Worry differentially mediates posttraumatic cognition and posttraumatic stress symptom relationships among veterans seeking treatment associated with military sexual trauma.

Research has established negative posttraumatic cognitions (NPC) affect the development and course of posttraumatic stress symptoms (PTSS) following trauma exposure (L. A. Brown et al., 2019). Previous studies in civilian and combat veteran populations also suggest positive associations among worry, NPC (Beck et al., 2004; Bennett et al., 2009), and PTSS (Fergus & Bardeen, 2017). However, little research has investigated the prevalence of worry in veterans who have experienced military sexual trauma (MST), and no research has examined the role of worry in the relation between NPC and PTSS among veterans seeking treatment associated with MST. This project examined the prevalence of worry in a MST sample and whether worry mediated NPC-PTSS associations. Veterans (N = 91) seeking MST-related treatment presented to a Veterans Affairs Posttraumatic Stress Disorder specialty clinic for assessment and treatment recommendations. Veterans completed questionnaires assessing NPC, worry, and PTSS. Bootstrapped mediation analyses examined NPC-PTSS associations. Veterans reported similar levels of worry as nonveterans seeking treatment associated with generalized anxiety disorder. Mediation analyses showed worry significantly mediated NPC-PTSS relationships for beliefs about the world, self-blame, and coping competence but not for beliefs about the self or global NPC severity. Further, the degree of mediation differed by NPC type. Though a limitation of this study is the use of cross-sectional data, these results inform the use of clinical intervention strategies targeting worry in trauma-focused interventions and necessitate further research on whether trauma-focused interventions ameliorate co-occurring worry among veterans exposed to MST. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A prospective examination of the role of psychological (in)flexibility in posttraumatic stress: A cross-lagged panel design.

Functional contextualist models of psychopathology suggest that psychological inflexibility and psychological flexibility are of central importance for understanding the development and maintenance of posttraumatic stress (PTS) symptomatology. To our knowledge, these two constructs and their domain-specific factors (e.g., cognitive fusion, experiential avoidance) have not been assessed in their entirety and examined in relation to PTS symptoms using a longitudinal study design. As such, the primary aim of the present study was to use cross-lagged panel analysis, an analytic approach that allows stronger causal inferences to be made regarding the nature of temporal relations among study variables, to determine the directional relations among PTS symptoms and psychological flexibility and inflexibility over an eight-month time period. Trauma-exposed adults (N = 810), recruited online via Amazon's Mechanical Turk (MTurk), completed a battery of self-report measures via a secure online platform at three time points, spanning eight months. Results suggest that the relationship between psychological inflexibility and PTS symptoms is bidirectional and mutually reinforcing. In contrast, significant prospective relations were not observed between psychological flexibility and PTS symptoms. Results of a follow-up exploratory path analysis showed that cognitive fusion was the only psychological inflexibility subfactor that partially mediated the relationship between PTS symptoms from baseline to the eight-month follow-up assessment. Taken together, these results suggest that psychological inflexibility, and primarily the domain of cognitive fusion, maintains PTS symptoms following trauma exposure. As such, it may important to integrate cognitive defusion techniques into evidence-based treatments for Posttraumatic Stress Disorder (PTSD).

Examining the Factor Structure and Incremental Utility of the Contrast Avoidance Questionnaires via Bifactor Analysis.

The negative emotional contrast avoidance model posits that pathological worry is maintained by the avoidance of negative emotional shifts. The Contrast Avoidance Questionnaires (CAQ-Worry and CAQ-General Emotion) aim to assess contrast avoidance beliefs and behaviors. Questions remain around the factor structures of the CAQs, whether such structures replicate in nonundergraduate samples, and whether their domain-specific factors are valid for independent use. This study used bifactor analysis in a large community sample (N = 827) to address these gaps in the literature. Results supported bifactor models of both measures. Complementary analyses supported the multidimensionality of the CAQ-Worry, including its strong general factor and independent use of two domain-specific factors, rather than the original three domain-specific factors. The CAQ-General Emotion's general factor was strong, but the merits of the Discomfort domain-specific factor require more exploration, and use of the Avoidance domain-specific factor is discouraged.

Military sexual trauma in context: Ethnoracial differences in ecological resources among treatment-seeking veterans.

