonetheless suggest that coping-oriented clinical intervention has potential to reduce PTSD symptoms and promote positive growth following trauma exposure.