Veterans who have experienced military sexual trauma (MST) are at increased risk for a host of negative outcomes, including posttraumatic stress disorder, depressive disorders, and substance use disorders. Previous studies have shown racial differences in MST exposure, namely that Black veterans experience MST more frequently than White veterans. One way to help clinicians and researchers understand the impact of these ethnoracial differences in MST exposure is through an applied theory of ecological resources, which has demonstrated ecological factors (e.g., aspects of identity, beliefs, and environmental stressors) contribute to veteran well-being in the aftermath of MST. The present study aimed to examine ethnoracial differences in ecological resources (i.e., available social support, spiritual coping, past-year interpersonal violence, financial sufficiency, and stable living environment). Participants (N = 505) were U.S. veterans who sought care at a Veterans Healthcare Administration clinic in the midwestern United States for mental health issues related to MST. Results demonstrated Black veterans were more likely than White veterans to report being financially insecure, U = 18,091.50, z = -2.04, p = .042, r = .10. Black veterans were also more likely to report spiritual beliefs that assisted with coping, Cramer's V = .19, but less likely to report having a social support system, Cramer's V = .16. These findings highlight the importance of assessing and addressing disparities illuminated by ethnoracial differences in ecological resources and barriers in veterans seeking care for MST.

Contrasting ecological contexts among treatment-seeking military sexual assault survivors: Consideration of relationships with sexual and gender minority identification.

Survivors of military sexual trauma (MST) seeking mental health services may present with concerns extending beyond symptom relief. Attention to social, economic, and coping resource contexts is salient for care consideration. Although those identifying as sexual and gender minorities (SGM) are overrepresented among service members exposed to assaultive MST, research contrasting ecological resource variability among treatment seekers is limited. The present study delineates modifiable risk and protective factors that might be used to inform MST-related health care for Veterans, broadly, and SGM-identifying Veterans, specifically. Veterans (N = 493, 12.8% identifying as SGM) presenting for treatment secondary to military sexual assault completed a semistructured clinical interview and intake survey including demographic characteristics, diversity-related factors, and access to psychosocial resources. SGM/non-SGM-identifying groups were contrasted on individual-, interpersonal-, and community-level ecological characteristics. SGM-identifying Veterans were less likely to report access to sufficient financial resources and had double the prevalence rate of housing instability in contrast to non-SGM-identifying Veterans. No significant differences emerged in terms of past-year interpersonal violence exposure, endorsement of helpful spiritual beliefs, or availability of social support based on SGM identification. Findings underscore the importance of attending to the intersection of SGM identity and ecological factors that can influence Veterans' clinical presentation and treatment engagement. Recommendations for provision of MST services are made. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Health anxiety and attentional control interact to predict uncertainty-related attentional biases.

BACKGROUND AND OBJECTIVES: Current theories of health anxiety and a growing body of empirical literature suggest that those high in health anxiety symptoms might find uncertainty itself threatening and demonstrate attentional biases for uncertainty-related information (ABU). Moreover, a dual processes model of attention would suggest that individual differences in attentional control might modify such a relationship. The present study was designed to explore this proposed health anxiety-ABU relationship and also to consider attentional control as a moderator of theoretical and clinical relevance. METHODS: Undergraduate participants (N = 148) completed a self-report measure of health anxiety symptoms and two performance-based tasks to assess ABU and attentional control. RESULTS: Hierarchical regression analyses showed a significant interaction between health anxiety and attention control in predicting attentional disengagement from, but not engagement with, uncertainty-related words. Specifically, results of the simple slopes analysis suggested that those with elevated health anxiety symptoms and better attentional control may use top-down attentional control processes to disengage their attention from distressing uncertainty-related stimuli faster than those with worse attentional control. LIMITATIONS: The analogue sample is a study limitation. CONCLUSIONS: Results provide new insights into the nature of attentional biases within health anxiety. Results are discussed in light of recent work on attentional control and avoidance-based psychopathology.

An Examination of the Factor Structure of the Multidimensional Psychological Flexibility Inventory.

The Multidimensional Psychological Flexibility Inventory (MPFI), a 60-item self-report measure, assesses the Acceptance and Commitment Therapy Hexaflex. The factor structure of the MPFI was examined in this study. In a community sample of adults (N = 827), four models (correlated six-factor, one-factor, higher order, and bifactor) were tested for each of the constructs of interest (i.e., psychological flexibility and psychological inflexibility). All models, with the exception of the one-factor, provided adequate fit to the data. Differences between the three adequate fitting models were trivial in magnitude. Additional statistical indices from the bifactor models indicated that the general factors accounted for the large majority of reliable variance. The majority of the domain-specific factors evidenced redundancy with their respective general factors. Results from a series of structural regressions indicated that the domain-specific factors did not provide additional incremental utility above and beyond the general factors in predicting two relevant clinical constructs (i.e., health anxiety and depression). These results provide support for the use of the MPFI Flexibility and Inflexibility total scores, but not subscale scores. The MPFI may require further refinement to either greatly reduce the length of the measure, or to ensure that subscales have incremental utility.

A network analysis of two conceptual approaches to the etiology of PTSD.

Two prominent conceptual models of posttraumatic stress disorder (PTSD) are the cognitive model, associated with cognitive processing therapy (CPT; Resick & Schnicke, 1992), and the functional contextualist model, underlying acceptance and commitment therapy (ACT; Hayes et al., 1999). Network analysis was used to examine dynamic interactions among cognitive (relating to CPT) and functional contextualistic (relating to ACT) variables and PTSD symptoms in a sample of 722 trauma-exposed adults. Results from the cognitive networks highlighted the importance of maladaptive beliefs about threat in maintaining the co-occurrence of PTSD symptoms and cognitive variables. Additionally, PTSD symptoms were more likely to lead to cognitive variables, rather than the reverse direction. Results from the functional contextualist networks identified numerous associations amongst variables that contribute to the co-occurrence of PTSD symptoms and psychological inflexibility. Findings from this study may help generate causal hypotheses that can be tested further using a longitudinal study design.

Factor Structure and Incremental Utility of the Distress Tolerance Scale: A Bifactor Analysis.

The Distress Tolerance Scale (DTS) is a self-report measure of perceived capacity to withstand aversive emotions. Initial factor analysis of this measure suggested a structure comprising one higher-order factor and four lower-order domain-specific factors. However, there is limited evidence in support of the DTS's purported multidimensionality, and despite use of the DTS subscales, research has yet to assess their incremental utility. The current investigation sought to rectify the paucity of evidence in support of the DTS's factor structure and independent use of DTS subscales via bifactor analysis. In the present study (N = 826 community adults), a bifactor model of the DTS provided the best fit to the data. However, an examination of statistical indices associated with bifactor modeling, as well as results from an examination of incremental utility, suggest that the domain-specific factors are largely redundant with the general factor and do not provide incremental utility in predicting relevant clinical constructs beyond the general factor. Measurement invariance between sexes was confirmed. Taken together, results support use of a DTS total score, but not subscale scores.

Factor Structure and Incremental Validity of the Original and Modified Versions of the Difficulties in Emotion Regulation Scale.

The Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004) is a self-report measure that assesses six facets of emotion dysregulation. A modified version of the DERS (M-DERS) was developed to address psychometric limitations of the original measure (Bardeen, Fergus, Hannan, & Orcutt, 2016). Although the factor structure of the M-DERS (i.e., two models: correlated trait and second-order models) has been supported via confirmatory factor analysis (CFA), the tenability of a bifactor model of the M-DERS has yet to be examined. Preliminary research suggests that a bifactor model of the M-DERS is tenable. In this study (Ns of 993 and 578), results from a series of CFAs indicated adequate fit of the M-DERS and poor fit of the original DERS across several tested models (e.g., correlated trait, second-order, bifactor). Although a considerable amount of variance was accounted for by the general factor, statistical indexes from the bifactor model supported a multidimensional conceptualization of the M-DERS. The Nonacceptance and Goals subscales evidenced incremental utility, after accounting for the general factor, in predicting general distress (Nonacceptance only) and intolerance of uncertainty. Implications for future use of the DERS and M-DERS are discussed.

Network models of posttraumatic stress symptoms across trauma types.

Evidence suggests that posttraumatic stress (PTS) disorder (PTSD) symptom presentations may vary as a function of index trauma type. Network analysis was employed in the present study to examine differences in PTS symptom centrality (i.e., the relative influence of a symptom on the network), and PTS symptom associations across three trauma types: motor vehicle accident (MVA), sexual assault (SA), and sudden accidental/violent death of a loved one (SAD). The final sample comprised 554 female undergraduates who had experienced a MVA (n = 226), SA (n = 222), or SAD (n = 106) per Diagnostic Statistical Manual-Fifth Edition (DSM-5) criteria. Within the pooled network, anhedonia and dysphoria emerged as the most central symptoms, while trauma-related amnesia was the least central. The SA network was largely consistent with the DSM-5 conceptualization of PTSD. In contrast, the SAD network was the least consistent with the DSM-5 conceptualization of PTSD, and centrality estimates for the SAD network were inconsistent with the MVA and SA networks. Findings of the current study suggest a need to consider index trauma type as an important factor in the ontology of PTSD. Findings also add to the ongoing discussions about the suitability of SAD as a PTSD-relevant trauma type and about the importance of trauma-related amnesia as a PTSD symptom.